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Reports


Inspection carried out on 21 May 2019

During a routine inspection

About the service:

Summerville is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. Summerville has the capacity to support up to 45 people; at the time of the inspection 31 people were living at the care home.

People’s experience of using this service:

The quality and safety of care people received had improved since the last inspection.

People’s level of risk was assessed and determined from the outset; measures were put in place to monitor people’s health and well-being as a measure of keeping them safe.

Care records contained consistent, up to date and relevant information in relation to the care people needed. Staff told us they were provided with up to date and timely information.

Safeguarding procedures had improved; staff told us they were aware of safeguarding processes and the importance of keeping people safe. People who lived at Summerville told us they felt safe.

Staffing levels were routinely analysed and reviewed in relation to the dependency needs of people who were living at Summerville. The registered manager also listened to the views of the people receiving support and responded accordingly in relation to the levels of staff.

Recruitment procedures had been improved since the last inspection. Staff had been appropriately vetted and had undergone the necessary pre-employment recruitment checks.

The registered provider was now complying with the principles of the Mental Capacity Act 2005. People were appropriately assessed from the outset and measures were in place to ensure people were not unlawfully restricted.

We observed kind and compassionate interactions between staff and people receiving support. People received dignified and respectful care that was tailored around their support needs.

The complaints procedure had improved since the last inspection. Complaints were regularly reviewed, discussed and responded to in line with organisational policy.

Improvements had been made in relation to 'person-centred care'. Care records contained tailored information in relation to people’s likes, wishes and preferences.

Effective quality assurance measures were now in place. Processes and systems to assess and monitor the provision of care had improved since the last inspection.

Audits and checks were routinely completed; these helped to maintain a good level of high-quality, person-centred care.

Effective health and safety checks were in place and regulatory compliance was maintained. Up to date certificates were in place for gas, electricity, legionella and fire safety.

Whilst Summerville was homely and offered a friendly atmosphere, aspects of the design and decoration could be further reviewed and adapted.

We recommend that the registered provider reviews the home environment and areas of refurbishment that are required.

Medicine management procedures were safely in place. Staff received medication administration training, regularly had their competency levels checked and were familiar with the medication administration policy.

Staff were supported with training, learning and development opportunities. People and relatives told us that staff were experienced and could provide the support they required.

There was a dedicated activities co-ordinator in post; people were supported to engage and participate in a range of different activities that they enjoyed. Summerville now had access to a mini-bus and external activities were arranged as often as possible.

Rating at last inspection: At the last inspection the service was rated ‘Requires Improvement’ (Report published June 2018). Following the last inspection, the registered provider submitted an improvement plan which we checked during the inspection. We found that improvements had been made.

Why we inspec

Inspection carried out on 12 March 2018

During a routine inspection

inspection on 16, 26 and 27 June 2017 and found breaches of the regulations in respect of person centred care, dignity and respect, consent, safe care and treatment, safeguarding, premises and equipment, staffing and good governance. We served a notice of decision to impose a condition on the provider’s registration which was for the provider to ask the Commission for their permission prior to accepting any new people into the home. This condition remains in place. The home was placed in special measures.

At this inspection, we found that although there were some improvements there were continued breaches of a number of the regulations. However, the impact for people living at the home was assessed to be mainly low level. You can see what action we told the provider to take at the back of the full version of the report. The registered provider had taken enough action to be taken out of special measures.

Summerville Care Home is a nursing home with three units over two floors. There were areas of the home which had adapted facilities for people. There were 34 people living in the care home at the time of our inspection with a maximum occupancy of 45 beds. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This location requires a registered manager to be in post. A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We continued to remain concerned regarding the governance systems within the care home because they had not identified the issues we found on this inspection. Not all safeguarding concerns we found had been reported to the safeguarding authority.

On this inspection we found concerns related to staffing/staff deployment to meet people’s care needs. Some staff we spoke with told us they had concerns related to staffing. There had been staff turnover and some positions had been recruited into but staff had not yet started work.

The dependency levels were high with a high number of people requiring two care staff for most care tasks such as personal care and for managing behaviours which were challenging.

We observed people were not always receiving the support they required in order for them to have their nutritional needs met.

The Mental Capacity Act 2005 legislation framework was in place but not always being applied or documented to demonstrate the process being followed.

People told us there were not enough activities or things for them to occupy themselves with. There was a new activities coordinator who had recently been recruited to the home and was waiting for the necessary checks before starting work.

People were not always being listened to and some people told us they felt lonely. People’s care was not always person centred.

Care plans were not always providing staff with detailed information for them to know how to best manage people’s behaviours which were challenging.

People’s dignity was not always being upheld due to the manner in which people were spoken with by staff and due to people not always receiving support when they needed it.

All three recruitment files contained two references but one staff file did not contain the most appropriate reference from a previous employer who was a care provider.

Complaints were not being recorded contemporaneously to see how they had been managed by the registered manager.

On our last inspection we found concerns in relation to the premises and found the home was unsafe. We found improvements had been made on this inspection a

Inspection carried out on 16 June 2017

During a routine inspection

This was the first rated inspection of this location which was registered in January 2017.

We undertook an urgent inspection on 16 June 2017 following serious concerns which were sent to the Commission. This unannounced inspection was undertaken at night and we checked on people's safety and welfare. Following this inspection the provider increased their staffing levels at night by one carer as a result of our findings. The provider also confirmed they were not accepting any new admissions.

On 26 and 27 June 2017 we undertook a further unannounced inspection.

Summerville Care Home is a nursing home with three units over two floors. There are lounges and a dining area and a lift for people to access both floors. There are gardens at the rear and separate outbuildings used for storage areas. There were 41 people living in the care home at the time of our inspection with a maximum occupancy of 45 beds.

This location requires a registered manager to be in post. A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found that the provider was in breach of regulations 9, 10, 11, 12, 13, 14, 15, 17 and 18 of the Health and Social Care Act Regulations 2014.

The service was not safe. We undertook a walk around of the care home and found it was not secure in some areas. The kitchens and corridor leading to the boiler and meter room were accessible to anyone entering the care home. The registered manager was made aware of this on 16 June 2017. We found this had not been remedied when we returned on 26 June 2017. The acting regional manager took action and ensured it was secured immediately.

There were not enough personal protective equipment (PPE) for staff to use and they were searching for items during delivering care for people. The registered manager agreed there should have been additional stock items within the care home for staff to access easily.

There were not enough staff on duty according to the dependency levels of the people needing care. Some people remained in bed as there were not enough staff to get people up, washed and dressed. The management confirmed their dependency tool had been incorrectly completed and therefore, the staffing levels were incorrect. Action was taken immediately and staffing including the number of qualified nurses on duty was increased.

Management of medicines was not always safe. We found prescribed thickeners were not being administered or stored safely.

Call bells were not being given to people who were able to use them to assist them to alert staff in an emergency or when they needed care. People's lights and televisions were being left on at night without their preferences being known to staff. People were making complaints regards noise levels at night including staff laughing and joking.

People were not always being protected from abuse or harm. The Commission are looking into specific incidents prior to making regulatory decisions about these incidents known to us.

People who were identified as being at high risk of falls were not being reviewed following each fall to mitigate the risks of a reoccurrence. Therefore, the provider was not taking reasonable steps to keep people safe.

Staff recruitment systems were safe and nurses’ professional credentials were found to be active. Disclosure Barring Service (DBS) systems were in place with staff starting work when this check was completed.

People were complimentary about the food. We were concerned people's choices about what they wished to eat and drink were not always being adhered to.

Consent was not always being sought during care delivery. Deprivation of Lib