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Inspection carried out on 14 June 2018

During a routine inspection

Summerhayes is a small family run home providing personal care and accommodation for up to 14 older people with a range of needs catered for. The home is a large detached Georgian property standing in its own gardens in the small village of Sandford, near Crediton. There were 14 people living at the home at the time of the inspection. There are two floors, which are accessed by a stair lift.

Summerhayes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found that the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager at the service, who was also the registered provider. 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.

Why the service is rated Good.

People remain very happy living at Summerhayes. They expressed their appreciation and thanks to all the staff who provided care and support for them. Staff provided compassionate care and treated people as family members. There was a lot of laughter and joy in the home, and a strong visible person-centred culture. Care staff worked with people to encourage independence wherever possible. Care staff had thought of different ways to enhance people’s lives and this had a positive impact on their wellbeing.

There were excellent relationships with families and they were made to feel very welcome at the home. People enjoyed their meals and had a choice every day. People said they were treated with dignity and respect. Attention was made to ensure people felt comfortable about the care they were given. One relative said “Excellent care, can’t fault them”.

End of life care had been provided with sensitivity and respect for people’s needs and individual wishes. People felt able to make decisions about their care and the staff respected those decisions. Staff were mindful of people’s needs regarding equality, diversity and human rights. The service was meeting the requirements of the Mental Capacity Act 2005 and the Accessible Information Standard. One relative said “They always ask consent and always include her in discussions. They use gentle persuasion in a subtle way”.

Staff were skilled and experienced and received up to date training and regular supervision. People received safe care and risks were managed well. Health care needs were managed well and staff were very proactive in contacting the GPs if needed. There were personalised care plans for each person. Staff were aware of people’s personal histories and what was important to them.

There were a range of activities and opportunities for people to experience. People went out of the home on a regular basis and could keep in touch with their local community. There were sufficient numbers of staff working at the home with the necessary skills to provide care for people. One person said “Nothing is too much trouble. I am never rushed”. Everyone we spoke with said the staff were very knowledgeable and helpful in every way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff had

Inspection carried out on 17 February 2016

During a routine inspection

This inspection took place on 17 and 20 February 2016. The first day of the inspection was unannounced. The service was last inspected in September 2013 and was meeting all legal requirements.

Summerhayes is a small family run care home providing personal care and accommodation for up to fourteen older people. At this visit there were twelve people living at the home and another two were in hospital. The home is a large detached Georgian property standing in its own gardens in the small village of Sandford, near Crediton.

There is a registered manager at the service, who is also the registered provider. 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.

People were very happy with the standard of care at the home. People said that the staff were kind, caring and considerate. Without exception, relatives were full of praise for the caring nature of the staff working at the home. People living at the home expressed their appreciation for the kindness shown to them. “ She’s my guardian angel, she’s always here.” People said they were treated with dignity and respect. One person said “I can’t complain about anything. Dignity and respect? Very much so.” Relatives were full of praise for the caring and responsive nature of the staff. One relative said “They are very good. Everything about it is very good. They go beyond what they must do. Nothing is too much trouble. I am very happy with everything.” Relatives were very happy with the regular communication between the staff and themselves. They felt they were always updated when necessary. They also commented on the “lovely family atmosphere” of the home, where everyone was made to feel welcome.

There were sufficient numbers of staff on duty to meet the needs of the people living at the home. A training co coordinator was in post and was responsible for ensuring all staff were kept up to date with their training. All staff received regular supervisions and appraisals. Recruitment procedures were robust.

The management of risk was well documented and regularly reviewed; helping to ensure that people and the staff remained safe at the home. Medicines were also managed safety.

People’s health and social care needs were well met. All health and social care professionals we contacted were very positive about how people’s needs were met. There was good communication between them and the staff.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The registered manager was in the process of submitting applications to the Local Authority where it was assessed that people may need restriction of freedom in order to protect them from harm.

People were very complimentary about the standard of meals provided. There were choices from a menu for each meal time. People had enough to eat and drink to maintain their health. Actions were taken when people were at risk of not eating or drinking enough.

There were comprehensive quality assurance systems in place. These included checks of care plans, the building, medicine records, training records and cleanliness. The management team strived to continually improve the service provided to people. This included future plans to improve the building.

Inspection carried out on 9 July 2014

During a routine inspection

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well led?

As part of the inspection we spoke with seven people who lived at the home, nine relatives, seven care staff, two domestic staff, the chef, deputy manager and the registered manager, who was also the provider. We reviewed policies and records relating to the management of the home which included, six care plans, daily care records and seven staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that people were cared for in a fresh and clean environment and that the home was well maintained.

We found that the service was individually tailored to meet people's care needs and that people were treated with dignity and respect by the staff.

There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe. Risk assessments had been undertaken which were regularly reviewed. This helped to ensure people received care that was safe. People were given choice and remained in control of decisions about their care and lives.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted in the last year. We noted that the home had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in place.

The home had systems in place which ensured staff learnt from adverse events such as accidents and incidents. These were investigated and followed up which helped risk to be managed and kept people safe.

We examined six staff files and found that the recruitment, selection and training processes were thorough, which meant that suitably skilled and qualified staff were employed to provide a safe service.

One of the people we spoke with said, �I�m safe here, I can talk to anyone�. A member of staff said �we�re here to protect people � that�s what we do�.

Is the service effective?

People we spoke with and their relatives were very positive in their comments about the home and the service provided. A relative told us they were �very lucky to a get room in the home. The home has a good reputation locally�. Another relative commented, �the professional care and superb meals mixed with a friendly relaxed atmosphere is very impressive and much appreciated�.

Where people lacked capacity to consent to their care the provider had arranged best interest meetings which ensured the care and support provided was agreed.

People�s health and care needs were assessed with their involvement and a family member or representative. Care plans were continually reviewed and updated wherever a change occurred. From speaking with staff it was clear they knew people well and understood people�s individual care and support needs.

We observed how staff cooperated and supported with each other to make sure no one was kept waiting and everyone received the care and support they needed at the right time.

Is the service caring?

We found that the home was homely cosy and comfortable. No one was rushed or hurried and we noticed gentle, calm reassurance from staff coupled with a touch of humour.

Care, treatment and support were person centred, and planned to take account of individual preferences, wishes and choice.

We observed friendly, warm exchanges between people, visitors and staff. Staff were kind and attentive. We saw that the staff encouraged and supported people in making their own decisions about how they needed help and spent their time.

We met and spoke with nine relatives who visited the home on the day of the inspection. They told us they were always welcomed at any time and said there was always someone on hand to talk to. One relative we talked with said, �my Mum has settled in very well. She likes the company�. Another relative commented on the amount of time that had been taken with their relative when they first arrived to make sure they were comfortable.

Is the service responsive?

We found that staff responded promptly to people�s requests for help. We observed that where a person needed extra support staff worked well together and supported each other to ensure matters were dealt with quickly without fuss or embarrassment.

People�s health and care needs had been assessed prior to their arrival at the home. We reviewed six care plans and found that records were well organised, up to date and accurate. The care plans confirmed people�s preferences, interests and diverse needs which ensured care and support provided met individual need. Care plans were held in people�s rooms which meant they could easily be accessed.

Care plans were updated daily and regularly reviewed which meant that staff were able to respond promptly to people�s changing needs.

The people we spoke with said that staff were �always around� and told us if they needed anything they would use their call bell. We noticed that staff had time to talk with people in the lounge, in the garden and with those who chose to stay in their rooms. We noted that the internet had been installed in the home at the request of one of the people and this illustrated how the provider responded to individual requests for improvements to the home�s facilities.

Is the service well led?

There were systems in place to monitor the quality of the service provided. People, their relatives, outside professionals and the staff were encouraged to provide feedback on the service. Suggestions and ideas for improvement to the service were welcomed and acted on.

Meetings between people, their relatives and staff were used as opportunities for issues to be raised, discussed and shared before any changes to the management of the home were implemented. One of the visitors we spoke with said, �the home is very open � you can say anything to any of staff if there are ever any concerns�.

The registered manger had introduced new working practices for staff which had clarified roles and improved procedures to the benefit of people in their care.

Changes had been implemented to the staffing structure which had provided staff with greater opportunities to develop their skills and experience. The home benefitted from a stable and experienced staff team.

The home worked closely with other agencies and local services and had developed close working relationships and collaborative working practice which helped to provide an effective service for people at the home.

Clear management structures and lines of accountability were in place. Staff understood their roles and responsibilities and had a good understanding of the ethos and values of the home and to quality processes in place.

The home benefitted from the experience of the provider, who was also the registered manager, who worked together with people and staff to ensure a quality service was provided.

Inspection carried out on 9 July 2013

During a routine inspection

There were 14 older people living at the home at the time of the inspection. During our inspection we looked at the safety and suitability of the premises. We also looked at the way people close to the end of their lives were cared for. We spoke with the provider and a senior care worker. We also spoke with, or observed staff interacting with eight people living in their home.

When we arrived at the home six people had been taken on an outing to the seaside. When they returned later in the day we heard everyone had enjoyed the day out. People told us they were happy with the care and support they received from the staff team. Comments included �I get very good attention here.�

The property was a period building with rooms of different sizes and shapes. All areas were well maintained, comfortable and homely. Some bedrooms were small while others were spacious. People told us they were happy with their accommodation. The provider had plans to make further improvements to the property, including improvements to the laundry in the next few weeks.

We looked at the arrangements for care of people with high dependency needs. We saw that the home had assessed all potential areas of risk and had detailed plans in place showing how those needs would be met. The home had sought assessments, treatment and guidance from relevant health and social care professionals. We found people lived in a safe environment, with the care and equipment necessary to meet their needs.

Inspection carried out on 4 February 2013

During a routine inspection

There were 14 people living at the home at the time of the inspection.

People who used the service were very positive and agreed that they were treated with respect and kindness.

People we spoke to in the home said "Being able to live a normal life as I would at home is really important to me". Another person said "Its very nice and friendly here and its the best place I could find". This demonstrated to us that people were happy at the home and their needs were being met with respect and dignity.

People told us that they felt safe in the home. One person said "I didn't sleep well in my own home as I was frightened of being broken into. Now I sleep really well as I feel safe here".

We observed that staff were supervised, supported and encouraged to develop in their roles. This demonstrated that staff were helped to give better care to the people in the home.

We observed that quality monitoring systems were in place to help maintain the quality of services at the home. A visiting professional said "This is a lovely caring and friendly home and I am very impressed with the opportunities that are given to residents to be actively involved".

During the visit we looked at three care plans. All care plans demonstrated that they had been discussed with the person and their wishes had been recorded. We saw that people had been asked about their preferred daily routines and if they wanted to be checked on during the night.