Archived: Summerdale Court Care Home

Summerdale Court Care Home is a care home providing personal and nursing care. It is registered to provide care and support for up to 110 people in one purpose-built building. However, the top floor units were closed for refurbishment and the service had a limited capacity to provide care to 58 people. There was one unit which specialised in supporting people living with dementia. There was one nursing unit which provided care to people with nursing care needs. Both of the units were on the ground floor.

People’s experience of using this service

We were not assured the service was following safe infection prevention and control (IPC) procedures to keep people safe. The service had not assessed the individual IPC risks people faced and did not have plans to keep people safe. The provider had not established safe operating procedures, such as those relating to visiting arrangements. Audits to check the quality of IPC measures were not robust enough to ensure they were safe.

In line with best practice, the service was not using agency staff in order to prevent the spread of infection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 24 October 2020) and there was a breach of one Regulation. We did not review whether the service had met this breach at this inspection.

Why we inspected

The inspection was prompted due to concerns received about infection control. A decision was made for us to inspect and examine this risk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Summerdale Court Care Home is a care home providing personal and nursing care. It is registered to provide care and support for up to 110 people in one purpose-built building. However, the top floor units were closed for refurbishment and the service had a limited capacity to provide care to 58 people. Fifty four people were living at the service at the time of the inspection. There was one unit which specialised in supporting people living with dementia. There was one nursing unit which provided care to people with nursing care needs. Both of the units were on the ground floor.

People’s experience of using this service and what we found

The service was not always well-led. The service had completed a range of audits however these had not always led to improvements with medicine management, care planning and managing the risk of falls. Contrary to the provider’s written statements, the service had not embedded good practice about assessing whether people’s health was deteriorating. The management team had improved the service in other areas.

The majority of people’s relatives told us the service was safe and there were enough staff to meet people’s needs. The service had assessed the risks people faced and developed plans to help reduce them. People had access to healthcare support.

Care plans were personalised and reflected people’s preferences, likes and dislikes. Relatives told us staff were caring and treated their loved ones with respect and dignity. Most relatives told us they knew how to make a complaint if they needed to and felt the service would respond appropriately. Staff and relatives told us the management team were approachable and there had been recent improvements at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 March 2020) and there were multiple breaches of regulations and the service remained in special measures. The service has been in special measures since July 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements had been noted but not enough improvements had been made around good governance and the provider was still in breach of one regulation.

Why we inspected

We undertook this targeted inspection to check whether the previous breaches in relation to Regulation 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Furthermore, we needed to check whether the previous recommendation in relation to Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also undertook the inspection to check that previous improvements in relation to Regulations 9, 10 and 12 had been sustained. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. The service remains in special measures following this targeted inspection.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one ongoing breach in relation to good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The service remains in special measures following this targeted inspection.

The overall rating for this service is 'Requires improvement'. However, the service is remaining in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be in the same question at each of these inspections for us to place/keep services in special measures. This means we will keep the service under review and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures, which includes the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Summerdale Court Care Home is a care home with nursing. It is registered to provide care and support for up to 110 people in one purpose built building. However, the provider had closed two of the units and limited their capacity to 58. Forty six people were living at the service at the time of the inspection. There was one unit which specialised in supporting people living with dementia. There was one nursing unit which provided care to people with nursing care needs. Both of the units were on the ground floor.

People’s experience of using this service and what we found

People described the service’s safety as reasonable. However, people, relatives and staff told us there were not enough staff deployed to meet people’s needs and that staff did not always have the right knowledge to support them. People received their medicines as prescribed however agency staff did not always record the reason why medicines given on an ‘as needed’ basis had been administered.

Staff told us they would report instances of abuse and records we reviewed showed allegations of abuse were escalated to the appropriate safeguarding authority to be investigated. The provider had assessed most risks people faced and had plans to keep them safe from the risk of harm. Staff understood how to prevent the spread of infection.

Staff had developed good relationships with people living at the service and treated them with respect. Staff knew people’s preferences and most care plans contained personalised information however, records of the care provided each day did not always demonstrate whether or not care had been tailored to their preferences.

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

People had enough food and drink but menus and place settings were not dementia-friendly. People had access to health care services and people were supported with their oral care. Similarly, the building was not set up to provide people living with dementia to reminisce about their lives but the registered manager told us they had an improvement plan for the building.

The registered manager had been in post for four months and was supported by an experienced deputy manager. The management team had begun to make improvements in the team culture and care delivery following our previous inspection but these were not yet fully embedded at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 30 July 2019) and there were multiple breaches of regulations. The service was placed in special measures. At this inspection we found some improvements had been made but the service continued to be in breach of other regulations. The service remains in special measures because we cannot be assured improvements have been fully embedded at the service.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches of the Regulations in relation to staffing, good governance and safeguarding adults from abuse and improper treatment.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Requires improvement’. However, the service is remaining in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place/keep services in special measures. This means we will keep the service under review and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures, which includes the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Summerdale Court Care Home is a care home with nursing. It is registered to provide care and support to up to 110 people in one purpose built building. However, the provider had closed two of the units and limited their capacity to 58. There was one residential unit which specialised in supporting people living with dementia. There was one nursing unit which provided care to people with nursing care needs. Both of the units were on the ground floor.

People’s experience of using this service and what we found

People told us they felt secure and that staff knew how to keep them safe. Allegations of abuse were appropriately escalated to the local authority to investigate. However, records and risk assessments were not always clear, and staff relied on their knowledge of people to keep them safe. People had not always been supported to take their medicines as they were prescribed.

Peoples views and opinions about their care needs and preferences were not consistently captured. People’s goals had not been updated since they were written. People told us they liked the food, but there was very limited information about their preferences. Information about people’s healthcare needs was not always clear or up to date.

Staff spoke about people in a derogatory way and offered very limited opportunities for people to have meaningful engagement. People’s religious beliefs were captured, but there was no information about what this meant for their care preferences. We saw people’s dignity was not always protected and staff did not take action to support people to preserve this.

People were supported by dedicated activities staff to attend a range of activities, including ones where external agencies and groups visited the home. However, the previous atmosphere of engagement with all care workers taking opportunities to provide stimulation to people had not been sustained. People had extremely limited opportunities for engagement or interaction with staff. Although people told us they found staff to be kind, they also told us staff were often busy. Care plans were reviewed each month but there was no evidence people were involved in this process. People and relatives told us they could make complaints to the manager.

The governance arrangements had failed to sustain and build on the improvements identified in May 2018. The quality assurance systems had not prevented a deterioration in the quality and safety of the service. The manager told us there was a problematic culture at the service but the provider had known this for a long time and effective action had not taken place to address this. The audit systems had repeatedly identified multiple shortfalls in the quality and safety of the service but the actions in place were not specific and would not improve the quality of life for people living in the home.

People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support this practice. People told us staff asked for their consent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 9 July 2018) and there were multiple breaches of regulations. At this inspection improvements had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk assessments and medicines management, person centred care, dignity and respect, staff training and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the last inspection we met with the provider and asked them to complete an action plan to show what they would do by when to improve the service to bring them out of special measures and address our concerns about the rating of well-led. Although there had been significant progress in some areas, further improvements are needed to improve the overall rating to ‘good’.

Summerdale Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Summerdale Court can accommodate up to 116 people in a purpose build nursing home. The home is divided into four units across two floors. Two of the units provide nursing care, and two are specialist residential units for people living with dementia. At the time of our inspection 55 people were living in the home.

There was a registered manager in post. 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.

Recruitment records had not been appropriately maintained and did not demonstrate safe recruitment practice had been followed. Staff had not received the training and support they needed to perform their roles.

Staff completed a range of audits to monitor the quality of the service. However, these had failed to identify or address issues with staff training, supervision and recruitment. Analysis of serious incidents focussed on the actions of individuals and did not consider organisational solutions and learning. Despite multiple reviews, the style of care plans meant it was not easy to find the most pertinent information.

People told us they felt safe and staff were knowledgeable about safeguarding adults from harm and abuse. Risks faced by people receiving care had been identified with clear measures in place to mitigate risk. People were supported to take medicines and this was managed in a safe way.

People gave us mixed feedback about the staffing levels in the home. Records showed sufficient staff numbers were deployed, but people’s feedback reflected there were frequently more senior staff than care workers on duty. People told us this meant they sometimes had to wait for support with care tasks.

The home was clean and free from malodour. The home was accessible to people who lived there. Adaptations had been made to the building, including re-purposing rooms to ensure it met people’s needs.

People and their relatives where appropriate were involved in planning their care. Care plans contained details of people’s preferences and choices. People’s healthcare needs were detailed as well as the support they needed to access healthcare and other services involved in providing their care.

People told us they liked the food and they were offered choices. We saw people were able to have individual meals if they did not like the food on the main menu.

People were offered choices in their day to day life. Where people lacked capacity to consent to their care and treatment staff had completed appropriate capacity assessments and followed best interests’ decision making principles in line with the Mental Capacity Act 2005. Where people’s support amounted to a deprivation of liberty appropriate applications had been made to the local authority.

People told us, and we saw staff treated people with kindness and compassion. Staff recognised and responded appropriately to people’s emotional needs. People’s relationships were valued and family members told us they felt welcome in the home. The service had taken steps to ensure they provided a welcoming environment to people who identified as Lesbian, Gay, Bisexual and Transgender.

People were supported to practice their religious faith if they wished to do so. Various representatives of faith groups visited the home regularly.

People told us they felt staff respected and valued them. Staff described how they promoted people’s dignity and measures to protect people’s dignity were embedded in the home.

Care staff knew people very well and we observed individualised and personalised care being given. Staff had supported people to create multi-sensory life story books which included a high level of personalisation and detail.

The range and quality of activities on offer had significantly improved. A wide variety of group and individual activities were offered tailored to the different needs of people living in the home. As well as traditional group activities such as quizzes and bingo, sensory sessions were in place for people with more complex needs related to dementia. The home had a garden room and had created a bar called ‘The Summerdale Arms’ where people could play darts and dominoes. In response to feedback from people living in the home, the service had developed links with local primary schools who now visited the home regularly. Care workers took opportunities to engage with people over traditionally passive activities such as watching television. Staff kept clear records of people’s support and engagement with activities.

People and relatives told us they knew how to make complaints and where they had done so were happy with their resolution. Records showed complaints were responded to in line with the provider’s policy.

People and relatives told us they were confident the home would provide them with compassionate care at the end of their lives. Where people were approaching the end of their life they had appropriate plans in place. The home had liaised with relevant healthcare teams to ensure they had all the support they needed in place.

There were regular meetings for people, relatives and staff. People and relatives were involved in consultations about the future of the home.

There had been significant changes to the senior leadership of the provider. Additional resources had been provided to the home. During the inspection where issues were identified further resources were allocated to address our concerns.

We found breaches of three regulations relating to staffing, fit and proper persons employed and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

This is the second consecutive time the service has been rated ‘Requires Improvement.’ As no key question is rated inadequate the service is no longer in special measures.

Summerdale Court is a large care home with nursing registered to provide care for up to 116 people. At the time of our inspection 75 people were living in the home. The home provides care for older people, people who have a physical disability and people living with dementia. There are four units within the home. Two of these units provide residential care for people living with dementia. The other two units provide nursing care, one of which specialises in providing nursing care for people living with dementia. The home is fully accessible and arranged over two floors. There are a variety of communal areas including gardens for people who live in the home.

The home had a registered manager in post. 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.

The last inspection took place in February 2017 when we rated the service as inadequate, identified breaches of seven regulations and placed the service into special measures. This inspection found five of those breaches had been addressed. However, issues relating to the safety of the service, leadership and governance had not been fully addressed and breaches continued. The rating for well-led remains inadequate. The overall rating for this service is ‘Requires improvement’. However, we are extending 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Managers in the home completed a wide range of audits to monitor and improve the quality of the service. They had an action plan to address the concerns from the previous inspection and other issues identified since. However, there were a number of issues with the quality of records identified during the inspection that had not been addressed by the provider’s systems.

Risk assessments were in place to mitigate risks faced by people living in the home. However, these were inconsistent. While some were clear about what staff needed to do to ensure people were safe, others lacked detail.

People were supported to take their medicines by trained and qualified staff. Records showed they were supported to take their medicines in a safe way. However, where medicines were stored in fridges safe temperatures had not been maintained.

People were supported to access healthcare services when they needed them. However, support plans around people’s healthcare needs were not always consistent or clear and some diabetes care was not provided in line with best practice guidance.

During the inspection we saw there were occasions where people’s dignity was not always protected. The provider responded to this feedback and developed ways to ensure people’s dignity was protected.

There was variation in the quality of care plans across the home. While some were personalised and detailed, others did not inform staff how to meet people’s individual needs. Observations showed occasions when a task focussed approach was taken rather than a person-centred approach.

People’s views on the provision of activities were mixed. Some people felt they were offered a range of appropriate activities but others felt there were limited options that were suitable for them. The purpose of activities was not always clear and levels of engagement were not captured.

People and their relatives told us they felt safe in the home. Staff were knowledgeable about how to protect people from avoidable harm and abuse and knew how to escalate concerns about abuse.

People and staff told us the staffing levels had improved. Records showed the home deployed more staff than their staffing levels tool calculated as required. Staff were recruited in a safe way that ensured they were suitable to work in a care setting.

Staff told us they were supported in their roles and received regular supervision and training. Records showed staff received the training they required to perform their roles. Some staff had only received group supervisions so had not had the opportunity to discuss their personal development.

The service sought consent from people in line with legislation and guidance. Where people lacked capacity to consent to their care, appropriate assessments had taken place. Best interests decision making processes were clearly recorded and showed appropriate people had been involved. Where people were deprived of their liberty the home had made appropriate applications to ensure this was lawful.

People told us they were offered a varied choice of food that met their cultural and religious preferences. Records showed the menu was varied and reflected the diverse backgrounds of people living in the home.

People and relatives told us they thought staff demonstrated a caring approach to supporting them. Staff spoke about the people they supported with kindness and affection.

People were supported to access religious services where they wished to do so. The provider had taken steps to ensure people who identified as lesbian, gay, bisexual or transgender felt welcome at the home.

The service held regular meetings for people and their relatives where they could provide feedback about the home. People and relatives felt they could make complaints and records showed these were responded to in a timely manner. Apologies were given where mistakes had been made.

People and staff told us they found management to be visible and approachable. The provider had taken on board concerns about the culture at the home and taken steps to ensure people and staff could raise their concerns and felt supported to do so.

Communication amongst the staff team had improved and key information was shared across the staff team.

Summerdale Court Care Home is a large care home with nursing registered to provide care to up to 116 people. At the time of our inspection 87 people were living in the home. The home provides care for older people, people who have a physical disability and people living with dementia. There are four units within the home. Two of these units provide residential care for people living with dementia. The other two units provide nursing care, one of which specialises in providing nursing care for people living with dementia. The home is fully accessible and located on two floors. There are a variety of communal areas including gardens for people who lived in the home.

The home had a registered manager in post. 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.

The last inspection took place in April 2016 when we rated the service as requires improvement and made four recommendations to drive improvement. Although one of these recommendations had been followed, the others had not and we found the quality of care had deteriorated since our last inspection.

People were not supported to be safe as needs assessments, care plans and risk assessments were poorly completed. Measures to mitigate risk, particularly risks around behaviour which challenged the service, were not robust and did not incorporate advice and guidance from healthcare professionals. People’s preferences were not consistently recorded, and where they were recorded records did not show they had been respected. People were not involved in writing or reviewing their care plans.

Medicines were administered by trained staff and were stored and managed in a safe way. However, where people were given medicines covertly there was insufficient information in care plans to ensure this was done safely.

People gave us mixed feedback about the staffing levels at the home. Records showed that the home did not always deploy the number of staff their staffing assessment tool showed they needed. Records showed the home did not consistently follow safe recruitment practice as gaps in employment and professional qualification checks were not performed in a timely manner. We have made a recommendation about safe recruitment.

Healthcare assistants received the training they required to perform their role. However, it was not clear that senior staff performing assessments and line management tasks had received appropriate training in these aspects of their role.

The home had made appropriate applications to the local authority where people were being deprived of their liberty. However, it was not clear if people were actively consenting to their care, and relatives had provided consent without clear records they had the legal authority to do so. Staff understanding of the Mental Capacity Act 2005 and its application was poor.

Some people told us they liked the food, but others found it was not to their taste. The menu was varied and people were able to choose food that was not on the menu if they wished. The dining experience was not positive for people who lived in the home.

People told us the staff were caring, and staff demonstrated they treated people with dignity and respect. The home had not addressed our previous concerns about supporting people who identified as lesbian, gay, bisexual or transgender. Information about people’s pasts, relationships and interests remained inconsistent.

People told us the activities were limited and it was not clear people were supported with activities in line with their preferences. The home provided a daily schedule of activities but did not maintain records of who attended or levels of engagement with activities provided.

The home had a robust complaints policy and records showed complaints were responded to in line with it. Relatives told us they knew how to make complaints.

Quality assurance and audits were ineffective as they had not identified issues with the quality and content of care plans and risk assessments, and actions in place to make improvements had not worked. The staff team was divided in its opinion of the management of the home and the culture among staff was not positive or person centred.

We found breaches of seven regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home is registered to provide accommodation and nursing or personal care for up to 110 people. The home provides care for older people, people who have a physical disability and people living with dementia. There are four units within the home. Two of these units provide residential care, the other two units provide nursing care, one of these specialises in nursing care for people living with dementia. The home is fully accessible and divided across two floors. There are a variety of communal areas including gardens for people who live in the home.

There was no registered manager in place at the time of 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 person have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The manager in post had joined the service a month prior to inspection and had not yet submitted their application to become registered.

The last inspection of the service took place in October 2015. During that inspection we found the provider was in breach of a number of regulations. The breaches related to safe care and treatment, medicines management, safeguarding adults, consent to care, person centred care, staffing and good governance.

We found significant improvements across all areas of the service during this inspection. We have found the service is no longer rated as inadequate for any of the five key questions. Therefore, Summerdale Court Care Home will no longer be in special measures and we have stopped taking enforcement action against the provider. Services are placed in special measures when rated as inadequate and we have significant concerns about the quality of the care delivered. We found the provider is no longer in breach of the regulations. However, we identified some areas where further improvements can be made, which are detailed below.

The management of medicines, including the administration and recording of topical medicines, had improved and medicines were now managed in a way that ensured that people received them safely. There remained some issues regarding guidance for medicines that had been prescribed on an 'as needed' basis. We have made a recommendation about medicines.

People's care plans contained a variety of risk assessments and plans to mitigate the risks faced by people living in the home. The home had received support from relevant professionals regarding supporting people with behaviour which challenged the service, however, this had not been incorporated into people's care plans. We have made a recommendation about supporting people who present with behaviour which challenges the service.

At the last inspection we found the service was not meeting the needs of people who identified as being lesbian, gay, bisexual or transgender (LGBT). Although there had been some improvements in this area, staff lacked confidence in supporting people with this aspect of their lives. We have made a recommendation about supporting people who identify as LGBT.

People were supported to receive the support of relevant healthcare professionals as required. There were some inconsistencies in how this information was shared among staff providing support.

The new management team had introduced a range of quality assurance audits and improvements to the management structures of the home. These had not yet been embedded into the usual practice of the home.

People were protected from avoidable harm and abuse. Staff were knowledgeable about their role in safeguarding adults from harm. Relatives and people told us they felt safer in the home.

There were sufficient numbers of staff working in the home. Staff had been recruited safely. The home had reduced its reliance on agency staff. Staff training had improved, although there remained inconsistencies in the support and supervision provided to staff. The home had a clear plan in place to address this.

Consent to care and treatment was sought in line with legislation and guidance. The home was meeting the requirements of any Deprivation of Liberty Safeguard authorisations in place at the home. Care plans were not always clear about how to support people whose capacity to make decisions fluctuated and this had been identified by the home management. Staff understanding of the Mental Capacity Act 2005 had improved since our last inspection.

People were supported to eat and drink enough to maintain a balanced diet. Where people had specific needs in relation to their nutritional and hydration these were clearly recorded and well understood by staff supporting them. People were able to choose their meals from a rotating menu, and individual alternatives were offered if people did not like what was on the menu.

Staff told us they had time to build up caring relationships with people who used the service. Observations showed that interactions between staff and people were kind and sensitive. Work had been completed on peoples' life histories and care plans were more personalised. People and their relatives had been invited to review meetings to update their care plans and this was clearly recorded. People's care plans were reviewed and updated regularly to ensure care continued to meet their needs.

People were treated with dignity and respect. People who were in the last stages of their life were treated with compassion and kindness. There had been improvements in end of life care at the home.

The home had a robust complaints policy and records showed that complaints were responded to in line with the policy. People and relatives knew how to make complaints. The home had various systems in place to capture feedback from people and their relatives. Records showed action was taken in response to feedback received.

The leadership and management of the service was improving, and staff, people and relatives were optimistic about the future of the home. Various systems to monitor and improve the quality of the service had been introduced, which had led to clear action plans to complete. People, relatives and staff gave positive feedback about the new manager, describing them as visible and approachable.

The provider had systems in place to respond appropriately to allegations of abuse. Our conversation with junior and senior staff showed that they understood what constituted abuse and the procedure that needed to be followed if they had concerns or suspicions that people were being abused.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained .People told us that they thought the home was a nice place to live. Communal areas were well presented.

Staff received appropriate professional development. All staff had completed training in a number of key areas to ensure they were competent to do their job. This included training in manual handling, infection control, health and safety and safeguarding. Staff were being supervised on a regular basis.

On the day of our visit, people were supported to eat sufficient amounts. People were offered varied meals which represented their values or culture. People told us they chose when to have their breakfast. Staff told us they monitored those who were at risk of malnutrition by weighing the regularly and monitoring their food and fluid intake.

Staff thought that staffing was adequate. We saw staff supporting people in an appropriate manner. People's calls were responded to in a timely manner. Staff were able to tell us the different types of abuse and how and where to report abuse.

Relatives told us that they thought there were enough staff to meet people's needs. Another relative said 'staff are fantastic. They always look after mum. They play her favourite music. She looks the best I have seen her in years.'

The home responded appropriately to comments and complaints. There were regular staff meetings, clinical governance meetings and relatives meetings which were held in order to seek ways to improve the service provided. We also reviewed a customer satisfaction survey which was done in 2012, which showed hat the home had done well on communication and staffing but could do more activities.