Somerset House Nursing Home

We found the following examples of good practice.

The service was clean and free from any unpleasant odours. Detailed cleaning schedules were completed which included the deep cleaning of some rooms to maintain cleanliness and reduce the risks from infection.

There was enough personal protective equipment PPE such as aprons, gloves and masks. A range of additional checks were completed to screen people entering and leaving the service, minimising the risks from COVID-19 and enabling visiting of loved ones.

Staff and people were tested regularly for COVID-19. Evidence of completion of the required vaccinations was maintained for staff.

Staff had worked well as a team to help promote people’s wellbeing throughout the pandemic. Contingency plans ensured people’s needs continued to be met from staff employed at the service.

Individual risk assessments helped to keep people safe when enjoying the outdoors and meeting with their loved ones. The provider had a policy of reviewing any outbreaks of COVID-19 to identify any trends for action. This helped to mitigate further outbreaks and reduce further spread of infection, keeping everyone safe.

Further information is in the detailed findings below.

Somerset House Nursing Home is a care home providing personal and nursing care to 35 people at the time of the inspection. The service can support up to 44 older people, people with a physical disability or people living with dementia.

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

People received safe, person-centred care. The provider had continued to make and sustain improvements at the home. These improvements included the management of risks to people, medicines practices, care records and the effectiveness of quality assurance systems. People benefitted from a more consistent staff team, who were knowledgeable about their needs and individual risks. Staff received training and supervision.

The provider had a safeguarding policy and staff were aware of how to identify and report any signs of abuse. People received their medicines in line with their prescription. Further work was required to ensure the administration of people’s creams and topical medications was consistently recorded. The registered manager agreed to address this.

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 supported this practice. People were offered choice and their decisions were respected. People were supported to access the GP and any specialist services they needed. The provider acted promptly to clarify aspects of health care needs in a small number of care plans. People’s nutrition and hydration needs were well monitored.

Staff were caring and treated people with respect. People’s privacy and dignity was upheld. Staff adapted their support according to people needs, in order to promote people's independence.

Care plans were in place and regularly reviewed. This provided staff with relevant information about how to support people in line with their needs and preferences. People were offered opportunities to take part in activities at the home and trips out.

There was a positive, person-centred culture and the management team demonstrated a commitment to continually improving the service. Meetings were held with people, relatives and staff to exchange information and gather feedback. Staff spoke highly of the registered manager.

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 26 March 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a scheduled inspection based on the service’s previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: Work was still required to improve the staff and provider's knowledge and practice in key areas such as risk management, care planning and records. All staff needed to understand people’s needs and be skilled to meet them. Systems to check that people were receiving safe and good quality care required further development.

The provider had worked hard since the last inspection to make changes that impacted positively on people's experience of using the service. Most people and their relatives were happy with the care provided and said that things had improved. A relative told is, “The change has been unbelievable, I feel happy going home now, knowing that people are being well cared for.”

Activities were available for people and further improvements were planned to increase these and provide further access to the local community. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, their wishes and beliefs had been sought. 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 supported this practice.

Staff received training and assessment of their competency to ensure they had the appropriate skills to meet peoples’ individual needs. A programme of ongoing recruitment was in place to reduce the reliance on agency staff.

The manager and management team were well respected. Most people, their relatives and staff felt confident raising concerns and ideas. All feedback was being used to continuously improve the service.

The manager and provider had developed their ongoing action plan to address the concerns we identified as part of the inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rating at last inspection: Inadequate (report published January 2019).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: The provider was in breach of one regulation at this inspection relating to governance of the service. You can see the action we have told the provider to take at the end of the full report.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. If any concerning information is received we may inspect sooner.

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

Somerset House Nursing 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. The home is registered to provide nursing, personal care and accommodation for up to 44 older people, including those living with dementia. At the time of our inspection there were 40 people living at the home.

This was the first inspection of the service since the current provider took over in July 2018. We have found multiple breaches in regulation and the overall rating for the service is 'Inadequate'. The service is therefore in 'special measures'.

The inspection was partly prompted by an incident which had a serious impact on a person using the service. This indicated potential concerns about the management of risk in the service and the level of care provided to people. We did not look at the circumstances of the specific incident, as this may be subject to criminal investigation, but we looked at associated risks.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of the inspection a manager was in place but had yet to register with CQC.

The service was chaotic and was not well-led. People’s care needs were not being met due to insufficient staffing numbers and unsupported staff. The service was heavily reliant on agency staff and the management team failed to provide any support or leadership to staff members who did not know the people or the service.

Recruitment processes in place were not safe and medicines procedures were not robust.

The management team had completed checks on the quality of care provided. However, a number of these checks had not picked up on the shortfalls identified during the inspection. We found that the management checks focused on paperwork and failed to recognise the lack of care being provided to people.

Staff were not sufficiently trained or supported to enable them to fully understand their role. Staff had not received sufficient training in specialist areas such as behaviours that can be challenging to others, moving and handling and restraint. This meant that staff were not skilled in ensuring that care was provided in a safe and least restrictive way.

People’s nutrition and hydration needs were not being catered for. People did not receive the support they required to eat and drink and their intake was not being monitored effectively. Actions were not taken when people required additional support or a referral to a health care practitioner.

Staff did not have knowledge of people which impacted on their ability to provide person-centred care. Staff were very task focused throughout the inspection which led to people’s care needs being neglected.

Care plans failed to reflect people’s current needs and risks. Poor behaviour management plans placed staff and people at risk within the service. Accidents and incidents were not recorded, reviewed or monitored for trends and reoccurrences. Lessons which could be learned from any incidents were not considered.

The meeting of people’s wider needs could be improved through the provision of more meaningful activities that are monitored and reviewed. We received mixed feedback from people regarding the provision of activities.

Care records demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. The manager was in the process of submitting all DoLS requests to the local authority as the current provider had been unable to locate copies of applications made under the previous provider.

Relatives we spoke with were not satisfied with the care that was being provided to their loved ones and felt the service was not well-led.

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.

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.