Summerley Care Home

Summerley Care Home is a residential care home providing personal care for up to 21 people. The service provides support to older adults with a range of care needs, including frailty of old age, dementia and learning disabilities. At the time of our inspection there were 19 people using the service.

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

People, staff and relatives told us there was not always enough staff to deliver person centred care. Most of the feedback we received from people and relatives expressed concerns about staff availability to support people with meaningful activity. Staff confirmed they felt pressured to rush when supporting people.

People's medicines were not always managed safely, records of medicines were not always available or were in a disordered state, this increased the risk of medicines not being managed safely. People's associated health risks were not always appropriately assessed and planned for when discharged from hospital with additional health needs.

People who were living with dementia did not always receive support in line with current guidance. Incident records had identified potential shortfalls in staff practice supporting people when they were distressed. Monitoring audits had not always identified concerns about incident management, staffing levels, medicines or health risks.

Staff were recruited safely and received supervision where opportunities to develop and feedback about their practice were discussed. Their comments included, “I can't fault the [registered managers] support they have supported me with training.”

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, their relatives and staff gave positive feedback about the leadership and management at the service. One relative said, “The registered manager is a credit you can see their passion they are treated like family.”

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 January 2022) and there were breaches 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 15 October 2021 breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerley Care Home on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Summerley Care Home is a residential care home providing personal care to 18 people at the time of the inspection. The service can support up to 21 people and specialises in providing care to people living with dementia. The home is a large converted property located in Felpham, West Sussex. Accommodation is over three floors. There is a communal lounge and dining area.

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

People told us they were very happy at the service and had good relationships with the staff team.

Staff told us there were not always enough staff on duty to deliver person-centred care. Due to pressures on the staff team, some staff woke and got people up earlier than they would have preferred. Staff expressed distress at not always being able to provide person-centred care. One staff member said, “The residents deserve to be cared for properly.” Staff were working extremely hard to cover shifts and vacancies within the team. The registered manager was regularly supporting staff on the floor. We have made a recommendation to the provider to review staffing levels.

The service was transitioning to an electronic care planning system. Some care records were on paper, some electronic and aspects of some were missing. Some risks had not been identified and assessed in a robust way and staff did not always have accurate and reliable information to refer to. This put people at risk of harm. Management tasks, including monitoring and auditing the service, supervising staff and record keeping had fallen behind. Where improvements were identified in audits, actions had not always been taken in a timely or thorough way.

Accidents and incidents were not consistently recorded on the new system. We found two bruises that had not been recorded and one that had not been investigated. Incidents were logged in an individual’s care record and the registered manager was not yet using the system to oversee incidents on a home level. This would help to spot any emerging trends and make changes to improve safety for people.

Medicines were not always managed safely. Errors were not identified in a timely way. There were some gaps in the medicine records, which put people at risk of not receiving their medicines as prescribed.

Staff opinion about the leadership and culture at the service was divided. Some staff were very happy and felt supported. Others felt their feedback was not taken on board and spoke of friction between staff members and management. Staff had not always received sufficient training and supervision to support them in their duties.

The service had policies and processes to manage infection prevention and control but some of these required updating. Some staff carried out multiple tasks close together, including care, laundry, cleaning and food preparation. This increased the risk of cross-contamination as available PPE was not always used appropriately.

People were generally 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. We did raise concerns about some staff waking people earlier than they would have preferred.

Since our last inspection, the registered manager and provider had made improvements to the home environment to better support people living with dementia.

Staff worked collaboratively with external health and social care professionals. Relatives told us staff communicated with them and they were informed of any changes or health concerns.

People and relatives spoke extremely highly of the support and the caring nature of the staff team. Although some relatives had concerns about staffing levels, feedback was positive. One person told us, “It is a lovely place to live”. Another told us, “I’ve got everything I need. Staff are very helpful and very friendly.” A relative said, “We are very happy, nothing is too much trouble.” Another told us, “They are great there, they really are.”

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 7 November 2019). The service remains rated requires improvement. This service has been rated requires improvement at the last two inspections.

Why we inspected

We received concerns in relation to staffing levels, residents being woken early, bruising, medicines management and continence care. As a result, we undertook a focused ‘out of hours’ inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerley Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Summerley Care Home is a care home registered to provide residential care and accommodation for 21 people with various health conditions, including dementia and frailty. There were 19 people living at the service on the day of our inspection. Summerley Care Home is a large converted property located in Felpham, West Sussex.

People’s experience of using this service:

Many people at the service were living with dementia. Feedback we received from people, their relatives and our own observations showed that people were happy with the care they received, felt relaxed with staff and told us they were treated with kindness.

However, we identified areas of practice needing improvement in relation to the management of medicines and people’s mealtime experience.

We have made a recommendation in respect to the environment of the service being more appropriate for people living with dementia.

People said they felt safe, were well supported and there were sufficient staff to care for them. Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “The staff are amazing, they’re so caring”. People felt their healthcare needs were met and they had access to professionals should this be required.

People enjoyed an independent lifestyle and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “I do enjoy the food they give us”.

People felt the service was homely and welcoming to them and their visitors. A relative told us, “It’s a lovely home, very friendly and homely”. People told us they thought the service was well managed and they enjoyed living there. One person told us, “The man [registered manager] comes and talks to me, it’s all very good”.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and 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.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care from dedicated and enthusiastic staff that met their needs and improved their wellbeing. A member of staff said, “Everyone is really supportive here. I love caring for the residents”.

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 good (published 1 February 2018).

Why we inspected: The inspection was prompted in part due to concerns received about the quality of care delivery and people’s safety. A decision was made for us to inspect and examine those risks.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service good. At this inspection we found 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. At this inspection we found the service remained Good.

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

There were sufficient numbers of staff on duty to keep people safe and meet their needs. We observed that people were not left waiting for assistance and people were responded to in a timely way.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, given to people as prescribed and disposed of safely.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff were trained in the Mental Capacity Act 2005 (MCA) appropriate assessments of capacity were carried out.

People said they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

There were sufficient numbers of staff to meet people’s needs and the registered manager monitored people’s needs and adjusted staffing levels as needed. Staff recruitment procedures were safe and ensured that only suitable staff were employed.

People and their relatives spoke positively about the home and the kind and caring manner of the staff. Staff treated people with dignity and respect.

People’s care plans were individualised and contained information about people’s life history, they reflected people’s choices and preferences. People’s cultural and religious needs were documented and their spiritual needs were met.

People and relatives spoke positively of the home and told us it was well led. A number of audits and checks were used to ensure the effectiveness, safety and quality of the service.

Further information is in the detailed findings below.

One inspector carried out this inspection. We considered our findings to answer the questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff who supported them and from the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke to a relative who was visiting during our inspection. They told us, 'All the staff seem to know X so well. It's a relief to know that their safe.'

We saw that potential risks to people were appropriately assessed and planned for. The service routinely screened for risks associated with mobility, falls, nutrition and additional risks specific to the individual. There were instructions for staff on how to reduce risks to people in these care areas.

People were protected against the risks of abuse as the provider ensured staff received appropriate training. Staff we spoke with knew the different types of abuse that might occur and the signs that might indicate abuse. Staff were aware of their responsibility to report abuse and told us they felt confident to do so. We saw information was displayed within the service with contact details for external agencies such as CQC and safeguarding team.

Recruitment practice was safe and thorough. We looked at staff records and found that appropriate checks were made before staff began work. We found that the provider had taken appropriate steps to ensure staff were qualified and competent to carry out their role.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted the Manager demonstrated that they knew their responsibilities in respect of this.

Is the service effective?

People confirmed that they were happy with the care and support provided. One person told us, "The staff are all very nice. I always have help.' Another person told us, 'It works well.'

People's health and care needs were assessed and people and their relatives were consulted in planning their care. Daily records showed that care was delivered in line with people's care plans. Staff we spoke with demonstrated that they knew people's care and support needs well and the way in which individuals preferred their care to be delivered.

Specialist needs such as dietary needs and pressure care had been identified in care plans where required. We saw that people received visits from health professionals such as district nurses and their GP.

Is the service caring?

People told us, 'The staff are all very nice. They talk to me nicely." Another person told us, 'I do like this place very much.'

Relatives told us that care, 'Spreads beyond residents, they care for us. It has a family feeling.' They told us the atmosphere was positive when they visited and described the service as, 'A happy place, a lot of fun.'

Staff told us they enjoyed working at the home as it was a small home and they were able to get to know people who used the service very well. They told us, 'It is family orientated, we all sit together.'

People were treated with respect and dignity by the staff.

People were supported by kind and attentive staff. We observed staff asking people if they needed any help, engaging in conversations, joining in singing with one person and offering reassurance to another. We observed staff and people shared a joke and laughed together. There was a positive and warm atmosphere.

We saw in the minutes of a staff meeting that staff who supported people with morning routines were encouraged to, `Spend time chatting about day to day things that might be happening that day.`

Is the service responsive?

We found that there were regular residents meetings. In addition there were also relatives meetings that took place. We saw a that regular satisfaction surveys were undertaken and evidence that the provider had acted upon feedback received.

Relatives described the management team as very approachable and told us action was taken if they raised an issue.

The provider undertook regular health and safety audits in order to identify assess and manage risks relating to the health, wealth and safety of people who used the service. We saw that the provider took action to ensure people were supported within a safe service.

Is the service well-led?

The staff we spoke with were clear about their roles and responsibilities. They told us that they felt confident in being able to deliver the care and support people needed. Staff told us they felt supported in their role.

We saw that people's consent was sought, wherever possible, before care and support was provided. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We saw that medicines were properly handled and administered in line with the providers policy. We noted that staff were properly supported to carry out their duties. We also found that systems were in place for people and relatives to make a complaint about the service if necessary.