Summerville Care Home

Summerville Care Home is a residential care home providing nursing and personal care for up to 45 people in one adapted building. The service provides support to older people and people living with dementia. At the time of our inspection there were 31 people using the service.

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

People told us they were safe at the home. One person said about the home, “Oh, its lovely. The staff are fine. I've never seen anything that would upset me.” They told us they had confidence in reporting anything of concern to staff. Another person said, “They treat me nice; I’m quite happy here.” We saw that people had positive, comfortable, and relaxed interactions with staff members. People told us they trusted the staff caring for them.

There was a calm atmosphere at the home and there were positive relationships between people at the home and staff members. We observed staff being attentive, kind, and respectful to people and their needs. One person told us, “The staff can’t do enough for us.” Another person said, “The staff are great.”

Staff, some people and their families told us the culture of the home was not always open, inclusive, and empowering. There had been some improvement in culture and management engaging with other staff members. However, this had not always been effective, was not embedded and had not led to significant improvements in the culture amongst the staff team.

People’s family members told us the new manager had not been visible, there had been minimal interactions with them, and they had not communicated effectively. They told us that frequent changes of management at the home has had a destabilising effect.

The provider was responsive to our feedback and took steps to address the culture of the service.

The service provided for people was safe; risks in people’s care were monitored and well managed. Staff received appropriate training to support people safely. The provider had ensured the building and its services were well maintained and safe. People’s medicines were safely managed.

There were enough staff at the home to meet people’s needs safely. The provider had a system for assessing people’s support needs and deploying staff to meet people’s needs safely.

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 and their family member told us the home was clean, fresh and well maintained. One person told us, “The home is immaculately clean.”

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 26 October 2021).

Why we inspected

The inspection was prompted in part due to concerns highlighted during our ongoing monitoring of the service in relation to the culture and leadership of the service. A decision was made for us to inspect and examine those risks.

The provider took action during the inspection window to mitigate these risks.

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.

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 changed from requires improvement to good, based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Summerville Care Home provides accommodation, personal and nursing care for up to 45 people over two floors with lift access to the upper floor. At the time of our inspection 25 people were living at the service.

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

Whilst the provider told us staffing numbers were based on people's dependency levels, staff told us they did not feel there were enough to meet people's needs and keep them safe from harm. Staff told us low numbers of staff often meant certain tasks, such as bathing and showering, could not be completed. Most people living in the home required two staff to support with tasks associated with mobility and personal care. This meant that at times there were not enough staff available to support other people where needed. Despite this, people told us staff responded quickly to requests for support and felt they received the care they needed in a timely manner.

Staff reported low morale and told us they felt unsupported and unappreciated by managers. They told us they did not feel able to discuss any work or personal concerns with the registered manager and felt previously reported issues had not been listened to or addressed. The provider had taken steps to address issues raised by staff and the registered manager provided records to show their recent engagement with staff. People and family members told us they had had limited communication with the registered manager and therefore were unable to offer any feedback. However, one person raised concerns about the registered managers conduct and attitude whilst communicating with staff.

Whilst cleaning schedules were maintained, some gaps were identified in daily cleaning tasks due to lack of housekeeping staff. The registered manager assured us this was being addressed with recruitment of further staff. The home and equipment used appeared clean and hygienic and staff received adequate training and guidance in relation to infection prevention and control.

Risks to people's health, safety and welfare had been assessed and plans were in place to manage these and keep people safe from avoidable harm. Staff knew how to identify and respond to concerns of abuse and safeguarding records showed appropriate action was taken where concerns were reported. People told us they felt safe and family members were assured of their relatives safety whilst living at Summerville.

Care was planned in a way that was person-centred and people and family members spoke highly of the staff and the level of care and support they provided. Family members told us staff kept them updated with any concerns and felt staff responded quickly to any changes in their relative's needs. Positive relationships had been developed between staff, people and their family members.

Regular checks on the quality and safety of the service were completed by the registered manager and provider. The registered manager had created a development plan to show improvements they planned to make to 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

The last rating for this service was good (published 20 June 2019).

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

Why we inspected

We received concerns in relation to staffing levels and manager conduct. As a result, we undertook a focused inspection to review the key questions of safe 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 changed from good to requires improvement. This is based on the findings at this inspection.

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

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.

We found the following examples of good practice.

We were assured the provider and staff at the home had taken appropriate action to help minimise the spread of infection and help ensure people were safe during the COVID-19 pandemic.

The service made effective use of available COVID-19 testing for both people living at the home and staff members. The service had taken part in a pilot for testing early in the pandemic and used additional testing for staff members to ensure they were tested multiple times each week. People coming to live at the home were supported to do so safely.

Staff supported people in a safe manner making effective use of personal protective equipment (PPE) and changing into a uniform on site when arriving for work in a designated staff room. Senior staff ensured there was always a good supply of PPE, hand gel and hand washing facilities available at convenient locations throughout the home. All staff had received training in infection prevention and control (IPC). The home was kept clean by a housekeeping team who adhered to regular cleaning schedules.

Each team within the home had an infection control champion who was able to offer guidance and advice for their colleagues and periodically met with the IPC team from the local authority to share learning and ensure they were up to date with best practise.

Visiting within the main building was restricted. Arrangements had been made for outdoor visits and for use of the home’s ‘Sun Lounge’ when appropriate.

There had been a focus on helping people with their mental health whilst isolating, with attention paid to particular details, for example, making an occasion of special meals, taking time to talk with people and supporting people to stay in touch with their loved ones. One staff member told us, “During this pandemic we are like people’s family.”

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

People’s experience of using this service:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why we inspected: This was a scheduled inspection based on previous ratings.

Follow up: We will continue to monitor the quality and safety of care being provided and return to inspect the service as per inspection schedule. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On our last inspection we found concerns in relation to the premises and found the home was unsafe. We found improvements had been made on this inspection and the provider was no longer in breach of the regulation in respect of the premises. There was enough personal protective equipment {PPE} for staff to use during our inspection.

On our last inspection we found concerns related to how prescribed medicines were being managed. On this inspection we found medicine management systems were safe. Medicine audits were being completed.

Staff we spoke with understood safeguarding and the different types of abuse. They could describe how to report a safeguarding concern and knew about whistleblowing. However, we found not all safeguarding concerns had been reported to the safeguarding authority.

Staff had undertaken a range of training including safeguarding, mental capacity and infection control. Staff received an induction, supervision but not all staff had received an annual appraisal.

People’s cultural and religious needs were being considered by staff within the home. Staff knew people well and could describe people’s individual care needs.

A choice of foods and drinks were being offered to people. People provided positive comments about the food.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Consent was not always being sought during care delivery. Deprivation of Liberty Safeguards (DoLS) applications were in place for people when appropriate and the service had a mental capacity framework in the care plans, however, staff were not always following it.

People we spoke were complimentary about the care staff. Staff we spoke with were concerned the care being delivered was task focused. We observed this on our inspection.

People's dignity was not always maintained due to the task led delivery of care and staff shortages with one person who had a toothbrush in a beaker of water which appeared to have been there for a significant number of days/weeks and an insect within it.

Activities were taking place within the care home but not tailored for people with dementia or for people within their bedrooms nursed in bed. There were no areas designed for people with dementia within the care home.

Complaints were being dealt with by the registered manager and residents’ meetings were being held. The registered manager was following up on concerns raised by people.

Staff and people who lived there were complimentary about the registered manager. However, we did not always find the registered manager effective in identifying all the breaches that we found within our inspection. The registered manager regarded staffing levels to be accurate in meeting people's care needs however, we found the staffing levels were grossly under estimated to enable staff to meet people's care needs. This demonstrated a lack of effective leadership and governance within the care home.

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.