We carried out an unannounced comprehensive inspection on 14 February 2017 and returned announced for a second day on 20 February 2017. Summerleaze Residential Home is a large detached Victorian house in the town of Exmouth. They provide care and accommodation for up to 31 people with all rooms having ensuite facilities. On the first day of the inspection there were 29 people staying at the service. One of these people was staying at the service for a short stay respite period.We had previously carried out a comprehensive inspection of this service in August 2015. A breach of a legal requirement had been found at that inspection. The breach was because people were not protected from unsafe and unsuitable premises. In particular, we highlighted scald risks from the hot water supply and windows on the first floor which were not restricted to prevent vulnerable people from the risk of falling out. Following the inspection we were sent an action plan setting out the actions the provider was going to take. At this inspection we found action had been taken regarding these concerns and the requirement had been met.
The service has two registered managers at the service. 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. One of the registered managers was a director who had decided to take a step back reducing their role at the service. Therefore the second registered manager undertook the majority of the registered manager’s role. They said they were supported by the second registered manager and responsible person who would step in when they were taking leave. The responsible person was aware of the additional pressures and responsibilities the registered manager had taken on. They were putting in place a care administrator role to complete care plans and reviews and senior care workers were being delegated additional roles. These included undertaking supervisions for staff in their teams to relieve the additional work load on the registered manager.
Everyone gave us positive feedback about the registered manager and said they were very visible at the service and undertook an active role. They promoted a strong caring and supportive approach to staff. They felt this was then the culture in which staff cared for people at the service.
People were supported to follow their interests and take part in social activities. There was a designated activity person who along with the management team recognised the importance of social events for people. During the inspection a new weekly newsletter was started to keep people informed.
Staff were able to anticipate people’s needs and were respectful, discreet and appropriate in how they managed those needs. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff were compassionate, treated people as individuals and with dignity and respect. Staff knew the people they supported, about their personal histories and daily preferences. Staff showed concern for people’s wellbeing in a caring and meaningful way. Where possible, people were involved in making decisions and planning their own care on a day to day basis. People said staff were caring and compassionate and treated everyone with dignity and respect at all times.
The management team and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) (2005). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA for the majority of decisions. Following the inspection we received confirmation from the registered manager that best interest decisions had been formally recorded for all decisions made.
People were not always supported by sufficient staff to meet their needs promptly. This had been recognised by the management team and changes to the deployment of staff and additional staff were being implemented. Staff had the required recruitment checks in place and were trained and had the skills and knowledge to meet their needs. Staff had received an induction and were knowledgeable about the signs of abuse and how to report concerns.
People were supported to eat and drink enough and maintain a balanced diet. The management team had been working closely with people to make changes to the menu. They were also making changes to their catering team. People were seen to be enjoying the food they received during the inspection.
Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.
The provider used a computerised care system to record the care people received. Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people where able and their families had been involved in their development. Accidents and incidents were reported and action was taken to reduce the risks of recurrence.
People were referred promptly to health care services when required and received on-going healthcare support. Healthcare professionals were positive about the quality of care provided at the home and the commitment of the whole team to provide a good service.
The premises were well managed to keep people safe. The home was cleaned and decorated to a good standard and homely features made it welcoming. Systems were used to ensure the environment was kept clean and safe. There were emergency plans in place to protect people in the event of a fire or emergency.
The provider had a quality monitoring system at the service and were looking at ways they could improve their documentation. The registered manager actively sought the views of people, their relatives and staff. There was a complaints procedure in place and people were confident any concerns they raised would be looked into. The registered manager was reviewing and updating the homes policies to ensure they reflected current guidance.