All inspections: Summerlea House Nursing Home

We carried out a comprehensive inspection of this service in January 2015 and found the provider was not meeting the legal requirements in relation to standards of care and welfare for people who use the service. We carried out a focused inspection of this service on the 14 April 2015 to follow up on Warning Notices we had served on the provider in March 2015. Repeated breaches of the legal requirements were found in relation to the standards of care and welfare for people who used the service. Care and treatment was not designed to meet people’s needs or preferences. There was a failure to ensure systems and processes were in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people, or to improve the quality and safety of services provided. After this focused inspection the service was placed into special measures and a condition was placed on the registration of the service prohibiting admissions to the service without the express permission of the Commission.

We undertook this unannounced comprehensive inspection on the 14 and 15 October 2015 to check the service had made improvements and met legal requirements. The service had taken sufficient steps to be taken out of special measures.

The home provides accommodation and nursing care for up to 74 older people. At the time of our inspection 38 people lived at the home.

A registered manager was in place; however they were on leave 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 the registered provider and manager had not met all of the requirements of the Regulations to meet the fundamental standards, and further work was required to embed practices in the home.

Whilst medicines were stored and ordered in a safe and effective way, some medicines were not administered as they were prescribed.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. Health and social care professionals were involved in the care of people, especially those with enhanced needs; care plans reflected this.

There were sufficient staff to meet the needs of people who lived at the home, however further work was required to identify the increased needs of people when they were admitted to the service. Staff had a good understanding of how to keep people safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs.

Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. People had opportunities to be involved in planning and reviewing their care however further work was required to embed this practice in the home.

People’s nutritional needs were met in line with their preferences and needs; people who required specific dietary requirements for a health need were supported to manage these. Some work was required to ensure staff accurately recorded and monitored the nutritional and fluid intake of people.

Care plans in place for people reflected their identified needs and the associated risks, however records were not always accurate and did not always reflect the care people received. Staff were aware of people’s needs and understood their role in supporting these. Staff were caring and compassionate and knew people in the home well.

There was a wide variety of activities available for people, however some people were at risk of isolation as staff did not always take opportunities to interact with them. We have made a recommendation to improve staff interaction with people.

Complaints had been responded to in line with the registered provider’s policy and this work needed to be sustained. Incidents and accidents had been reported and investigated however further work was required to improve the responsiveness of action plans and embed this practice in the home.

The registered provider had supported the registered manager and their staff with additional resources to improve the management structure in the home and improve the quality assurance systems in place. This work required further embedding in the service as audits in place to ensure the safety and welfare of people were not always effective. Care records were not always held securely and did not always contain information which was consistent or accurate. People, their relatives and staff felt positive in the recent changes in the service; however these needed to be sustained.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an unannounced inspection of this home on 5 January 2015. Breaches of Regulation 9 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were found. After the comprehensive inspection we served a warning notice on the registered provider and registered manager of the service requiring them to be compliant with the Regulations by 12 April 2015.

We undertook this focused inspection on the 14 April 2015 to check they had met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Summerlea House Nursing Home on our website at www.cqc.org.uk

A registered manager was in place 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 the registered provider and manager had not met the requirements of the Regulations to meet the fundamental standards.

Care records did not identify individualised plans of care for people, particularly those with specific health or social needs. Risk assessments in place had identified actions required to reduce risk for people who had fallen. However, there was no care plan in place which identified the specific needs or actions for people to respond to and reduce these risks.

Care staff did not access or inform care plans to ensure the care the person received was in line with their needs. Registered nurses prepared care plans for people which lacked information about their specific needs and these were not reviewed effectively.

Care staff responded to people’s needs in a calm, kind and effective way. The environment of the Rosemead Unit had been altered to accommodate the needs of people who live with dementia although people had not been involved in the planning of this work.

A lack of leadership in the management of care planning and review meant staff were not aware of their responsibilities in the planning of individualised care for people.

Incidents and accidents were not always reviewed and appropriate actions were not taken to inform learning and make changes to people’s care appropriately.

Audits of records were not used effectively to ensure the safety and welfare of people.

We found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of this report.

We carried out an unannounced inspection of this home on 5 January 2015. Summerlea House Nursing Home provides accommodation and nursing care for up to 76 older people. The home is a large, purpose built property and accommodation is arranged over three floors although only two were in use. The second floor houses the Rosemead Unit . This is a specialist unit which accommodates up to 16 people who live with dementia. Two passenger lifts are in place to assist people to move between the floors. The accommodation provided is a mixture of single bedrooms and shared rooms for two people. There were 61 people living at the home at the time of our inspection, 11 of whom lived in the Rosemead Unit.

The service had a registered manager. 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.

Following an inspection in September 2014, the registered provider was found to be in breach of the regulations relating to the care and welfare of people, meeting people’s nutritional needs, the cleanliness and infection control processes in the home, assessing and monitoring the quality of the service provided, and the quality of the records kept in the service. The registered provider sent us an action plan stating they would be compliant with these regulations by October 2014. The registered provider had addressed some areas of concern, whilst others were continuing to be monitored or further actions implemented.

People said they felt safe at the home. Relatives had no concerns about the safety of people although they felt more senior staff were required at the home at weekends. The home was clean and tidy and the kitchen area had been deep cleaned.

Staff had been trained and had an understanding of the risks of abuse against people. They said they were confident to report any concerns of abuse they may have through the appropriate channels. However the registered manager and staff had not identified several incidents of concern which should have been reported to the local authority and CQC. We reported these incidents to the local authority.

Although recruitment and training processes meant people were cared for by staff who had the skills to meet their needs, there were not sufficient staff to meet the needs of people who lived with dementia. A lack of nursing staff present in the home meant people did not always receive care which was led by nurses.

People were supported by nursing staff to take their medicines. However there was a lack of policy and procedures in place to ensure medicines were administered safely and effectively when they were not required regularly. Staff had not ensured the correct processes were followed when a person received their medicines covertly.

Staff gave people a choice of nutritious food and drink. New menus had been implemented following consultation with people and feedback was being monitored by the registered manager.

Staff at the home had not been guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked the capacity to make decisions. The registered manager and staff had not always sought people’s consent to their care. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This is relevant where people may need to have their freedom restricted in their best interests with authorisation from a local authority to do so. The registered manager and staff did not have a good understanding of when DoLS should be implemented.

People had access to health and social care professionals as they were required. External professionals were well received by staff who welcomed advice and support.

People said staff were caring and supportive. Staff knew people at the home well. However, people who lived with dementia did not always receive support which was meaningful and in line with their needs.

Individualised plans of care provided information about people’s needs, however these lacked detail. Some people told us they were able to participate in activities, however for people who lived with dementia there was a lack of stimulating and meaningful activity.

People were provided with opportunities to express their views on the service through quality assurance surveys and through discussions with the manager and staff. Meetings were held with people and their relatives/representatives to allow them to express their views.

Whilst a programme of audits was completed by the registered manager and the registered provider to ensure the welfare and safety of people, they had not identified the lack of mental capacity assessments or medicines policies in place to ensure the safety of people. Incidents and accidents were not recorded, reported and investigated thoroughly. This meant people were at risk of further harm following these events. The registered manager had not always identified any learning from these and shared this with staff to prevent recurrence of these issues.

People who worked and lived at the home felt able to express any concerns they had and these were responded to. The registered manager worked to promote an open and honest culture of communication in the home, however this was not always reflected in the comments we received from people and relatives.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Regulations of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out a responsive inspection of this home following concerns which had been raised with us about the care and welfare of people who lived there. At the time of our visit 55 people lived at the home. A single inspector and an expert by experience visited the home and spoke with; the registered manager, the head of care, nine members of staff including the cook, care staff, nursing staff, and domestic staff. We spoke with five people who lived at the home and some visitors.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, caring, responsive, effective and well led.

This is a summary of what we found-

Is the service safe?

There were sufficient numbers of qualified, skilled and experienced staff on duty at the time of our visit to meet the needs of people. Staff had a good awareness of the needs of people who lived at the home.

People were cared for in an environment which was clean, however we found infection control measures at the home had not always been fully implemented. We have asked the provider to tell us how they will address this.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had no DoLS in place and the head of care had an understanding of this process and its application.

Is the service caring?

People told us staff were very caring and responded to their needs. Staff were knowledgeable about people's preferences and demonstrated patience and understanding when communicating with people. We observed staff communicating with people in a calm, dignified and respectful way, ensuring they were given opportunities to express their needs and communicate with others.

People we spoke with were positive about the care they received. One said, 'They always ask if there is anything else I want.' Another told us, 'The girls are all lovely, very kind and look after me well.'

Is the service responsive?

People's needs were assessed before they moved into the home. Records showed people had been involved in the planning of their care. However, we found care plans had not always been updated effectively to ensure staff would know how to deliver care based on people's individual needs. The registered manager and head of care told us registered nurses were responsible for the updating and maintenance of care records. We have asked the provider to tell us what they are will do to ensure care plans are responsive to people's individual needs.

People and their representatives were given opportunities to discuss their care and any concerns they had about the home with staff. People told us they were happy any issues they had would be addressed.

Is the service effective?

People told us they were happy with the care delivered for them and their needs had been met. Relatives told us the care their loved one received was good. It was clear from our observations staff knew people who lived in the home very well and understood their needs.

However, we found assessments of some people's needs did not reflect the risks associated with their specific health conditions. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The provider had some systems in place to monitor the quality of the service that people received, however some of these systems were not effective. We have asked the provider to tell us how they plan to address these.

People told us the registered manager and head of care for this service were approachable. Staff told us they received support from the management to develop their role and improve their skills. Records showed that staff, people who lived at the home and their representatives had regular meetings and opportunities to express any concerns to the manager and provider.

Complaints, comments, accidents and incidents had all been responded to in a timely way and actions taken to prevent these recurring. This meant that staff and people who lived at the home were supported to raise concerns and have them dealt with.

During our visit we met and spoke with seven people living at the home. We also spoke with three relatives of people living at the home.

Some of the people living at the home had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

People told us that they were happy living at the home and that they felt that their care needs were being met. One relative that we spoke with told us, "I would recommend the place to anyone".

We found that people had planned care that met their needs. We also found that people's consent had been obtained prior to treatment, where appropriate.

We found that the home had followed safe recruitment processes. We saw that staff had been trained appropriately and encouraged to develop within their roles.

During our visit we talked with five people, and two family members. We also gathered evidence of people's experiences of the service by indirectly observing the care they received from staff.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very good here, the staff are so kind, they always look after me well".

Another person said, "I don't want to be here, I would rather be at home but I get looked after very well. They couldn't do any more for me ".

As one family member explained, "They look after X very well, I come in every day and I have only ever seen good care here, staff are friendly and kind".

Another family member told us, "I am not backwards in coming forwards! If I had an issue with anything I would tell the manager straight away. I have only needed to complain once and it was dealt with straight away. I feel lucky that my family member is here as I think it is pretty good".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.

The people that lived at Summerlea House Nursing Home had dementia and other conditions and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we spent time observing what was going on in the service, how people spent their time, the support they received from staff and whether they had positive outcomes.

From our observations we found that overall people had positive experiences. The staff assisting them knew what support they needed and were seen speaking to people in a kind and respectful way.

We spoke with six people who lived at the service. All said they were treated with respect and were happy with the care they received. For example, one person said, 'I'm lucky and can tend to myself; staff understand that'.

Someone else said, 'I had an ulcer when I came here. They have done wonders. I have a pressure relieving mattress on my bed and a special cushion on my chair. One is very well looked after'.

Another person said, 'I go in the lounge when there is entertainment on. We can go in the garden as well. We all come to life with the old music ' it jogs the old memory. I'm lucky with my family; they visit and I talk to them on the phone. I have a land line in my room so I don't have to rely on staff'.

One person expressed dissatisfaction with activities. They said, 'I find it boring and that makes you feel useless'.

None of the people we spoke with said they had been given a copy of their care plan.

We spoke with five relatives of people who lived at the service. All said they were happy with the care their family members received. For example, one person said, 'They did an assessment before my aunt came here. They have been very good at getting to know her'.

Another said, 'They have been good at getting medical attention if my wife has needed this'.

We also spoke with the relatives of people who lived at the service about staffing levels. Four expressed satisfaction. For example, one said, 'On the whole people don't seem to have to wait too long if they need help'.

One relative said, 'Sometimes they seem short staffed, most of the time its fine. I think it's a bit of a problem if staff phone in sick. They used to have issues with call bells being answered, but that's not been a problem recently. Most of the time they are answered within five to ten minutes now'.

All six people who lived at the service expressed satisfaction with the staff. For example, one person said, 'They are all very good, I can't fault them'.

Someone else said, 'Staff are very helpful. There are cultural differences and this can take a little getting used to but they are kind'.

We conducted this compliance review to monitor the home's progress in addressing concerns raised at a previous review of the service in September 2011.

On this occasion we focussed our review on the care and treatment of the most vulnerable people in the home. The people we saw were unable to voice an opinion about their care and treatment. Therefore we cannot report on what people using the service said.

Whilst most people told us they were happy with the care they received at Summerlea, this was not universal. We were told about people who were left alone in their rooms for long periods and who felt they did not receive good care.

People told us that whilst staff were generally kind and gentle, there were times when the staffing levels meant that shortcuts were taken.

People who lived in the home told us they were happy with the care they received. They said that they were treated with respect, that they were well looked after and that staff were kind. People told us that there were usually enough staff for the number of people living at the home, however there were times when they had to wait for some time for staff to answer their call bell.

People told us that they were able to get up when they wanted, and visitors could come and go whenever they wanted. People told us that medicines come on time, and that they can see a doctor whenever they need to. People who live at the home told us that generally the food was good and that they always had a choice.

Archived: Summerlea House Nursing Home

All Inspections

14 and 15 October 2015

During a routine inspection

14 April 2015

During an inspection looking at part of the service

5 January 2015

During a routine inspection

10 September 2014

During an inspection in response to concerns

9 July 2013

During a routine inspection

18 February 2013

During a routine inspection

16 April 2012

During a routine inspection

21 November 2011

During an inspection looking at part of the service

24 September 2011

During an inspection in response to concerns

8 March and 6 May 2011

During a routine inspection