Summerfield Care Home

Summerfield Care Home is a residential care home providing personal care to up to 21 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 18 people using the service.

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

People’s care plans did not always consistently provide enough information of identified risks or guidance for staff to safely manage them. Hygiene practices through the bathrooms required reviewing to help ensure safety was promoted.

People’s care records contained some out of date or contradictory information. Staff did not always consistently work with other health and social care professionals to effectively meet people’s needs.

Whilst improvements had been made since our last inspection, the auditing systems in place were still not always effective at identifying areas for improvement. The systems had not identified risk assessments and care plans required updating or where further professional input was required.

The provider had made improvements to ensure action was taken when staff identified any risk of harm. They had reviewed their systems in place to help ensure people received their medicines safely and as prescribed. Lessons were learnt when things went wrong and people were supported by staff who were safely recruited to work at the home.

People were supported by staff who were trained to meet their needs and people were supported to eat and drink and maintain a healthy diet. The service was adapted and decorated to meet people’s needs. 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, although further reviews to ensure decision specific records were in place.

The registered manager and staff shared a positive culture, and they were passionate about caring for people. People, their relatives and staff were engaged and involved in the running of the service.

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 5 July 2021) 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 whilst we found improvements had been made and the provider was no longer in breach of some regulations, further improvements were still required, and the provider remained in breach of regulation 17.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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 based on the findings of this inspection.

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 see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement

We have identified breaches in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visitors were checked on arrival for proof of vaccination where it was applicable.

The provider completed regular checks to ensure staff followed effective infection prevention and control practices.

The provider worked with other healthcare professionals to ensure they were following best practice guidance in preventing the spread of infections.

Staff and people were regularly tested and had received COVID-19 vaccinations unless exempt.

The provider ensured PPE supplies were plentiful and accessible throughout the buildings. We saw staff were using PPE appropriately at all times.

Summerfield Care Home is a residential care home providing personal care to 8 people aged 65 and over at the time of the inspection. The service can support up to 21 people, some of whom may be living with dementia.

Summerfield Care Home accommodates up to 21 people in one adapted building.

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

Improvements had been made, however new processes and systems needed to be further embedded into practice to ensure the service was consistently safe and well-led.

New systems had been introduced to ensure people were safeguarded from abuse and avoidable harm. However, these were still not being followed consistently, and we found that some incidents had not been reported to the safeguarding authority when required.

Improvements were required to ensure people had their medicines as prescribed.

Staff knew people’s risks and there were plans in place to mitigate risks and keep people safe. However, these were not always written down. People were protected from the spread of infection.

There were enough staff on shift to meet people’s needs and people did not have to wait for the support they required. There were plans in place to recruit more staff.

The provider and registered managers had improved oversight of people’s risks and needs. However, improvements were still required to ensure staff were following new systems and that governance systems were identifying issues and effecting change.

Relatives felt that staff were caring, and staff felt well supported and enjoyed working at the home.

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 inadequate (published 17 December 2020 and supplementary report published 25 February 2021).

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 but they needed to be fully embedded and sustained and the provider was still in breach of some regulations.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 November 2020. Four 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 safe care and treatment, safeguarding service users from abuse, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to medicines, safeguarding and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. Following the last inspection, we imposed conditions on the provider’s registration which required them to update us monthly on their progress. These conditions will remain in place to allow us to closely monitor the service and ensure improvements are progressing. We will also work alongside the provider and 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.

Summerfield Care Home is a residential care home providing personal care for up to 21 people aged 65 and over who may be living with dementia. At the time of the inspection, 13 people were being supported.

Summerfield Care Home accommodates up to 21 people in one adapted building.

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

People did not receive a safe service because there was not always enough staff to support them.

People’s risks were not promptly identified and managed. Staff did not always know how to support people safely because they had not had all the training they required and some plans were not in place to follow.

Medicines were not always safely managed and we could not be assured people were protected from the spread of infection. People were not always protected from the risk of abuse because systems were not in place to identify, report and investigate concerns.

The management team and provider did not have thorough oversight of the service and did not have systems in place to keep people safe and to identify areas for improvements. There was not a positive culture in the service.

Feedback was gathered from people, relatives and staff. Staff knew how to raise concerns outside of 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 requires improvement (published 6 June 2019).

Why we inspected

We received concerns in relation to the safety of people being supported. 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. 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate risks we identified including increasing staffing levels.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerfield 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, safe care, safeguarding people from abuse and improper treatment and governance at this inspection.

Please see the action we have told the provider to take in relation to safeguarding people from abuse and improper treatment at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have met with the provider prior to this report being published to discuss how they will make changes to ensure they improve their rating. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

People’s experience of using this service: Accurate and up to date records had not always been completed. We recommend the provider ensures records are accurate and up to date. Audits are robust to identify shortfalls so immediate action can be taken. The environment was not always clean and areas of the home require renovations. We have made a recommendation about the environment and premises.

We found staffing levels had been increased to ensure people’s needs were being met. Recruitment checks were robust to ensure new staff were suitable to support people who used the service. Staff had an induction and training programme which was completed by most staff. We found one person who had not completed their induction training.

People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people.

Incidents and accidents were managed effectively. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practice, to reduce the risk of further occurrences.

The management of medicines was safe. Risk assessments had been completed, provided detailed guidance for staff to follow and were reviewed regularly.

Staff used personal protective equipment to prevent against cross infection.

People and staff had positive relationships. People told us staff supported them when required and were helpful. Staff treated people with respect and dignity. Staff respected people’s privacy and people were encouraged by staff to be as independent as possible.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People told us they were involved in making every day decisions and choices about how they wanted to live their lives.

Initial assessments were carried out to ensure people’s needs could be met and personalised care plans followed. People’s likes, dislikes and preferences had been included in care plans and people told us they were offered choices about their care. However, care plans had not been updated since 2017.

People were supported with their nutritional needs. People were supported to live a healthy life and staff supported people to access health care professionals when required.

A complaints system was in place and these were managed effectively. People and staff told us they felt confident to raise any concerns and felt these would be managed.

The provider worked in partnership with other services to support people’s care and quality of life. The registered manger told us regular reviews of people’s care were carried out but these had not been recorded.

Staff told us the management team were approachable and said they were supported with regular supervisions and appraisals.

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

Rating at last inspection: This was the providers first inspection. The provider registered with the CQC on the 24 November 2017.

Why we inspected: This was a planned inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. The overall rating at this inspection is requires improvement. We will continue to work with the provider to understand the action they have taken to improve the rating to at least good.