Archived: Somerset Villa

We found the following examples of good practice:

Visitors to the service received a temperature check on arrival and completed a Lateral Flow Test (LFT) prior to entering the building. Visitors were encouraged to wait in the car park until their result is identified. This reduced the risk of cross infection between the visitors and those supported within the service.

Where an individual had received a positive test result for COIVD-19, the service had taken appropriate action and contacted the required professional bodies. A care plan and risk assessment had been implemented to maintain the individual and others safety. Clear signage had been placed on the door of the individual's bedroom to identify them as positive in a respectful manner. To ensure the correct precautions were taken before staff supported this individual.

Staff were observed wearing the required PPE for the task they were completing. Staff were donning and doffing their PPE in line with current government guidelines and remaining socially distanced wherever possible.

Cleaning schedules evidenced regular cleaning had been taking place within the service. This included touch points being cleaned numerous times a day to further reduce the risk of contamination. The service appeared clean on the day of the visit.

Somerset Villa provides accommodation, support and care for up to 16 older people, some of whom are living with dementia. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 14 people were using the service.

There was a registered manager 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 our last inspection of this service on 17 May 2017 we rated the service Inadequate and placed it into special measures because we had some serious concern relating to the staffing levels and staff training, recruitment practices, management of risk and of medicines, consent, nutrition, complaints and overall governance of the service. We issued requirement notices for all these breaches of regulation. Since that inspection the service has been acquired by a new owner and a new registered manager has been appointed. The new owner and management team provided us with action plans showing us how they would make the required improvements. They kept us regularly updated on the progress of these action plans. At this inspection we found improvements in all the areas we had previously been concerned about. It was clear to us that a great deal of hard work had been carried out by the new owner of the business and the registered manager. This had brought about some significant improvements at the service and further improvements were planned.

People who used the service and relatives were happy with the care provided and all praised the way the new provider had made positive changes to the safety and quality of the service.

People received safe care. The registered manager assessed and managed risks well. People were supported to be as independent as possible and involved in their local community. Any associated risks were incorporated into their care plan.

Medicines were mostly well managed and people received their prescribed medicines on time. Occasional stocktaking errors meant we could not be fully assured that all medicines were being given as prescribed. The registered manager took prompt action to address the issue and planned to provide staff with further training and support.

Staff understood their responsibilities with regard to keeping people safe from the risk of abuse. Staff were confident and knew how to raise concerns. Individual safeguarding incidents were well managed and the provider was open and transparent when carrying out safeguarding investigations.

Infection control procedures were in place and staff demonstrated a good knowledge of how to reduce the risk and spread of infection.

Staff were trained to carry out their roles and felt supported. A structured system of induction, training, supervision and appraisal had been set up since the last inspection and was welcomed by staff.

People’s needs related to eating and drinking were managed well and records were good. Staff demonstrated a good knowledge of people’s particular needs in this area, although choice could have been improved.

People had good and prompt access to healthcare and staff worked well with other healthcare professionals to meet people’s needs in this area. Healthcare records had been reviewed and were now electronic, which meant information was more easily shared with relevant health professionals.

The service mostly worked in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. Some further work was needed to ensure that all decisions taken with regard to the sharing of rooms were done in line with the MCA. Shared rooms did not afford people total privacy and the service needed to confirm that all the people who share rooms were happy with the arrangement.

Staff were kind and caring and demonstrated that they had built up good relationships with the people they were supporting and caring for. People were supported to be as involved in decisions about their care as they wished to be.

People who used the service had the opportunity to follow a variety of hobbies and interests and the provision of activities had greatly increased since our last inspection. Activities were inclusive and many were tailored to those people living with dementia.

New care plans were detailed, person centred and reflected people’s individual needs and preferences. People confirmed that their wishes with regard to their care, were respected.

Care for people at the end of their life was good. There was a commitment to ensuring people had a dignified and pain free death and their wishes relating to the end of their life had been established and recorded.

The service was well-led by the newly appointed registered manager. There was a clear vision for the service and a structured approach to driving improvement. Staff were well supported and there were excellent quality assurance systems in place. We had confidence in the registered manager to continue delivering the good practice we found and to address the concerns which remained. A significant change in the quality of the service had taken place in a short space of time and this is to the new provider’s credit.

The service provides care for up to 16 people, some of whom are living with dementia. At the time of our inspection 14 people were using the service.

We carried out this inspection after concerns were shared with us about the staffing and management of the service. This comprehensive inspection followed up our previous inspection on 10 May 2016. At that inspection we identified two breaches of regulation related to the staffing and management of the service. We rated the service Requires Improvement and the provider submitted an action plan setting out how they would address the shortfalls we identified..

At this inspection we checked to see if the actions had all been completed and found that they had not. We continue to have concerns about the operation of this service.

Since our last inspection a new provider had been identified to buy the business and at the time of our inspection this sale was going through and has since completed. This report relates to Reminiscence Care Limited, which remains the current registered provider.

A registered manager was in post and was also the owner of the business. This provider was intending to remain in post for a period of months following the purchase of the business. 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 continued to have serious concerns regarding the safety of the service and the management of risk. We found poor practice with regard to the risks fire posed in particular. Fire exits could not be easily accessed and staff were not clear about fire procedures. Safety checks were routinely carried out as required, but risks were not assessed in detail and actions put in place to reduce them.

Medicines were not managed safely as stocktaking procedures were not accurate. This resulted in confusion and an inability to be certain that people had always received their medicines as prescribed. Some medicines were being routinely used to manage people’s behaviour rather than employing techniques to distract and calm them.

Staffing levels had improved since our last inspection and were found to be generally satisfactory. Staff were very busy and this made their approach task focussed at times. Agency staff were frequently used which concerned relatives due to the lack of continuity. Recruitment procedures were not always sufficiently robust.

Most staff received training in safeguarding people from abuse and staff demonstrated a good understanding of action to take if they suspected abuse had taken place.

Staff received training but it was not up to date for all staff. Some key training which would have increased their skills and knowledge had not been provided. Staff did not receive appropriate induction, supervision and support.

The provider was not always operating in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that any decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

The provider had failed to ensure the required process was followed with regard to some important decisions about people’s care and treatment. All people who used the service were effectively being deprived of their liberty due to a system of locked doors.

People were provided with enough to eat and drink and people’s dietary preferences were taken into consideration. Ongoing monitoring of people’s dietary needs could be more robust and people were not always referred to appropriate healthcare professionals for further advice.

People who used the service had their health needs met promptly in most cases but were not always being monitored effectively to ensure their health did not deteriorate.

Although staff were patient, kind and caring and people were treated with respect, the layout of the building, and some accepted practice, did not ensure everyone’s dignity was maintained.

People were not enabled to be involved in decisions about their care and there was little commitment to providing information in accessible formats.

The service did not have a robust complaints procedure in operation and records of any formal or informal complaints were not present.

People’s basic needs were met but they did not receive individualised care based on their particular needs and preferences. People were often lacking in stimulation and occupation. Although staff knew people well they did not demonstrate skills and expertise in managing people’s distress and anxiety.

The provider had failed to bring about the required improvements identified at the last inspection. Many similar issues were identified at this inspection. The prospective sale of the business had had an impact on the quality of care as the provider did not delegate any responsibilities to others and failed to develop the staff to support her. This resulted in the provider being unable to ensure the quality and safety of the service despite their willingness to do so.

There were six breaches of regulation identified during this inspection. You can see what action we have told the provider to take at the back of the full version of this report.

The home 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.

Somerset Villa provides accommodation and personal care for up to 16 older people, some of whom may be living with dementia. On the day of our visit, there were 13 people living at the home.

At this inspection we found two breaches 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.

The staff knew how to support people to make day to day decisions about their care. However, the principles of the Mental Capacity Act had not always been followed when some decisions had been made on behalf of people. Some people were being deprived of their liberty without the required Deprivation of Liberty Safeguards (DoLS) authorisations being applied for. We asked the registered manager to take action regarding this.

There were enough staff on duty to keep people safe, however there was not enough staff on duty to provide activities or respond to people’s needs in a timely way. Some people had to wait for to receive the care they needed. People were provided with support to eat and drink, mobilise and for personal care.

Staff were kind and friendly towards people living at the home, people responded warmly to staff and relationships were positive. Visitors were welcomed in to the home and appeared at ease.

Some staff had received training on how to provide people with safe and effective care, but there were significant gaps in all staff being trained, or receiving updated or refresher training. Assessment of staff’s competency had only been carried out informally and this was not documented. Improvements were needed to ensure staff understood their role in recognising potential harm or abuse and in protecting people.

People received their medicines when they needed them, but these were not always stored appropriately. There were some minor discrepancies in the records of the administration of medicines.

Improvements were needed to ensure staff had regular supervision and support in order to reflect on their practice and develop their skills. Appropriate pre-employment checks had been carried out for new members of staff.

People were happy with the food provided and were able to make choices about what they wanted to eat. Advice had been sought where people had dietary requirements.

The environment was not fully designed to promote people’s independence and was not suitable for people living with dementia. The environment was in need of refurbishment

The registered manager ensured that people had access to appropriate healthcare. People were able to see a GP when they needed to and access support from community healthcare professionals.

People were not actively involved in planning their care, and plans lacked personal information about choice, routines and interests although staff had an understanding of these. Risks to people had been identified and assessed to reduce and mitigate potential harm.

There was not enough for people to do to occupy them. There was no planning of activities, these were limited to watching television or reading a newspaper. People were bored.

The governance systems in place were not effective at assessing and identifying improvements that were needed to the quality and safety of the care that was being provided. Areas that had been identified as requiring improvement, such as the provision of activities, had not been addressed.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Records we looked at showed us that risk assessments were completed where a risk had been identified. Measures were described and in place to reduce or eliminate such risks. Requirements under the Mental Capacity Act 2005 including deprivation of liberty (DoLS) were recognised and recorded. Staff explained that they undertook regular training and we saw a list of dates when the staff refresher training was due to be updated. This showed that people were supported by members of staff who knew how to provide support in a safe and appropriate way

Records showed that equipment such as hoists had been regularly serviced and fire checks had been completed on extinguishers. This supported the safety of people who lived at the service, as well as the safety of visitors and staff.

Is the service effective?

Our observations showed us that people who lived at the service were relaxed and confident when they discussed matters with members of staff. Staff took action when they saw anyone who appeared to be unsure or uncomfortable. One person was objecting to the music being played at lunch time. A member of staff discussed this with the person who voiced their opinion and the music was turned down a little as other people were enjoying listening.

Nutrition was monitored by staff as they watched to see how much each person ate at meal times. We saw staff appropriately encouraging people to eat their meals and regular checks on people's weight was recorded to support the early detection of any problems. Our observations, a review of records plus discussions with the cook, showed us that staff did provide alternative meals that people had requested.

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw that people were dressed cleanly and appropriately for the weather on the day of our inspection.

Although we spoke with people who lived at the service, not everyone was able to answer our questions. This was because some people lived with dementia. However, our observations showed us that staff spoke with respect and in an appropriate manner when they provided support or care to people in the home.

Is the service responsive?

We saw that people's individual physical needs were being met. People were gently encouraged to decide what they wanted to eat at lunch time. Staff showed people what their food choices were by providing each meal for them to see. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. This showed us that members of staff supported and involved people and did not rush anyone into a quick decision and responded to all requests.

Is the service well led?

Due to the lack of response from questionnaires that had been sent out previously, the provider had employed an external company to deal with surveys. This had meant that a larger number of people had provided feedback. The results of these surveys had been analysed and figures were on record regarding the quality of the service. However, where any issues had been followed up we found there was very little recording of the action that had been taken.

Records showed that members of staff had recorded what routines they had completed for example areas cleaned within the building or in the kitchen area. The manager completed regular spot checks and audits that covered all areas of the service.

One person we spoke with told us, 'It's quite good really ' I can't think of things they could do better.' Another person told us, 'They are all sociable here and they are very kind.' One person's relative said, 'I'm just happy with everything ' nothing could be done better.'

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that people's care and treatment reflected relevant research and guidance.

Medication was obtained, handled and stored correctly. Appropriate arrangements were in place in relation to administering medication.

We found that full consideration had not been given in line with current guidance to provide an environment to meet the needs of people, some of whom were living with dementia.

We found that there were enough qualified, skilled and experienced staff to meet people's needs. People were made aware of the complaints system and this was provided in a format that met their needs.