Summerhill

Summerhill is a residential care home providing accommodation and personal care for up to 29 people. The service provides support to older people, some of whom may be living with a dementia. At the time of our inspection there were 25 people using the service.

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

Care records were not always accurate, complete or detailed. Personal emergency evacuation plans were not specific to the person and not written in line with guidance. Risks to the health and safety of people had not always been effectively assessed and mitigated. Systems were not effective in assessing, monitoring and improving the quality and safety of the service. Quality assurance systems had not identified the shortfalls in care records.

Practices in relation to IPC and the management of COVID-19 were in line with government guidance. However, the provider’s Covid-19 policies were out of date. We have made a recommendation about this.

Overall, recruitment practices were safe. However, the provider needed to make sure all applicants provided a full employment history. We have made a recommendation about this.

Records were not fully available to demonstrate how the provider was meeting their responsibilities under the duty of candour. The duty of candour regulation tells providers they must be open and transparent with people about their care and treatment, as well as with people acting on their behalf. It sets out some specific thing’s providers must do when something goes wrong with someone's care or treatment, including telling them what has happened, giving support, giving truthful information and apologising. We have made a recommendation about this.

Following the inspection site visit, we wrote to the provider requesting an improvement plan and details on action that would be taken to improve the service. This was received.

People’s needs were assessed before they moved to Summerhill and staff said they had no concerns about people’s care. People told us they felt safe and relatives confirmed they felt their loved ones were well cared for. 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.

Staff told us the morale at the home was good and they felt well supported by the registered manager and deputy manager. Staff completed a range of training to enable them to understand people’s needs. We observed patient and compassionate relationships between people and staff.

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 18 November 2021).

At our last inspection we recommended the provider keep infection control guidance under review to ensure best practice was followed. At this inspection we found some improvements had been made, however, we have made a further recommendation.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We had received some concerns in relation to the culture, care and management of Summerhill. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to requires improvement based on the findings of this inspection. We found no evidence of concern in relation to the culture of the home however the provider needs to make improvements. Please see the safe 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We identified breaches of Regulation 12 and 17 in relation to risk management, the maintenance of records and quality assurance at this inspection. We have made recommendations in the safe and well-led key questions.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an update on the action plan from the provider to understand how they will continue 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.

Summerhill provides care, support and accommodation for up to 29 older people. There were 26 people living at the home at the time of our inspection many of whom had a dementia related condition.

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

Checks to monitor the quality and safety of the service were now being carried out. Action had been taken to address the previous shortfalls relating to the assessment of risk, medicines management, the safety of the premises, the maintenance of records and the quality monitoring system.

Relatives told us that the home was safe. One relative stated, “I can’t speak highly enough of Summerhill and the staff who work there. I am able to relax knowing that she is happy and being kept safe there.”

A safeguarding system was in place. Staff raised no concerns about people’s care or staff practices. They said they felt confident that management staff would take immediate action if any safeguarding allegations were raised.

We received mixed feedback from people and staff about whether there were sufficient staff to look after people. The registered manager told us that whilst there were sufficient staff to look after the people currently living at the home; they were not accepting any new admissions to the service until more staff were recruited. Recruitment was ongoing, although this was proving difficult due to the COVID-19 pandemic and related staffing shortages.

A safe recruitment system was in place. Relatives spoke positively about the skills of the staff. One relative stated, “Thanks to the professionalism and dedication of the staff, [name of person] is settling in well, her health has improved and we are very pleased with her progress and care.”

An infection control system was in place. We signposted the provider to resources to develop their approach and made a recommendation that they keep infection control guidance under review to ensure that best practice was followed.

Relatives were complimentary about the home. Comments included, “She calls Summerhill her home, which is the highest recommendation” and “It's a testament to Summerhill that [name of relative] has put on weight and is visibly much healthier than at the start of the year.”

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 25 May 2021). There were two breaches of the regulations relating to safe care and treatment and good governance. We issued two Warning Notices and told the provider they needed to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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 requires improvement to good. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.

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

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.

Summerhill provides care, support and accommodation for up to 29 older people. There were 13 people living at the home at the time of our inspection.

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

An effective system to assess, monitor and mitigate risks was not fully in place. Not all areas of the building were well maintained. Checks and remedial work had not been carried out as planned.

An electronic care management system had been introduced by the previous manager for the recording and monitoring of care plans and risk assessments. Staff who were able to use this system had left. Current staff were unable to fully use the system which meant that which meant that certain risks had not been assessed reviewed or documented.

Not all aspects of medicines management were carried out safely. Topical administration medicines records were in place, but these were not being used currently to evidence the administration of topical medicines.

Prior to our inspection, we received several anonymous whistleblowing concerns relating to people’s care and support and the environment. We checked the concerns raised and reviewed people’s electronic care records. Due to the poor standard of record keeping; electronic records did not fully document the care and support provided. We were therefore unable to fully check that people received care and support as planned.

We identified minor shortfalls relating to the use of PPE and infection control. We have made a recommendation about this.

A safe recruitment system was in place. People’s needs were met by the number of staff on duty. Due to the current Covid-19 pandemic, occupancy levels had reduced.

There had been three managers at the home within the last 12 months. Several staff explained that this had been unsettling. They spoke positively about the new manager. Some staff said however, that the culture at the home was not always positive and staff did not always work together effectively as a team. We have made a recommendation about this.

Checks to monitor the quality and safety of the service were not being carried out. Timely action had not always been taken to address the shortfalls relating to the premises. Records relating to people, staff and the management of the service were not well maintained.

We acknowledged that the home had been through a difficult period due to the Covid-19 pandemic. The new manager was aware of the issues we had identified. Action was being taken to address the shortfalls.

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 15 March 2019)

Why we inspected

We received concerns in relation to people’s care and treatment infection control, the environment and equipment, the management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

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 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 key sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerhill 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 identified two breaches of the regulations relating to safe care and treatment and good governance. 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 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.

People’s experience of using this service: All people told us they enjoyed living at the home. They told us there was a “homely” and “friendly” atmosphere. One person said, “I don’t think you could better it. I am so fortunate to be able to come here.”

The home was clean and well maintained. Practical fire drills had not been carried out by night staff at the time of our visits to the home. Following our visits, the registered manager and night staff confirmed that practical fire drills had been carried out.

People told us they felt safe. Staff were knowledgeable about the action they would take if abuse were suspected. Abuse had been substantiated following a recent safeguarding investigation. Lessons had been learnt and actions taken to reduce the risk of any reoccurrence.

There was a creative activities programme in place. People were supported to access the local community and nearby towns and villages. Entertainers visited regularly and the home had their own backing singers known as the ‘Summerettes.’

Several staff told us the culture at the home was not always positive. Some thought that this was due to staffing levels and the pressures on them at certain times of the day. Staffing levels were increased at the time of our inspection. We have made a recommendation that the provider reviews their quality assurance system to ensure timely action is taken to address any shortfalls.

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

Rating at last inspection: Requires improvement (report published 17 January 2018).

Why we inspected: This was a planned inspection which was based upon the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate and high quality care. Further inspections will be planned for future dates.

Summerhill is a ‘care home’. 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. The home is registered to provide support for up to 29 people over two floors. At the time of the inspection there were 26 people using the service. Nursing care is not provided at the home.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. A registered manager is a person who has registered with the CQC 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.

People told us they were safe living at the home and staff had a good understanding of safeguarding adults procedures. We found some safety issues at the home including furniture and electrical items stored on an emergency exit route and an unsecured laundry area. Maintenance of the premises had been undertaken and certificates were available. Accidents and incidents were recorded and monitored.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff members told us there were enough staff at the home. We found some issues with the management of topical medicines at the home, such as creams and lotions. Records regarding these were not available or up to date. People told us the home was maintained in a clean and tidy manner.

Staff told us they had access to a range of training. They said they had regular supervision and annual appraisals. People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found legal consent and best interests decisions were not always well recorded and could not determine if the MCA guidance on this matter had been followed.

People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements. Where people’s intake was monitored we found food and fluid charts were not always up to date or accurately completed.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity. People and relatives told us they were regularly involved in care decisions.

Care plans were detailed and related appropriately to the individual needs of the person. Care records were not always easily followed as updates were sometimes added to the margin of documents. Reviews of care were variable in quality. A wide variety of activities were offered for people to participate in and people spoke very highly about the range and quality of events at the home. The registered manager dealt with complaints appropriately. People and relatives told us they had no reason to raise concerns or issues were dealt with immediately.

The registered manager told us regular checks on people’s care and the environment of the home were undertaken. However, these checks and audits had failed to identify the issues we noted at this inspection, particularly around safety issues, consent and maintenance of records. Staff felt well supported by the registered manager, who they said was approachable and responsive. They told us they could raise issues or make suggestions and these were dealt with or acted upon. People and relatives told us the registered manager was known to them and responsive to their needs.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Safe care and treatment, Consent and Good Governance. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We spoke with four relatives and six people to find out their opinions of Summerhill. We also consulted a clinician in challenging behaviour, care manager and reviewing officer to hear their opinions concerning Summerhill. All spoke positively about the home.

People were treated with respect and dignity by the staff. They were cared for in an environment that was safe, clean and hygienic. People themselves informed us the home was 'very clean.' They also told us that they felt safe. One relative told us 'She says 'they are so lovely with me' so whenever I leave the home I know she is safe. I would know if something was wrong.' We spoke with the local authority's safeguarding adults' team and contracts and commissioning team who did not raise any concerns about the service.

Systems were in place to make sure that lessons were learnt from events such as accidents and incidents and complaints and concerns. This reduced any risk to the people and helped the service continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to have been submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People were extremely happy with the care that was delivered. They told us that their needs were met. One person commented, 'It's brilliant, the staff really look after you.' It was clear from our observations and through speaking with staff that they had a good understanding of people's care and support needs.

People told us that consent was gained before any treatment was carried out. 'They check with me and they check with mum about everything.'

Is the service caring?

People were supported by 'kind' and 'lovely' staff. We saw that care workers showed patience and gave encouragement when supporting people. One person informed us, 'The staff are lovely.' Another person said, 'Every need is met here.' Health and social care professionals informed us that they had no concerns about people's care and welfare. The care manager and reviewing officer with whom we spoke informed us that they were happy with the care that was delivered at Summerhill. The clinician in challenging behaviour told us that one person's relative had gone on holiday. She explained that staff had taken the person out into the local community on a number of occasions to try to distract her from her daughter's temporary absence.

There was a cheerful atmosphere at Summerhill. Many staff had worked there for a considerable period of time. This experience contributed to the efficiency and skill with which staff carried out their duties.

Is the service responsive?

People's needs had been assessed before they visited the service. They had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. The service had its own minibus, which helped to keep them involved with the local community. One relative was very appreciative of the transport facilities and told us, 'The transport is really good. They go out three times a week.'

Health and social care professionals with whom we spoke, informed us that staff always contacted them if there were any problems or concerns.

Is the service well-led?

The manager was currently on annual leave. Two deputy managers assisted us with the inspection. They were extremely knowledgeable about processes and systems at Summerhill and were able to locate all documents which we requested immediately.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly.

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held. This was confirmed by minutes of meetings. Staff morale at the home was good and staff spoke positively about working there and the support the manager gave them.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We contacted a number of health and social care professionals to find out their opinion of the service. These included a GP, a district nurse, a member of the challenging behaviour team, a member of the occupational therapy team, a dentist, a podiatrist, a member of the local authority review team and a social worker. We concluded that people's health, safety and welfare was protected because the provider worked in co-operation with others.

We found there was enough equipment to promote the health, independence and comfort of people who use the service.

People were complimentary about the staff. Comments included, 'The staff are lovely' and 'They seem to recruit well.' We concluded appropriate checks were undertaken before staff began work and effective recruitment and selection processes were in place.

.

We found that people's personal records and those records which related to staff and the management of the service were accurate and fit for purpose.