Summerfield House Nursing Home

Summerfield House Nursing Home is a residential care home providing nursing and personal care for up to 107 people, some of whom may be living with dementia. The home is purpose built providing accommodation on three floors: Oak, Cedar and Maple. Each floor has separate adapted facilities. Oak provides residential care, Cedar specialises in providing care to people living with dementia and Maple provides nursing care. There were 94 people living at Summerfield House when we inspected.

People’s experience of the service and what we found:

People were at risk of harm as the provider had not always identified, assessed or mitigated risks. Systems in place to manage medicines were unsafe which placed people at risk of harm. There were not always enough staff to meet people's needs and keep them safe. Staff were not always appropriately deployed and training was not kept up to date. Recruitment processes were not robust.

People were not always treated with dignity and respect. Staff were not always caring. Some staff were task focused, lacked empathy and did not communicate with people when providing support. People were not always protected from the risk of abuse and improper treatment. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in place did not support this practice.

Care was not person-centred, and people's needs and preferences were not always met. The culture of the service was not person-centred. Systems and processes had not identified, or resolved in a timely manner, concerns around person-centred care, safeguarding, medicines and dignity and respect. The provider's systems and processes were not established or operated effectively to ensure continuous learning and the improvement of the quality of care.

People's care records were variable. Some had detailed and personalised information, whereas others were not always accurate and up to date. The environment was clean and well maintained. Infection control was well managed. People were supported to stay in touch with friends and relatives and there were no restrictions on visiting. People had access to healthcare services.

Feedback from people and relatives was generally positive describing staff as good and helpful. Some individual staff were noted to be exceptional and said to go 'above and beyond'. We also saw staff who did treat people with respect and maintained people’s dignity.

The provider took action during and after the inspection in response to the concerns we raised. An action plan has been put in place and additional senior management have been brought in to support the staff team. The local authority and ICB continue to work with the provider to make improvements.

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 9 November 2023). There was 1 breach of regulation and 3 recommendations. At this inspection we found the provider remained in breach of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about the management of the home, care and treatment and privacy and dignity. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by notification of incidents where people’s safety, health and well-being had been put at risk. These incidents are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Summerfield House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified 6 breaches in relation to safe care and treatment, privacy and dignity, safeguarding, staffing, recruitment and 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

Summerfield House Nursing Home is a residential care home providing nursing and personal care for up to 107 people, some of whom may be living with dementia. The home is purpose built providing accommodation on three floors – Oak, Cedar and Maple. Each floor has separate adapted facilities. Oak provides residential care, Cedar specialises in providing care to people living with dementia and Maple provides nursing care. There were 84 people living at Summerfield House when we inspected.

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

Improvements had been made at Summerfield House since a new manager joined the service. An improvement plan was in place and the home acknowledged further changes and improvements were needed. New quality assurance systems had been introduced.

Risks to people were usually assessed and managed. However, we found examples where risk was not consistently assessed and managed. Accidents and incidents were not always recorded correctly and so could not be reviewed to reduce further occurrences.

The provider told us staff numbers were adjusted to ensure peoples needs were met all of the time. However, staff were observed to be busy, and task focused. We have made a recommendation to review staffing dependency for the home.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We have made a recommendation for staff training and understanding of the best interest process and recording.

People's end of life plans were not always person-centred. We have made a recommendation to the information in the plans.

There were not many activities organised for people to take part in. The home was recruiting more activities coordinators and a full weekly plan for activities was being arranged. The home was being redecorated, with an art and craft room, sensory room and bar area.

Staff received training and support for their role. Staff were safely recruited and were kind and respectful. Staff told us morale had improved at the home and they felt they could raise any suggestions or issues with their seniors and unit managers.

People were supported to maintain their food and fluid. However, we found some issues with record keeping of meals eaten. People were supported to maintain their health. People received their medicines as prescribed.

Feedback from people and their relatives was positive, about the staff team and the changes being introduced at the home.

The local authority and safeguarding teams had worked closely with the home on improvements at the home and felt the home was moving in the right direction under the leadership of the new manager. Four visiting professionals were also positive about changes at the home, saying the staff were now more involved and knowledgeable about the people living 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 requires improvement (published 12 April 2023) and there were 3 breaches of regulation. The provider completed an action plan after the inspection to show what they would do to improve. They sent us a monthly update on their progress.

At this inspection we found improvements had been made. Further work was needed to implement all the improvements identified and embed them within the service. We found a continued breach in 1 regulation and have made 2 recommendations.

The last rating for this service was requires improvement (published 12 April 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last 5 consecutive inspections (since March 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the home, staffing, medicines, and falls. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report. The service had an improvement plan in place to address these issues.

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 and Recommendations

We have identified a breach in relation to risk management at this inspection. We have made recommendations in relation to staffing, best interest decisions and end of life care plans.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

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

Summerfield House Nursing Home is a residential care home providing nursing and personal care for up to 107 people, some of whom may be living with dementia. The home is purpose built providing accommodation on three floors – Oak, Cedar and Maple. Each floor has separate adapted facilities. Cedar specialises in providing care to people living with dementia and Maple provides nursing care. On the first day we inspected there were 89 people using the service and 91 people when we visited on 2 March 2023.

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

People were at risk of harm as the provider had not always identified, assessed or mitigated risks. Medicines were not always managed safely.

There were not always enough staff to meet people’s needs and keep them safe. Staff training was kept up to date, though some staff required further specialist training in dementia care and Parkinson’s disease. This was being organised by the manager.

Quality audits were not always effective in identifying or securing improvements. The provider had identified some issues and started to address these through their service improvement plan. People’s care records were variable. Some had detailed and personalised information, whereas others were not always accurate and up to date.

People enjoyed the food and nutritional needs were met, however mealtime experiences varied and some practices needed to improve.

Recruitment processes were robust. People said they felt safe in the home and safeguarding incidents were recognised and reported. The environment was clean and well maintained. Infection control was well managed.

People and relatives were generally positive about the service. Staff were described as kind and caring. People were supported to keep in touch with family and friends. People had access to healthcare services. 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.

The manager took action during the inspection to address some of the issues we raised.

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 15 July 2022) 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 we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 17 and 23 May 2022. Breaches of legal requirements were found. We served a warning notice regarding medicines in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 and good governance.

The inspection was also prompted in part due to concerns received about medicines and safeguarding. As a result, we undertook a focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective 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 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 remained 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 House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and 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.

Summerfield House Nursing Home is a care home providing nursing and residential care to up to 107 people. The service provides support to people aged 65 and over. At the time of our inspection there were 94 people using the service. The home accommodates people across three separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia.

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

We found systems for managing medicines were not always safe. Staff did not order medicines in a timely manner. There were no robust processes for the administration of covert medicines and medicines administered via a stomach tube (PEG). There were audits of medicines management, but these were not sufficiently robust to identify issues affecting people's safety. Management did not always act in a timely manner to address medicine concerns when they were identified. As a result, people did not always receive their medicine as prescribed.

Staff understood how to manage risks to people and knew the processes to follow to manage any allegations of abuse. Recruitment processes were robust. Infection control practice met current requirements and staff wore PPE appropriately.

Healthy lifestyles were promoted, and systems were in place to make sure people's health needs were met. Menu planning met people’s dietary needs and took into account individual and cultural preferences. Dependency assessments had been regularly carried out to ensure staffing levels met people’s needs. Staff had the skills and knowledge to deliver care effectively. The environment was well maintained and designed 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.

The Provider’s quality management systems had not identified some of the issues we found during the inspection.

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 22 September 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines. We also took the opportunity to review other key questions that had previously been rated requires improvement. 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 not changed. 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 House Nursing 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.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Summerfield House Nursing Home is a care home providing nursing and residential care to people aged 65 and over, some of whom live with dementia. At the time of the inspection 91 people were using the service. They can support up to 107 people. The care home is purpose-built and accommodates people across three separate units, each of which has adapted facilities.

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

Medicines were not always managed safely. Staff did not have access to sufficient information about how to administer some medicines in a person-centred way. People felt safe living at Summerfield House Nursing Home and that their personal belongings were safe. Accidents and incidents were recorded and monitored by the management team, and risks to people were assessed and managed. Staff understood whistle-blowing procedures and told us they would always report any concerns to a member of the management team. They were confident any issues would be dealt with appropriately. Staffing arrangements kept people safe. The service followed safe infection, prevention and control procedures.

Quality monitoring systems were in place and usually identified good practice, concerns and actions to drive improvement. However, audits had not highlighted shortfalls in the medicine management system. Notifications about significant events were not always reported to CQC without delay.

People’s experience at Summerfield House Nursing Home was positive. They found staff and management were kind and caring. One person said, “They make us so comfortable and create a lovely atmosphere.” The registered manager was engaging and knowledgeable about the service. They were responsive to the inspection findings and shared evidence they were taking action to address shortfalls.

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 March 2020) and there were three 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 we found some improvements had been made and the provider was no longer in breach of two of the regulations. However, they were still in breach of one regulation.

Why we inspected

The inspection was prompted in part due to concerns about medicines, staffing and management. A decision was made for us to inspect and examine those risks. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerfield House Nursing 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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 monitor the service.

We have identified a breach in relation to managing medicines safely.

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 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.

Summerfield House Nursing Home is a purpose-built care home providing nursing and residential care to a maximum of 106 older adults, some of whom live with dementia. Accommodation is over three floors and the building is fully accessible. At the time of this inspection, 98 people lived in the home.

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

We found evidence the provider was in breach of legal requirements in respect of medicines management, staffing and good governance. We have also made a recommendation about ensuring the environment is supportive of people living with dementia or memory problems.

Whilst we saw the core numbers of staff needed to deliver safe care were in place, the way in which staff were organised and deployed was not always effective or well-managed. This was because shift leaders on each floor did not always have sufficient oversight as they were too busy engaged in other tasks.

In 2019, the home had been successful in achieving a national award in recognition of the good work that had taken place around ensuring food served within the home was healthy, home cooked and sourced sustainably. However, we found the overall mealtime experience needed improving.

A combination of electronic and paper-based care records was in use. In respect of the electronic records, we found some inconsistencies in the way information had been recorded and some records had not been updated in response to people’s changing needs.

We also found people’s care records were routinely stored outside their bedrooms. This meant there was a risk of private information being accessed by people not authorised to do so.

Systems for audit, quality assurance, questioning of practice and acting on feedback were not operated effectively.

Staff received equality and diversity training and through our discussions with staff, we found they were confident with difference. This helped to shape how care and support would be provided in a way that was personalised to the individual.

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.

There were no prescriptive visiting times which meant people were able to maintain relationships with people that mattered to them. A wide range of in-house activities were on offer throughout the week which sought to encourage social interaction and wellbeing.

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 13 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

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 for the provider to understand what they will do to improve the standards of quality and safety. 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.

At the last inspection, the service was rated Good.

One key question was rated ‘Requires Improvement.’ The service had not always been effective in protecting people from abuse and recruitment processes were not always followed. At this inspection we found the provider had made improvements in these areas.

At this inspection we found the service remained Good.

Why the service is rated Good

People received support, if and when they needed this, which was individual to their needs. Risks were minimised, wherever possible, whilst maintaining people’s independence. Staff received training and support which helped them be effective in their roles. The registered manager on the day of inspection had arranged further online training courses which ensured all staff were up to date with their required training. People had choice and control of their own lives. The service provider’s policies and systems were up to date and effective. We observed a relaxed atmosphere throughout the home. The registered manager ensured the quality of the service was monitored, and improvements were made when required. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Further information is in the detailed findings below.