Summerfield House Nursing Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

During our assessment of this key question, we found the rating has improved from requires improvement to good. People's needs were assessed and planned for in a person-centred way. People were supported to access healthcare services when needed. The provider assessed people's mental capacity and made decisions in their best interests. Staff worked with external professionals to provide care and support which reflected best practice. Staff spoke positively about working at the home. They said they were well supported by their new manager.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives, apart from one, told us they were involved in care planning and decision making. One relative said they were fully involved in their family member’s care plan and included in discussions about this as their family member didn’t have capacity to discuss what they wanted. One relative said they didn’t feel fully involved with their family member’s care plan. However, our review of this person’s care plan showed the relative had been consulted and involved in decisions about their care.

Staff told us the training they had received meant there was now clearer information in care plans about people’s needs and this information was kept updated. The manager confirmed there have been no new admissions since the last inspection as the provider has maintained a voluntary embargo. The manager confirmed when admissions resumed, pre-admission assessments would be carried out by the management team to ensure they could meet people’s needs. They said risk assessments would be put in place within 24 hours and care plans within 7 days. The manager told us the home had a range of tools to meet individual’s specific communication needs.

Care plans showed people’s needs were fully assessed in a range of areas addressing their physical, mental, emotional, and social needs. Effective processes ensured these were regularly reviewed and kept up-to-date and accurate. Information was displayed throughout the home in accessible formats including pictures and large print.

People and relatives gave positive feedback about the food and drink provided. People told us they always had a choice and could have extra if they wanted. One person said they often asked for an omelette, and this was always freshly prepared. Another person said the soup at teatime was always tasty but ‘Sunday roast is my favourite.’ A further person said, “The staff are always offering a drink of tea/coffee/juice. There’s plenty of snacks available too. It’s lovely.” A relative said their family member required a soft diet, this always appeared at the same time as the main meals and was nicely presented.

The manager told us they had implemented best practice guidance in relation to dementia care by separating the floor into 2 smaller areas. They said this had resulted in better outcomes for people as those who were more mobile were now able to walk around freely and not feel restricted by the staff redirecting them to maintain their safety. This also reduced the risk of these people entering the bedrooms of other vulnerable people that were less mobile.

The service used best practice guidance to deliver evidence-based care. For example, we saw NICE guidance had been followed to help ensure that enteral tube feeding was safe and effective. People’s nutritional needs were assessed, and clear guidance produced for staff. People’s weights were routinely monitored and where concerns were identified, appropriate action taken. There was good oversight of nutritional risks and needs. The environment for people living with dementia had been changed to create two smaller households in line with best practice guidance from the Department of Health: Dementia-Friendly Health and Social Care Environments. Since making this change, accidents, incidents, and safeguarding reports showed there had been a decrease in distress reactions escalating to physical distress and unwitnessed incidents.

People and relatives said they felt staff worked well together and with them. Comments included: “Staff work very well together, always with care, compassion and gentle humour” and “I’m very impressed with how the staff always seem to be able to assess what needs doing and how professional they are when dealing with my relative.”

Staff told us communication had improved both internally and with external stakeholders. They said handovers had improved and they were kept fully informed about people’s needs and any changes required in their support. One nurse said partnership working had improved greatly. They said, “I feel confident in my role and know who to contact if we need specialist input. I know the soft signs which indicate a deterioration and get help promptly. I’m not afraid to challenge, if I need to, on behalf of the resident.” The manager said staff and the multidisciplinary team worked very well together to ensure people received good holistic care.

We received positive feedback about partnership working prior to the inspection. The health professionals we met on the site visit said they had seen a massive improvement at the home. They said they found the staff and management to be polite and open to feedback where previously they had been unhelpful and dismissive.

Processes were in place to enable staff and specialist services to work together effectively. Visits from health and social care professionals were recorded in people’s care plans which showed advice given was implemented. This communication was also shared and monitored through handovers and daily meetings with the manager and senior staff from all floors.

People were supported to access health care services. One person had recently had a chest infection. Their relative told us staff realised very quickly their family member was unwell and the GP was called immediately. Antibiotics were prescribed and the person made a full recovery. Another person said they had required hospital care, and the staff were very good in getting this sorted out promptly. People told us the chiropodist and optician visited regularly.

Staff were able to tell us about health professionals’ involvement and how it had improved people’s outcomes. The manager told us the residential units worked closely with the district nurse team who provided advice and care regarding wound management, catheter and continence care and medication support. The GP carried out a weekly ward round remotely and the quest team of advanced practitioners and matrons provided face to face visits. Other specialist services were also accessed including the speech and language team, dieticians, the mental health team, the palliative care team, and tissue viability nurses.

Processes showed people were supported to live healthier lives. Records showed contacts with a range of health and social care professionals, including GP, District Nurses, Dentists, Mental Health professionals and SALT. Their advice was clearly recorded and used to update plans of care. Clear advice was recorded on people’s healthcare conditions and how to manage them. Records showed people were encouraged to participate in gentle exercise if they wished.

People and relatives told us they were satisfied with the care provided. One relative spoke very highly about the care provided to their family member who had previously been in another care home where they were kept in bed all day every day. They said when their family member came to Summerfield House the staff gradually got them from being bed bound to being up, washed and dressed. The relative said they felt their family member now had a much better quality of life.

Staff knew which people needed to be monitored and ensured any concerns or changes in people’s health needs were reported promptly.

Processes were in place to ensure people were closely monitored, where needed. For example, where people required monitoring because they were losing weight, food and fluid records were in place and well completed. Where people required repositioning records were good, including where people required repositioning when they were sat in a chair for any length of time. The development of the sensory room positively impacted one person's anxiety levels. Monitoring records were well completed in the care records we reviewed. There was good oversight of the electronic care management system to monitor people’s outcomes. This included regularly monitoring skin integrity and associated care and people’s nutritional and continence care. Any concerns were quickly flagged and the unit manager had good oversight of people’s clinical needs.

People’s consent was sought, and they were involved in making choices and decisions about their care and treatment. One person told us they were able to decide what they wanted to do, and the staff never put any pressure on them to do something they didn’t want to do.

Staff understood the need to gain consent before carrying out any care or support. We saw this happened in practice and recorded in care plans. Staff confirmed they had received training in MCA & DoLS.

Processes were in place to ensure people's consent was sought. Where people lacked capacity, the principles of the MCA were followed. This included ensuring best interest processes were followed, protecting people’s rights. Capacity assessments were completed and where people lacked capacity best interest assessments were in place for relevant areas. Best interest assessments evidenced how staff had tried to involve the individual with the decision and then followed up with people's representatives. People had clear communication care plans which described their preferred way of communication and potential barriers. This supported staff to help people to make choices on a day-to-day basis. Clear care plans were in place around managing restrictions and appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made.