Summerfield House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found the rating has improved from Inadequate to good. Risks to people's safety and wellbeing had been assessed and planned. People lived in a safe environment. Systems were in place to investigate accidents, incidents, complaints, and safeguarding incidents. Staff and the manager communicated and worked with other agencies to help keep people safe. There were systems to help prevent and control infection. People’s medicines were managed safely, and they received these as prescribed. There were effective systems in place to safely recruit staff. Staff were well trained and supported by the 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 relatives knew who to approach if they wanted to raise concerns and felt confident, they would be listened to, and the concerns would be addressed.  One person said they wouldn’t hesitate to speak with the manager now as they felt things would be dealt with better than before.   A relative said, “The manager is always available if I have any concerns, and it feels that I am listened to.” 

Staff were confident the manager would ensure any concerns raised around people's safety were investigated and acted upon. Staff told us incidents/accidents and lessons learned were discussed in shift handovers and in daily meetings.

Effective processes had been implemented to ensure risks were identified and managed and lessons learned were acted on.     We reviewed the monthly analysis of accidents and incidents for July and August 2024. This encompassed all accidents and incidents including falls, medicine errors, any skin damage, any incidents had been safeguarded. The analysis was thorough considering themes such as times and location of incidents as well as reviewing individuals who had experienced more than one incident, and lessons learned.  Any actions required were followed up with staff at handovers and daily meetings with nurses and senior staff to ensure actions had been completed.    Our review of complaint records showed these were appropriately investigated and acted upon. 

People and their relatives said staff supported them in accessing healthcare services and worked in partnership with healthcare specialists to ensure they received the care they needed. 

The manager told us a transfer form providing an overview of the person’s overall needs was printed out for transfer to another service or hospital. The systems in place ensured information on relevant documents was updated automatically when the care plan was reviewed, ensuring information was accurate and current.

Professionals told us the provider worked in partnership with them and had made improvements to ensure safe continuity of care. They said the relationship with the GP surgery has improved tenfold. Referrals they told us were appropriate, timely and accurate.

Processes were in place to ensure safe systems, pathways, and transitions of care for people. Care records demonstrated care was planned with people and partner organisations. For example, the home had worked closely with other services to understand a person’s condition and develop safe plans of care to effectively manage and reduce distress, benefiting them and others within the home.

People said they felt safe at Summerfield House, and this was echoed by relatives. One relative said they felt their family member was safe as staff kept an eye on what people were doing, so they never felt their family member was left at risk. They said whenever they visited their family member in their bedroom the call bell was always in easy reach which hadn’t been the case some months ago. 

Staff confirmed they had received safeguarding training and had a good understanding of how to protect people from abuse. They knew how to report any safeguarding concerns and confirmed learning from incidents was shared with them. 

We observed people were comfortable and relaxed around staff. This was evident from the rapport built up between people and staff, people’s body language and positive comments they made towards staff. When people experienced distress, staff intervened promptly, comforting and re-directing people, improving their mood and wellbeing.  Staff were vigilant to ensure people were not left waiting for care or exposed to any unacceptable risks.  

Improvements had been made since the last inspection. Effective systems were in place to ensure people were kept safe and protected from abuse and neglect.     The provider had an up-to-date safeguarding policy. Information about safeguarding and the processes to follow were displayed in the service.     Systems and processes were in place to report, record and review any safeguarding incidents. Monthly safeguarding logs showed incidents had been reported to the local authority safeguarding team and notified to CQC. Outcome details, any further actions and lesson learned were also recorded.  A Deprivation of Liberty Safeguards (DoLS) tracker was in place which showed who had an authorisation in place and whether there were any conditions.  Monthly audits were carried out by the manager to ensure DoLS conditions were being met. 

People, and their relative’s, felt risks were managed well. One relative said the staff needed to use a hoist to transfer their family member from bed to chair and staff always made sure this was ready for use before they started to carry out the transfer. Although their family member couldn’t communicate verbally, the relative said staff spoke gently to them, explaining what they were going to do and asking if that was ok. The relative said, “It seems to be second nature to them to behave in this way.” 

Staff confirmed they had been given training and support to enable them to manage risks to people and ensure their safety. Staff demonstrated a good knowledge of people’s needs. Staff knew how to support people safely with their mobility. Staff understood people's dietary needs and knew what people were able to eat and drink safely. Staff recognised signs of distress in people and understood how to respond to minimise risks and provide comfort to people.  

We observed staff supporting people to mobilise appropriately. Where people needed to use a hoist to transfer, we saw staff were patient and kind, explaining what they were doing and checking the person was okay throughout the procedure. Where people required sensor or pressure relieving equipment, this was in place. Staff understood people well, which helped minimise risks. For example, we saw they intervened using knowledge of a person to promptly reduce distress.    We observed people being supported appropriately at mealtimes in line with safe plans of care. 

Processes were in place to ensure risks were safely managed. Risk assessments were clear and regularly reviewed and updated with the views of people, families and health professionals clearly recorded. Records of care delivery showed staff were adhering to care plans, for example regarding diet, pressure area care and ongoing checks on people’s welfare.   Risks relating to skin integrity, falls, nutrition, complex behaviours and A Personal Emergency Evacuation Plan (PEEP) were in place and linked with the information in people's care plans. Where people were at risk of losing weight clear plans were in place including weekly weighing, fortified meals/supplements, and referrals to health professionals.     Where people presented with complex behaviors risk plans were robust and included person centered detail. For example, one person benefitted from using a technique which involved talking about five things they could see, hear, smell etc. This was clearly described in their risk assessment to support staff to use this technique effectively. Another person benefitted from accessing the sensory room.     There was a summary of the risks on the 'clinical risk board'. All staff accessed this, and the unit manager described it as the unit's 'bible'. This covered all key risks at a glance and was clear and regularly updated.  

People and relatives praised the improvements that had been made to the environment.  Comments included, “The work that has been done in the garden is lovely” and “A lot of redecorating has taken place, and it is so much better.”

Feedback from staff and the manager confirmed effective systems were in place to ensure the safety of the premises and equipment.     Staff confirmed they had received fire safety training and taken part in fire drills, which had been identified as an issue at the last inspection. 

We observed the building was kept safe. Equipment was stored appropriately so it didn’t present a fire hazard and to ensure good access and egress. Safety features such as window restrictors were in place to reduce the risk of falls.      Improvements had been made to the environment to meet people’s needs. New lighting and décor provided a light, bright unobstructed environment. A garden room had been created within the home for people who were less able to go outside as well as splitting the residential floor for people living with dementia into two sections, creating a calmer, more person-centred environment.   Since the last inspection, following consultation with people, staff and relatives, CCTV has been installed in communal areas and corridors. The manager has access to the footage which is password protected for essential use only. 

We saw improvements had been made since the last inspection.     Processes were in place to monitor and maintain the safety of the premises and equipment in the service.     The service and maintenance log showed all safety checks had been completed, and certificates were up to date. Regular safety checks of equipment and the premises were carried out and recorded by the maintenance team, all were up to date.      A fire risk assessment was in place and any actions had plans in place to address these. Minutes from a health and safety meeting showed the actions were being monitored by the manager and followed up. At the last inspection there had been no records to show night staff had participated in fire drills. At this inspection records showed regular fire drills had been held at various times throughout the day, including the early hours of the morning to ensure night staff could participate.  

All of the people and relatives we spoke with, apart from one, said there were enough staff.     People said when they used their call bell staff usually responded quickly.    One relative said there seemed to be more staff around now, even at weekends, than there used to be. They said, “I’m not sure if they have got more staff or just that the staff are more visible now.”  Another relative who visited daily said there always seemed to be enough staff to care for people.     One relative said they would like more staff to care for their family member, but did not expand on why they felt more staff were required    People and relatives told us staff were well-trained and knew how to provide the care and support people needed.    Another relative commented that a lot more staff training had been taking place recently.   

The manager told us night staffing levels had increased. Also, in consultation with staff and following a review of people experiences in getting up and having breakfast they had changed the shift pattern. They said this had meant people could get up closer to the time they wanted and have breakfast without feeling rushed as more staff were available.    Staff felt there were enough staff to meet people’s needs without rushing. They spoke team morale had improved and felt staff now worked well together as a team. On occasions, when agency staff were used, the agency staff did not work alone and were paired with an experienced staff member.     Staff told us they now felt confident in their roles and said they were given training and support to enable them to do it well. Nurses told us they received clinical support to maintain their competencies. The manager told us they were committed in supporting staff to develop in their careers. Which echoed through the staff comments on how one staff member had completed Train the Trainer syringe driver training which meant they could train other staff and another staff member completing their NVQ 5.   Staff survey results in August 2024 showed 100% positive feedback on the training provided by the external consultants.  Staff received appropriate support and supervision.

We observed there were enough suitably qualified staff to meet people’s needs.  People were provided with a high level of interaction and stimulation keeping them occupied and content.  Call bells and people’s calls for assistance were answered promptly.  We observed frequent staff interventions which had a positive impact on people’s mood and wellbeing. Staff were knowledgeable about people and their needs. Staff appropriately supervised people both in their rooms and communal areas. 

Processes were in place and implemented effectively to ensure there were enough staff to meet people’s needs and keep them safe. The manager used a dependency tool to calculate safe staffing levels. This was reviewed monthly or whenever there was a change in people’s needs.    The staff training matrix showed a significant improvement in compliance, with the majority of staff having achieved 100% compliance. The home has provided bespoke training to staff in a variety of areas including the Person-Centred Software (PCS) system, nutrition and hydration, mobility, medications, positive behaviour support and dementia.      Recruitment processes had improved, ensuring staff had the skills, competence and experience required to carry out their roles. 

People and relatives told us the home was kept clean and tidy. One person told us it made them very happy to have their room kept so clean. One relative said they were very pleased with how clean the home was and said the domestic staff always worked very hard. 

Domestic staff spoke of the improvements that had been made since the last inspection. Daily cleaning schedules were in place which were managed and overseen by the housekeeper who also carried out regular audits.  The manager reviewed the cleaning schedules and monthly audits.  Laundry staff said better systems had been implemented to ensure clothing was labelled correctly and returned to the right person. Each person had a named drawer in the laundry for their clothing and there was a portable hanging rail both of which were used to transfer items to people’s rooms.    The manager had implemented regular meetings with ancillary staff to update them on any changes and provide an opportunity for them to provide any feedback. Domestic and laundry staff said communication was now much better. 

We found the home was clean and hygienic and good standards of cleanliness were maintained. Cleaning staff were appropriately deployed on the unit.    Plentiful supplies of PPE and hand sanitiser were available throughout the home. We saw staff using and disposing of PPE appropriately.   

Processes were in place to ensure infection control risks were assessed and managed safely.  The provider had an up-to-date infection control policy. Staff were designated to lead roles in infection control; the housekeeper was the infection control champion, and the deputy manager was the decontamination lead.     Monthly infection control audits were carried out on each unit and any areas identified for improvement were actioned.   Staff were trained in infection control.

People received their medicines at the right time and when they needed them. No concerns were raised by people or their relatives about medicines. 

The manager told us the medicine audit systems had been redeveloped. Weekly and monthly medicines audits were taking place on each floor. The manager and regional manager had oversight and reviewed the audits.    Staff confirmed they had received medicines training and completed competency assessments. 

Effective systems were in place to ensure people received their medicines as prescribed.   Records we reviewed shows all medicines were in stock and none had been missed.  There was clear guidance in place for people who received their medicines covertly and this was being followed by staff.  Records showed people who required thickened fluids were receiving drinks at the correct consistency. We found in one person’s record occasionally yoghurt was being recorded as a drink rather than a food. The manager took action to address this immediately.  Information to support staff to safely give medicines enterally was recorded in the care plan. However, the Medication Administration Record (MAR) did not show all medicines were to be given via the percutaneous endoscopic gastrostomy (PEG). The manager addressed this immediately.  As and when needed (PRN) protocols provided clear guidance for staff on when to administer ‘as required’ medicines. Clear instructions were recorded and body maps showing when, where and how often creams should be applied and were signed by staff as given.    Records showed medicine patches were rotated in accordance with the manufacturer's instructions and the location of the patch was recorded. Records showed time-specific medicines were given at the correct time.    Medicine rounds were completed in a timely fashion to ensure people received their medicines at the right time.   Records showed all staff who administered medicines had completed up to date training and competency assessments.