This inspection took place on 19 February 2018 and was unannounced. The inspection continued on 22 February 2018 and was announced.

This service combines a care home, known as Somerleigh Court and a Domiciliary Care Agency known as Close Care.

Somerleigh Court is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The care home accommodates up to 40 people across three floors. The service is located in Dorchester and is a large purpose built building with rooms arranged over three floors. Each floor has a communal lounge and dining area. There is lift and stairs access to each floor. People are able to access secure outside space at the home. There were 36 people living at the home at the time of our inspection.

Close Care is a domiciliary care agency. It provides personal care to people living in their own apartments in the village surrounding Somerleigh Court. There are 68 apartments in the surrounding village. Close care provides a service to older adults. Not everyone living in the village receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection, Close Care was providing support to 13 people.

At our last comprehensive inspection of both services on 10, 11 and 17 November 2016 we found that the provider did not have systems that effectively and consistently assessed and monitored the quality and safety of people using the service and therefore they did not have an effective system to identify areas for improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take steps to improve and ensure that they were compliant. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Well Led to at least good. At this inspection we found that improvements had been made.

There was a registered manager in post. 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.

Care Home and Care at Home services.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care. Medicines were stored securely and recorded accurately.

People were supported from the spread of infection by staff who understood their role in infection control and used appropriate Personal Protective Equipment (PPE).

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

People were supported to have enough to eat and drink and there were systems in place to ensure that any concerns around weight loss were monitored. People’s preference

At our last inspection in July 2014, we had concerns that there were not always a sufficient number of suitably qualified, skilled and experienced staff on duty and that records were not always accurate or complete. There were breaches in two regulations and we asked the provider to take action about these concerns. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches and told us that they would be compliant with the regulations by January 2015. At this inspection we found that there had been improvements in some areas, but that there was a breach around people’s records and the governance arrangements at the service.

This inspection took place on 10, 11 and 17 November 2016 and was unannounced.

Somerleigh Court is registered to provide accommodation and nursing or personal care for up to 40 people. There were 37 people living at the service at the time of inspection. The home is situated in Dorchester and offers accommodation split over three floors. There are communal lounge and dining areas on each floor. There is lift access for the upper floors and all bedrooms have an en suite. There is a sensory garden to the side of the service which people are able to use and the main entrance is wheelchair accessible. Somerleigh Court also provides personal care support to 12 of the people who live in sheltered apartments around the home which they call the village. There are a total of 68 apartments in the village and people receive daily safety check calls and other services as part of their tenancy agreements.

There was a registered manager in post. 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.

People’s risks were not always recognised or managed safely. Risks around the use of pressure mattresses were not accurately managed and there were no risk assessments relating to the introduction of a pet to the home. Risks around peoples eating and drinking were not always identified.

Topical creams, as required medicines and nutritional supplements were not always given as prescribed.

There were sufficient staff to support people and we observed that call bells were answered promptly. There were systems in place to ensure that there were sufficient staff to meet people’s needs. People received support from staff who had been safely recruited and understood their needs.

People felt safe at the service, they were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

Staff received training in a number of mandatory topics but did not receive training in specific conditions which reflected the needs of people at the home. There were plans in place to improve training opportunities for staff.

Mealtimes were not a sociable occasion. Very few people used the communal areas for their meals and we observed little social interaction at mealtimes. Use of chairs and over chair tables also made eating more difficult for some people.

Staff did not receive regular supervisions which meant that they did not have planned opportunities to discuss issues with people or discuss their own learning and development.

Assessments were completed in line with MCA and where necessary, best interest’s decisions were made. Decisions were evidenced, however assessments were not always signed or dated and in the case of covert medicines, had not included involvement of a relevant health professional and were therefore not in line with MCA best practice.

People had a choic

People spoke highly of the care they received and the staff that provided their care. However, we found that although people’s needs were assessed, care and treatment was not always planned and delivered in line with their individual needs.

People told us they were provided with a suitable choice nutritious food and drink, and we saw that people were supported to eat their meals where required.

Although people spoke highly of the staff and the care they received, they told us that at times there were not enough staff to meet their needs in a timely manner.

The home had some systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. However, the absence of the effective auditing of care plan documentation had not ensured all documentation was current or had been completed accurately.

People’s records did not always contain accurate and appropriate information.

In this report the name of Jane Slater appears as a registered manager. They were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with three people and observed care provided to people in communal areas. People confirmed that they felt safe and that staff were available when they needed them. The majority of people who used this service remained in their rooms, either in bed due to their condition or because they chose to remain there. People that we saw in bed looked comfortable and relaxed. We noted that people's position had been changed during the course of the day.

We spoke with one relative who said they were happy with the care that was provided at the home. They told us that there was good communication and they were kept informed about any changes in their family member’s condition.

We also spoke with some of the staff on duty during our visit. These included three care staff, two qualified nurses, an activities co-ordinator, the head of care and the registered manager.

There were good quality monitoring systems in place. This meant that the service was operating effectively, assessing and managing the needs of the people using the service. The service had been accredited by the ‘Gold Standards Framework in September 2011. The Gold Standards Framework (GSF) is a an approach to promote the best care for people nearing the end of life.

The inspection team who carried out this inspection consisted of an inspector and an expert by experience. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the 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.

Is the service safe?

Most people’s needs were assessed and care and treatment was planned and delivered safely in line with their care plan. We observed people being treated with care and their safety considered when using equipment, including mobility aids and hoists. One person had slipped down their bed and their heel was pressing against the base of the bed board. This had created pressure and they were being assessed and treated for a pressure wound. We found there was no label or information in the person's room guiding staff to the correct mattress pressure setting. It was unclear at the time whether the mattress was calibrated to the correct setting for the person's weight. This meant that staff may not have been aware of the correct setting and the risk of further pressure wound damage. We spoke with the registered manager about this.

There was not always enough staff to ensure that people were protected from the risk of unsafe care.

Some people’s care records were not always accurate and were sometimes incomplete. A re-positioning chart to help reduce pressure wounds did not indicate how often the person's position required moving or changing. This meant that staff might not have known how frequently they should be re-positioned and this could have led to the risk of pressure wounds. We found in one medicine administration record for skin creams, staff signatures were missing from six of eleven days of application. Compliance actions have been set and the provider must tell us how they plan to improve.

Is the service effective?

Most people’s needs were assessed and care and treatment was planned effectively and delivered in line with their individual care plan. One person said, "Since being here, they've helped me to do more, I still need assistance but things are better." Senior staff had developed systems to identify where the service required improvements and had reviewed their processes of checking that staff were providing care effectively.

Is the service caring?

We observed that staff were caring and kind towards people when they carried out their care. We saw staff checking that people were comfortable and asking them whether they needed anything. One relative commented, “I can’t fault them, staff are very caring and attentive; they remember to knock before entering the room.”

Is the service responsive?

The provider responded to people's ideas and suggestions. Two people and a relative told us they would like more outings. We spoke with activity planning staff and they gave examples of trips and outings including a trip to a singing group and a visit to a local castle. They also provided spontaneous activities like nail painting and reading to people, and group activities like memory box activities, word games and music groups.

Is the service well led?

The provider listened to people’s views and used their comments to improve the service. Surveys were sent to people who used the service and their representatives to gather their views about the home. As a result of the survey, the registered manager wrote to all relatives of people at the home to encourage their involvement with people's care reviews. One staff member had been involved in checking people's care records. This had improved the identification of areas in need of improvement. These were used to remind staff of progress the home was making and areas for further review and development.