The inspection took place on 10, 11 and 15 May 2018. The first day of the inspection was unannounced. The service was last inspected in September 2017 when we identified breaches of regulations about safe care and treatment, and good governance. The service had addressed our concerns about safe care and treatment. However, new concerns arose regarding staffing, recruitment and our concerns regarding governance remain.

Following the last inspection we met with the provider and asked them to complete an action plan to show what they would do by when to improve the service to bring them out of special measures and address our concerns about the rating of well-led. Although there had been significant progress in some areas, further improvements are needed to improve the overall rating to ‘good’.

Summerdale Court Care Home 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. Summerdale Court can accommodate up to 116 people in a purpose build nursing home. The home is divided into four units across two floors. Two of the units provide nursing care, and two are specialist residential units for people living with dementia. At the time of our inspection 55 people were living in the home.

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.

Recruitment records had not been appropriately maintained and did not demonstrate safe recruitment practice had been followed. Staff had not received the training and support they needed to perform their roles.

Staff completed a range of audits to monitor the quality of the service. However, these had failed to identify or address issues with staff training, supervision and recruitment. Analysis of serious incidents focussed on the actions of individuals and did not consider organisational solutions and learning. Despite multiple reviews, the style of care plans meant it was not easy to find the most pertinent information.

People told us they felt safe and staff were knowledgeable about safeguarding adults from harm and abuse. Risks faced by people receiving care had been identified with clear measures in place to mitigate risk. People were supported to take medicines and this was managed in a safe way.

People gave us mixed feedback about the staffing levels in the home. Records showed sufficient staff numbers were deployed, but people’s feedback reflected there were frequently more senior staff than care workers on duty. People told us this meant they sometimes had to wait for support with care tasks.

The home was clean and free from malodour. The home was accessible to people who lived there. Adaptations had been made to the building, including re-purposing rooms to ensure it met people’s needs.

People and their relatives where appropriate were involved in planning their care. Care plans contained details of people’s preferences and choices. People’s healthcare needs were detailed as well as the support they needed to access healthcare and other services involved in providing their care.

People told us they liked the food and they were offered choices. We saw people were able to have individual meals if they did not like the food on the main menu.

People were offered choices in their day to day life. Where people lacked capacity to consent to their care and treatment staff had completed appropriate capacity assessments and followed best interests’ decision making principles in line with the Mental Capacity Act 2005. Where people’s support amounted to a deprivation of liberty

Summerdale Court Care Home was inspected on 18, 19 and 21 September 2017. The first day of the inspection was unannounced.

Summerdale Court is a large care home with nursing registered to provide care for up to 116 people. At the time of our inspection 75 people were living in the home. The home provides care for older people, people who have a physical disability and people living with dementia. There are four units within the home. Two of these units provide residential care for people living with dementia. The other two units provide nursing care, one of which specialises in providing nursing care for people living with dementia. The home is fully accessible and arranged over two floors. There are a variety of communal areas including gardens for people who live in the home.

The home had 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.

The last inspection took place in February 2017 when we rated the service as inadequate, identified breaches of seven regulations and placed the service into special measures. This inspection found five of those breaches had been addressed. However, issues relating to the safety of the service, leadership and governance had not been fully addressed and breaches continued. The rating for well-led remains inadequate. The overall rating for this service is ‘Requires improvement’. However, we are extending 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Managers in the home completed a wide range of audits to monitor and improve the quality of the service. They had an action plan to address the concerns from the previous inspection and other issues identified since. However, there were a number of issues with the quality of records identified during the inspection that had not been addressed by the provider’s systems.

Risk assessments were in place to mitigate risks faced by people living in the home. However, these were inconsistent. While some were clear about what staff needed to do to ensure people were safe, others lacked detail.

People were supported to take their medicines by trained and qualified staff. Records showed they were supported to take their medicines in a safe way. However, where medicines were stored in fridges safe temperatures had not been maintained.

People were supported to access healthcare services when they needed them. However, support plans around people’s healthcare needs were not always consistent or clear and some diabetes care was not provided in line with best practice guidance.

During the inspection we saw there were occasions where people’s dignity was not always protected. The provider responded to this feedback and developed ways to ensure people’s dignity was protected.

There was variation in the quality of care plans across the home. While some were personalised and detailed, others did not inform staff how to meet people’s individual needs. Observations showed occasions when a task focussed approach was taken rather than a person-centred approach.

People’s views on the provision of activities were mixed. Some people felt they were offered a range of appropriate activities but others felt there were limited options that were suitable for them. The purpose of activities was not always clear and levels of engagement were not captured.

People and their relatives told us they felt safe in the home. Staff were knowledgeable about how to protect people from avoidable harm and abuse and knew how to escalate concerns about abuse.

People and staff told us the staffing levels had improved. Records showed the home deployed more staff than their sta

Summerdale Court Care Home was inspected on 8, 9 and 15 February 2017. The first day of the inspection was unannounced.

Summerdale Court Care Home is a large care home with nursing registered to provide care to up to 116 people. At the time of our inspection 87 people were living in the home. The home provides care for older people, people who have a physical disability and people living with dementia. There are four units within the home. Two of these units provide residential care for people living with dementia. The other two units provide nursing care, one of which specialises in providing nursing care for people living with dementia. The home is fully accessible and located on two floors. There are a variety of communal areas including gardens for people who lived in the home.

The home had 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.

The last inspection took place in April 2016 when we rated the service as requires improvement and made four recommendations to drive improvement. Although one of these recommendations had been followed, the others had not and we found the quality of care had deteriorated since our last inspection.

People were not supported to be safe as needs assessments, care plans and risk assessments were poorly completed. Measures to mitigate risk, particularly risks around behaviour which challenged the service, were not robust and did not incorporate advice and guidance from healthcare professionals. People’s preferences were not consistently recorded, and where they were recorded records did not show they had been respected. People were not involved in writing or reviewing their care plans.

Medicines were administered by trained staff and were stored and managed in a safe way. However, where people were given medicines covertly there was insufficient information in care plans to ensure this was done safely.

People gave us mixed feedback about the staffing levels at the home. Records showed that the home did not always deploy the number of staff their staffing assessment tool showed they needed. Records showed the home did not consistently follow safe recruitment practice as gaps in employment and professional qualification checks were not performed in a timely manner. We have made a recommendation about safe recruitment.

Healthcare assistants received the training they required to perform their role. However, it was not clear that senior staff performing assessments and line management tasks had received appropriate training in these aspects of their role.

The home had made appropriate applications to the local authority where people were being deprived of their liberty. However, it was not clear if people were actively consenting to their care, and relatives had provided consent without clear records they had the legal authority to do so. Staff understanding of the Mental Capacity Act 2005 and its application was poor.

Some people told us they liked the food, but others found it was not to their taste. The menu was varied and people were able to choose food that was not on the menu if they wished. The dining experience was not positive for people who lived in the home.

People told us the staff were caring, and staff demonstrated they treated people with dignity and respect. The home had not addressed our previous concerns about supporting people who identified as lesbian, gay, bisexual or transgender. Information about people’s pasts, relationships and interests remained inconsistent.

People told us the activities were limited and it was not clear people were supported with activities in line with their preferences. The home provided a daily schedule of activities but did

Summerdale Court Care Home was inspected on 20, 22 and 25 April 2016. The first day of the inspection was unannounced. There were 77 people living in the home at the time of the inspection.

The home is registered to provide accommodation and nursing or personal care for up to 110 people. The home provides care for older people, people who have a physical disability and people living with dementia. There are four units within the home. Two of these units provide residential care, the other two units provide nursing care, one of these specialises in nursing care for people living with dementia. The home is fully accessible and divided across two floors. There are a variety of communal areas including gardens for people who live in the home.

There was no registered manager in place at the time of inspection. 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 person have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The manager in post had joined the service a month prior to inspection and had not yet submitted their application to become registered.

The last inspection of the service took place in October 2015. During that inspection we found the provider was in breach of a number of regulations. The breaches related to safe care and treatment, medicines management, safeguarding adults, consent to care, person centred care, staffing and good governance.

We found significant improvements across all areas of the service during this inspection. We have found the service is no longer rated as inadequate for any of the five key questions. Therefore, Summerdale Court Care Home will no longer be in special measures and we have stopped taking enforcement action against the provider. Services are placed in special measures when rated as inadequate and we have significant concerns about the quality of the care delivered. We found the provider is no longer in breach of the regulations. However, we identified some areas where further improvements can be made, which are detailed below.

The management of medicines, including the administration and recording of topical medicines, had improved and medicines were now managed in a way that ensured that people received them safely. There remained some issues regarding guidance for medicines that had been prescribed on an 'as needed' basis. We have made a recommendation about medicines.

People's care plans contained a variety of risk assessments and plans to mitigate the risks faced by people living in the home. The home had received support from relevant professionals regarding supporting people with behaviour which challenged the service, however, this had not been incorporated into people's care plans. We have made a recommendation about supporting people who present with behaviour which challenges the service.

At the last inspection we found the service was not meeting the needs of people who identified as being lesbian, gay, bisexual or transgender (LGBT). Although there had been some improvements in this area, staff lacked confidence in supporting people with this aspect of their lives. We have made a recommendation about supporting people who identify as LGBT.

People were supported to receive the support of relevant healthcare professionals as required. There were some inconsistencies in how this information was shared among staff providing support.

The new management team had introduced a range of quality assurance audits and improvements to the management structures of the home. These had not yet been embedded into the usual practice of the home.

People were protected from avoidable harm and abuse. Staff were knowledgeable about their role in safeguarding adults from harm. Relatives and people told us they felt safer in the home.

There were sufficient num

We spoke to seven staff, three relatives and 14 people who use the service. People told us they were happy with the care they received. One person said, "The care is top notch." Another said, “I can't fault the care at all. Nurses work very hard." We reviewed eight care records which were kept in people's rooms. We found that there was more staff and person engagement and activities on the dementia unit than on the nursing units.

The provider had systems in place to respond appropriately to allegations of abuse. Our conversation with junior and senior staff showed that they understood what constituted abuse and the procedure that needed to be followed if they had concerns or suspicions that people were being abused.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained .People told us that they thought the home was a nice place to live. Communal areas were well presented.

Staff received appropriate professional development. All staff had completed training in a number of key areas to ensure they were competent to do their job. This included training in manual handling, infection control, health and safety and safeguarding. Staff were being supervised on a regular basis.

We found that people's privacy and dignity was respected. People were involved in their daily care. We saw that people's religious and cultural beliefs were respected. Staff were aware of people's individual needs and care was assessed and planned to meet individual’s needs.

On the day of our visit, people were supported to eat sufficient amounts. People were offered varied meals which represented their values or culture. People told us they chose when to have their breakfast. Staff told us they monitored those who were at risk of malnutrition by weighing the regularly and monitoring their food and fluid intake.

Staff thought that staffing was adequate. We saw staff supporting people in an appropriate manner. People's calls were responded to in a timely manner. Staff were able to tell us the different types of abuse and how and where to report abuse.

Relatives told us that they thought there were enough staff to meet people’s needs. Another relative said “staff are fantastic. They always look after mum. They play her favourite music. She looks the best I have seen her in years.”

The home responded appropriately to comments and complaints. There were regular staff meetings, clinical governance meetings and relatives meetings which were held in order to seek ways to improve the service provided. We also reviewed a customer satisfaction survey which was done in 2012, which showed hat the home had done well on communication and staffing but could do more activities.

The inspection took place on 12,13,15 and 22 October 2015 and was unannounced. The home was last inspected in October 2013 and at that time was compliant with all the outcomes inspected.

Summerdale Court Care Home is a large, purpose built care home with nursing with capacity to support 110 residents. 88 people were living there at the time of our inspection. It is divided into four units, two residential units and two with nursing care. At the time of our inspection 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 and their relatives told us the staff were hardworking and people’s dignity and privacy was respected. There were enough staff on duty during our inspection.

People told us they did not always feel safe and records showed that incidents were not always reported on to the relevant authorities. Risk assessments were not robust and did not provide sufficient detail to mitigate risks identified. There were inconsistencies in how risks were managed and this put people at risk of harm. Medicines were not always administered as prescribed and the administration of controlled drugs was not in line with legal requirements. Health and safety checks of equipment and routine maintenance tasks were not being completed.

Care plans did not contain enough information to provide good care. The review and audit mechanisms were not effective and plans were not updated to reflect changes in people’s needs.

People had sufficient food and drink to keep them healthy. However, some people had to wait to be supported to eat their meals which meant they were no longer warm by the time they were eaten. People’s healthcare needs were being met. The GP visited the service twice a week. Visits from other healthcare professionals also took place.

Consent was not sought in line with legislation and records were not clear about whether or not people had consented to their care. Where people required Deprivation of Liberty Safeguard authorisations the appropriate authorisations had been sought. However, the service had not notified CQC of this as is required.

Staff training was not sufficient to ensure that staff had the correct skills to carry out their roles.

People were not always involved in making decisions about their care and the home did not always respected where decisions had been made regarding end of life care. We have made a recommendation about end of life care.

Staff treated people with dignity and respect, although they did not always show understanding of sexuality issues in care homes. We have made recommendation about equality and diversity.

Staff recruitment procedures were safe and most employment files contained the relevant checks to help ensure only appropriate people were employed to work in the home. We have made a recommendation about employment references.

Group activities were available to people living in the home. People who did not leave their rooms did not access activities.

There was a complaints procedure available to people in the home and records showed complaints made had been appropriately responded to.

Quality assurance and audit mechanisms were ineffective and did not ensure the service was delivering good care.

We found seven breaches of regulations. We are taking enforcement action against the registered provider. We will publish an update to this report when this is completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.