Summerfield Private Residential Home is a care home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Summerfield Private Residential Home provides accommodation to a maximum of 32 people, spread over two floors. The service caters for older people over 65 some of whom are living with dementia. The accommodation is mostly single rooms with a small number of double rooms. It is located in Silsden, near Keighley in West Yorkshire. At the time of the inspection 30 people were living in the home.

The inspection was undertaken on 12 February 2018 and was unannounced. At the last inspection in September 2016 we rated the service ‘Requires Improvement’ overall. We identified a breach of Regulation 9 ‘Person centred care’. At this inspection we found improvements had been made and the location was no longer in breach of this Regulation.

A registered manager was in place. 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 relatives provided consistently positive feedback about the home. They said that care was of high quality, personalised and met people’s individual needs. People praised the nice atmosphere within the home and said staff were consistently kind and caring.

People felt safe living in the home. Systems were in place to protect people from abuse. Risks to people’s health and safety were regularly assessed and care plans put in place to help keep them safe. Staff had a good understanding of the people living in the home and how to care for them safely. People received their medicines consistently as prescribed.

There were enough staff working in the home to ensure people received prompt care and support. Staff had time to chat with people as well as completing care tasks. Staff were recruited safely to help ensure they were of suitable character to work with vulnerable people.

The premises was safely managed and suitable for its purpose as a care home. There was pleasant décor, furniture and fittings and the home was kept clean and well maintained.

Incidents and accidents were recorded, investigated and used to make improvements to the safety of the service. When things went wrong, lessons were learnt to help ensure continuous improvement.

People received care from staff with the right skills and knowledge to care for them effectively. Staff received a range of training and support from the management team.

People had access to a good range of food with sufficient choice and variability. People’s nutritional needs were assessed and where people were deemed at risk, plans of care were put in place to mitigate these risks.

The service was compliant with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s consent was sought before care and support was offered.

The service worked well with a range of health professionals to help ensure people’s needs were met. Care needs were assessed and appropriate plans of care put in place. People told us care needs were met by the service.

Staff were kind and caring and treated people with a high level of dignity and respect. Staff had developed good relationships with people and knew them well. Care was person centred, focused on meeting people’s individual preferences and taking their views into account. People had access to a wide range of activities and social opportunities.

People were very satisfied with the service

Summerfield provides care and support for up to thirty one people. The people using the service are predominantly older people and people living with dementia. The home is situated in Silsden near Keighley and is within easy reach of the town and local areas of interest.

The inspection was unannounced and was carried out on 27 September 2016. There were 31 people living at the home at the time of the inspection.

A registered manager was in place. ‘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.’

At the last inspection in August 2015 we found several breaches of regulation and rated the service as ‘Inadequate.’ We placed the service into special measures. At this inspection we checked whether improvements had been made.

At this inspection, we found significant improvements had been made to the overall quality of the service. However we found some aspects of the way mealtimes were organised did not promote a person centred approach to care. The service would need to rectify this issue and demonstrate improvements were sustained over time before we could be assured the service provided a ‘good’ overall quality of care.

People and relatives all spoke positively about the service. They said care was appropriate and met people’s individual needs. They said staff were kind and caring and treated people with dignity and respect.

Medicines were safely managed. People received their medicines as prescribed and they were stored safely. Medicines records were subject to regular review to identify any errors.

People said they felt safe from abuse. Staff understood how to identify and act on any allegations of abuse. Risks to people’s health and safety were assessed and plans of care put in place, which were subject to regular review.

There were enough staff to ensure people received prompt care and support. Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.

The premises was suitable for its purpose and maintenance and safety checks took place to help keep people safe.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff demonstrated they had the required skills and knowledge to care for people safely. Staff received the required training, support and supervision from management.

People and relatives praised the food and said there was sufficient choice. People’s nutritional needs were regularly assessed and reviewed and action was taken following any weight loss.

People’s healthcare needs were assessed and appropriate plans of care put in place. People had access to a range of health professionals.

Care was delivered by kind and compassionate staff who knew people well and their individual needs and preferences.

People said they felt listened to by staff and had any queries or concerns acted on.

People’s needs were assessed and appropriate plans of care put in place. Care records were clear and personalised. We found appropriate care was delivered to people that used the service.

A range of activities took place, arranged by a dedicated activities co-ordinator. This included entertainers and trips out.

A system was in place to log, investigate and respond to any complaints. People said they were satisfied with the service and any minor issues had been effectively dealt with.

Systems were in place to assess, monitor and improve the service. Although we found significant improvements had been made to the service, it had failed to act on our feedback regarding the timings of mealtimes to ensure they met people’s individual needs and requirements.

People’s feedback was regularl

As part of our inspection we looked at how medication administration records and information in care notes for people living in the service supported the safe handling of their medicines. People were not protected against the risks associated with medicines because the provider had not ensured that its staff were correctly administering medicines in accordance with a prescriber's directions. Furthermore prescribed medicines on one occasion had not been administered and no meaningful explanation was given as to the reason.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe

We found the home was clean, well maintained and free of unpleasant odours. We saw people were protected by the risk assessments in place in relation to the environment.

In the care records we looked at we saw people had risk assessments which covered areas of potential risk such as pressure ulcers and falls. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

We found there were enough suitably qualified, skilled and experienced staff to meet people’s needs.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and we discussed the recent Supreme Court judgment on the Deprivation of Liberty Safeguards.

We found improvements were needed to the way the service managed people’s medicines and we have asked the provider to tell us what they are going to do to make sure people are protected from the risks associated with medicines.

Effective -

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The home had good working relationships with other healthcare professionals and worked closely with them to make sure people’s needs were met. The input of other healthcare professionals involved in people's care and treatment was recorded in their care records.

Caring –

The relative of one person who used the service told us they were “More than satisfied with the care” provided at Summerfield. They said they were kept informed about their relative’s needs and any changes in their condition. They said their relative always looked clean and well cared for. The relatives of another person who used the service said “I would not want my father to be anywhere else”. They said their relative had been in Summerfield for over two years and during that time they had never had any concerns about the care they received.

The people we spoke with were complimentary about the staff; one person said they were “kind, friendly and very patient”. They said the home was “very lucky with the staff”. Another person said the staff were “very gentle.”

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Responsive –

People’s needs were assessed before they moved into the home. We saw people’s care records had information about people’s individual needs and preferences.

People had access to a range of activities and were consulted about the types of activities they wanted to take part in.

People’s relatives told us there were no restrictions on visiting and said they were always made welcome.

Well led –

People told us the Registered Manager was approachable and listened to what they had to say. They said they would not hesitate to talk to the manager if they had any concerns and were confident their concerns would be dealt with.

The staff we spoke with said they enjoyed working at the home. They said the worked well as a team and felt supported by the management.

As part of the quality assurance monitoring process the service sent out annual survey questionnaires to people who used the service and/or their relatives to seek their views about the care and support they received. This gave people the opportunity to air their views and opinions of the service.

During the inspection we had the opportunity to speak with five people who used the service, a relative and five staff members.

The people who used the service and the relative told us they were looked after very well and felt safe with the care and treatment provided. Their comments included: "they are all lovely staff"; “they are all fabulous”. We spent time observing the three lounges and dining area during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

The interactions we saw between staff and people who used the service and visitors was respectful. We saw some people engaged in activities with members of staff such as watching TV and talking about things to do during the day.

The home smelt fresh and looked clean. All of the people we spoke with on the day of our visit were satisfied with the facilities and cleanliness of Summerfield Private Residential Care Home.

People had their comments and complaints listened to and acted on, without the fear they would be discriminated against for making a complaint.

When we visited Summerfield Private Residential Care Home we spoke with two people who lived there and a relative who visited. People told us they were happy with their care and that the staff were kind and supportive. One person told us “The staff are kind and they give you time.” A relative told us “They treat people with respect.”

People were consulted and we saw evidence that people received the care they needed. For example we saw up to date plans of care which considered individual physical, emotional and mental health care needs. We saw risk assessments and that all documentation was kept up to date to ensure people had their changing needs met. We saw that the home consulted with specialists to make sure people had the benefit of expert advice.

Staff had training to ensure they could meet people’s needs safely. People were also protected from harm through risk assessments. The service referred safeguarding incidents to the local authority and to the Care Quality Commission (CQC) as required to ensure people were protected.

Staff were well recruited so that people were protected from from staff who were unsuitable to work with vulnerable adults. The home had a complaints procedure and people told us that they knew how to complain. The manager monitored the quality of care through a comprehensive quality assurance system. Areas for improvement were identified and plans were put in place to ensure people received safe and appropriate care.

The inspection was unannounced and was carried out over two days on 18 and 24 August 2015. There were 30 people living at the home at the time of the inspection.

Summerfield provides care and support for up to thirty one people. The people using the service are predominantly older people and people living with dementia. The home is situated in Silsden near Keighley and is within easy reach of the town and local areas of interest.

The home had a registered manager. 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.

We inspected the service in May 2014 and found the provider did not have suitable arrangements in place to make sure people’s medicines were managed safety. The provider sent us an action plan and in December 2014 we carried out another inspection to check if improvements had been made. We found that although some improvements had been made further improvements were needed to protect people from the risks associated with the unsafe management of medicines. We gave the provider another opportunity to resolve this. During this inspection we followed this up to check if the required improvements had been made. We found they had not and people were not protected because the provider did not have proper systems in place to make sure medicines were managed safely.

People told us they felt safe. However, we found people were not always protected from abuse or the risk of abuse because the correct safeguarding procedures were not always followed. The service was not working in accordance with the requirements of the Mental Capacity Act and this meant people were at risk of being deprived of their liberty without the proper authorisation.

The provider told us they had enough staff to meet people’s needs and when necessary they adjusted the staffing levels to take account of changes in people’s needs. However, we observed there were times when staff were not available to attend to people’s needs in a timely way.

We found people were not always receiving the right support to meet their nutritional needs. People were not always being supported to have access to the full range of NHS services, such as the services of dieticians or speech and language therapists when they had difficulties eating and drinking.

We observed a lot of positive interactions between staff and people living at the home and people told us the staff were kind and caring. However, we found the daily routines in the home were organised in way which was not conducive to promoting a person centred approach to care. For example, people who needed help to eat and drink were having their breakfast from 5.30am onwards with no evidence to show this was to meet their individual preferences.

We found people’s needs were not always assessed and care plans were not always in place to guide staff on how to deliver care and support. This risked people not receiving care and support which was appropriate and met their needs. We found appropriate action was not always taken to manage risks to people’s safety such as falls.

We found shortfalls in the way records were maintained about people’s care and treatment and this created a risk that people would not receive appropriate care which met their needs.

The provider had processes in place to monitor and assess the quality of the services provided. However, we found they were not robust enough because they had not identified the shortfalls we found during the inspection.

We found the home was well maintained, clean and free of unpleasant odours.

There was a complaints procedure in place and people were given information about how to make a complaint.

We found the provider was in breach of a number of regulations. You can see what action we told the provider to take at the back of the full version of the report.

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.