This inspection took place on 25 September 2018 and was unannounced. Summerfield is a ‘care home’. People in care homes receive accommodation and nursing or 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. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to 35 people in one adapted building. At the time of our inspection there were 21 people living in the home.

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.

The service had previously been rated as ‘requires improvement’. At this inspection the service was rated as ‘good’. The service had addressed the issues raised at previous inspections and arrangements were in place to deliver a good standard of care and improve quality.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Risk assessments were not in place for bed rails however the registered manager put this in place immediately after our inspection. The environment was clean. There were arrangements to prevent and control infections.

Guidance was in place to ensure people received their medicines when required. Processes were in place to manage medicines. Where people required their medicines in food arrangements had not been in place to ensure the method of administration did not affect the efficacy of the medicine. The medicine policy was not in line with good practice guidance.

Where people were unable to make decisions arrangements were in place to ensure decisions were made in people's best interests. Best interests decisions were specific to the decisions which were needed to be made.

A system was in place to carry out suitable quality checks and appropriate checks had been regularly carried out. Where required, actions had been taken to improve the service. The provider had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy.

Staff had been supported to deliver care in line with current best practice guidance. Arrangements were in place to ensure staff received training to provide care appropriately and effectively. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a range of activities. People were supported to access local community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care. Arrangement

This was an unannounced inspection carried out on 23 February 2017.

Summerfield Rest Home can provide accommodation and personal care for 35 older people and people who live with dementia. There were 18 people living in the service at the time of our inspection.

The service was run by a company who was the registered provider. 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’.

Suitable steps had not always been taken to avoid preventable accidents. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. Medicines were safely managed and there were enough staff on duty. Background checks had been completed before new staff were appointed.

Some areas of the accommodation were not well decorated or maintained. Although staff knew how to care for people in the right way they had not received all of the training and guidance the registered persons said they needed. People enjoyed their meals and were assisted to eat and drink enough. Staff ensured that people received all of the healthcare they needed.

The registered persons had ensured that whenever possible people were helped to make decisions for themselves. However, when this was not possible the registered persons had not taken all of the necessary steps to ensure that people only received care that promoted their best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that people only received lawful care.

Although people’s right to privacy was not fully promoted, staff treated people with kindness and compassion. Confidential information was kept private.

People had not been fully supported to pursue their hobbies and positive outcomes were not always achieved for people who lived with dementia. However, people had been consulted about the help they wanted to receive and they had been given all of the practical assistance they needed. There was a system for quickly and fairly resolving complaints.

Quality checks had not always effectively resolved problems in the running of the service and people had not fully benefited from staff acting upon good practice guidance. However, people had been consulted about the development of their home and the service was run in an open and inclusive way. Good team work was promoted and staff were supported to speak out if they had any concerns.

We inspected Summerfield Rest Home on 7 January 2015. The inspection was unannounced.

The last inspection took place on 1 August 2014. As a result of the inspection we asked the provider to take action to improve infection control arrangements and this action has been completed.

Summerfield Rest Home provides care and treatment for up to 38 people over the age of 55 years, some of whom live with needs related to dementia. There were 25 people living in the home on the day of our inspection. Accommodation is arranged over two floors; the upstairs being accessed by stairways and a passenger lift. Five bedrooms are able to accommodate two people if anyone wishes to share a room. The home is located in a sea side town and is close to local amenities such as shops and restaurants.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons who have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.

At the time of the inspection no-one who lived at the home had their freedom restricted. People’s rights were also protected by staff who understood the Mental Capacity Act 2005 Code of practice and the Deprivation of Liberty Safeguards, and followed the correct procedures.

People were happy and felt safe living in the home. They were treated with respect and dignity and staff displayed a warm and sensitive approach when supporting them. The same respectful and warm approach was extended to people’s relatives and visitors.

The manager and staff promoted an open and inclusive atmosphere within the home. People had the opportunity share their views and opinions and were involved in planning and reviewing their care. They understood how to raise any complaints or issues they had and were confident the right actions would be taken to resolve issues.

People were provided with a varied diet that took account of their likes, dislikes and preferences. They had access to appropriate healthcare professionals and support services and their medicines were managed safely.

Staff were recruited, trained and supported to meet people’s needs appropriately. There were enough staff on each shift to meet people’s needs. They understood how to manage risks and protect people from avoidable harm. They also knew how to raise any concerns and report them appropriately.

We have made a recommendation about providing meaningful activities and a stimulating environment for older people and those who may experience memory loss.

A single inspector carried out this inspection. At the last inspection in January 2014, the provider was asked to take action to improve procedures relating to consent, provide training and support for staff, and introduce systems for monitoring the quality of the service. At this inspection we found these issues had been addressed.

We talked with four of the twenty four people using the service and three sets of relatives. We looked at five people’s care records and observed care being provided. We talked with three care staff, the cook, a housekeeper, the manager and deputy manager. We examined the training records for staff, records of staff supervision and quality audits.

This helped us to answer the questions below:

Is the service safe?

Staff obtained the consent of the people using the service before giving care and support. People told us they felt safe and they had confidence in the staff looking after them.

Risk assessments had been completed for each person and care planned to reduce the risk and keep the person safe.

Although the majority of the home was clean we found one toilet was soiled and some examples of equipment with damage to the surfaces, making cleaning difficult. This increased the risk of infection to the people using them. The staff removed and disposed of these items during the visit. Staff were conversant with the cleaning requirements and worked diligently to keep the home clean but there was no formal cleaning schedule for new staff or to indicate when periodic cleaning was due.

Is the service effective?

Care was planned with the person using the service or their relatives. Specialist equipment needs had been identified and required equipment was in place.

The service worked with other professional to ensure people's specialist needs were met.

Is the service caring?

People we talked with told us staff were kind and caring. One relative said, “Staff are fantastic. They can’t do enough for them (people using the service).”

When we talked with staff they demonstrated understanding and empathy for the people they cared for. One person using the service said, “I think they choose staff for their character. The staff are all very good.”

People’s preferences and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People using the service and their relatives told us that staff listened to them and acted on their concerns. Each person’s care record contained a record of feedback from relatives when care was reviewed with them.

Visitors told us they could visit at any time and they were made to feel welcome by staff.

Is the service well led?

A programme of quality assurance audits were in place to monitor and assess the quality of the service provided.

A programme for staff training was in place and staff received regular supervision.

Staff told us they felt well supported by the manager and deputy manager and staff meetings had been introduced to ensure good communication flows.

When we visited, 20 people were living in the home and the atmosphere was calm and unrushed.

We spoke with eight people who lived there as well as staff, the manager and visiting friends and relatives. We looked at records and observed how staff supported the people who lived in the home.

People were asked for verbal permission/consent by staff before they undertook any care needs or treatment and their responses were respected. However, documented consent was not always obtained and there was no policy with regard to consent for staff to follow.

People we spoke with told us they were happy living in the home. Visitors told us they thought the care was very good. One person told us, ”The staff are smashing. They are so patient.” People received the care and support they needed and this was reflected in their care records.

There was sufficient staff to meet people’s needs.

Staff were not supported to deliver safe and effective care because of the lack of training, supervision and appraisals.

Effective systems were not in place to monitor the quality of service given to people. However, people we spoke with told us they could raise any issues with the manager and felt confident they would be dealt with quickly.

When we arrived at the home we found it had a relaxed and calm atmosphere and everyone looked happy. People were doing a variety of activities and the Registered Manager and care staff were encouraging and helping them.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences. We looked at records. These included care plans, minutes of meetings and surveys undertaken by the Registered Manager of the home.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to understand the needs of people who could not talk with us.

We observed that staff respected people’s individual needs and provided sensitive support when people needed it. We saw that people, or their representative, were involved in their plan of care.

We saw there was a range of things for people to take part in as well as opportunities for them to go out into the community with support on a regular basis.

People felt safe living in the home and a relative told us the care staff were always very patient and kind to those who lived there.

People and their relatives were confident the manager would quickly resolve any concerns raised about the home. We also saw that regular audits were undertaken to ensure the quality of care was good.