This comprehensive inspection took place on 14 January 2019 and was unannounced.

Summerville House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Summerville House is registered to accommodate up to 26 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit 22 people were living in the home, all of whom were living with dementia.

There was a registered manager working at the service. 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 of Summerville House, we rated the home overall as good. At this inspection the overall rating has reduced to requires improvement. We also found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not all risks to people’s safety had been assessed and therefore mitigated. Staff practice was mixed which placed people at risk of avoidable harm. The provider had determined the number of staff required to meet people’s needs but this had not regularly been met. Staff told us they struggled to provide people with stimulation to enhance their wellbeing.

Staff working on the night shift had not all received training in how to give people their medicines safely. This meant there may have been a delay in people receiving medicines for pain or distress. Following the inspection visit, the registered manager told us this had been corrected.

Some staff were observed to lack the necessary skills when dealing with people living with dementia. Most had only received training in this area online via a computer. The provider told us training for staff in this area was being improved to give them better knowledge and skills.

Most people were treated with dignity and respect although this was not consistently applied by staff and some people did not always have choice or control over their care. People’s consent had not always been sought in line with the relevant legislation.

People did not always have a choice of food to eat and the dining experience required improvement. People who were at risk of not eating enough were monitored to ensure they had sufficient food to remain healthy. We were not made aware of any concerns regarding people's fluid intake however, the systems in place to monitor if people had received enough to drink were not robust and needed improving.

The current governance systems and processes in place were not all effective at monitoring the quality of care people received or to drive improvement within the home.

The premises would benefit from some improvements to help people living with dementia orientate themselves. We therefore recommend the provider consults appropriate guidance in this area to make the necessary improvements.

People received their medicines when they needed them and systems were in place to protect them from the risk of abuse. Any incidents or accidents that had occurred had been fully investigated and lessons learnt to try to prevent them from happening again.

When people became unwell, the staff acted quickly to ensure they received the appropriate medical advice. Staff were very happy working at the service. They felt supported, told us their morale was good and could develop and complete qualifications within care.

There was an open culture in the home. People and relatives could approach the staff or manager whenever they wished

This inspection took place on 13 February 2017 and was unannounced. Summerville House is a care home providing personal care for up to 26 people, some of whom live with dementia. On the day of our visit 24 people were living at the home.

The home has had the current registered manager in post since before January 2011 when they were registered under the Health and Social Care Act 2008. 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 February 2016, we asked the provider to take action to make improvements to staff training, to safeguard people from unlawful deprivation of their liberty and to quality assurance processes. These actions have been taken.

Staff members received training, which provided them with the skills and knowledge to carry out their roles.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity to make their own decisions, the staff made these for them in their best interests.

Good leadership was in place and the registered manager and provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

There was not enough for people to do during the day and they were sometimes bored. We have made a recommendation about the provision of activities.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the registered manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

People received their medicines when they needed them, and staff members who administered medicines had been trained to do this safely. Staff received adequate support from the registered manager and senior staff, which they found helpful.

People enjoyed their meals and were able to choose what they ate and drank. They received enough food and drink to meet their needs. Staff members contacted health professionals to make sure people received advice and treatment quickly if needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People were happy living at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

Summerville House is registered to provide accommodation and personal care for up to 26 people, some of whom live with dementia. The home, which is situated in a West Norfolk seaside resort, has two floors, with communal dining, lounge and bathing and toilet facilities. There is an enclosed garden to the rear of the home. Short and long term stays are offered. At the time of our visit there were 25 people using the service.

This comprehensive inspection took place on 9 February 2016 and was unannounced.

A registered manager was 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’. 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 were kept safe most of the time and staff were knowledgeable about reporting any incidents of harm. However, there was inadequate action taken to report a significant safeguarding concern to the local authority. We received mixed views about staffing numbers although when we visited people were looked after by enough staff to support them with their individual needs. Satisfactory pre-employment checks were completed on staff before they were allowed to look after people living in the home. People were supported to take their medicines as prescribed and medicines were safely managed.

People were supported to eat and drink sufficient amounts of food and drink and there were choices of food from what was on the main menu. They were also supported to access health care services and their individual health needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Assessments were in place to determine if people had the capacity to make decisions in relation to their care. When people were assessed to lack capacity, their care was provided in their best interests. However, DoLS applications had not been made to responsible authorities when some of the people had restrictions imposed on them. Therefore the provider was not acting in accordance with the requirements of the MCA.

People were supported by kind, respectful and attentive staff. People, or their relatives, were not given opportunities to be involved in the review of their individual care plans.

People were supported with a range of hobbies and interests that took part in and out of the home. Care was provided based on people’s individual needs. There was a process in place so that people’s concerns and complaints were listened and responded to.

Although the last Care Quality Commission rating of the home was available on the provider’s website, this was not on display in the home. This omission had reduced the provider’s ability to demonstrate that they operated a transparent culture as part of their duty of candour.

People were looked after by some but not all staff who were trained and supported to do their job. The registered manager was supported by a team of managerial, care and ancillary staff. Staff were supported and managed to look after people but the systems used to do so, were not robust enough to monitor the progress of the training of staff.

Staff, people and their relatives were able to make suggestions and actions were taken as a result.

Quality monitoring procedures were in place but these had not always been effective to detect the omissions that we had found during our inspection. In addition, there was a lack of reviewing and analysing information in relation to incidents that had taken place. Therefore, there were missed opportunities to take action, if needed, to improve the safety and quality of people living at Summerville House.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities

During our inspection on 19 June 2014 we reviewed the checks that were in place to ensure that the quality of the service being provided was of an acceptable standard. We found that these did not provide enough information to support a judgement about the quality of the service.

The provider wrote to us and described the additional checks and audits that they would put into place. They told us that some new checks and quality audit systems would be put into place immediately and others would be fully in place by 31 July 2014.

During this inspection on 06 August 2014, we found that the provider had taken the appropriate action and had made the improvements required.

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

This is a summary of what we found:

Is the service safe?

Records we looked at showed us that risk assessments were completed where a risk had been identified. Measures were described and in place to reduce or eliminate such risks. Requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguarding (DoLS) were recognised by members of staff. Staff explained that they undertook regular training and we saw a list of dates when the staff refresher training was due to be updated. This showed that people were supported by members of staff who knew how to provide support in a safe and appropriate way

Full information was on display to provide people with enough detail to take any concerns they may have to the relevant organisation. This information included details of the type of procedures and actions that would be taken by the supporting agency.

Records showed that equipment such as hoists had been regularly serviced and fire checks had been completed on extinguishers. This supported the safety of people who lived at the service, as well as the safety of visitors and staff.

Is the service effective?

Our observations showed us that people who lived at the service were relaxed and confident when they discussed matters with members of staff. Staff took action when they saw anyone who appeared to be unsure or uncomfortable. One person was sleeping a lot during the lunch time and staff tried to encourage this person to eat and to speak with them.

Nutrition was monitored by staff as they watched to see how much each person ate at meal times. The cook was told if a person did not eat their meal so alternative options could be offered. We saw staff appropriately encouraging people to eat their meals. and regular checks on people's weight supported the early detection of any problems. Our observations and review of records showed us that staff did provide alternative meals when needed.

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw that people were dressed cleanly and appropriately for the weather on the day of our inspection.

Although we spoke with people who lived at the service, not everyone was able to answer our questions. This was because some people lived with dementia. However, our observations showed us that staff spoke with respect and in an appropriate manner when they provided support or care to people in the home.

Is the service responsive?

We saw that people's individual physical needs were being met. People were gently encouraged to decide what they wanted to eat at lunch time. Staff showed people what their food choices were by providing each meal for them to see. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. This showed us that staff supported and involved people. They did not rush anyone into a quick decision and responded to all requests.

Is the service well led?

We saw that a number of quality assurance systems, such as the issue of questionnaires, were in place. However, we found that not all these records were monitored or regularly completed. This meant that there was no information to indicate how comments and suggestions made by people living at the service their representatives, or staff had been appropriately responded to.

Records showed that members of staff had recorded what routines they had completed for example areas cleaned within the building or in the kitchen area. However, there were no spot checks or audits to ensure these duties had been completed to an acceptable standard.

We observed that staff members obtained people’s consent before supporting them with care or treatment. Care records recorded which decisions people were able to make for themselves and which decisions they did not have the capacity to make.

People did not always receive the care and support they required to improve their health and well-being. Assessments were completed and provided actions to reduce most risks identified. Care records were generally written in enough detail to provide guidance to staff members. However, care plans for social care needs and dementia care were not written in enough detail to meet people’s individual needs. Care records showed that people had access to the advice or treatment of a health care professional.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required. The cultural dietary needs of one person were not supported and they were not provided with alternative meals.

Medicines were stored appropriately and records were maintained to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

The service had a policy and procedure to guide people in how to make a complaint but there was inadequate information about taking complaints further.

We had not received notifications of events, such as the deaths of people at the service, which they are required to inform the commission about.

During our inspection of 20 September 2012 people told us they could relax at Summerville House, that the food was always very good and that staff always spoke kindly with them.

One person we spoke with said, "I like to read a lot and I sometimes go to the local library to get books or read the ones on the bookshelf". Another person we spoke with told us, "I can help out around the home whenever I want to, I keep myself busy".

During our visit on 25 August 2011 we spoke with a few people using the service and spent time in the communal areas of the home observing how care was provided. We also spoke with five different family carers who were visiting on the day.

We saw that staff were polite and respectful towards people using the service. They gave them explanations about the care they wanted to give and asked people's permission before they attempted to provide assistance to them. Staff supported people to make choices in their daily lives.

People told us that staff encouraged them to be independent and all the family carers we spoke with said that people using the service were treated with dignity. We saw that staff protected people's privacy and dignity when they were assisting with personal care. However, there was a lack of privacy screening at some of the ground floor windows. We noticed that any visitors at the front door could see into two people's bedrooms and one person, who was in bed during our visit was clearly visible.

People using the service and their relatives told us that they received good care at Summerville House. They said that staff were good at providing the care they needed. A family carer told us that staff tried hard to meet their relatives changing needs. Another relative said that their mother had a recurring health problem and said the staff dealt with it very well, calling the GP promptly whenever it was necessary.

There were various group activities in the home. On the day of our visit we saw people enjoyed a visit from the PAT dog and there was an external entertainer in the afternoon. One person told us that staff took them out whenever they asked, either to the local village or to town. Other people went out with family members.

People told us that they felt safe at the home and they would feel able to talk to the manager if there was anything they were unhappy or worried about. Family carers said they were satisfied with the way people were treated at Summerville House. One family carer told us, "I have never seen staff be anything but patient with everyone."

This inspection took place on 4 March 2015 and was unannounced, we also returned on 5 March 2015 to complete this inspection. Summerville House is a residential care home that provides accommodation, care and support for older people, some of who are living with dementia. There was a registered manager 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 and associated Regulations about how the service is run.

People felt safe living at the home and felt that their needs were met by staff who were caring, respectful and friendly. Staff treated people with respect and used a kind and considerate approach when providing any kind of support. People felt the staff and manager were approachable and they felt they could speak with them if they had any concerns or worries.

Staff knew how to make sure that people were safe and protected from abuse. They had been trained and had the skills and knowledge that was needed to provide support to people. They had completed training in the Mental Capacity Act (2005) and understood when best interest decisions were needed. The manager and senior staff dealt with any decisions about applications to be sent to a local authority Supervisory Body.

People had access to healthcare professionals when they became unwell or required specialist support for a medical condition. Their independence was encouraged. People and their representatives were consulted and involved in reviewing individual plans of care to ensure their needs were met.

The staff were feeling more confident about the management team as they felt they were now able to offer suggestions and felt supported and listened to. Staff worked together as a team and supported each other. A survey questionnaire had been sent to people to gain their view of the care and support provided. Relatives felt that their concerns and complaints had been quickly dealt with and resolved to their satisfaction.

Regular checks were made on the premises to make sure the home was suitable for people. People lived in a safe environment. Medicines were stored correctly and records showed that people had received them as prescribed.