About the service:

The Summers is a care home without nursing for a maximum of 35 older people, some of whom are living with dementia. There were 35 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People were cared for in a safe and friendly way at this home. The main reception area was a lively area of the home where people and staff congregated to socialise and enjoy the sun shining through the main doors. One relative told us, “The staff go above and beyond for the residents.” Another relative said, “ They are so kind here its incredible.” Staff danced, played games and chatted with people throughout the day giving the home a family atmosphere.

Although there had not been enough staff to ensure safe care for people at the time of the inspection, staff numbers were increased immediately following the inspection by the provider. Staff were well trained to safely care for people and knew how to engage and empower them. People had access to health care professionals throughout the week. One doctor told us, “They are a good service. They are consistent and ensure that people are looked after.”

People’s needs, choices and preferences were recorded in person centred care plans. The food at the service was enjoyed by people as they were able to choose what they ate from a menu with variety. The care records enabled staff to correctly provide care and support for people in a safe way. Complaints and concerns were recorded, responded to and used to consider improvements at the service.

The registered manager led by example in providing person centred care and interacting with everyone who visited the service. Detailed audits were completed to check and quality monitor the service and the care it provided. Where certain auditing needed improvement, the management team and provider were receptive and swift to implement changes.

Rating at last inspection:

Good (29 June 2016)

Why we inspected:

This was a scheduled comprehensive inspection. We inspect all services rated as 'Good' within 30 months to ensure that we regularly monitor and review the quality and safety of the service people receive.

The inspection took place on 29 June 2016 and was unannounced. Two inspectors carried out the inspection.

The Summers is a care home without nursing for a maximum of 35 older people, some of whom are living with dementia. There were 27 people using the service 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 and associated Regulations about how the service is run.

At our last inspection on 17 April 2015 we found breaches of Regulation 9, Regulation 12, and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection, we found the provider had taken action to meet the legal requirements and to improve the quality of care people received.

The management of medicines had improved. Staff had access to the training, supervision and support they needed to do their jobs. Care plans were reviewed regularly to ensure they reflected people’s needs and preferences about their care.

People were safe because there were enough staff on duty to meet their needs. Risks to people had been assessed and staff had taken action to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy.

Staff knew the needs of the people they supported and provided care in a consistent way. Staff shared information effectively, which meant that any changes in people’s needs were responded to appropriately. People were supported to stay healthy and to obtain medical treatment if they needed it.

The registered manager and staff acted in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions had been assessed and meetings had been held to ensure that decisions taken about people who lacked capacity were made in their best interests. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People enjoyed the food provided and could have alternatives to the menu if they wished. People’s nutritional needs had been assessed when they moved into the service and were kept under review. Staff ensured that people who required assistance to eat and drink received this support.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were professional and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity. Relatives told us they were made welcome when they visited.

People had opportunities to take part in activities they enjoyed. Activities and events that fostered engagement with the wider community had been introduced and the registered manager had plans to improve opportunities for trips to local places of interest.

The provider had a written complaints procedure, which was given to people and their families when they moved in. Any complaints received had been appropriately investigated and responded to. Regular residents and relatives meetings had been introduced to provide opportunities for people to give their views.

The

The inspection took place on 17 April 2015 and was unannounced.

The service is a purpose-built home providing residential care for up to 35 older people, some of whom are living with dementia. There were 21 people living at the home at the time of our inspection. Accommodation is arranged in four units over two storeys. All bedrooms are for single occupancy and have en suite bathroom facilities.

There was no registered manager in post at the time of our 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 persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The service manager had been in post for three weeks at the time of our visit and had begun the process of registering as manager with the CQC.

People’s medicines were not always administered or recorded accurately. For example there was no record that one person had received their medicines on four occasions during one week in March 2015 and no record that another person had received their medicines on four occasions during one week in April 2015.

Some staff had not attended training in core areas as often as the provider’s training policy stated they should. For example fewer than half the staff employed had attended dementia awareness or end of life care training in the last two years and only one third of staff had attended infection control training in that period. Staff had not been appropriately supported through supervision and appraisal or had opportunities to discuss their professional development needs.

People’s needs had been assessed but had not been regularly reviewed, which meant that their care plans did not accurately reflect their needs or preferences about their care. The service manager told us that recent quality monitoring checks carried out by the provider had identified that people’s care plans did not reflect their needs as they had not been reviewed or updated for some time.

People told us that there were not enough opportunities to take part in activities or to go on trips out. They said they enjoyed the activities and outings that had been arranged but that they would like these to be organised more often.

People told us they felt safe at the service and that staff were available when they needed them.

Staff were aware of their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had.

Risks to people had been assessed and control measures had been put in place to mitigate against these risks. There were plans in place to deal with foreseeable emergencies and to ensure that people’s care would not be interrupted in the event of an emergency. People were kept safe by the provider’s recruitment procedures.

The service manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which meant that people’s care was provided in the least restrictive way. People told us that staff asked them for their consent when they were supporting them. They said staff encouraged them to make decisions and supported their choices.

People were supported to stay healthy and to obtain treatment when they needed it. People told us that they were able to see a doctor if they felt unwell and that staff supported them to attend medical appointments. People told us that they enjoyed the food provided by the service and that they could have alternatives to the menu if they wished. People’s nutritional needs were assessed and any dietary needs recorded in their care plans. Any specific dietary needs were communicated to kitchen staff by the care staff.

The service provided accessible, safe accommodation. The premises were suitably designed for their purpose and adaptations and specialist equipment were in place where needed to meet people’s mobility needs. The service manager told us that the service improvement plan included plans to make the environment more dementia-friendly for people living with this condition.

People told us that staff were kind and caring. They said they had good relationships with the staff and that staff treated them with respect. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity.

People told us that they would feel comfortable making a complaint if they needed to and were confident that any concerns they raised would be dealt with appropriately. The complaints record demonstrated that any complaints received had been investigated and responded to appropriately. The service manager had improved the systems through which people could give their views about the service. Regular meetings had been introduced for people who used the service, relatives and staff at which they were encouraged to provide feedback about the service and suggest improvements.

There was no registered manager in place at the time of our inspection. The service manager had been in post for three weeks at the time of our visit. Whilst the service manager had made improvements since their arrival, leadership of the service had been inadequate until that point.

Staff told us that the service manager had improved the leadership and support they received.

They said the service manager was open and approachable and available for advice if needed. The service manager had improved the systems for quality monitoring and auditing. A service improvement plan had been developed following a recent clinical governance audit, which aimed to address the areas where improvements were needed.

During the inspection we identified some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.