This inspection took place on 6 and 7 February 2017 and was unannounced. Whittington House Nursing Home (formerly known as Summerfield Nursing Unit) provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 25 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home. This service was last inspected in December 2015.

A registered manager was in place as required by their conditions of registration. 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 registered manager had been in post since August 2015.

This home had recently been acquired by Caring Homes Group and renamed Whittington House Nursing Home. The new provider had been proactive in monitoring the service and driving the quality of care being provided and the governance of the home. They had consulted with people, their relatives and staff and were implementing their systems and processes to standardise the quality of care.

People had their individual needs regularly assessed, recorded and reviewed. People were supported to have care plans that reflected how they liked to receive their care, treatment and support. Their risks were mainly managed well however people’s risks associated with their equipment had not always been considered and documented. We have made a recommendation about the use of people’s safety equipment.

Staff referred people to the appropriate health care services if their physical and mental well-being changed. There were safe medication administration systems in place and people received their medicines when required, however their some discrepancies in the stock of some people’s medicines and whether they had received their prescribed creams. The management were aware of these shortfalls and were actively working with staff to address these issues.

Staff encouraged people to make choices about their day and respected their decisions. Where people lacked capacity to understand significant decisions, other significant people such as GPs and family members had been involved in the decision process.

People had been given the support they required with maintaining a healthy nutritional diet. Risks relating to people’s nutrition had been identified and addressed. People’s weights were monitored and GPs were made aware of any nutritional concerns.

People and their relatives complimented the caring nature of staff. We received many positive comments about the home. Staff delivered compassionate care which was focused on people’s individual needs.

Two activity coordinators had been recently employed. They were consulting with people about their recreational interests and personal histories. Plans were in place to provide a selection of personalised and group activities to prevent social isolation.

There were sufficient staff to meet people’s care and support needs. Staff had been recruited well and trained to carry out their role. People were supported by staff who had access to support and a range of training to develop the skills and knowledge they needed to support people. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

This full comprehensive inspection took place on 14 and 15 December 2015 and was unannounced.

Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 27 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home.

A new manager had recently been appointed to run the home and was in the process of applying to become the 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.

At the last comprehensive inspection on 1 and 2 June 2015, this provider was placed into special measures by CQC. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do meet legal requirements in relation to breaches of regulations relating to people’s consent to their support and care which was personalised and focused on them.

We undertook this full comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements. This inspection found there were enough improvements to take the provider out of special measures. The provider now met their legal requirements but further improvement was required. We have made some recommendations which we will follow up at our next inspection.

A care management company previously commissioned by the provider and the new manager had made significant improvements to the standard of care that people received. They were working through a series of action plans with clear time frames to ensure the service progressed and improved. Effective systems and protocols were being developed and implemented to ensure people received appropriate care and support to meet their needs. The manager was aware of that the home had previously fallen below the required standards of care and was working with the provider and staff to ensure people received the care and support which they required. The manager recognised that whilst significant progress had been made in the care of people; there was still need for further improvement.

During the inspection we found the delivery of people’s care had significantly improved, however there still remained some inconsistencies in some people’s care and their records, although we found no negative impact on people as staff were knowledgeable about people’s needs.

People benefited from a service where staff understood their responsibility to protect people. Risk assessments were in place to support people but the monitoring of people’s risks was not consistently recorded. Systems were in place to ensure people’s medicines were ordered and given to them when required. People’s records of their daily administration of their medicines were accurate. However further details were required for some medicines which would provide staff with additional guidance.

Staff recruitment procedures ensured that people were supported by sufficient numbers of staff to meet their basic care needs. However, there was no formal system in place to monitor people who were left unsupervised for periods. Social interaction and encouragement was not consistently carried out when staff supported people with their meals.

Some people did not engage in meaningful activities or social interaction throughout the day. However an activities coordinator had recently been employed to provide recreational and social activities to people. Some people’s bedrooms had been personalised, though the home’s environment did not support people with

We carried out an unannounced comprehensive inspection of this service on1 and 2 June 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to people’s safety and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to people’s care records.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerfield Nursing Unit on our website at www.cqc.org.uk.

Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 28 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home.

The provider had recently appointed a new manager for the home who would be applying to be registered with the Care Quality Commission as required by their conditions of registration. 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. An ‘improvement lead’ from a care management company acted on behalf of the provider and supported us with our inspection as the new manager was not available on the day of our inspection. The provider had commissioned the care management company to help improve the quality of the service.

At this inspection we found the support and care provided was now safe and responsive to people’s care needs. The layout and detail of people’s care records had been reviewed and updated. People’s individual risks were being assessed, monitored and recorded. This gave staff with sufficient information to guide them on how best to deliver care that was centred on people’s needs and helped to reduce risks. There were improved links with other health care professionals.

The knowledge and clinical skills of staff was being monitored and updated to ensure people were cared for by staff with current care practices. The medicines policy had been updated to give staff clear guidance on how people’s medicines should be managed. Protocols were in place for people who needed their medicines ‘as required’.

At an inspection of this service in November 2014 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action with five of the breaches and issued a warning notice for one other breach, stating they must take action.

We undertook this focussed inspection on 25 March 2015 to follow up on the warning notice and to check if the provider had made improvements to the care and welfare of people. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Summerfield Nursing Unit on our website at www.cqc.org.uk.

At this inspection we found the support and care provided was not responsive to some people’s care needs. Some people still remained at risk because their care records still did not give staff the specific guidance required to meet people’s needs. Information was held in both electronic and paper form. However not all staff were able to access electronic records and so had to rely on verbal handover from paper records. Paper records did not always give enough information about people’s needs.

The purpose of this inspection was to follow up on some information we had received. We did not speak with any people about this but we examined records and spoke with the provider and registered manager.

The provider had recently moved locations after purchasing another service and combining the two. We had been told that a number of people had been asked to leave this service as the provider no longer wanted to provide a service to them. These people had a diagnosis of dementia. The provider told us the service they provided at the previous location was to people whose primary need was nursing care and not personal care. They also said they still provided care for people with dementia if their primary need was nursing.

The provider's terms and conditions stipulated the notice period they would give to a person if they felt they could no longer meet their needs.

The provider's Statement of Purpose informed people of the services provided and range of needs this location was intending to meet and those needs it was not able to meet.

People and their relatives/representatives had access to a complaints system. Comments and complaints people made were responded to appropriately.

This inspection took place on 1 and 2 June 2015 and was unannounced.

Summerfield Nursing Unit provides accommodation and nursing care for up to 66 people who have nursing needs. At the time of our inspection there were 31 people living in the home across two floors. The home is a four floor, purpose built building. Each floor had a lounge, dining room and small kitchen. A cinema, library, hairdresser’s salon and gardens were available to people who live in the home. A registered manager was not in place as required by their conditions of registration. 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 provider had commissioned a care management company to help improve the quality of the service. An ‘improvement lead’ from the care management company acted on behalf of the provider and supported us with our inspection.

People and their relatives were mainly positive about the care they received from staff. However, people’s safety and well-being continued to be compromised in a number of areas. The care of people with complex medical needs were not always supported and treated effectively. People’s care records did not always provide staff with enough personalised information and guidance on how best to support them. The management and assessment of some people’s risks had not been recorded accurately. Action taken when people became unwell had not always been recorded or managed in line with their care records or recommendations by other health care professionals. Whilst people were supported to have a nutritious diet those with specific needs such as being at risk of weight loss were not being managed well. Staff did not fully understand the princples of gaining people’s consent to their care if they lacked mental capacity.  Activities in the home were limited and some people were socially isolated. There were adequate numbers of staff to meet people’s needs.

Systems to recruit suitable staff were in place but not as thorough as they should be. The reasons why staff had left their previous employment were not always investigated. Some improvements had been made in the planning and delivery of staff training which was deemed as mandatory by the provider. However the clinical skills and knowledge of staff had not been assessed or updated. A plan was in place to ensure that staff were regularly supported and mentored. Staff meetings had been implemented so staff could share information about people and the running of the home. The home had an established staff team who were familiar with people who lived in the home.

The provider had put systems in place to understand the views and experiences of people and their relatives. The improvement lead had started to implement systems to monitor and check the quality of the service. Actions plans were being produced to address the identified shortfalls. The provider was actively recruiting a manager to run the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.