About the service:

Somerforde Limited is a residential care home that provides personal and nursing care to 22 people aged 65 and over. The service is in a large house, set in its own grounds, over three floors. It is in the Devon town of Newton Abbott and overlooks a mature park.

People’s experience of using this service:

• At our last inspection Somerforde Limited was rated requires improvement and we found two breaches of regulation relating to safe care and treatment and good governance. At this inspection we found improvements had been made and the service was no longer in breach of regulations.

• Overall medicines were managed safely, however some further improvements were required to improve recording. These issues were addressed during the inspection and after the inspection we were sent information to show how the changes had been embedded within staff practice. and after the inspection we were sent information to show the service had resolved them.

• People were supported by caring staff that enjoyed coming to work in the service and knew people well.

• Care plans were person centred and captured preferences and people’s histories. Staff tailored their support to how people liked it.

• People told us they felt safe and happy in the service. Relatives said they were happy their family members were living there.

• Staff were aware of how to report any safeguarding concerns and had become more confident in identifying deteriorating health, and referring onwards to health care professionals

• The environment had undergone improvements with the whole service being refurbished. Environmental checks were undertaken regularly. We identified that window restrictors did not meet best practise guidance so the provider addressed this on the day of inspection.

• People were asked for consent before care was provided. People were offered choice and control over their day.

• Staff were supported through supervision and training and the provider and registered manager now had a robust quality assurance system.

We have recommended that the service review how they manage medicines in line with NICE guidelines.

Rating at last inspection: The rating at the last inspection was requires improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will monitor the service on an ongoing basis and re-inspect according to our schedule. We may inspect sooner if we receive information of concern.

This unannounced inspection took place on 16 and 17 January 2018.

Somerforde 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.

Somerforde is a large detached property set within its own grounds and is registered to provide accommodation for up to 24 older people who require nursing or personal care. The home cannot provide nursing care. Accommodation is provided over two floors in one adapted building, a passenger lift provides access between floors. On the day of our inspection 20 people were living at the home.

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.

When we completed our previous inspection in November 2015 we awarded an overall rating of 'Good'. During this inspection on 16 and 17 January 2018 we found a number of concerns relating to the key questions safe and well led. Therefore, for this inspection the service has been awarded the overall rating of 'Requires Improvement'. This is the first time the service has been rated 'Requires Improvement'.

People were not always protected from the risk of avoidable harm. Risks to people's health and wellbeing were not always identified in people's care plans, and risk management plans were not always in place to instruct staff on how they should care for people safely. Where risks had been identified, action had been taken to minimise the risk, such as using pressure relieving mattresses. However, there was no guidance in care plans or risk assessments to instruct staff on what pressure the mattresses should be set at and there was no system in place to ensure mattresses were set at the correct setting.

Where risk management plans were in place, such as; repositioning charts and topical medicines application charts, we saw they had not been completed consistently and we could not be sure from the records that people had received the care they needed.

The accident and incident monitoring system was not robust. We found accidents or incidents relating to people had not always been documented by staff. Therefore, the registered manager was not in a position to investigate further to ensure actions were followed through to reduce the risk of incidents occurring. Accidents and incidents had not been audited and no analysis of accidents or incidents had taken place since November 2017 to look for patterns or trends.

Medicine audits were being undertaken; however these were not always effective. We found that whilst medicines were being administered safely, the arrangements in place to manage reordering of medicines and stock control meant there was a risk that people's medicines might not be available when they needed them. Medicines audits had not identified concerns, such as inaccurate stock, temperature monitoring of medicines storage and medicines not being dated once opened.

The registered manager had quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided at Somerforde. We found the registered manager used a variety of systems to monitor the home. However, governance systems had not identified a number of concerns we found at this inspection.

Following the inspection we received a report from the registered manager describing how they had responded to the concerns and what actions they had taken to address the issues. Medicines administration and stock replenishing systems and the monitoring of risks and falls have been strengthened and any issues dealt w

There were 23 people living at Somerforde at the time of our inspection. We spoke with eight people who lived at the home and also spoke with two care workers a senior care worker and the providers of which one was the manager of the home. At the time of our inspection the provider did not have a registered manager in post.

We found that people's consent had been obtained for care and treatment provided to them by the service.

People who lived at the home told us they were well looked after and were happy. One person said "You'd have to go a long way to find anywhere better".

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people's needs.

People told us that they felt safe and knew what to do if they had concerns. One person said "We have residents' meetings when we can raise any concerns we may have. If there are any urgent concerns we can talk to any of the staff. "People told us that they would not hesitate to report any issues to any member of staff. One person said, "I would complain if there was ever anything to complain about".

We (the Care Quality Commission) last visited Somerforde in March 2012 because some concerns had been raised with us. At that visit we found that Somerforde was not meeting one or more essential standards and that improvements were needed. During this inspection we looked to see if these improvements had been made and we found that they had.

People that we spoke with were very happy with the care being provided. One person told us "I'm very happy here. I come and go as I please". Another person told us they were "Thrilled to bits – can't believe it!".

We spoke with six people who were able to tell us about their experiences of living at the home. One person told us they had visited several homes before they came into Somerforde. They told us that they were really happy and that "It feels as if I have been here forever". People told us that staff supported and helped them when they needed assistance. They said that they felt well supported by staff and that there was always someone around to help them if they needed anything.

During our visit we heard staff speaking with people in a respectful and caring way. We also saw that staff were friendly and patient in their approach. People appeared relaxed and comfortable in their interactions with staff.

All the staff we spoke with told us that they felt supported by the providers. They also told us that they received regular supervision.

The home was last visited by the Commission for Social Care Inspection (the predecessor organisation of the Care Quality Commission) in October 2008.

We (The Care Quality Commission) had received concerns stating that Staff had been told that they must get a certain number of people living at the home up each morning. This meant that people were having to be woken as early as 5.30am in order for staff to get everyone up. We were also told the food at the home was terrible, that people cannot raise issues with the owners, that people are being admitted to the home whose needs cannot be met, that staff are too busy to spend 'social time' with people and that staff receive little training.

We arrived at the home at just before 7am and found two people up and sitting in the dining room. Night staff told us that both people had been awake when they had gone to get them up and that they had been in the dining room since about 6.30. Both people had a drink and bread and butter in front of them. Neither of these people could tell us if they had wanted to be got up, although their care plans did indicate that they normally woke around 7.00am.

We looked at the care files for three people living at the home. We saw that their preferences relating to times of getting up and going to bed as well as food likes and dislikes were recorded. The two people that we spoke with knew they had a care plan and what was in it.

We saw no evidence that the home was unable to meet the needs of anyone living there. The provider told us that they had often refused to accept people into the home if they felt their needs could not be met.

We saw a record of activities that showed an activity is available to people every afternoon, it also recorded who had attended the session. One person told us "there is always something going on".

The cook told us that people were always offered a choice of main meal at lunchtime. They told us that they made a list of items that were required and the owners then did the shopping. They were concerned that the majority of the food purchased was 'value' range and that sometimes quantities were limited. They told us that "it's the little extras that aren't there, that makes things special for people". They also said that they liked to make puddings themselves, but that these were often brought in 'ready made'. One person living at the home told us the food was "OK – sometimes good and sometimes bad" but added that they were "a very fussy eater".

Staff told us and the owner confirmed that not all staff had received up to date training in relation to moving and handling. Staff also told us that they had not received training in caring for people with a dementia type illness. The provider told us that some staff had received training in these areas.

Somerforde Ltd is a care home registered to provide accommodation for up to 24 older persons who require nursing or personal care. Nursing care is not provided by the home. The community nursing team provide nursing care and support when required. Some people were living at the home for short term respite care with a view to returning to their own home.

This inspection took place on 24 and 26 November 2015 and the first day was unannounced. There were 22 people living at the home at the time of the inspection.

One of the two company directors held the position of registered manager and was in day to day control of the running of the home. The other director attended the home daily. 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 received a mixed response when we asked people their views on the quality of the meals provided by the home. The majority of people said the food was “good”, “very nice” and “it’s lovely, too much sometimes.” Five of the thirteen people we spoke with said it was not to their liking. We discussed these findings with the registered manager who showed us the audits the home had previously undertaken to gain people’s views. We saw the results of these were all positive. However, they gave assurances they would speak with each person again to ascertain their views about how to improve their enjoyment of the meals.

People spoke highly of the care they received. They told us they felt safe and were supported by kind and caring staff. One person said, “yes, it’s especially nice here” and another said, “this is wonderful. The best place in England.” A relative told us “I can relax knowing mum is safe and cared for.”

The registered manager said, “residents’ wishes are at the forefront of their care to allow them to live their lives as fully as possible.” We saw risks to people’s safety and well-being were well managed and people’s rights were respected. Care needs and the support and assistance required to meet these was well documented and staff received clear guidance about how to keep people safe. People were involved in planning their care and reviewing how well the home was meeting their needs. Staff were knowledgeable about people’s needs and their preferences. People received their medicines as prescribed and medicines were managed safely.

Recruitment practices were safe and staff were employed in sufficient numbers to provide a safe and caring home. Staff told us they enjoyed working at the home. They all said, “I love working here” or “I love my job.” Staff had completed training in a variety of training topics such as person-centred care, nutrition, diabetes and dementia care as well as health and safety topics to give them the skills they needed to meet individual care needs.

People had regular access to healthcare professionals. When concerns about a person’s health were identified, staff sought professional advice promptly. Community nurses told us they had confidence in the staff’s ability to care for people well.

Leisure and social activities were planned to provide meaningful engagement for people. However, the involvement of people who may be at risk of social isolation needs to be better recorded.

People, relatives and staff told us the home was well managed. There were clear lines of responsibility in the home and staff worked well as a team. The registered manager was described as “wonderful, really supportive” and people also praised the deputy managers. People said if they had concerns they were confident these would be listened to and dealt with promptly.

People told us the home was always clean and fresh smelling. The premises and equipment were well maintained. There were systems in place to assess and monitor the quality of care. The registered manager had audited care records, policies, the environment, and staffing. People, relatives and staff were encouraged to share their views for improving the services provided at the home.