This focused inspection took place on 10 July 2017 and was unannounced. At the last full comprehensive inspection in November 2016, we rated the service as overall 'good' but we rated the well-led domain as 'requires improvement' and issued a requirement notice to ensure quality monitoring was improved. At this inspection, we found there had been some improvements in how quality was monitored but further improvements in recording how this was achieved was required.

Somerville house is registered to provide personal care for 18 older people, some of whom may be living with dementia or have mental health needs. The service is situated close to the city centre and the shopping area of Hessle Road; it has good access to all local facilities. Bedrooms, bathrooms and toilets are located on each of the three floors. The upper floors are accessed by a passenger lift and stairs. There is a sitting room with a dining area at one end, a second sitting room and a small quiet room with a table and chairs. There is an outside patio and garden area at the rear of the property.

The service had a 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.

There had been some improvements in quality monitoring and there was a system in place, however this had only been partially completed since the last inspection. There was a list of audits and checks to be carried out each month; we saw these had concentrated on medicines and the environment. A process of updating care plans was also underway. The registered manager told us they would ensure the planned monthly checks in all areas would take place and people informed of what action they had taken to address any shortfalls.

There were discussions with people who used the service and staff on a daily basis but these had not been formally recorded. People who used the service and staff confirmed the discussions took place.

Staff confirmed communication was good within the service and they received information in the form of memos, the communication book and daily discussions. They reported a style of shift handover that was a mixture of verbal exchange and checking the communication book. The registered manager told us that following the inspection, written handovers would recommence.

We saw there was an open and inclusive culture within the service. People who used the service and staff felt able to raise issues with the registered manager and provider.

The registered manager had developed links with other agencies, for example the local medicines management team had visited to audit medication practices. Staff from commissioning and safeguarding teams told us they had no concerns about the service and the registered manager contacted them when required.

This inspection took place on 16 November 2016 and was unannounced. At the last inspection on 26 and 27 March 2015 we judged the registered provider required improvements in specific areas such as staffing numbers, detailed care plans, risk assessments, the laundry area and a more structured quality monitoring system. Whilst we found improvements had been made in some areas, for example the laundry area and with the detail and guidance in care plans and risk assessments we have found some issues still remain with ensuring the auditing programme is completed fully so shortfalls can be highlighted and addressed in a timely way. You can see what action we have asked the registered provider to take at the back of the full version of this report.

Somerville House provides accommodation and personal care for up to 18 people who may be living with dementia and/or enduring mental health needs. The service is located in a residential area in the west of the city of Hull and is set over three floors. At the time of the inspection, there were 18 people living at the service.

The service is required to, and did have, a registered manager. 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.

The registered provider did not have an effective system in place to monitor and improve the quality of the service provided. We saw there was no evidence of audits to highlight any shortfalls, drive continual improvement and to learn from any incidents that occurred at the service. You can see what action we have asked the registered provider to take at the back of the full version of the report.

There were enough staff to meet the current needs of people who used the service. Recruitment systems in place would ensure all employment checks were carried out prior to staff starting work at the service.

Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. People told us they felt safe living in the service and they had risk assessments to guide staff in supporting them.

Plans were in place for emergencies such as a fire or a flood and staff knew what to do in the event of an emergency. Safety equipment, and gas and electrical appliances were checked regularly.

We saw that people had person-centred care plans in place to instruct staff on how best to support them and meet their needs.

We saw that people enjoyed premises that were suitable for their purpose. The environment was well-maintained and comfortable. We found the level of cleanliness in the service was satisfactory; There were some areas of the service that needed minor attention which included the laundry area and one upstairs bathroom. The registered manager assured us these would be addressed.

Medicines were administered safely by trained staff and the arrangements for ordering and storage were appropriate.

The registered manager was able to show they had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to make decisions in people's best interests if they were assessed as lacking capacity. We identified a minor concern about the way the service obtained consent with one person. It was not clear how the registered provider had ensured they had been consulted about their care needs, and that the person had agreed and consented to the care and support being provided for them.

Staff understood people's care needs and spoke confidently about the support people needed to meet those needs. They told us they felt supported and had undertaken training that provided them with the necessary knowledge and skills they needed to carry out their rol

We found people were consulted about the care they received and could make choices about aspects of their lives. People told us they were treated with dignity and respect. Comments included, “Anything I want I see management or staff and they try to help as best they can”, “I’m quite self caring but the staff are here if needed” and “I like to get up early and I enjoy going to the centre on Wednesdays.”

We found people’s needs were assessed and care was planned so staff had guidance in how to support people. People told us they were well looked after and could see their GP when required. Staff demonstrated they knew people’s needs well.

We found the service managed medicines well and ensured that people received their medicines as prescribed.

We found the service was clean, tidy and well maintained. Although there wasn’t a redecoration plan we were told this was ongoing. People told us they were happy with their home.

We found staff had access to training courses and supervision. This meant staff could develop their skills and knowledge and were supported by management.

We found the service had a complaints policy and procedure. People told us they knew how to make a complaint and said they felt able to complain knowing it would be addressed.

People spoken with told us they liked the home and they were able to see their GP and community nurse when required. They also said staff respected the choices they made about aspects of their lives. Comments included, “I like it here, I like the people and the staff and everybody is alright”, “My room is the best room – I’ve got some tomato plants”, “It’s a friendly place and you can get up and go to bed when you want” and “I’m happy at the home – everything is fine.”

Most people spoken with told us they liked the meals provided. Comments included, “I like all the food – its hot and well cooked”, “I like the food, breakfast is good and I generally have toast, marmalade and shreddies” and “The food is nice – it’s well presented and well cooked.”

One person did say that some days were better than others. This was mentioned to the manager so that staff could speak to the person and ensure their likes and dislikes were accommodated more fully.

People spoken with told us if they wanted to have something on the menu this would be arranged.

People spoken with liked the home and said the staff were caring.

One person told us how the home was in their area and close to relatives. They said they liked living at the home and they could go to bed and get up when they liked. They also said the staff were friendly and went to the shops for them.

Another person spoken with said, “The staff are wonderful – they really are” and “I’m poorly at the moment, they are good to me.”

One person spoken with told us that another person punched them on the arm and wouldn’t let them pass by. They said they told staff about this. One person told us they became upset by the way another person who lived in the home spoke to staff.

People told us they were happy with the care they received at the home. One person told us “The girls are very caring and nothing is too much trouble,” “My key worker takes me shopping and out for walks,” “I can come and go as I please.”

People told us they knew who to raise any concerns with. One person told us “I would see the boss.”

We undertook this unannounced inspection on the 26 and 27 March 2015. The last full inspection took place on 23 May 2013 and the registered provider was compliant in all the areas we assessed.

Somerville House is registered to provide accommodation and personal care for 18 older people, some of whom may have dementia. The home is situated close to the city centre and has good access to all local facilities. Bedrooms are located on each of the three floors. The upper floors are accessed by a passenger lift and stairs. On the day of the inspection there were 18 people using the service.

The service has a 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.

There were enough staff to meet the current needs of people who used the service. We saw there were some potential gaps in staffing numbers at specific times of the day. These were discussed with the registered manager and registered provider to check out. There were recruitment systems in place that would ensure all employment checks were carried out prior to staff starting work at the service.

Staff completed safeguarding training and knew what measures to take to help to protect people from the risk of abuse or harm. Risk assessments were completed although we found these lacked some important information to guide staff in how to manage and minimise risk.

People had their health needs met and had visits from professionals for advice and treatment. Staff administered medicines in a timely way so that people were not left waiting for their tablets.

People told us they enjoyed their meals and had enough to eat and drink.

Staff received guidance and completed essential and more specific training in order for them to feel confident when supporting people. The registered manager had completed training in how support people whose primary need was related to their mental health. A community psychiatric nurse had provided an awareness session for staff and additional training was being sourced.

Staff approach was seen as caring; they took time to speak to people, they respected privacy and dignity and they involved them in day to day decisions. We saw people were encouraged to participate in activities, to maintain their independence and to access community facilities.

We saw the care plans could be improved to include more personalised care and provide more thorough guidance to staff. Despite this we found staff knew people’s needs well.

People felt able to raise concerns and the registered manager and registered provider were available for people who used the service, their relatives and staff to talk to.

There were some checks completed but the quality monitoring system was more ad hoc than planned in a structured way and lacked robust recording. People’s views were sought in meetings and via questionnaires about the service. This helped to identify shortfalls so they could be addressed.