About the service: Summerhill is a care home which is registered to provide personal care and accommodation for up to 29 people, some of whom have a dementia related condition. Accommodation is over two floors. At the time of this inspection 28 people were living at the service.

People’s experience of using this service: All people told us they enjoyed living at the home. They told us there was a “homely” and “friendly” atmosphere. One person said, “I don’t think you could better it. I am so fortunate to be able to come here.”

The home was clean and well maintained. Practical fire drills had not been carried out by night staff at the time of our visits to the home. Following our visits, the registered manager and night staff confirmed that practical fire drills had been carried out.

People told us they felt safe. Staff were knowledgeable about the action they would take if abuse were suspected. Abuse had been substantiated following a recent safeguarding investigation. Lessons had been learnt and actions taken to reduce the risk of any reoccurrence.

There was a creative activities programme in place. People were supported to access the local community and nearby towns and villages. Entertainers visited regularly and the home had their own backing singers known as the ‘Summerettes.’

Several staff told us the culture at the home was not always positive. Some thought that this was due to staffing levels and the pressures on them at certain times of the day. Staffing levels were increased at the time of our inspection. We have made a recommendation that the provider reviews their quality assurance system to ensure timely action is taken to address any shortfalls.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Requires improvement (report published 17 January 2018).

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

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate and high quality care. Further inspections will be planned for future dates.

This inspection took place on 15, 20 and 21 November 2017 and was unannounced. A previous inspection, undertaken in August 2015, found there was one breach of legal requirements but rated the service as ‘Good’ overall.

Summerhill 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. The home is registered to provide support for up to 29 people over two floors. At the time of the inspection there were 26 people using the service. Nursing care is not provided at the home.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. A registered manager is a person who has registered with the 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 told us they were safe living at the home and staff had a good understanding of safeguarding adults procedures. We found some safety issues at the home including furniture and electrical items stored on an emergency exit route and an unsecured laundry area. Maintenance of the premises had been undertaken and certificates were available. Accidents and incidents were recorded and monitored.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff members told us there were enough staff at the home. We found some issues with the management of topical medicines at the home, such as creams and lotions. Records regarding these were not available or up to date. People told us the home was maintained in a clean and tidy manner.

Staff told us they had access to a range of training. They said they had regular supervision and annual appraisals. People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found legal consent and best interests decisions were not always well recorded and could not determine if the MCA guidance on this matter had been followed.

People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements. Where people’s intake was monitored we found food and fluid charts were not always up to date or accurately completed.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity. People and relatives told us they were regularly involved in care decisions.

Care plans were detailed and related appropriately to the individual needs of the person. Care records were not always easily followed as updates were sometimes added to the margin of documents. Reviews of care were variable in quality. A wide variety of activities were offered for people to participate in and people spoke very highly about the range and quality of events at the home. The registered manager dealt with complaints appropriately. People and relatives told us they had no reason to raise concerns or issues were dealt with immediately.

The registered manager told us regular checks on people

We considered our inspection findings in order to answer the questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We spoke with four relatives and six people to find out their opinions of Summerhill. We also consulted a clinician in challenging behaviour, care manager and reviewing officer to hear their opinions concerning Summerhill. All spoke positively about the home.

People were treated with respect and dignity by the staff. They were cared for in an environment that was safe, clean and hygienic. People themselves informed us the home was “very clean.” They also told us that they felt safe. One relative told us “She says ‘they are so lovely with me’ so whenever I leave the home I know she is safe. I would know if something was wrong.” We spoke with the local authority’s safeguarding adults’ team and contracts and commissioning team who did not raise any concerns about the service.

Systems were in place to make sure that lessons were learnt from events such as accidents and incidents and complaints and concerns. This reduced any risk to the people and helped the service continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to have been submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People were extremely happy with the care that was delivered. They told us that their needs were met. One person commented, “It’s brilliant, the staff really look after you.” It was clear from our observations and through speaking with staff that they had a good understanding of people's care and support needs.

People told us that consent was gained before any treatment was carried out. “They check with me and they check with mum about everything.”

Is the service caring?

People were supported by “kind” and “lovely” staff. We saw that care workers showed patience and gave encouragement when supporting people. One person informed us, “The staff are lovely.” Another person said, “Every need is met here.” Health and social care professionals informed us that they had no concerns about people’s care and welfare. The care manager and reviewing officer with whom we spoke informed us that they were happy with the care that was delivered at Summerhill. The clinician in challenging behaviour told us that one person’s relative had gone on holiday. She explained that staff had taken the person out into the local community on a number of occasions to try to distract her from her daughter’s temporary absence.

There was a cheerful atmosphere at Summerhill. Many staff had worked there for a considerable period of time. This experience contributed to the efficiency and skill with which staff carried out their duties.

Is the service responsive?

People's needs had been assessed before they visited the service. They had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. The service had its own minibus, which helped to keep them involved with the local community. One relative was very appreciative of the transport facilities and told us, “The transport is really good. They go out three times a week.”

Health and social care professionals with whom we spoke, informed us that staff always contacted them if there were any problems or concerns.

Is the service well-led?

The manager was currently on annual leave. Two deputy managers assisted us with the inspection. They were extremely knowledgeable about processes and systems at Summerhill and were able to locate all documents which we requested immediately.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly.

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held. This was confirmed by minutes of meetings. Staff morale at the home was good and staff spoke positively about working there and the support the manager gave them.

We spoke with seven people who used the service and two relatives to find out their opinions of the service. Comments from people included, “It’s homely.” One relative told us, “It’s fab – everything – the food, the atmosphere and there’s never any smells.”

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We contacted a number of health and social care professionals to find out their opinion of the service. These included a GP, a district nurse, a member of the challenging behaviour team, a member of the occupational therapy team, a dentist, a podiatrist, a member of the local authority review team and a social worker. We concluded that people’s health, safety and welfare was protected because the provider worked in co-operation with others.

We found there was enough equipment to promote the health, independence and comfort of people who use the service.

People were complimentary about the staff. Comments included, “The staff are lovely” and “They seem to recruit well.” We concluded appropriate checks were undertaken before staff began work and effective recruitment and selection processes were in place.

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We found that people’s personal records and those records which related to staff and the management of the service were accurate and fit for purpose.

We found that the provider now had appropriate arrangements in place to manage medicines. We spoke with three people who lived at the home to find out their opinions. People told us that staff were efficient at administering their medication. One person said, “I cannot fault them at all, everything is done and delivered at the correct time.” Another person told us, “It’s much better than what we could do at home. You never have to wait for your tablet; they’re very good, excellent.” Other comments included, “They never ever forget. After each meal, the medication comes” and “I’m on warfarin and they’re excellent. Any changes with my warfarin are seen to straight away.” Warfarin is a medication which helps prevent blood clotting.

We spoke with eight people who lived at the home and two relatives, to find out their opinions on the care provided at the home. One person who lived there said, “I love it here. They’re all very friendly. I’ve got everything I want. There’s nothing to complain about…I’m very lucky to be here – I’ve fallen on my feet” and “You don’t want for anything.” Another person told us, “We think it’s first class. We go out three days a week, that’s a plus.” Other comments included “I think it’s very homely here and very friendly. I have no grumbles.”

We also spoke with a GP who was visiting the home. Her comments are included within this report.

This review was carried out to check improvements made to the service's procedures for safeguarding adults. We did not speak directly with users of the service on this occasion.

The inspection was carried out over two days. We visited the service unannounced on 4 August 2015 and announced on 18 August 2015. Our expert by experience contacted relatives by telephone following our visits to the service.

The service met all of the regulations we inspected at our last inspection in April 2015.

Summerhill provides care for up to 29 older people, some of whom have a dementia related condition. Nursing care is not provided. There were 27 people living at the home on the days of our inspection.

There was a registered manager in post. 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 and associated regulations about how the service is run.

People, relatives and health and social care professionals spoke positively about the service. One relative said “I would thoroughly recommend it. It’s a fantastic place and the staff are excellent.”

We checked the premises and saw that the home was clean and well maintained. We observed however, that the windows did not have restrictors fitted and a risk assessment had not been completed to assess this risk. This meant window safety did not comply with current guidance from the Health and Safety Executive on preventing falls from windows in care homes.

Most people and relatives informed us that there was enough staff to meet people’s needs. One relative informed us that more staff were required to cover annual leave and sickness. The manager told us that two new staff had been recruited. We found that night time staffing levels had not been assessed to ensure that there were sufficient staff on duty to evacuate people safely in the event of an emergency. The manager told us that this would be addressed immediately.

Staff knew what action to take if abuse was suspected. There were no organisational safeguarding concerns. Safe recruitment procedures were followed.

We checked medicines management and saw that an effective system was in place for the receipt, storage, administration and disposal of medicines.

Staff were appropriately trained and told us they had completed training in safe working practices and were trained to meet the specific needs of people who lived there such as those who were living with dementia.

People received food and drink which met their nutritional needs. There was a happy atmosphere in the dining room and it was clear that people were enjoying their meals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care

homes. DoLS are part of the Mental Capacity Act 2005 (MCA). They aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager was aware of the Supreme Court judgement which had redefined the definition regarding what constituted a deprivation of liberty and was liaising with the local authority to ascertain the impact this ruling had on people who lived at Summerhill. While we saw that some mental capacity assessments were in place, further work was needed to ensure that decision-specific assessments were carried out and best interests meetings held to ensure that all actions taken were in the best interests of people in line with legislation.

Staff were knowledgeable about people’s needs and we saw that care was provided with patience and kindness and people’s privacy and dignity were respected.

We saw that an activities programme was in place. People were supported to access the local community. A complaints process was in place. Most of the people and relatives told us that they had no concerns about the service. One relative informed us they had not received a response to their complaint. This was not connected to staff or the care and support provided. The manager told us that she had passed the complaint to the provider, who was currently on annual leave and would deal with it on their return. We spoke with the provider who confirmed that he had written to the relative about their concern.

The manager assessed and monitored the quality of care. Surveys were undertaken for people, relatives and health and social care professionals. Audits and checks were carried out to monitor a number of areas such as health and safety, medicines, care plans and meal times.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the premises. The action we have asked the provider to take can be found at the back of the report.