We carried out an unannounced comprehensive inspection on 14 February 2017 and returned announced for a second day on 20 February 2017. Summerleaze Residential Home is a large detached Victorian house in the town of Exmouth. They provide care and accommodation for up to 31 people with all rooms having ensuite facilities. On the first day of the inspection there were 29 people staying at the service. One of these people was staying at the service for a short stay respite period.

We had previously carried out a comprehensive inspection of this service in August 2015. A breach of a legal requirement had been found at that inspection. The breach was because people were not protected from unsafe and unsuitable premises. In particular, we highlighted scald risks from the hot water supply and windows on the first floor which were not restricted to prevent vulnerable people from the risk of falling out. Following the inspection we were sent an action plan setting out the actions the provider was going to take. At this inspection we found action had been taken regarding these concerns and the requirement had been met.

The service has two registered managers at the service. 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. One of the registered managers was a director who had decided to take a step back reducing their role at the service. Therefore the second registered manager undertook the majority of the registered manager’s role. They said they were supported by the second registered manager and responsible person who would step in when they were taking leave. The responsible person was aware of the additional pressures and responsibilities the registered manager had taken on. They were putting in place a care administrator role to complete care plans and reviews and senior care workers were being delegated additional roles. These included undertaking supervisions for staff in their teams to relieve the additional work load on the registered manager.

Everyone gave us positive feedback about the registered manager and said they were very visible at the service and undertook an active role. They promoted a strong caring and supportive approach to staff. They felt this was then the culture in which staff cared for people at the service.

People were supported to follow their interests and take part in social activities. There was a designated activity person who along with the management team recognised the importance of social events for people. During the inspection a new weekly newsletter was started to keep people informed.

Staff were able to anticipate people’s needs and were respectful, discreet and appropriate in how they managed those needs. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff were compassionate, treated people as individuals and with dignity and respect. Staff knew the people they supported, about their personal histories and daily preferences. Staff showed concern for people’s wellbeing in a caring and meaningful way. Where possible, people were involved in making decisions and planning their own care on a day to day basis. People said staff were caring and compassionate and treated everyone with dignity and respect at all times.

The management team and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) (2005). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA for the majority of decisions. Following the inspection we received confirmation from the registered manager that best interest decisions

The home was inspected by the Care Quality Commission on 7 February 2014. We found that improvements were required which related to records. Not all records were reviewed or updated regularly. Care records had not been reviewed since November 2013 and some records had not been completed.

We found at this inspection that all care records had been reviewed and updated and were reviewed at least every month or as people’s needs changed.

At the time of our inspection 31 people were living at Summerleaze. We spoke with nine of those people. We observed that people appeared at ease and comfortable around care workers. People were treated with dignity and respect. They had opportunities to be involved in and make decisions about their own care. Where people did not have the capacity to make decisions for themselves their rights were protected. People told us they felt safe and were well cared for. Comments included, "It's very good here, they look after me so well".

We found that staff recruitment processes were not robust and that although appropriate checks had been undertaken they were not always done in a timely way. Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.

Not all records were reviewed or updated regularly. Care records had not been reviewed since November 2013 and some records had not been completed.

We carried out this inspection as part of a planned inspection. We also received information that people living at the home were made to get up early, received inappropriate manual handling and that there had been concerns with medications. At our inspection we found no evidence to support any allegations made.

At the time of our inspection 28 people lived at the home. We spoke with five people. We spoke with the Manager, Provider, four care staff and two relatives. We found that staff administered medicines safely and all medicines were stored securely.

People told us they were very happy at the home. One person said “Oh yes, the staff are lovely.” Another person said “It’s very good here.” People told us they were supported to access all the care they needed and were happy with the care and support provided. Staff respected people’s wishes and people told us they felt respected.

People told us the food was “very good.” People were happy with the environment. We found people were supported to use different parts of the home. One person said “You can please yourself. You don’t get made to do anything but they always offer.”

People told us that they felt safe and knew what to do and who to speak with if they had concerns. Staff knew what to do if they suspected abuse or poor practice. Staff were well supported. Staff received training, supervision and appraisals. The home was well managed and had systems to monitor the quality and safety of the service provided.

We carried out an unannounced comprehensive inspection on 14 and 20 August 2015. Summerleaze Residential Home provides care and accommodation for up to 31 people. On the first day of the inspection there were 30 people staying at the service.

We undertook an inspection in March 2014 and found the service was compliant in the one outcome inspected.

The service has two registered managers who share the role, only one was available at the inspection as the other was on leave. 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. Everyone was positive about the registered managers and felt they were approachable and caring. The registered manager we met was very visible at the service and undertook an active role. They promoted a strong caring and supportive approach to staff as they felt this was then the culture in which staff cared for people at the service.

People were not protected from unsafe and unsuitable premises. In particular, we highlighted scald risks from the hot water supply and windows on the first floor which were not restricted to prevent vulnerable people from the risk of falling out. During the inspection, the registered manager took immediate steps to mitigate the risks of both the concerns regarding the hot water supply and the windows safety.

There were sufficient staff numbers of suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary to ensure staffing levels were maintained.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported by staff who had the required recruitment checks in place. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. The majority of care staff had undertaken relevant qualifications in health and social care. Staff had the skills and knowledge to meet people’s needs. The registered manager was implementing training which the provider had purchased to ensure all staff had undertaken the provider’s mandatory training.

People were supported to eat and drink enough and maintained a balanced diet. People and visitors were positive about the food at the service.

People and relatives said staff treated their relatives with dignity and respect at all times in a caring and compassionate way. People received their prescribed medicines on time and in a safe way.

Staff supported people to follow their interests and take part in social activities. A designated activity person was employed by the provider and implemented an activity programme for everyone living at the service.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The provider had a quality monitoring system at the service. However they had not identified the environmental concerns we highlighted. The provider actively sought the views of people, their relatives and staff. There was a complaints procedure in place and the registered manager had a clear understanding how to respond to concerns appropriately.

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