The comprehensive inspection was carried out by one inspector on the 14 and 17 July. The inspection was announced to ensure people were present at the small service.

This is the first inspection of Summerville with the additional regulated activity of personal care. The last inspection of Summerville care home took place in January 2017, this inspection focused upon the ‘well-led’ domain following concerns from a comprehensive inspection on December 2015. This inspection found that the 'well-led' domain had improved from requires improvement to good, thus making the service good overall.

We found that the service requires improvement. This is the first time the service has been rated Requires Improvement since the change of registration.

Summerville is a large detached ‘care home’ in Margate. 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.

Summerville provides personal care and support to up to four people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were three people living at the service at the time of the inspection.

Summerville also provides care and support to three people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone at Summerville receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care;’ help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was a registered manager for the 'care home' and the former deputy manager had now become the registered manager for the 'supported living' support provided by Summerville. Both registered managers were present during both days of the inspection. 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.’

Summerville supported people to live their lives to the full. The atmosphere was calm and friendly, staff and people talked and laughed together. Staff treated people with kindness and respect. A relative told us, “[loved one] has been a resident with Manor Care homes for 17 years now… Throughout that time I have always been very satisfied with the care he has received and the attitude of the staff." Another relative stated, "[Loved one] has been in the care of Manor Care Homes since 2003, and during all that time the care [they] has received has been exemplary."

However, despite positive feedback we found some shortfalls at the service. Medicine records were not always completed correctly. The manager used systems to continually monitor the quality of the service and this series of audits had identified medicine recording failings. Action had been taken to address these errors, however there remained gaps in medication recording sheets which indicate that the action taken was ineffective.

On the day of inspection, the registered managers took immed

Care service description

Summerville is a privately owned care home providing personal care and support to up to four people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were four people living at the service at the time of the inspection.

Rating at last inspection

At the last inspection, the service was rated Good overall and Requires Improvement in the ‘Well –led’ domain.

Why we inspected

We previously carried out an unannounced comprehensive inspection at this service on 7 December 2015. A breach of a legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

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 Summerville on our website at www.cqc.org.uk.

At this inspection we found the service had improved. We found the service remained Good overall and is now rated Good in the ‘Well –led’ domain.

Why the service is rated Good in the Well- led.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support that promoted people’s independence and autonomy. Staff and people were part of the continuous improvement of the service.

People and staff told us they thought the service was well led. Staff told us that there was an open and inclusive culture within the service. They said they could talk to the registered and deputy manager about anything and they were always supportive. The registered manager told us, "We want to increase people's independence. We want to encourage them to do as much as possible. We want people to enjoy their lives”.

The provider had systems in place to monitor the quality of the service. There were records to show that any identified shortfalls had been addressed and improvements made. The provider asked people, staff and relatives their opinion about the service and had included other stakeholders, like doctors or community specialists, about what action they thought the provider could take to make improvements.

The registered manager was aware of submitting notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

This inspection took place on 7 December 2015, was unannounced and was carried out by one inspector.

Summerville is a privately owned care home providing personal care and support to up to four people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were four people living at the service at the time of the inspection.

The service is a detached property close to the centre of Margate. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had access to a vehicle which was shared with the providers other nearby service, to access facilities in the local area and to access a variety of activities.

There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of the other service owned by the provider which was close by. 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, deputy manager and staff supported us throughout the inspection.

The registered manager had worked at the service for many years firstly as a support worker and then as the deputy manager. They became the registered manager of the service in August 2015. They knew people and staff well and had good oversight of everything that happened at the service. The registered manager and deputy led by example and promoted the ethos of the service which was to support people to achieve their full potential and to be as independent as possible. The registered manager and provider made sure there were regular checks of the safety and quality of the service. They listened to peoples’ views and opinions and acted on them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager was in the process of applying for DoLs authorisations for people who were at risk of having their liberty restricted. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people decided to move into the service their support needs were assessed by the registered manager or the deputy manager to make sure the service would be able to offer them the care that they needed. People indicated that they were satisfied and happy with the care and support they received. People were involved with the day to day running of the house. The service was planned around people’s individual preferences and care needs. The care and support they received was personal to them. Staff understood their specific needs. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with.

Potential risks to people were identified. There was guidance in place for staff on how to care for people effectively and safely and keep risks to minimum without restricting their activities or their life styles. People received the interventions and support they needed to keep them as safe as possible. The complaints procedure was on display in a format that was assessable to people. If people, staff or relatives did make a complaint they would be listened to and action would be taken.

Throughout the inspection we observed people and the staff as they engaged in activities and relaxed at the service. Some people could not communicate by using speech and staff understood the needs of the people they supported. Staff were able to understand people through body language, facial expressions and certain sounds and supported people in a discreet, friendly and reassuring manner. There were positive and caring interactions between the staff and people. People were comfortable and at ease with the staff. When people could not communicate verbally, staff anticipated or interpreted what they wanted and responded quickly.

Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and waited for them to respond. Throughout the inspection people were treated with dignity, kindness and respect. People privacy was respected and they were able to make choices about their day to day lives.

People were involved in activities which they enjoyed and indicated that they wanted to do them again. Planned activities took place regularly. People had choices about how they wanted to live their lives. Staff respected decisions that people made when they did not want to do something and supported them to do the things they wanted to.

People indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted and were involved in buying food and preparing their meals. If people had special dietary requirements they were seen by community specialists to make sure their diet was suitable and safe.

People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The management team made sure the staff were supported and guided to provide care and support to people enabling them to live fulfilled and meaningful lives. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular one to one meetings with a senior member of staff. They had an annual appraisal so had the opportunity to discuss their developmental needs for the following year. Staff were positive about the support they received from the registered manager. Staff had support from the registered manager to make sure they could care safely and effectively for people.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There was enough staff to take people out to do the things they wanted to. New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. Staff had core training and more specialist training, so they had the skills and knowledge to meet people’s specific needs. Staff fully understood their roles and responsibilities as well as the values of the service.

Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. Safety checks were done regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service. Staff told us that there was an open culture and they openly talk to the registered manager and the deputy manager about anything. The provider had systems in place to monitor the quality of the service, but there were no records to show that any identified shortfalls had been addressed and improvements made. The provider asked people, staff and relatives their opinion about the service but had not included other stakeholders like doctors or community specialists about what action they thought the provider could take to make improvements. The registered manager was aware of submitting notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Following an inspection on 1st March 2013 we took enforcement action as the service was not compliant with some of the essential standards of quality and safety. We looked at these standards during this inspection and found that the provider had achieved compliance.

People who used the service were unable to tell us about their care due to their level of learning disability. However, they indicated that they were happy with their care and knew the staff well. We observed staff interacting with people in a positive manner and saw that they were able to manage behaviours that challenge positively, appropriately and effectively. People's care records had been reviewed and were person centred, accurate and up to date. The manager had met with people using the service along with their families and representatives to update their care plans, which included initial assessments, risk assessments and mental capacity assessments.

We found that the provider had introduced robust recruitment processes and that all staff had received criminal records checks. Staff we spoke to told us that they had worked at the service for a number of years and knew the people who used the service well.

We found evidence that the provider had sought advice and guidance from outside professionals in regards to managing risks and behaviours that challenge and that monitoring and auditing processes had been introduced to ensure peoples care plans remained up to date and fit for purpose.

There were 3 people living at Summerville when we completed our inspection. People who used the service were not able to talk to us directly to tell us about their experiences. However, we observed that people who used the service appeared happy with their care and had built relationships with the staff.

People were supported to make some choices regarding how they spent their time. However, we found that arrangements were not in place to assess the special needs of people who lacked capacity to make specific decisions. This had resulted in some people not being fully supported to make informed decisions that were in their best interests.

We found that some staff were able to demonstrate they had knowledge and understanding of people's needs, knew people's routines and how they liked to be supported. However, we found that care was not planned around the outcomes of assessments of the person’s needs. People’s individual plans had not been reviewed to ensure that they remained relevant. The provider had not taken action to ensure that staff provided consistent care and support to people.

The provider had processes in place to manage people’s medicines safely and had taken appropriate action where necessary.

We found that the provider did not operate an effective recruitment procedure which ensured that all the necessary checks were completed satisfactorily before someone began working at the service.

People expressed that they were happy at Summerville. They told us that they had been there a long time and liked the staff.

They expressed that they were able to make choices about their care and welfare and saw medical professionals regularly.

They told us that they were supported to go to college and were encouraged to be involved in the local community.

People told us that they liked the staff and felt safe in the service. They appeared calm and at ease with the staff.