This comprehensive inspection took place on 14 January 2019 and was unannounced. Summerville House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Summerville House is registered to accommodate up to 26 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit 22 people were living in the home, all of whom were living with dementia.
There was a registered manager working 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.
At the last inspection of Summerville House, we rated the home overall as good. At this inspection the overall rating has reduced to requires improvement. We also found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Not all risks to people’s safety had been assessed and therefore mitigated. Staff practice was mixed which placed people at risk of avoidable harm. The provider had determined the number of staff required to meet people’s needs but this had not regularly been met. Staff told us they struggled to provide people with stimulation to enhance their wellbeing.
Staff working on the night shift had not all received training in how to give people their medicines safely. This meant there may have been a delay in people receiving medicines for pain or distress. Following the inspection visit, the registered manager told us this had been corrected.
Some staff were observed to lack the necessary skills when dealing with people living with dementia. Most had only received training in this area online via a computer. The provider told us training for staff in this area was being improved to give them better knowledge and skills.
Most people were treated with dignity and respect although this was not consistently applied by staff and some people did not always have choice or control over their care. People’s consent had not always been sought in line with the relevant legislation.
People did not always have a choice of food to eat and the dining experience required improvement. People who were at risk of not eating enough were monitored to ensure they had sufficient food to remain healthy. We were not made aware of any concerns regarding people's fluid intake however, the systems in place to monitor if people had received enough to drink were not robust and needed improving.
The current governance systems and processes in place were not all effective at monitoring the quality of care people received or to drive improvement within the home.
The premises would benefit from some improvements to help people living with dementia orientate themselves. We therefore recommend the provider consults appropriate guidance in this area to make the necessary improvements.
People received their medicines when they needed them and systems were in place to protect them from the risk of abuse. Any incidents or accidents that had occurred had been fully investigated and lessons learnt to try to prevent them from happening again.
When people became unwell, the staff acted quickly to ensure they received the appropriate medical advice. Staff were very happy working at the service. They felt supported, told us their morale was good and could develop and complete qualifications within care.
There was an open culture in the home. People and relatives could approach the staff or manager whenever they wished and were listened to and their opinions respected.
You can see what action we told the provider to take at the back of the full version of the report.