We inspected Summerson House on 15, 21 and 26 January 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. Summerson House is a six bedded care home providing personal care to people with a learning disability. It is a purpose built house situated close to local shops and amenities.
No registered manager had been in place since August 2015. 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. It is a condition of the provider’s registration to have a registered manager and this was a breach of that condition.
In the last year there had been three managers, one of whom was registered but left in August 2015. Another previously registered manager for the home notified us in September 2015 that they would be adding this service to their registration but this had not occurred. A new manager was appointed in November 2015 but had yet to become the registered manager.
We found that the new manager was very open and transparent and their primary concern was the welfare of the people who used the service. Since being appointed they had critically reviewed the service and identified work was needed to make improvements to the operation of the home. We found that they had worked diligently to take action to make the identified improvements.
Prior to the inspection there had been a high level of staff vacancies and although the new manager was actively recruiting staff at the time of the inspection there continued to be vacancies. The registered provider had ensured that the staffing levels remained in line with those required either via the permanent staff completing additional shifts or the use of relief staff who knew the people. They were also actively recruiting new staff. However we had not been notified about these difficulties and should have been.
We found the care records were comprehensive however we found that they needed to be reviewed and updated.
We met with four of the people who used the service and we were able to speak with one person. Three of the people who used the service were unable to communicate verbally but we found that staff could readily interpret their facial and body language. We observed staff practices and saw that the people were treated with compassion and respect. We saw that people were very comfortable with each other and staff presence and there was lots of laughter.
There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.
Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.
People were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. Each individual’s preference was catered for and people were supported to manage their weight.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports.
Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities. The manager confirmed that staff were also in the process of completing refresher mandatory courses over the next few months.
Staff had also received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The staff we spoke with understood the requirements of this Act and but needed to ensure that all of the DoLS authorisation were renewed as needed.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs and we observed that were sufficient staff on duty to meet people’s needs. We saw that six staff were on duty when the six people were at home and two staff were on duty overnight. The manager was on duty during the weekdays.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. There was an accessible complaints policy and relatives were regularly contacted and knew how to complain.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home.
The registered provider had developed a range of systems to monitor and improve the quality of the service provided. However we found that after the registered manager had left, no one had completed the audits and monitored the performance. This lack of oversight had led to the records not being maintained and the position whereby the new manager needed to take a wide range of actions to improve the performance of the home.
We found the provider was breaching three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also highlighted that the provider did need to ensure notifications were submitted in line with the requirements of The Care Quality Commission Registration Regulations 2009. You can see what action we took at the back of the full version of this report.