The Care Quality Commission
  • Care Home
  • Care home

Archived: Somerset Lodge

Overall: Inadequate read more about inspection ratings

Perrett Way, Ham Green, Pill, Somerset, BS20 0HE (01275) 372224

Provided and run by:
Milestones Trust

All Inspections

31 May 2016

During an inspection looking at part of the service

The last inspection of the home was carried out in December 2015 and the home was rated inadequate. Five breaches of regulations 17, 14, 18, 10, 16 and 9 of the Health and Social Care Act 2008 were made. The provider sent us an action plan describing how they would improve.

This inspection was unannounced and was a focussed inspection to check what improvements the home had made regarding the breaches of regulations. This meant we did not check all key lines of enquiry which meant we cannot change the rating of the service until the next comprehensive inspection.

The home was divided into two units. One unit known as Bluebell supported people living with dementia. The other called Snowdrop cared for people with long term mental health needs. At the time of the inspection there were 24 people living at the home.

There is a manager in post who has applied to become registered. 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 previous inspection we found people’s daily records were not maintained accurately. Quality assurance systems did not identify the shortfalls we found. During this inspection, we saw records were well written and the manager monitored care plans and other records.

People were supported by staff who were kind and caring. People were very comfortable with the staff who supported them. Staff respected people’s privacy and dignity, and gave people choices.

A number of fire drills had taken place. Staff had access to records which gave them information about the support people would need in the event of an emergency.

Where agency staff were used, the home had a block booking which meant staff worked in the home regularly. Most care staff were employed directly by the home. The home had identified the need for five nurses; however staff for two of these posts had been identified. Staff said there were enough staff on duty to provide the support people needed.

People were given choices of meals and where they ate their meals. Snacks were readily available. Staff provided appropriate support where people needed this. If people needed specialist diets, these were available.

Staff had been provided with a range of training courses, including specialist training such as understanding dementia, mental capacity and deprivation of liberty. Staff were able to undertake nationally recognised training if they wished.

Where people had made complaints, these were listened to and changes made.

Care plans were personalised to the individual and gave details about their likes and dislikes. Staff had information they needed to be able to give people the support to meet their needs.

Work was underway to improve the environment. Re-decoration of the home was ongoing and people had been able to choose the wallpaper in the lounge.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

07 and 09 December 2015

During a routine inspection

This inspection was unannounced and took place on 07 and 09 December 2015.

There was a general manager in post, but this person was not registered. As the registered manager left in November 2015 the process for appointing a new registered manager had only just started. 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 manage left the service in November 2015 and Milestones Trust were in the early stages of replacing him.

Somerset Lodge is registered to provide care for up to 35 people with dementia or mental health needs. At the time of our inspection, there were 27 people living there. The general manager explained they had no plans to admit any new residents because they had a voluntary suspension on private placements. They said although they felt they had the correct number of staff on duty, they were employing high numbers of agency staff. The general manager explained the difficulties they had trying to recruit qualified nurses. At the time of our inspection, the home was also under local authority whole home safeguarding, which was not commissioning any new placements at the home. This is being kept under review by the local authority.

At our last inspection on 03 and 04 April 2014 Somerset Lodge was non-compliant with five Regulations;

  1. Infection control (Regulation 12). This corresponds with Regulation 12 (2) (h) of the Health and Social Care Act 2008 Regulations 2014. The required improvements had been made.
  2. The principles of the Mental Capacity Act (2005) were not being followed (Regulation 17). This corresponds with Regulation 11 of the Health and Social Care Act 2008 Regulations 2014. We did not see the required improvements had been made.
  3. Protecting people from unsafe or inappropriate care or treatment (Regulation 9). This corresponds with Regulation 12 of the Health and Social Care Act 2008 Regulations 2014. We saw partial improvements had been made.
  4. Supporting Workers (Regulation 23). This corresponds with Regulation 18 of the Health and Social Care Act 2008 Regulations (2014). We did not see the required improvements had been made.
  5. Assessing and monitoring the quality of services (Regulation 10). This corresponds with Regulation 17 of the Health and Social Care Act 2008 Regulations 2014. We saw partial improvements had been made.

People’s daily records were not maintained accurately and staff did not have the information they needed to be able to meet people’s needs and reflect their preferences. Care plans contained personalised information but staff were not aware of this. Relatives were not given access to care plans, and people’s preferences for gender specific care was ignored.

Fluid charts showed some people did not have enough to drink. Relatives told us their relatives were always hungry and thirsty.

The home relied heavily on agency staff. Staff supervisions had started to take place but staff had not received the training required by the organisation. Relatives told us they did not feel their relatives were safe because staff did not know how to look after them.

Staff did not make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Staff made decisions for people to use bed rails and relatives said they had not been asked to consent to this.

People had access to GP’s who visited weekly. When people needed care or treatment from other healthcare professionals, this was sometimes provided.

People’s privacy was not always respected. Activities were not tailored to individual tastes and most people were unable to take part in group activities.

Although relatives knew how to make complaints, they told us they were not responded to and no changes were made. Everyone we spoke with told us they did not have confidence in the general manager. Staff said the home had potential to improve but they were not supported.

Quality audits did not always pick up shortfalls in the service meaning the provider was not always responsive to the changes required. For example, the lack of accurate, effective daily records had not been identified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found repeat breaches. We are taking further action in relation to this provider and will report on this when it is completed.

3-4 April 2014

During a routine inspection

Somerset Lodge provides support for 35 people with dementia or severe mental health issues. The service is divided into three units. One of the units is called Sunnyside where 12 people with mental health care needs live. The remaining 23 people live with dementia and reside in the other two units of the building. The two units have not been named and were referred to as Group 1 and Group 3.

Relatives we spoke with felt it was a good service and their relatives were well looked after.

We observed that the majority of staff treated people with respect and compassion. Our observations highlighted a variation in the way staff spoke or communicated with people with people. In the main, staff were patient and understanding of people’s needs. There were exceptions such as limited communication with a person when a staff member was assisting them to eat and talking about another individual to a staff member in front of them. 

During the week there was a full activities programme offered to people. It offered an opportunity for them to get together and join in with activities such as singing, dancing and visits from an external theatre company. There was no structured programme of activities at the weekend.

The service has been awarded funds by the Prime Minister’s dementia challenge fund. The fund has been used to build an activities kitchen, refurbish bathrooms, install a dementia friendly garden and introduce controllable mood lighting in the building. The purpose of the dementia funding is to improve services for people with dementia.

The service had a registered manager in post. The staff felt well-supported by their manager as he placed an emphasis on having an open culture. Family members we spoke with told us that they would approach the manager if they had any concerns and felt confident that these would be addressed.

There were enough staff on duty to meet the needs of the people who lived at the home. The management team had a system in place to assess and monitor  there were sufficient numbers of staff in place, with the right competencies, knowledge, qualifications, skills and experience to meet people’s needs. The organisation was involved in a recruitment drive to increase the level of registered nurses.

Whilst there were a range of quality assurance and audit programmes in place these were not always effective.  Despite care plan audits being undertaken as part of the audit process they did not identify or rectify the shortfalls in the documentation and were therefore ineffective.  You can see what action we told the provider to take at back of the full version of the report.

The service did not have adequate systems in place to manage and monitor the prevention and control of infection. There were no infection control audits in place to examine the potential risks and whether enough precautions had been taken to prevent them. You can see what action we told the provider to take at back of the full version of the report.

Up to date information about people’s care needs was not always in the care plan. It was necessary to refer to alternative documentation to locate it. If there was an emergency the care planning documentation would not always ensure that the needs of the person could be met. You can see what action we told the provider to take at the back of the full version of the report.

Where people did not have the capacity to make decisions, their friends and family were not formally involved or given the appropriate information they needed. The service had policies in place about upholding people’s rights but they were not consistently followed. The principles of the Mental Capacity Act 2005 were not being followed. People’s human rights were not properly recognised, respected and promoted. You can see what action we told the provider to take at the back of the full version of the report.

Each member of staff received induction training which included subjects such as safeguarding, moving and handling, infection control and health and safety. Staff training was up-dated regularly. Staff supervisions were not held regularly.  Not having regular supervisory arrangements in place meant that staff did not talk through any issues about their role, or about the people they provide care, treatment and support to. You can see what action we told the provider to take at back of the full version of the report.

We found that the service was currently meeting the requirements of the Deprivation of Liberty Safeguards.

30 July 2013

During a routine inspection

We spoke with six people who used the service to find out what it was like to live at Somerset Lodge. We met three people's relatives at the home. We spoke with a GP who was at the home for their weekly review of the health needs of people who used the service.

We observed staff were respectful and attentive when they assisted people. The staff communicated with people who could not make their views known by using facial expressions, body language, and humour. People looked happy and responded when staff communicated with them using these approaches.

People had positive views of Somerset Lodge and the staff. Examples of comments included, 'they are brilliant, they are so nice', 'that nurse is a very nice chap', 'the staff are brilliant with them'.

People benefited because there were a variety of innovative social and therapeutic activities put on for their stimulation at the home.

People had positive views of the meals at the home. There were a number of people and their relatives who had feedback to the provider that the food lacked flavour and was repetitious. Action was being taken to address these concerns.

The quality of care and overall service people received was checked and monitored. This was to make sure people were provided with a suitable and effective service.

15 October 2012

During a routine inspection

Somerset Lodge has three individual units, two units that support people with dementia care and nursing needs and one unit called "Sunnyside" that supports people with enduring mental illness. This report reflects our inspection of all three units.

At the time of our visit there were 34 people living at Somerset lodge. Not everyone was able to discuss their experience with us verbally. However, we made observations of their care, spoke with support staff and observed staff interactions with people that used the service.

We observed staff supporting people in a respectful way, offering people choices and giving them appropriate time to respond. We saw that staff adapted their communication when speaking to different people at the home according to their needs.

One member of staff told us "I would be happy to place a member of my own family here, for me that's a good sign of the care we give". One relative told us "I don't know how they do it here, they are fantastic the way they cope with X". Another member of staff said " the key to success of good care delivery is the right staff team".

Staff we spoke with believed that people were treated well by the team, and they had no concerns about the safety of people living in the home. One person was able to tell us they felt safe in the home.

17, 27 April 2011

During a routine inspection

People who live at the home have dementia and complex mental health needs, this makes it harder to make their views known.

We saw people being properly cared for and supported with their needs by the staff and the manager. People who use the service looked relaxed and comfortable with the staff who were caring for them. One person told us that they feel that Somerset lodge is a supportive place to live, one person said, 'it's not too bad here at all'.

We saw the staff team spending time helping people, listening to them and talking to them. The staff conveyed respect and sensitivity to peoples needs.

We saw that people who use the service each have a detailed and informative care plan written about their needs. We saw that care plans explained effectively how to give people support. The care plans aimed to ensure that staff treat each person as a unique individual with their own needs.

We found that people who use the service are effectively supported by the staff to eat a varied and nutritious diet.