This unannounced inspection took place on 16 and 17 January 2018.Somerforde is a care home. 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.
Somerforde is a large detached property set within its own grounds and is registered to provide accommodation for up to 24 older people who require nursing or personal care. The home cannot provide nursing care. Accommodation is provided over two floors in one adapted building, a passenger lift provides access between floors. On the day of our inspection 20 people were living at the home.
There was a registered manager in post. 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.
When we completed our previous inspection in November 2015 we awarded an overall rating of 'Good'. During this inspection on 16 and 17 January 2018 we found a number of concerns relating to the key questions safe and well led. Therefore, for this inspection the service has been awarded the overall rating of 'Requires Improvement'. This is the first time the service has been rated 'Requires Improvement'.
People were not always protected from the risk of avoidable harm. Risks to people's health and wellbeing were not always identified in people's care plans, and risk management plans were not always in place to instruct staff on how they should care for people safely. Where risks had been identified, action had been taken to minimise the risk, such as using pressure relieving mattresses. However, there was no guidance in care plans or risk assessments to instruct staff on what pressure the mattresses should be set at and there was no system in place to ensure mattresses were set at the correct setting.
Where risk management plans were in place, such as; repositioning charts and topical medicines application charts, we saw they had not been completed consistently and we could not be sure from the records that people had received the care they needed.
The accident and incident monitoring system was not robust. We found accidents or incidents relating to people had not always been documented by staff. Therefore, the registered manager was not in a position to investigate further to ensure actions were followed through to reduce the risk of incidents occurring. Accidents and incidents had not been audited and no analysis of accidents or incidents had taken place since November 2017 to look for patterns or trends.
Medicine audits were being undertaken; however these were not always effective. We found that whilst medicines were being administered safely, the arrangements in place to manage reordering of medicines and stock control meant there was a risk that people's medicines might not be available when they needed them. Medicines audits had not identified concerns, such as inaccurate stock, temperature monitoring of medicines storage and medicines not being dated once opened.
The registered manager had quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided at Somerforde. We found the registered manager used a variety of systems to monitor the home. However, governance systems had not identified a number of concerns we found at this inspection.
Following the inspection we received a report from the registered manager describing how they had responded to the concerns and what actions they had taken to address the issues. Medicines administration and stock replenishing systems and the monitoring of risks and falls have been strengthened and any issues dealt with. Robust management oversight is now in place to ensure good practice within the service.
People were consulted about their care to ensure wishes and preferences were met. We saw people's individual needs were assessed and person centred care plans were developed to identify what care and support they required. However, for one person an initial assessment had been completed but a comprehensive care plan, including assessment of risks, had not been completed at the time of the inspection, despite them having been admitted six days before. This meant there was a risk the person would not receive person centred care that was appropriate, met their needs and reflected their personal preferences. We have made a recommendation to the provider about care planning systems.
Care plans contained information about people’s specific communication needs, any barriers to communication and how staff could help people communicate. We saw that staff did not always respond to these needs in a timely way. For example, a relative told us their family member lost their hearing aid several weeks ago, they told us, “I’ve raised it with the deputy manager as the registered manager has been away, but nothing’s been done.” We spoke to the registered manager about this and they acted immediately.
People told us they felt safe living at Somerforde. One person told us “It feels safe here. I’ve lived here for some time now and it’s improved quite a lot recently.” Another said, “I haven’t lived here for more than a few months, but they’ve been very enjoyable months and I feel much safer now than I did living alone in my house” People were protected from the risk of abuse because staff understood how to keep people safe. Safeguarding procedures were in place to help protect people from harm and staff understood their responsibilities to do so and to report any concerns.
People spoke highly of the staff and said that they were caring and kind. People's comments included, “I am very well cared for. Nothing is too much trouble for the staff” and “I like living here, it suits me in every way.” The home had a calm and relaxed feel. We observed positive and caring relationships between people and staff. We saw staff treated people with respect and in a kind and compassionate way. People's privacy and dignity was respected by staff. People were able to choose what they wanted to do and were supported to maintain their independence as much as possible.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The home worked within the principles of the Mental Capacity Act and the registered manager completed appropriate documentation to evidence this. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).
We looked at recruitment processes and found that staff had been recruited safely. Staff told us they were well supported in their role and received appropriate training and professional development. Staff attended mandatory training in a range of subjects and also had the opportunity to attend other training courses to ensure staff were able to meet the specific care needs of the people who lived in the home.
People were supported by sufficient numbers of staff. During our inspection we observed call bells were answered promptly and staff responded to people in a timely manner. Staff said there were enough staff to care for people and keep them safe.
A variety of activities were arranged for people living at the home which provided stimulation and social interaction. People told us they enjoyed the activities on offer. One person told us, “There’s always plenty to keep you occupied here. One lady organises events and trips as well as social gatherings.” Another said, “I look forward to the activities, it’s history group today and I won’t miss that.”
People told us they enjoyed the food and were happy with the quality and quantity of food provided. Comments included, “The food here is wonderful. Always plenty of it and a super choice”, “The food here is impressive in its quality and variety” and “The food here is consistently good. In fact let me correct that, it’s consistently very good.” We observed people's lunchtime experience and saw it was a very relaxed sociable experience. People were offered a choice of meals and we observed a staff showing people the different choices that were on offer. People's nutritional needs were assessed and the home responded appropriately to any nutritional concerns.
People were supported to maintain good health and staff ensured they received appropriate and timely healthcare support. Appropriate referrals were made to other care professionals if a need was identified such as dieticians and the Speech and Language Therapy Service.
People were able to enjoy a clean comfortable homely environment. The home was undergoing a full re-decoration and improvement programme inside and out. The provider told us they wanted to create a home to be proud of so that people would feel looked after in a cared for, comfortable home. People were involved in the refurbishment and were encouraged to choose their room decoration. We saw that people had personalised their rooms with pictures and objects that were personal to them.
We found two breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.