CQC report explained · a nursing home
What the CQC found at Summerville Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, July 2023
Rated Good overall; inspectors found safe, kind care, but leadership and communication still required improvement.
Inspectors visited unannounced on 22 February and 23 March 2023. They spoke with people living at the home, relatives and staff, and reviewed care, medicine, recruitment, safety and management records.
The home was rated Good for Safe. Inspectors found enough staff, suitable risk assessments, safe medicines management, appropriate recruitment checks and a clean, well-maintained building. People said they felt safe and trusted staff.
Well-led remained Requires Improvement. The culture was not consistently open or inclusive, relatives said communication from management was inconsistent, and frequent management changes had unsettled the home. The overall rating rose from Requires Improvement to Good, partly because other areas kept their previous ratings.
People felt safe
People told inspectors they felt safe and trusted the staff. Staff had safeguarding training and the provider monitored safeguarding concerns.
“People told us they trusted the staff caring for them.” from the report
Risks were managed
People had detailed risk assessments, which were kept under review. The provider used reports and meetings to identify risks and improve care.
“The service provided for people was safe; risks in people's care were monitored and well managed.” from the report
Safe staffing and medicines
Inspectors found enough staff to meet people's needs safely. Medicines were managed safely, with accurate records and regular reviews.
“People's medicines were safely managed.” from the report
Kind daily care
Inspectors saw calm, positive relationships between people and staff. Staff were attentive, kind and respectful.
“We observed staff being attentive, kind, and respectful to people and their needs.” from the report
Leadership culture
needs fixingStaff, some people and relatives said the culture was not always open, inclusive or empowering. Improvements had not become consistent across the staff team.
“There had been improvements in aspects of the culture within the service, however they were inconsistent” from the report
Management communication
needs fixingRelatives said the manager was not visible enough and communication was not effective or consistent. Some relatives also found it difficult to obtain information about actions taken after problems.
“People's family members told us the new manager had not been visible, there had been minimal interactions with them, and they had not communicated effectively.” from the report
Management stability
needs fixingRelatives said frequent changes in management had unsettled the home. There was no registered manager in post during the inspection.
“They told us that frequent changes of management at the home has had a destabilising effect.” from the report
No clear improvement strategy
needs fixingSenior staff were not always clear about their influence on the home's culture and did not have a clear strategy to improve relationships between management and staff.
“Senior staff were not always clear about how they influenced and had an impact on the culture of the service” from the report
- 01Who is currently responsible for managing the home, and when will a registered manager be in post?
- 02What specific actions are being taken to improve relationships between managers and staff?
- 03How will relatives receive regular and timely updates from management?
- 04How will the home check that improvements to its culture are consistent and lasting?
- 05How many staff are trained to administer medicines, and how are their competencies checked?
This was a focused inspection of Safe and Well-led; the other key-question ratings were carried over from the previous inspection. This explanation was written from the published report of 5 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2021
Summerville Care Home was rated Requires Improvement; inspectors found concerns about staffing and leadership, although people described positive and timely care.
This was an unannounced focused inspection on 3 September 2021. Inspectors looked at Safe and Well-led after concerns about staffing levels and management conduct. They spoke with people, relatives and staff, and reviewed care, medicines, recruitment and management records.
Inspectors found that staffing levels were not always enough to meet people's needs safely. Staff said personal care could be missed and that there were times when people might be at risk. Cleaning records also had gaps because of a shortage of housekeeping staff.
People and relatives generally said staff responded quickly and provided good care. Risks were assessed, medicines were managed safely and safeguarding systems were in place. However, staff described low morale and poor communication with managers, so both Safe and Well-led were rated Requires Improvement.
Risks were assessed
Inspectors found that risks to people's health, safety and welfare were assessed and managed. Equipment needed to support mobility or alert staff was available.
“Risks to people's health, safety and welfare were appropriately assessed and managed.” from the report
Medicines were managed safely
Medicines were stored, given and disposed of safely. Staff responsible for medicines had training and regular checks.
“Medicines were safely stored, administered and disposed of.” from the report
Positive care relationships
People and relatives spoke positively about the care and support from staff. Inspectors found positive relationships between staff, people and families.
“Positive relationships had been developed between staff, people and their family members.” from the report
Good infection control practice
The home and equipment appeared clean and hygienic. Staff followed current guidance on protective equipment and infection prevention.
“Staff were observed following current best practice guidance in the use of PPE.” from the report
Not enough staff at times
seriousInspectors could not always be assured that staffing levels were enough to keep people safe. Staff said personal care could be missed and that some people might be placed at risk.
“We could not always be assured that the service deployed enough staff to keep people safe and ensure their needs were met.” from the report
Low staff morale and poor communication
needs fixingStaff said they felt unsupported, unappreciated and unable to discuss concerns with the registered manager. Inspectors found that management did not consistently create an open and inclusive culture.
“We could not always be assured that the registered manager promoted a positive culture that was open and inclusive for all staff.” from the report
Gaps in cleaning records
minorSome regular cleaning tasks were not recorded as completed. Inspectors linked this to a shortage of housekeeping staff, although the home and equipment appeared clean.
“Cleaning records and schedules identified some gaps in regular cleaning tasks.” from the report
- 01How many care staff are planned for each shift, and what happens when staffing levels fall below plan?
- 02How do you make sure people who need two staff receive safe mobility support and personal care?
- 03What has changed since the inspection to improve staff morale and make it easier for staff to raise concerns?
- 04How are cleaning tasks checked now, and has the shortage of housekeeping staff been resolved?
- 05How will families receive regular updates and raise concerns with the management team?
This was a focused inspection of Safe and Well-led only; the other key question ratings were not inspected and previous ratings were used in calculating the overall rating. This explanation was written from the published report of 26 October 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Summerville Care Home
5 rated inspections over 6 years: the service has improved, from Inadequate to Good.
- July 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2021Inspected but not ratedSafe: Inspected but not rated
- June 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- June 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2017InadequateSafe: InadequateEffective: Requires improvementCaring: InadequateResponsive: Requires improvementWell-led: Inadequate
- January 2017
Registered with the Care Quality Commission on 31 January 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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