Archived: Sunningdale House

Updated 24 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The service was last inspected in July 2017 and was rated as Good. In February 2018 we received serious concerns from health and social care professionals about the care that people received. The concerns were in relation to end of life planning. Personal care needs not being me, medication concerns, medical concerns not being escalated to health professionals in a timely manner, staffing levels, staff culture, infection control practices, lack of confidence in record keeping, and a higher than expected number of deaths. Due to these concerns we brought our inspection forward.

This comprehensive inspection took place on 26 March and 3 April 2018 and was unannounced. Two inspectors and a Specialist Advisor visited the service on the 26 March 2018. At that time 19 people were living at the service. Two inspectors visited the service on the 3 April 2018, at that time 6 people were living at Sunningdale house.

Before visiting the service we reviewed information we kept about the service such as previous inspection reports and notifications of incidents. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern.

During the inspection, we looked around the premises. We observed the lunchtime experience and interactions between people and staff. We spoke with seven people who lived at the service and observed others who could not communicate their wishes and feelings verbally. We also spoke with four relatives. Throughout the inspection, we spoke with 12 members of staff and three visiting health and social care professionals.

We looked at seven records relating to people’s individual care, training records for all staff, staff personnel files, policies and procedures and a range of further documents relating to the running of the service.

Updated 24 May 2018

Sunningdale House is a care home which offers care and support for up to 36 predominately older people. Some of these people were living with dementia.

The service was last inspected in July 2017 and was rated as Good. In February 2018 we received serious concerns from health and social care professionals about the care that people received. The concerns were in relation to end of life planning, personal care needs not being met, medication, medical concerns not being escalated to health professionals in a timely manner, staffing levels, staff culture, infection control practices, lack of confidence in record keeping, and a higher than expected number of deaths. Due to these concerns we brought our inspection forward.

This comprehensive inspection took place on 26 March and 3 April 2018 and was unannounced. Two inspectors and a Specialist Advisor visited the service on the 26 March 2018. At that time 19 people were living at the service. Two inspectors visited the service on the 3 April 2018, at that time 6 people were living at Sunningdale house.

Due to the high level of concerns commissioners reviewed all people they funded. Prior to the inspection 11 people were moved to nursing home provision so that their health and social care needs could be met. From the 26 March 2018 a further 16 people were moved to other care provision.

The service is required to have a registered manager. The registered manager handed in their notice in January 2018. On being informed of the concerns, the provider promptly deployed their operational management team to address the concerns and support the service. On the 3 April 2018 an interim manager was appointed at the service.

Care staff had not received training in safeguarding and had limited or no knowledge about the safeguarding process and how to recognise potential signs of abuse or mistreatment. They were unable to tell us who they would report concerns to outside of the service. A staff member commented “People have been unsafe but we didn’t know. Even the things we thought we were doing right we weren’t.”

Care records were kept electronically and stored securely on computers and laptops. Staff recorded on hand held electronic devices when they had supported people with personal care. The devices were also used to update any monitoring records such as food and fluid charts and repositioning records. All staff were required to record on the devices when they had completed a task which sometimes meant tasks were recorded twice if two staff had been involved in the delivery of care.

Some people’s care plans, were not effectively updated to ensure they were reflective of people's current care needs. Following commissioner’s reviews of people’s care needs, it was evident that some people’s health needs had changed. This meant that people’s health needs had not been reviewed appropriately by the service to ensure they could continue to meet the person’s current health and care needs.

People’s risks were not safely managed at the service. For example, a number of people were at risk of falling out of bed. There was no relevant risk assessment in place or documentary evidence to support how the risks could be minimised to keep the person safe. Consultation with those involved with the person was not evident. Therefore we were not assured that risks had been properly considered and addressed.

The operations manager had developed a new handover system as they were aware that, due to the lack of accurate care plans, staff had limited guidance, information or direction in how to meet people’s needs. The operations manager was aware that this needed to be developed further.

Arrangements for the management of medicines were ineffective. There were some gaps in Medicine Administration Records (MAR) charts. The management of Controlled Drugs (CD) were not robust. This meant that it was not always possible to identify if people had received their medicines as prescribed.

There was no evidence that medicines that were logged as no longer required had been returned to the pharmacy. This raised concerns regarding the accountability of medicines. Some medicines required refrigeration. Fridge temperatures were inconsistently logged which meant that the medicines may not have been correctly stored. An internal medicines audit had not identified any of these concerns.

People were not protected from the risks associated with cross infection. The service had notified us of two incidents relating to infection control since December 2017. As local commissioners were reviewing people’s care needs it became apparent that a high number of people had contracted oral thrush. The provider had arranged for an external contractor to come into the service to provide a deep clean which was in progress on the first day of our inspection.

Staff had not received infection control training and lacked knowledge, skill and expertise in this area. For example, we saw staff support a person with personal care and did not wash their hands before assisting the person with their food. The service also had shared slings to use when transferring people. We noted mops were not colour coded to clearly indicate what they should be used for. These examples demonstrated that there continued to be a risk of cross infection.

Due to the concerns in how people’s care needs were being met the provider had recently increased staffing levels. As the numbers of people they supported declined the provider recalculated staffing levels using a dependency tool. Staff said they felt there were sufficient staff levels on duty to meet people’s current care needs.

The managers were unable to locate any mental capacity assessments (MCA) or evidence of any applications submitted to the Deprivation of Liberties Safeguard (DoLS) team. The managers were unsure who, if anyone, was subject to a DoLS authorisation. This meant it was not possible to understand what decisions the service had taken on behalf of others or to assess whether these decisions were in the person’s best interest and the least restrictive available.

In the last five months the service had employed a number of new staff who had no previous experience of working in care. South West Care Homes had an organisational induction process but it had not been followed. Staff said the induction was not comprehensive and commented “We learnt everything by doing things wrong, or not doing them at all and getting blasted for it.”

People were not always supported by staff who had received training in order to carry out their role effectively. Training records showed that care staff had not received training in the areas of challenging behaviour, communication or pressure relief. There were significant gaps in training for care staff. For example safeguarding training, medicines and MCA. Staff told us that moving and handling training had occurred the previous month but this had not been well organised or effective. Staff confirmed they had been in post for “some months” before they had been provided with moving and handling training. However, they had been using equipment and supporting people to transfer since they started work. The lack of training and induction meant that staff did not have the correct skills and knowledge to safely care for people’s needs.

Following our inspection visit on the 26 March we raised our concerns regarding the lack of induction and training for staff. The provider contacted an external training company and sourced an intensive training programme for the staff team. Whilst the provider had responded to the lack of training, it is of serious concern that staff were not equipped with the correct skills and knowledge to undertake their role to ensure that people received effective and safe care.

Health and social care professionals had raised concerns prior to the inspection that the service was not following advice that they provided. We found that monitoring records were not consistently completed so that it was not possible to understand the care that was being provided and whether people’s health concerns were being addressed appropriately.

People’s fluid and food intake was recorded on a computerised system. However, the amounts recorded were not always accurate and staff would then not be aware when people were at risk due to poor nutrition and hydration. Due to this the operational manager implemented a paper record of food and fluid chart. Records showed peoples weights increased. This demonstrated that the focus on people’s food and fluid intake had contributed to an increase in people’s weight.

Staff spoke to us about people fondly and went out of their way to support people. However people’s privacy was not always respected. For example access to bathroom areas in private, and ensuring people wore their own clothes.

There were currently no activities arranged by Sunningdale house for people. There was no evidence people’s preferences were taken into account when organising their routines.

There had been a number of staff changes at the service since October 2017. The deputy manager had left, as had experienced care staff, and the registered manager had handed their notice in. New staff had been recruited but some were new to care. With a lack of leadership, new staff not receiving an induction or training to their role, they were unable to provide effective care that met the needs of the people they supported. Staff did not feel able to approach the registered manager and there was a breakdown of communication between the registered manager, staff and people they supported. Health and social care professionals also gave a mixed response to the registered manager’s approach and how the service responded to advice given to ensure people’s needs were met.

Some staff were kind and compassionate and committed to improving standards. We witnessed some examples of positive interactions between people and staff.