Sundial Lodge Care Home

Sundial Lodge is a care home registered to provide accommodation and personal care to up 48 people. The service provides support to older people. People live in their own flats which have a bedroom, lounge, kitchen and bathroom. However, meals are available from the home’s kitchen if people don’t wish to make their own food. At the time of our inspection there were 36 people using the service.

The home is spread over several floors and some outside mews type cottages. Outside there is a large patio and a large lawn for people to enjoy.

People’s experience of using this service and what we found

The provider had taken steps to ensure people’s safety within the service. People told us they felt safe at the service, “I couldn’t feel safer, it’s all so good” and “Yes I definitely feel safe, staff come and check on me regularly.” There were systems and process in place to safeguard people from abuse.

People’s needs were assessed before they moved in, and risk assessments and care plans written once the person moved in.

Health and safety checks were in place, for example about fire safety.

We were assured about how the provider was preventing and controlling infection in the home.

Medicines were managed safely and administered by staff who had been trained to do so safely

There were enough staff employed to meet peoples’ needs and staff were recruited safely. People we spoke to praised staff, telling us, “The staff are kind, always respectful and polite” and “They are exceptionally good and kind, people are never neglected or left.” Some people told us staff worked very hard, and they wished staff had more time to sit and talk with them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had not maintained good governance oversight to ensure audits were kept up to date by the registered manager. The registered manager had recently left and the provider had begun to set up new systems to improve governance oversight, but there had not yet been time for them to become embedded.

People told us they were asked for their views of the service, both in annual questionnaires and at resident meetings. Relatives were happy with the communication they had with the home. People and relatives told us how pleased they were with the service they received.

Rating at last inspection

The last rating for this service was good (11 October 2017).

Why we inspected

We received concerns in relation to the management of risks associated with people having falls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

The provider had reviewed their practice, improved governance systems, changed their criteria for admission, and recognised the need to support people to move elsewhere if the service assessed they could no longer meet people’s increased needs.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sundial Lodge on our website at www.cqc.org.uk.

We found the following examples of good practice:

When visits were able to be carried out, all visitors had their temperature checked on arrival, a lateral flow test was also carried out. Visitors were requested to use to use hand sanitiser. All visits were pre-booked and the care home had a visiting 'pod' with appropriate screening in place. There was clear signage in place and visiting procedures had been shared with family and friends. Residents were also supported to contact friends and family by use of social media and electronic devices.

All residents lived in self contained apartments, which had a small kitchen and washing facilities. The care home was working with Public Health England on how to zone areas if there was an outbreak of COVID-19. Furniture had been rearranged in communal areas to promote social distancing, but the residents did not like this. The care home carried out a risk assessment and the furniture had been arranged in line with residents’ wishes. There were garden spaces that could be used.

Areas had been set aside for staff to put on and remove personal protective equipment (PPE) safely and clear signage was in place. All staff had received training on infection control processes, which included specific COVID-19 training. Hand hygiene audits and infection control audits were regularly carried out and recorded. The care home ensured that any actions identified from these audits were actioned to maintain safety.

If the home admitted new residents then they would make sure that a negative COVID-19 test had been received and they had enough information to meet the resident’s needs. New admissions were isolated in accordance with current guidance,

Staff who worked in the care home were tested in line with current guidance. There were no staff who were deemed to be in a risk group. The manager was aware of the need to carry out risk assessments for staff in risk groups if needed. Arrangements were in place to make sure staff isolated if they became symptomatic, which included isolation at home until they had received a COVID-19 test and its result. All staff participated in the testing regime, and if able had received a vaccine dependant on their personal health needs. If bank staff were used, they received COVID-19 testing on the same basis as permanent staff. At the time of this visit none of the staff worked in any other health and social care settings.

The care home knew where to access appropriate support and guidance and there was a business continuity and pandemic action plan in place, which were routinely reviewed.

This inspection took place on 11 and 16 October 2017, both days were unannounced. The service was last inspected in April 2016 when it was rated as Requires Improvement. This was because we found people did not always receive person-centred care, the requirements of the Mental Capacity Act 2005 had not always been followed and risks to people’s health and safety and medicines were not always well managed. We also found there were not always sufficient staff to meet people’s needs. Following the inspection the provider sent us an action plan telling us how they would make improvements. At this inspection in October 2017 we found the improvements had been made.

A registered manager was 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.

Staff received training that helped them meet people’s needs. Training included equality and diversity, food safety, health and safety, moving and transferring and first aid. Where people had specific needs specialist training was arranged such as pressure area care, death and dying and caring for people living with dementia. Staff received regular supervision and appraisals to ensure they remained competent to do their job.

People’s needs were met in a safe and timely way as there were enough staff available. People and staff told us they thought there were enough staff on duty. One person told us if they pressed their call bell staff came quickly “No doubt about that.” People also told us staff had time to chat with them.

The service used a computerised care planning system and staff used hand held devices to obtain and input information about people’s needs. People’s care plans contained details of how their needs were to be met. Staff had good knowledge of the people they supported and delivered care in a respectful and caring manner and all personal care was provided in private. Staff ensured people received care and support that was responsive to their needs. Staff knew people well and were able to describe their preferences. For example, one staff member described how one person liked an alcoholic drink twice a day. Staff told us that many people were independent and their job was to support them to maintain their independence, but be available if needed.

People praised the staff for their attention and comments included “Staff always do whatever you ask them to do”, “Staff are all very pleasant, willing and friendly. Never make you feel you are a problem”, and “Staff are awfully nice, they are very kind to me.”

People could be involved in making decisions about their care if they chose. People told us staff regularly discussed their care with them, to ensure their needs continued to be met. One staff member told us whenever they made recordings on their hand held devices they showed them to the person so they could see what had been written about them. Visitors told us they were kept well informed about their relatives care and one told us this gave them “Peace of mind.” Visitors told us they were made welcome at any time.

There was a regular programme of activities available for people to participate in. Activities on offer included trips out, exercises and games as well as visiting entertainers. People’s spiritual needs were met. People were supported to visit church each Sunday and monthly communion was held at the service

People were supported to maintain a healthy balanced diet. There were choices for each meal and people told us the food was good. People were supported to receive any health care services they may need. There were safe systems in place to manage people's medicines. Medicines were stored securely and administered as prescribed to maintain good health.

People were protected from the risks of abuse as staff knew how to recognise and report abuse. Thorough recruitment procedures ensured the risks of employing unsuitable staff were minimised. A senior member of staff told us they felt the registered manager was good at employing the right staff with the right attitude.

Staff ensured people’s human rights were protected as they had a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). 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 registered manager was very open and approachable. Staff told us they felt well supported to do a good job. There were systems in place to assess, monitor, and improve the quality and safety of care. A series of audits and checks were undertaken to maintain the quality of care being provided. In order to gather the views of people about the quality of care being provided, questionnaires had been sent out to people, visitors and visiting professionals in February 2017. The results had been collated and made available to people. Comments in the questionnaires had all been positive.

Records were well maintained. They were accurate and complete and recorded the care provided. All records we asked for were kept securely but easily accessible.

The registered manager had notified the Care Quality Commission of all significant events which had occurred in line with their legal responsibilities.

This inspection took place on 20th and 21st April 2016 and was unannounced. We last inspected in October 2013. There were no concerns identified with the care being provided to people at that time.

The service had a registered manager. 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 home is arranged into self-contained apartments which include a bedroom, bathroom, dining and sitting area and kitchenette. Most of these apartments are situated within the main building with some apartments behind the main building, known as the Stables and the Mews. A lounge area is available for everyone to use. Meals are provided to people’s rooms on trays by staff. People can also cook simple meals themselves as there is a kitchenette and fridge in each apartment. The home is set in gardens and is close to Torquay seafront and town centre. Two minibuses are available to ensure people can get out and about to medical appointments, supermarket and the town.

The home works well for people who are more independent and everyone we met spoke highly of the service. People and relatives all felt the care and support at Sundial Lodge was safe. However, we found a number of areas requiring improvement. Some people’s health care needs had increased recently and these were not always being managed safely. For example, in relation to choking and dehydration. We also found medicines were not always managed safely in relation to how they were recorded or how they were stored. Staffing levels were not always safe because there were not enough staff available to meet the number and needs of some people living at the home at all times.

Staff did not always deliver care in line with professional guidance in relation to supporting people to eat and drink enough. Some people who were losing weight needed extra calories in their meals or snacks offered, but records did not demonstrate this was always happening. Systems for recording what people were having to eat or drink were not effective or being reliably followed.

Staff and the registered manager had knowledge of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, however assessments and decisions had not been recorded fully or in line with legal requirements.

Information in care plans sometimes lacked detail or was incorrect, conflicting or out of date. This meant that staff did not always have clear or up to date guidance from which to work in order to meet people’s needs and preferences. However, there was good verbal communication between staff about people’s care needs. All care staff attended handover meetings in the morning, afternoon and evenings where information was shared about any changes to people’s health or any other important changes or appointments. The registered manager was actively working towards making care plans more person centred and involving people in this.

People and relatives expressed a high level of satisfaction with food at Sundial Lodge. One person said “there is beautiful food here” and “the food is super here”. People made their meal choices a week in advance which most were happy with. Everyone received a copy of their menu choices. However, this did not suit people living with dementia. A relative said they were concerned that they regularly found evening meals left in the fridge that their family member had forgotten about. This meant staff may be unable to determine if people living with dementia were eating sufficiently. The lack of communal dining facilities at the home meant not everyone could have their preference to eat together met and this could lead to social isolation.

We have made a recommendation about setting up a system that helps assure the service that people are eating sufficiently. Since the inspection the registered manager has informed us that as well as everyone being weighed, intake charts showing how much people have eaten have been improved and implemented.

People spoke highly of the care they received. One person said “I am very happy here. I like the staff and the food”. Another said “It’s the best of what there is – the staff are so good” There were numerous cards and notes in the compliments book, thanking staff for their support and care. Relatives also spoke highly of the service “Staff here are wonderful, nothing is too much trouble” “Sundial Lodge is home from home”.

People’s right to privacy and dignity was respected in the home. One person said “It’s not regimented here; you have your privacy”.

Many people living at Sundial enjoyed a full and active social life. People were in and out of the home all of the time we were there; visiting friends or going out for walks. They made good use of the minibus service that took them to the shops and town and valued the support the home offered that enabled them to remain as independent as possible. However for those who were less independent there were limited activities on offer. People did not benefit from individual activity plans to promote their wellbeing. People sitting in the lounge area told us they were bored. Staff said they no longer had time to sit and talk with people. This meant not all people benefitted from meaningful activity in their lives.

The home used quality assurance processes but these had not identified the concerns we recognised through the inspection. Survey’s showed a high level of satisfaction from people living at the service and families. No complaints had been received and the registered manager operated an open door policy where any concerns could be raised informally and resolved at an early stage.

Staff had a good understanding of safeguarding and how to protect people from possible harm. Safe recruitment practices were in place to ensure that staff with the right attitudes and skills were recruited. The environment was clean and well maintained and there were regular fire safety checks and testing of other equipment.

People had access to health services. GP’s and other healthcare professionals were contacted where necessary to discuss people’s care needs. Health professionals told us the home was good at asking for advice and support.

Staff were very happy with the level of support they received from the management team. This allowed them to develop their learning and consider career progression. Most were involved in studying for diplomas in health and social care. Training was provided to ensure that staff had the skills needed to provide suitable care for people. However this was all currently through e-learning. The manager wanted staff to have face-to-face training too and was looking for a suitable training provider. Since the inspection we have been informed that training from an external provider is in place.

Staff said there had been considerable improvements made at the home since the registered manager started two years ago. They felt that they were operating more professionally and working as a team. People, families and staff all expressed a high level of confidence in the registered manager. The registered manager told us they had worked hard to introduce changes, such as new risk assessments, a stronger team and better communication systems in the home. They had a good relationship with the provider and felt well supported. However they sometimes missed having the support of another professional from a care background. They told us that they would be resuming contact with other manager’s from the local provider care forums to gain this support.

During the inspection we identified a number of concerns about the care, safety and welfare of people who lived at Sundial Lodge. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who lived at the home felt respected and involved in their care. People pursued hobbies and engaged in regular activities at the home. One person told us 'I go to town, we have transport that takes us for two hours, sometimes twice a week.'

People's needs had been assessed and were delivered in line with their care plan. There was a variety of healthy and nutritious food and drink for people. However, feedback about the food was mixed. One person said "it's not as good as it used to be."

People were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. Care workers understood their responsibilities and knew how to identify and raise concerns. People told us they felt safe at Sundial Lodge.

We found that medication was being managed well and was stored securely at the home. Appropriate and accurate medication administration records were kept.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and sought regular feedback.

People experienced care, treatment and support that met their needs and protected their rights. We spoke with four people using the service. People told us that they were happy with the care they received. One person said "I am looked after very well" another person said "all the staff are lovely, I can't complain at all".

People were cared for in a clean, hygienic environment. Each individual's apartment was clean and staff we spoke with were aware of the standards they were to maintain.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We checked the premises and saw that the building and d'cor were in a good state of repair and appropriately maintained.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.