Sunnybank House

Sunnybank House is a care home providing personal and nursing care to up to 60 people. There were 38 people using the service when we inspected. The accommodation is arranged over three floors. The Rose Unit is on the ground floor and provides residential care for people with less complex needs. Dahlia Unit is on the first floor and is a registered nurse led unit supporting people with a range of more complex clinical needs. Nemesia Unit is on the top floor. This unit had only recently reopened after being redeveloped as a specialist unit for people living with dementia.

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

People were safe and we observed care being provided in a caring and unhurried manner. However, we also received feedback which indicated that there were times when staff were not able to be fully responsive to people's needs. Medicines were not always administered as planned due to not being available or out of stock or because staff had not always been sufficiently proactive about overcoming other barriers to administration. Risks to people’s care had been assessed and planned for. A range of health and safety checks were taking place to ensure that the building and the equipment within it were safe to use and had been serviced and maintained regularly. As part of CQC's response to the coronavirus pandemic we conducted a review of infection prevention and control (IPC) measures in the home and were assured by the systems in place. There were systems and processes in place to safeguard people from the risk of abuse and to learn from safety related events. We did identify one potential safety related concern in relation to how food for people who required a modified diet was being prepared.

We have made a recommendation about how the International Dysphagia Diet Standardisation Initiative (IDDSI) is used within the service.

Staff completed a suitable induction and undertook a wide range of training, relevant to their role.

Assessments were completed to establish people’s needs and to ensure these could be fully met. People’s nutritional needs were met. Staff worked with other agencies to ensure people had access to healthcare services. The design and layout of the building was suitable and had been developed with the needs of people living with dementia in mind. Staff were well informed about the principles of the Mental Capacity Act 2005.

We have made a recommendation that the service develop specific DoLS care plans which show how the liberty of people, with a DoLS authorisation, is being promoted.

People told us that staff were kind and caring and treated them with respect. People were supported to maintain their independence and autonomy where able. Staff sought people’s consent before delivering care and care plans included information about people's preferences and wishes and the relationships that were important to them.

People had access to a range of events and activities which helped to boost their well-being and keep them engaged and entertained. The number of agency staff used had reduced which helped to ensure that people received care from staff that knew them and their needs well. People’s communication needs continued to be identified and planned for. Complaints had been responded to appropriately. Staff worked with local health care professionals to provide responsive and compassionate end of life care.

People benefited from a well led service and the registered manager and provider had shaped a culture where staff strived to provide person centred care. The registered manager maintained a visible presence within the home and actively supported staff and interacted with people on a daily basis. Staff were clear about their role and responsibilities and spoke positively about the registered managers leadership and their impact on the service since their appointment. There were effective quality assurance systems in place that lead to improvements that had positive outcomes for people. People were encouraged to give feedback about the care they received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was ‘Requires Improvement’ (published October 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sunnybank House is a care home providing personal and nursing care to up to 60 people. There were 52 people using the service when we inspected. The accommodation is arranged over three floors. The Rose unit is on the ground floor and provides residential care for people with less complex needs. Dahlia Unit is on the first floor and cares for people living with dementia. Nemesia Unit is on the upper floor and is a registered nurse led unit providing care to people with complex needs.

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

We continued to find that some of the risks to people’s safety had not been fully mitigated. Improvements were still needed to ensure that suitable numbers of staff were deployed to meet people’s needs. Records did not provide assurances that people had always received their medicines as prescribed. The service was visibly clean throughout and no malodours were noted. Staff received training in safeguarding adults from harm and had a positive attitude to reporting concerns.

The deployment and availability of staff did not always allow staff the time to provide person centred care. Improvements were needed to ensure that people were able to take part in activities which were meaningful to them and which provided enjoyment and occupation. People's communication needs were identified and planned for. People expressed confidence that they could raise any issues or concerns with any member of staff or the management team and that these would be addressed. People’s wishes in relation to their end of life care had been recorded and staff had received training to enable them to ensure people had a dignified and pain free death.

The governance and leadership systems in place were not yet being fully effective at helping the service increase its rating to at least ‘Good’. Our conversations with the provider did offer reassurances that they understood what good care looked like and they maintained a commitment to drive improvements and to support organisational learning. People and their relatives were consulted and involved on an ongoing basis about their care and wider issues within the home.

People consistently told us that staff were kind and caring. People had developed caring and meaningful relationships with staff. Where people could make decisions about their care, they were encouraged to do so, and this helped them to feel that they had control over their lives. Relatives and friends could visit without restrictions and were encouraged to be fully involved in their family members care. Staff understood the importance of supporting people to maintain their independence.

People needs were assessed and planned for. Staff were suitably trained, well supported and overall had the necessary skills and knowledge to perform their roles and meet their responsibilities. Overall people’s nutritional needs were met. The design and layout of the building met people’s needs. 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was ‘Requires improvement’ (August 2018). There was one breach of the legal requirements relating to safe care and treatment. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of this regulation, but some of the improvements needed were yet to be fully embedded.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Our last inspection had identified concerns regarding the safe and proper management of medicines. This inspection found that overall the required improvements had been made and the legal requirements were now being met.

We did however identify some new concerns.

There had been a failure to assess and mitigate risks to some people.

Improvements were needed to the management and governance arrangements in the service. There were instances where the safety and quality of the service had been compromised. Staff were not always following risk management plans and were not clear on their roles and responsibilities. Staff lacked understanding on the accountability for decision making.

Staff had not always been deployed in a safe manner and the high use of agency workers had impacted upon the continuity of care people received.

Some of the records relating to people’s care and support could still be improved. For example, daily records did not consistently show that people’s care was being delivered in line with their care plan.

The service were making improvements to ensure that staff were always acting in line with the Mental Capacity Act 2005 and relevant guidance.

Environmental risks were managed.

Recruitment practices were safe and relevant checks had been completed before staff worked in the service unsupervised.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

Each of the people we spoke with felt that the home was clean. Throughout our visit, we did not find any malodours and we observed that staff used appropriate personal protective equipment (PPE).

Improvements to the induction of new staff and with the supervision programme were being embedded. Staff had completed a range of training.

People were mostly positive about the food. A selection of hot and cold drinks was available throughout the day.

A range of healthcare professionals including GP’s, community mental health nurses, occupational therapists and physiotherapists had been involved in planning peoples support to ensure their health care needs were met.

Overall the design and layout of the premises met people’s needs.

People were cared for by kind and compassionate staff. It was clear that the permanent staff and the longer-term agency staff had developed meaningful relationships with people.

People were encouraged and supported to make decisions about their care and support and staff tried to promote people’s independence wherever possible.

People were treated with dignity and respect.

Care plans recorded people’s individual preferences and the permanent staff and longer-term agency staff knew people well.

Improvements were being made to the activities programme provided.

Information about how to complain was readily available within the service and the provider maintained a record of the complaints that had been received and how these had been responded to.

The provider sought feedback from people, their relatives and from staff and used this to continually improve the service.

There was evidence that people had been supported by staff to have a comfortable and dignified death.

Staff were generally positive about the registered manager and most felt supported in their roles. They told us morale was improving.

The registered manager demonstrated an understanding of the performance of, and challenges within, the service and expressed a commitment to their role and to driving improvements within the service.

This is the second consecutive time the service has been rated ‘Requires Improvement’. The service is not yet consistently providing good care. We will meet with the provider to discuss the findings of this report and continue to monitor the service to ensure that improvements are ongoing.

A registered manager was not in post at the time of our inspection. 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 service had appointed a new manager whose intention it was to register with CQC. However, the home had had numerous changes in management over the past two years. People and staff felt the frequent changes in management had a negative effect on the quality and running of the home.

The manager had identified areas for improvement within the service and was working towards completing an action plan, which identified where changes were required. People and staff spoke positively about the initial changes the manager had made to the running of the home. The manager had recently implemented a series of cyclical audits, which would monitor and assess the quality of the care and the safety of the home. The improvements needed to be embedded and sustained to ensure people received high quality care over an prolonged period of time.

Systems to safely manage people’s medicines were not always effective. People did not always receive their medicines as prescribed and recordings of medicines given were not always accurate. The manager had made changes to the home’s medicines management system, which had resulted in improvements being made in these areas; however, improvements were in the initial stages and could not be evidenced as sustained.

People’s care plans did not always reflect people’s most up to date needs. The manager had identified these issues and assigned staff to complete the areas which were outstanding. The manager had also arranged for staff to complete training which gave them knowledge and skills in effective care planning. People’s care plans which were completed were detailed; person centred and met people’s needs. Risks to people were identified and incidents were analysed to look for ways to reduce future risks and likelihood of reoccurrence.

People were supported to access healthcare services and were supported to follow a diet in line with their preference and dietary requirements.

The provider had not implemented systems and processes to gain formal feedback from people using the service or their relatives. A questionnaire was due to be sent out to people asking for their feedback about the quality of the care being provided, but the provider was unable to locate the results of any previous feedback sought. A complaints policy was in place, which the manager followed. Records of investigations were thorough and transparent, with lessons learnt from mistakes and people fed back to about findings.

There were sufficient numbers of staff available to support people. However, there were shortages of permanent staff, which meant that agency staff were required to complete full staff allocation. People, relatives and staff felt that agency staff did not always provide effective and compassionate care. The provider was in the process of recruiting additional permanent staff.

Permanent staff were caring and understood people’s needs well. Staff had received training in safeguarding and understood the steps required in order to keep people safe. Staff had also received training in The Mental Capacity Act (2005) and understood how to promote and respect people’s rights.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken in the full version of this report.