Sunnymeade Quality Care

Sunnymeade Quality Care is a residential care home that was providing personal care for up to 31 people. At the time of the inspection 28 people living at the service.

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

Changes from a paper reporting system to an electronic recording system for care and managing risk had been slow to be implemented. Some people were at high risk of falls. These were being reviewed and responded to by the manager. There had been a choking incident. This person’s risk assessment had not been updated at the time. However, recent review and changes meant the current risk assessments were satisfactory and any risks to people were minimised. There was no evidence of reporting on patterns or trends of incidents and what additional measures had been put in place to mitigate risk. The current management team had recognised this and created an area on the electronic system to report falls and review patterns to manage this in the future.

Systems to assess and monitor the quality and safety of the care provided were being developed. However, these systems were still being implemented and were not yet fully effective in assessing quality or identifying and driving improvement.

People’s capacity had not always been assessed following the principles of the Mental Capacity Act 2005 (MCA). Where people lacked capacity there had been no assessment or applications made to the local authority for any Deprivations of Liberty Safeguards that were necessary to keep people safe.

Health and safety checks of the environment and equipment were in place. However, the services environmental fire risk assessment had not been reviewed since 2019. The records stated it was due for review in October 2020. This had not occurred, but had been recently identified by the management team who were in the process of updating this assessment.

People’s medicines were managed safely. However, there were gaps in the temperature monitoring of the medicine refrigerator. The manager took immediate action to address this by reminding staff responsible.

The service had suitable safeguarding systems in place. Most staff had received training, however there were some gaps where training updates had lapsed. Staff spoken with were able to explain how they recognised abuse and what to do if they suspected abuse was occurring. The managers had identified where updates were required and this had been factored into the training plan.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Staff were informed about people’s changing needs through effective shift handovers and records of the daily care provided for people.

People were offered a range of healthy meal choices.

Relatives told us they were happy with the care their family member received and believed it was a safe environment. Comments included, “Yes, it all seems very good. The place is very clean and does not smell at all. (Person’s name) is very happy here” and “The care, love, and dignity you treated our relative with was above and beyond. The sincerity that you afforded me when I was with my relative in the final hours will always be remembered”.

Staff were recruited safely. The service had experienced staffing shortages and was a nationally identified issue. Staffing rotas identified where gaps had occurred and what action had been taken to fill those gaps. The staff team and managers were supporting each other to ensure people’s needs were being met.

There was an active recruitment process in place. It was anticipated staffing levels were improving. Agency staff were also supporting any gaps. Staff told us, “We have struggled like everywhere else. We are not fully staffed but this week as one of us is on holiday, we get on with it, we are a good team and we are currently on a bit of a programme and when there are three of us and we are blitzing rooms and it is nice because we are slowly getting back up to where we should be.”

Many staff had been provided with supervision this year, although this had not been as regularly as planned due to the impact of recent staffing pressures and the challenges of the pandemic. We saw a more robust programme of supervision and competency checks which was being implemented for all staff.

The training rota had recently been reviewed and updated. There had been some gaps in training during the COVID-19 pandemic period. However, they had been identified and dates were in place to carry out this training.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per current government guidance.

Staff supported people in the least restrictive way possible. Changes in policies and systems in the service supported staff. People who wished to remain in their bedroom did so. Those spoken with confirmed this was their choice.

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 good (report published 13 February 2019).

Why we inspected

We received concerns in relation to safeguarding people. Intelligence showed there was inconsistency in the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this report.

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

Enforcement

At this inspection we have identified breaches in relation to governance, risk and monitoring systems.

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 any concerning information is received, we may inspect sooner.

People’s experience of using this service:

People’s experience of using this service:

• People told us they felt safe and happy living at Sunnymeade Quality Care.

• People told us staff met their needs and staff confirmed they received sufficient training.

• Staff knew people well and had an in depth understanding of people’s individual preferences and how to meet them.

• Staff ensured people’s healthcare needs were met and external advice was sought promptly where required.

• People were treated with respect and staff protected their privacy and dignity.

• Staff ensured people could spend their day where they wanted and supported them to spend their time in a way that reflected their interests.

• People could influence what, where and when they ate, and staff provided support where necessary.

• Regular checks were completed of medicines, records and the standard of care provided. Information collected was then used to ensure any required improvements were made.

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

Rating at last inspection: Good (report published 12 October 2016)

Why we inspected: This was a planned inspection based on previous rating.

Sunnymeade Quality Care is a care home which offers care and support for up to 40 predominantly older people. At the time of the inspection there were 36 people living at the service. Some of these people were living with dementia. The accommodation is spread across two floors and one area is specifically arranged to cater for those people with higher support needs. There are several lounge areas where people can choose to spend their time. There was a pleasant garden adjacent to the building.

The service had two full time registered managers in post with clearly defined areas of responsibility. 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.

There were enough staff to help ensure people’s health and social needs were met. Staff were effectively deployed across the service and people’s needs were met in a timely manner. Staff were friendly and compassionate in their approach to people. People commented; “They look after me very well” and “Staff are good.”

Risk assessments were in place with information to guide staff on how to protect people from any identified risk. We observed staff supporting people in line with guidance. The assessments were reviewed and updated regularly to help ensure they reflected people’s changing needs.

People told us they received their medicines as prescribed and systems for the safe storage of medicines were robust. We found the system for recording when medicines which were to be taken as required had been administered were not robust. We have made a recommendation about the management of these medicines in the report.

Staff received a thorough induction when they started working at the service. Training was regularly refreshed and staff told us it was effective. Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure staff were suitable to work in the care sector.

Staff supported people to be involved in and make decisions about their daily lives. People chose where they spent their time, when they got up and when they went to bed. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were protected from the risk of abuse because staff had a good understanding of the potential signs of abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

Care plans were well organised and contained information covering all aspects of people’s health and social care needs. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

One member of staff had responsibility for overseeing the programme of activities provided for people. Activities took place both within the service and outside. As well as trips out for special occasions or events, people were supported to access the local community regularly to visit cafes and go on local walks.

The registered managers were well supported by the provider. They attended local forums to keep up to date with any developments in the care sector. They were supported in the day to day running of the service by senior team leaders. There were plans to introduce a key worker system to give members of staff responsibility for the oversight of individuals care plans.

People and their relatives were asked for their views on the service provided. This was done using a variety of methods including questionnaires, meetings and a suggestion box. People’s suggestions were listened to and acted on if appropriate.