Sundial Care Home

Updated 24 August 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.

This comprehensive inspection took place on 5 and 7 June 2018 and the first day was unannounced. The inspection team on the first day consisted of two adult social care inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day was carried out by an adult social care inspector.

Before the inspection we reviewed the information we held about the service. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about. We also contacted the local authority commissioners for the service and the local Healthwatch England to gain their views of the service provided. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We also used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spent time with people living at the service. We carried out observations using the Short Observational Framework for Inspections (SOFI). SOFI is a tool used to capture the experiences of people who use services who may not be able to express this for themselves.

We spoke with eight people, two relatives and a member of the local community who wanted to share their views about the service. We spoke with nine members of the staff team including the registered manager, deputy manager, administrator, care shift leaders, care staff, a member of the housekeeping team and the cook. We spoke with the four of the provider’s representatives and a visiting health professional.

We reviewed three people's care records on the provider’s computerised care system and two staff files including recruitment, supervision and training information. We reviewed medicine administration records for five people as well as records relating to the management of the service. We also contacted 14 health and social care professionals for their views. We received a response from one of them.

Updated 24 August 2018

This comprehensive inspection took place on 5 and 7 June 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming. This was the first inspection of this service since the new provider registered with the Care Quality Commission (CQC) in August 2017. During the inspection the provider changed the name of the service from Sundial View to Sundial Care Home.

Sundial Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sundial care home can accommodate up to 37 people in a detached period property in the village of Tipton St. John, East Devon, near the seaside town of Sidmouth. The home consists of two floors with a passenger lift providing level access to each floor. There are two large communal areas, both providing kitchenettes, dining areas and comfortable seating where people could spend their time as they chose. To the rear of the house was a large secure landscaped garden with country views which people could access independently.

At the time of this inspection there were 23 people using the service. One of these was staying at the service for a period of respite (respite is planned or emergency temporary care provided to people who require short term support). One house of 11 bedrooms was closed for refurbishment which was due to be completed later this year.

There was a registered manager. A registered manager is a person who has registered with CQC to manage the service. Like registered persons, 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 registered manager was supported by a deputy manager and the provider’s management team. They covered seven days a week and worked closely with people, relatives and the staff team.

People received outstanding care and were supported to have the best quality of life possible. People and visitors said they felt the care at the home was exceptionally good. Comments included, “It’s a good quality place to be. Very comfortable. I am looked after extremely well. They are very kind here.”

The provider had recruited a specialist team to design their model of care to cater specifically for people they support. They had completed research examining care models in Australia and America and best practice in care homes in the United Kingdom. They had written ‘The Evolve Household Model of Care’. This model ensured that barriers between people and staff do not exist. Staff were trained to be with people, talking and listening, enabling them to maintain maximum independence and constantly evolving to improve the quality of people’s lives. For example enabling people to do everyday tasks like making a cup of tea, sweeping the floor and making and buttering their own toast. It was clear people were at home at Sundial.

The provider recognised the importance of recruiting the right staff with the right skills. They involved people in the recruitment process. The registered manager said, “Skills can be taught however the drive to have a career in care is heartfelt and driven by a person’s (staff member’s) beliefs and values.” Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

Staff demonstrated a passion to provide individualised care for people. They were highly motivated and offered care and support that was exceptionally compassionate and kind. There was a strong person-centred culture at the home, with people being at the centre and focus of everything. Staff had a real empathy for the people they cared for and treated people like family members. They interacted positively with people and had a good knowledge of the people they cared for. Care plans contained detailed information, including life history, to help staff support people in a personalised way. Relatives were made to feel welcome and were involved in the care planning process. Staff provided care in a way that protected people's privacy and dignity and promoted independence. People and relatives were very happy with the care the staff provided. People and visitors said the care at the home was exceptionally good. Comments included, “It’s a good quality place to be. Very comfortable. I am looked after extremely well.”

People received care that was tailored to their individual needs. They were very well supported by sufficient numbers of staff on duty to care for them safely and spend time with them. The provider monitored people’s needs and took prompt action to increase staff levels as people’s needs changed.

The staff demonstrated a real passion to ensure people were supported at the end of their life with dignity and respect. There was a strong sense of people being an important part of a family at Sundial Care. An area in the garden referred to as a remembrance garden remembered people who had stayed at the home. There were numerous thankyou messages from relatives regarding the good quality care people had received at the end of their lives at the service.

Staff were highly skilled and had the knowledge to meet people's individual physical, psychological and social needs. They had received the provider’s very comprehensive induction and bespoke training which was based on the provider’s model of care and CQC’s key line of enquiries. There were designated staff champions for providing knowledge and expertise for other staff. Equality and diversity was part of the provider's mandatory training requirements and people were cared for without discrimination and in a way that respected their differences.

People's medicines were managed safely and overseen by a medicines champion. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines.

People were protected from harm as staff were able to demonstrate a good understanding of what constituted abuse and how to report if concerns were raised. Staff had safeguarding of vulnerable adults training and had the knowledge on how to report any concerns internally and externally and what action they would take to protect people. Robust systems were in place to manage risks to people, which were monitored by the provider’s senior management team. Risks had been identified and managed appropriately with full involvement of people and relatives in a meaningful way. People had individual personal emergency evacuation plans in place. Accident and incident records showed staff had taken appropriate action at the time to protect people. The management team had analysed these to look for patterns or trends. The provider had completed a near miss project which gave staff clear examples of environmental near misses and how to report and prevent them.

People were assessed in line with the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguarding (DoLS). People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected and staff worked with other professionals in their best interest. 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. Capacity assessments were being undertaken and best interest decisions were being recorded.

People were supported to maintain their health and wellbeing and had access to health professionals when needed. Staff had a strong emphasis on the importance of eating and drinking well at the home. They supported people to have sufficient to eat and drink and maintain a balanced diet and enjoy their food. The service provided good quality food with a variety of different options to choose from each day. People told us they enjoyed their meals, there was plenty of food and we observed people were not rushed. People who had previously used the service for respite stays remained involved in the life of the service, through the monthly lunch clubs and social events.

People were actively encouraged to use the two kitchenette areas to make food as they chose supported by staff. Snacks and drinks were always accessible if people required them. People's weights were monitored regularly and advice sought from GPs if there were any cause for concern.

The provider actively involved people, staff and local people in developing the service. Regular residents and relative meetings were held giving them the opportunity to voice and share their opinions and ideas about the future of Sundial. People and their relatives were happy with the way care was delivered and happy with the staff approach. The national care homes review website had six positive reviews from relatives of people using the service. They all rated the service as excellent and good. One relative recorded, “Supported very well by the friendly, helpful staff. She is so much happier than when she was living at home.”

The management team continually strived to improve the service and their own practice finding new and creative ways to do that. The provider used a tailored quality monitoring system at the service. The staff team were fully involved in the provider’s governance process. They were supported to identify issues, address them and find more creative ways to support people's health and wellbeing.

The provider recognised the importance of social activities and that all activities no matter how small formed an important part of people’s lives. They used the phrase ‘magic moment’s’ where staff recognised throughout the day they can support people to do tasks for themselves, what th