All inspections: Sunnymead Manor - Care Quality Commission

This inspection took place on 11 March 2016 and was unannounced. The last full inspection took place on 2 February 2015 and, at that time, two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to safe care and treatment and good governance. These breaches were followed up as part of our inspection.

Sunnymead is registered to provide personal care and nursing care for up to 76 people. The service has two units, Hollies and Poplars. Poplars unit provides care and support to people living with dementia. At the time of our inspection there were 36 people living in the service.

There was no registered manager in place on the day of the 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 deputy manager had the current responsibility of running the service.

In February 2015 we found that people’s care records were not always maintained accurately and completely to ensure full information was available. At this inspection the provider had not made sufficient improvements.

In February 2015 people’s medicines were not always managed and administered safely. At this inspection the provider had not made sufficient improvements.

People were not always safe as there were not always sufficient numbers of suitably qualified and skilled staff to support their needs. Staffing levels were not maintained in accordance with the level determined by the provider’s dependency tool.

The provider had inconsistent arrangements in place for reporting and reviewing incidents and accidents. Records showed some incidents were clearly audited and actions were followed up and support plans adjusted accordingly. Other incidents were processed but there was not a clear audit trail of the investigation and the outcome.

Staff were not consistently supported through an effective training and supervision programme.

Staff demonstrated a basic understanding of how to recognise and report abuse. Although the majority of staff confirmed they had received safeguarding training, not all were able to describe what abuse was or how they would report it.

The provider had not consistently protected people against the risk of poor or inappropriate care as accurate records were not being maintained. Not all records were completed accurately to manage and ensure that people’s on-going needs were met and risks mitigated.

People’s nutrition and hydration needs were not consistently met.

People’s rights were not being upheld in line with the Mental Capacity Act (MCA) 2005. This provides a legal framework to protect people who are unable to make certain decisions themselves.

The service was not consistently responsive to a person’s needs. We found that the care plans did not reflect people’s individualised needs. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement.

Since the previous inspection conducted in February 2015 the provider had failed to fully implement the actions in their plan to ensure they were no longer acting in breach of the regulations. As well as not fully implementing the stated actions in the plan we found that the number of breaches of regulations has increased.

The provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. This resulted in poor practice across the service.

The majority of staff demonstrated kind and compassionate behaviour towards the people they were caring for.

Records showed a range of checks had been carried out on staff to determine their suitability for the work. For example, references had been obtained and information received from the Disclosure and Barring Service (DBS).

People were cared for in a safe, clean and hygienic environment. The home was free of odours and daily cleaning schedules were completed throughout the building.

People had their physical health and mental health needs monitored. The care plans showed people had access to healthcare professionals according to their needs. We noted that people had access to their GP, speech and language therapists, tissue viability nurses and the dementia well-being team.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

People were encouraged to provide feedback on their experience of the service.

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 this report.

This inspection took place on 2 February 2015 and was unannounced. The previous comprehensive inspection took place on 23 April 2014. There were nine breaches of the legal requirements at that time. These related to:

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. Records were not kept securely and could not be located promptly when needed.
People’s privacy, dignity and independence were not respected.
People were not cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.
The provider had a system to regularly assess and monitor the quality of service that people receive but this was not effective.
People who use the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
People had their comments and complaints listened to but their concerns were not acted upon.
People were not protected from the risks of inadequate nutrition and dehydration.
Care and treatment was not planned or delivered in a way that ensured people's safety and welfare.

In addition to this we took enforcement action and a warning notice was served in relation to Regulation 12 as we found people were not protected from the risk of infection because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. A focused inspection was undertaken on the 15 July 2014 in relation to the warning notice and found the provider had met the legal requirements in relation to Regulation 12.

Improvements had been made in some areas, but new improvements were needed following this inspection to meet the regulations.

Sunnymead Manor is registered to provide accommodation and personal care with nursing for up to 76 older people across two floors. The upper level of the home provides care and support to people living with a form of dementia.

A registered manager was in post at the time of 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.

At the time of our inspection there were 52 people using the service and some people told us what it was like to use the service. People’s comments included: : “Staff are all lovely, kind and considerate, I think of them as my friends”; “Staff are lovely, they look after me well”; “Staff are very good to me”. For other people that were unable to verbally express their views, we spent time in shared areas to observe the care that was being provided.

People’s medicines were not always managed and administered safely. Some records were not fully completed and the organisations policy and guidance in administration was not always followed by staff.

Although staffing levels were sufficient on the day of our inspection as people’s need were responded to quickly. We observed some people did not receive sufficient interaction. We were told a dependency tool was used to assess the level of staffing that was required. We were told this was adjusted according to people’s needs on a weekly basis.

Staff received training and understood their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. Within people’s support plans we found the service had acted in accordance with legal requirements when decisions had been made where people lacked capacity to make that decision themselves.

Staff had attended Deprivation of Liberty Safeguards training (DoLS). This is legislation to protect people who lack mental capacity and need to have their freedom restricted to keep them safe. One person in the home was subject to a DoLS authorisation. All documentation was appropriately completed that protected the person’s human rights.

We found the provider had systems in place that safeguarded people. People we spoke with told us “the usual staff are good and know me well. Sometimes we have agency staff and I don’t feel so safe”. Another person told us”, “I do feel safe living here, it is safer than at home” and “if I didn’t feel safe with staff I would tell [name]”.

Safe recruitment procedures were in place and followed by the registered manager. People did not work at the service until appropriate checks were made.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively. Training was provided about current practice guidance and staff we spoke with were knowledgeable about people’s needs. One member of staff told us how they were being supported to undertake further development training that would enhance their role and they would share this with the rest of the team.

Where risk to people’s well-being were identified, the care plans provided information to staff on how to minimise the risks. People at nutritional risk had food and fluid charts and turning charts in place. However we found some inconsistencies in their completion.

People received and were involved in reviews of their care needs to ensure that staff had up to date information about how to meet their. The care reviews also ensured the care plans continued to effectively meet people’s needs.

Staff meetings and registered manager meetings took place with the operations manager on a regular basis. Minutes were taken and any actions required were recorded and actioned.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. People were asked their views each time they used the service and at any reviews of their care and support needs so they could express their views and opinions about the service,

There were systems in place to obtain the views of people who used the service and their relatives. A board in the communal areas of the home showed what the service had done with people’s comments and detailed any changes to the service that had been made in response.

We found multiple beaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now correspond to 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.

Sunnymead Manor provides care home accommodation for people requiring nursing and personal care. The service can accommodate up to 76 people.

There had been no registered manger in place at the home since September 2013. 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 and associated Regulations about how the service is run.

We carried out a comprehensive inspection of all aspects of this service under Section 60 of the Health and Social Care Act 2008 on 23 April 2014, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to test a new inspection process being introduced by CQC which looks at the overall quality of the service .

Some breaches of legal requirements were found. As a result we undertook a focused inspection using the same legal powers on 15 July 2014 to follow up on whether action had been taken to deal with these breaches. The inspection carried out on 15 July followed up the warning notice served in relation to cleanliness and Infection control. The inspection of 23 April found there had been breaches of other relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We will be following up these in the near future to check if improvements have been made.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 23 April 2014

We found that the provider was in breach of regulation 12 of the Health and Social care Act 2008 in relation to cleanliness and Infection control. As a result we sent the provider a warning notice telling them that they must make improvements and meet regulation 12 by 30 June 2014. We received an action plan from the provider on 6 June 2014 telling us what they would do to ensure that they met the requirements of the warning notice by the 30 June 2014.

We found people were not consistently involved in their assessments of need and there was limited on-going involvement. This was particularly noted for people who were unable to express themselves verbally.

Staff were not using alternative methods of communication such as pictures or objects when interacting with people with cognitive difficulties. This means that some people with dementia were not being involved in conversations and decisions. Although there was some information about people's likes and interests there were limited social activities for people to be involved in. There was no activity programme in place based on consultation with people.

Each person had a care plan that outlined their needs and the support required to meet those needs. People received care that met their physical needs although we found there was limited support in place to meet people’s emotional and social needs. Risk assessments had been written and measures had been put in place to minimise the risks identified by the assessments but these were not kept under review.

There was a management structure in the home but it did not provide clear lines of responsibility and accountability. The acting manager had carried out quality monitoring to assess the quality of care provided and plan on-going improvements but these were not effective. The area manager was aware of the issues and a remedial action plan was in place to address some of the concerns highlighted in their quarterly monitoring reports but this plan was not improving standards at the service.

People we spoke with said that staff were kind and polite. We observed that staff assisted most people with their care needs in an unhurried manner. However we also saw that people’s privacy and dignity was not always respected

The concerns identified meant there had been breaches of the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010). You can see the action we have told the provider to take at the end of this report.

Focused inspection of 15 July 2014

We inspected Sunnymead Manor on 15 July 2014 to check that the improvements required had been made. We found that the home was still not clean and that as a result people were still at risk of acquiring infections.

Sunnymead Manor is a care home that provides nursing and personal care for up to 76 people. At the time of the inspection there were 56 people using the service. The people who received care at the home were older people. This included people who required support due to their dementia care needs.

The home was not clean and people were at risk of acquiring infections. The management of the home did not have effective systems in place to ensure that the home was clean.

We found people were not consistently involved in their assessments of need and there was limited ongoing involvement. This was particularly noted for people who were unable to express themselves verbally. No alternative methods of communication such as pictures or objects were considered by the staff to aid people.

Although there was some information about people's likes and interests there was limited social activities for people to be involved in. There was no activity programme in place based on consultation with people.

There was a management structure in the home but it did not provide people with clear lines of responsibility and accountability. There had been no registered manager in place at the home since September 2013. The acting manager in the home had carried out quality monitoring to assess the quality of care provided and plan ongoing improvements but these were not effective. However the area manager was aware of the issues and a remedial action plan was in place to address some of the concerns highlighted in their quarterly monitoring reports but this plan was not improving standards at the service.

Each person had a care plan that outlined their needs and the support required to meet those needs. People received care that met their physical needs although we found there was limited support in place to meet people’s emotional and social needs. Risk assessments had been written and measures had been put in place to minimise the risks identified by the assessments but these were not kept under review.

People we spoke with said that staff were kind and polite. We observed that staff assisted most people with their care needs in an unhurried manner. However we also saw that people’s privacy and dignity was not always respected.

There was always a registered nurse on duty which helped ensure people’s healthcare needs were met but we found that they did not always take the lead on providing guidance and support to other staff. People received care and treatment from healthcare professionals according to their individual needs.

At the time of our inspection there was no registered manager in post. The acting manager told us they were in the process of applying to become the registered manager. There were 49 people living at the home when we inspected. We spoke with seven people living at the home and two of their relatives. All the people we spoke with told us they liked the home and were happy with the care and support they received. One person told us 'It feels homely here, the staff are very caring. They all look after me and they get the doctor if I'm not feeling well'.

The home assessed people's needs and care plans were developed to provide guidance to staff to ensure these needs were met.

The staff had recently transferred people's care records to the new provider's documentation. The home was supporting staff with these changes and we found it was being managed and monitored effectively to ensure people's safety was maintained.

The home had introduced a new menu which was developed with people and their relatives. People told us that they liked the food and were given choice about what they wanted to eat.

We saw that there were systems in place, which ensured that staff were supported in their roles. Staff were provided with appropriate training in relation to their role.

The provider had systems in place to monitor the quality of the service. Where checks identified shortfalls, these were addressed and action plans put in place to ensure these areas were addressed.

Archived: Sunnymead Manor

All Inspections

11 March 2016

During a routine inspection

2 February 2015

During a routine inspection

15 July 2014

During an inspection looking at part of the service

23 April 2014

During a routine inspection

27, 30 September 2013

During a routine inspection