• Care Home
  • Care home

Rivermere Retirement and Care Home

Overall: Good read more about inspection ratings

64-70 Westerham Road, Bessels Green, Sevenoaks, Kent, TN13 2PZ (01732) 748400

Provided and run by:
WT UK Opco 2 Limited

Important: This care home is run by two companies: Willowbrook Healthcare Limited and WT UK Opco 2 Limited. These two companies have a dual registration and are jointly responsible for the services at the home.
Important: The provider of this service has requested a review of one or more of the ratings.

All Inspections

8 January 2021

During an inspection looking at part of the service

About the service

Rivermere Retirement and Care Home is a residential care home providing personal care and support for up to 102 older people. At the time of the inspection there were 47 people living in the service. A number of double rooms are available for partners or people who chose to share, some with kitchenettes and living rooms.

The home has two separate units, one of which is for people living with dementia. There were communal areas in each unit for people including activity lounges, café and cinema room.

Rivermere Retirement and Care Home is managed by Willowbrook Healthcare Limited (which is part of the Brand Avery) under licence from WT UK Opco 2 Limited.

People’s experience of using this service

People and their relatives told us that the service was well run and that they would recommend it to other people. One person told us, “They put their residents first. She has developed a nice relationship with the staff”; and “The care my mother receives at the home gives her a good quality of life”.

Improvements had been made to medicines management and staff consistency. Previous recommendations in relation to creams and lotions had been implemented. There were enough staff available to meet people’s needs. Regular agency staff had developed in staff teams, so everyone knew people well. Staff continued to receive training that ensured they were skilled and competent to meet people's needs. There were opportunities for staff to develop their skills through qualifications. Staff were supported through supervision meetings and team meetings

Risks to people's safety had been assessed and minimised to eliminate avoidable harm. The premises and equipment had been well maintained and there were effective systems in place to respond to emergencies.

The service was kept clean and staff followed national guidance to reduce the risk of infection.

People had enough to eat and drink to meet their needs and they were enabled to make choices about their

meals. Health professionals were contacted for advice when there were changes in people’s weights.

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 (published 28 January 2018).

Why we inspected

We undertook this targeted inspection to check specific concerns we had received about staffing levels, risk management, infection control, nutrition and the overall management of the service. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

18 October 2017

During a routine inspection

Rivermere retirement and care home is jointly managed by WT UK Opco 2 ltd and Willowbrook healthcare (which is part of the Brand Avery and is known operationally as Avery).

The service is required to have a registered manager as part of the conditions of their registration. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run. At the time of the inspection WT UK OPCO 2 ltd did not have a manager in post who was registered with the Care Quality Commission (CQC). Willowbrook healthcare had a registered manager in post. In terms of the day to day management of the service there was a registered manager in post and there was no impact on the people using the service. WT UK OPCO ltd took steps, following the inspection, to resolve this issue.

The service was registered to provide accommodation with care to older people and those living with dementia. The registered provider was also registered to provider the regulated activities treatment of disease, disorder and injury and diagnostics and screening. However, these regulated activities were unused as there was no nursing care provided at Rivermere. The registered provider agreed to cancel these regulated activities following the inspection.

This inspection was carried out on 18 October 2017. At the time of our inspection there were 49 people using the service. The service was structured into two units. The assisted living unit was located across two floors for older people and the memory care unit was located on the top floor for those who were living with dementia. There were 13 people living on the memory care floor. We previously inspected this service on in February 2017 when we rated the service requires improvement and made some recommendations about how the service could improve further. At this inspection we found that action had been taken in respect of all the recommendations we made.

People told us they felt safe using the service and had their needs met. Staff knew what action they needed to take to keep people safe. Risks to people’s safety had been assessed and minimised to eliminate avoidable harm. One potential safeguarding matter had been reported through the complaints procedure rather than using the safeguarding policy. This was resolved during the inspection. We made a recommendation about this for future practice. The premises and equipment had been well maintained and there were effective systems in place to respond to emergencies. The service was kept clean and hygienic to reduce the risk of infection. People were supported to manage their medicines safely. We made a recommendation about the system for disposing of topical medicines (creams and lotions).

There were enough staff working in the service to meet people’s needs. There were staff vacancies in the service that were being covered by agency staff. The manager had an ongoing recruitment plan to fill the vacancies. We made a recommendation about this. Staff recruitment procedures were robust and ensured that staff were safe and suitable to work in the service. Staff received training that ensured they were skilled and competent to meet people’s needs. There were opportunities for staff to develop their skills through qualifications. Staff were supported through supervision meetings and team meetings.

People had enough to eat and drink to meet their needs and they were enabled to make choices about their meals. They had care plans that ensured their health needs were met. People were supported to access relevant healthcare professionals and advice given was followed by staff.

People were asked for their consent to care before it was provided. Where people lacked capacity to make their own decisions the principles of the Mental Capacity Act 2005 were followed. People’s right to liberty was upheld and staff understood their responsibilities to ensure people’s human rights were upheld. The service had an effective policy for ensuring care provided did not discriminate in any way.

People received flexible and personalised care. They had been involved in developing and reviewing their care plans. People told us that their care was based around their preferred routines. Consideration had been given to the specific needs of people living with dementia when developing care plans and when planning the environment.

People told us they knew how to raise concerns about their care and they felt confident they would be listened to. There were a number of ways that people were supported to have their say about the service. The manager had responded appropriately to concerns, complaints and comments.

The manager and the registered provider had effective systems for monitoring the quality and safety of the service. They understood the risks and challenges the service faced and had a clear strategy to ensure continuous improvement of the service.

24 February 2017

During a routine inspection

This service had recently changed name. At the time of our last inspection the service was known as Sunrise Operations Sevenoaks. The name of the service had changed to Rivermere care home prior to this inspection visit. The registered provider was in the process of making changes to the management and ownership arrangements for the service. An additional provider of care services was applying to become jointly registered for Rivermere and this process was completed shortly after our inspection. The new provider, Willowbrook healthcare (which is part of the Brand Avery and is known operationally as Avery) had been managing the service on a day to day basis under the existing provider’s registration since December 2016. Avery had taken over the management of staff and had begun introducing systems and policies to the service. The registered manager remained in post and was also the registered manager for the new provider Avery.

This inspection was carried out on 24 and 27 February 2017. The service was registered to provide accommodation with care and nursing to older people and those living with dementia. At the time of our inspection there were 42 people using the service. The service was structured into two units. The residential unit was located across two floors for older people and the memory unit was located on the top floor for those who were living with dementia.

We previously inspected this service on 11 and 16 August 2016 where we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 had continued from our inspection in March 2016. We rated the service inadequate. The breaches of regulation related to safe care and treatment, safeguarding, good governance, staffing and dignity and respect. Our concerns centred on the care and treatment of people who were receiving nursing care in the service. The service remained in special measures and we undertook action to use our enforcement powers. The registered provider told us that, following our previous inspection, they had made the decision to stop the provision of nursing care in the service and to restrict new admissions to the home until improvements could be made. They sent us an action plan for the improvements they were making to the service. At the time of this inspection there was no provision of nursing care and people’s nursing needs were being met by the community district nursing team who visited people at the home.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

At this inspection we found that improvements had been made and the registered provider was no longer breaching the regulations.

People told us they felt safe using the service and had their needs met. Staff knew what action they needed to take to keep people safe. Risks to people’s safety had been assessed and minimised to eliminate avoidable harm. Improvements had been made to the systems for assessing and reducing risks. The premises and equipment had been well maintained and there were improved procedures for ensuring people were safely evacuated from the building if required in an emergency. The service was kept clean and hygienic to reduce the risk of infection.

There were enough staff working in the service to meet people’s needs. However, the service was at less than 50% occupancy and so we discussed with the registered provider that they must ensure that they have a clear plan for ensuring sufficient staffing numbers as the occupancy rate in the service rises.

People were supported to manage their medicines safely. Improvements had been made to the systems for ensuring that people had their health needs met. People had sufficient amounts of food and drink to meet their needs and they were enabled to make choices about their meals. The registered manager made frequent checks of care delivery to ensure people received the care in line with their care plans. Improvements had begun to ensure that people’s care plans were person centred and reflected their preferences. Work was still required to ensure this was consistent across the service and we have made a recommendation about this.

Improvements were underway to ensure all staff received the training they required to carry out their roles effectively. A programme of foundation training was being completed by all staff and was to be completed by the end of March 2017. We made a recommendation about ensuring the training is effective. Staff told us they had seen improvements to the quality of the training and also to the support they received in their roles. Improvements had been made to the arrangements for supervising staff to ensure they were performing effectively.

People told us they knew how to raise concerns about their care and they felt confident they would be listened to. People told us that they had seen improvements to the service since Avery had taken over the day to day management. The registered manager and the registered provider had improved the systems for monitoring the quality and safety of the service. They understood the risks and challenges the service faced and had a clear strategy to ensure continuous improvement of the service. It was too soon to assess that the improvements made could be sustained and we made a recommendation that the registered provider continues to closely monitor the service to ensure the changes were embedded.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated to us that improvements have been made. It is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures.

11 August 2016

During a routine inspection

This inspection was carried out on 11 and 16 August 2016. The service was registered to provide accommodation with care and nursing to older people and those living with dementia. At the time of our inspection there were 82 people using the service. 30 people were receiving nursing care. The service was structured into two neighbourhoods. There was an assisted living neighbourhood across two floors for people who were not living with dementia and a reminiscence neighbourhood on the top floor for those who were living with dementia. There were 22 people on the reminiscence neighbourhood and 60 people on the assisted living neighbourhood.

We previously inspected this service on 12, 13 and 14 October 2015 where we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and we rated the service as inadequate. The breaches of regulation related to safe care and treatment, safeguarding, good governance, staffing, consent, nutrition, person centred care and dignity and respect. The service was placed in special measures with an expectation that the necessary improvements would be made within six months. We further inspected the service on 7 and 8 March 2016 and found ongoing breaches of regulations. The ongoing breaches of regulations related to safe care and treatment, good governance, staffing, consent and person centred care. The service remained in special measures whilst we considered our enforcement powers. The registered provider told us that improvements had been made to the service and therefore we carried out this inspection. At this inspection we found that some improvements had been made, but the registered provider continued to breach the regulations relating to safe care and treatment, staffing and good governance.

At the time of the inspection there was not a registered manager in post, but the manager of the home had made an application to be registered with the Care Quality Commission (CQC). This was being processed by the Commission. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run. The registration process was completed shortly after the inspection visit.

At this inspection we found that whilst people spoke positively about the service, not everyone received safe care or treatment. Some people with nursing needs did not have these needs met. For example we found that people who had acquired pressure wounds had not received the appropriate treatment for these. The registered provider had not ensured that people who used a urinary catheter had this changed when required to reduce the risk of infection. Staff training had not been effective in ensuring that staff were skilled to meet people’s health needs. Staff working in senior care roles had not been provided with effective training to ensure they were clear about their leadership responsibilities.

Sufficient numbers of staff were not deployed in the service each day in a way that ensured people’s needs were met within an appropriate timeframe. People often had to wait for an unacceptable period of time for staff to respond when they called for assistance. The registered provider had not consistently ensured that agency staff working in the service were suitable and able to do so safely.

People were not adequately protected from the risk of harm or abuse in the service. Some people using the service had been subject to abuse and the registered provider had not made sufficient improvements to the delivery of care to ensure that this did not occur again. Staff were not always clear about how to manage risks to people’s safety and welfare. There was a lack of specific guidance for staff to follow in order to keep people safe and this meant that staff did not always provide support in a consistent way, leaving people at risk of injury. There was a lack of clear procedures for evacuating people from the building in the event of a fire or other emergency.

Staff working regularly with people knew them well and were generally caring and kind when supporting people. They were sensitive to their needs and gave them reassurance when they were anxious or distressed. However, we found that people’s privacy and dignity was not always respected.

The service was not well led. The registered provider had not ensured that there was good governance of the service. There was a lack of effective systems for identifying failures in service delivery and for making improvements in a reasonable timeframe. There were ongoing breaches of regulations and the service had remained in special measures since October 2015.

The service had not always ensured that people were asked for their consent before referring to their appointed lasting power of attorney. We have made a recommendation about this.

Clear information about the service was provided to people and their relatives about the service. People were clear about the procedure for making a complaint if they needed to. We made a recommendation that the registered provider review the arrangements for involving people in reviewing their care plan to ensure they are enabled to make decisions about their care.

Improvements had been made to people’s care plans to personalise them and reflect individuals’ needs and preferences. However, further work was required to ensure that staff were provided with clear guidance for meeting people’s needs in a personalised way, for example the specific support people living with dementia may require for finding their way around the premises. We have made a recommendation about this.

People were given the support they needed to manage their medicines safely. People told us they received their medicines on time.

People had their nutritional needs met. Significant improvements had been made to ensure that people were provided with sufficient food and drink to meet their needs. People were very satisfied with the quality and range of the meals provided. The service responded quickly to changes in people’s nutritional needs.

The service had made improvements to the knowledge and skills of nursing staff in the delivery of end of life care. Following our last inspection the registered provider had decided not to admit any new people to the service that needed to receive end of life nursing care until they felt assured that improvements to the service had been made. The manager told us they were not providing end of life care for anyone at the time of the inspection.

People were supported to be as independent as possible. The service encouraged people to live active lives and to be involved in a wide range of social activities. The service was making further improvements to the way they engaged with people living with dementia to ensure they were appropriately occupied and involved in activities in the service. People were supported to engage with their local community.

The premises were clean, well maintained and safe for people to use. The design of the premises met the needs of people using the service and provided a comfortable and pleasant environment for people.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

7 March 2016

During a routine inspection

Sunrise Operations Sevenoaks Limited provides accommodation, nursing and personal care for up to 102 older people. There were 79 people living at the home during our inspection. People cared for were mainly older people. People had a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Some people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were living with dementia. There were also people who lived independent lives, using their own transport, who came and went as they chose.

Sunrise is a large building with accommodation provided over three floors. There were communal areas on each floor, as well as large reception areas on the ground floor. The third floor, known as the ‘Reminiscence Neighbourhood’ was designed to accommodate people who were living with dementia. The ground and first floors were known as the ‘Assisted Living Neighbourhood.’ Although some people on these floors were independent and active, others were living with dementia and physical care and treatment needs.

The service had not had a registered manager since December 2014. 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 2008 and associated Regulations about how the service is run. At the time of the inspection in October a manager was in post and in the process of registering. However they subsequently went on long term leave, so they were not in a position to make the improvements to the care needed following the previous inspection. At the time of this inspection, a temporary manager had been in post for seven weeks. They reported they would be applying to register with CQC to become the manager.

The service was last inspected on 12, 13 and 14 October 2015. At that inspection, the home was rated as inadequate. This was because we identified breaches in the HSCA Regulations, and also the home had not sustained improvements from the previous inspection on 13 and 14 April 2015. At the inspection of 12, 13 and 14 October 2015, we identified eight breaches in the HSCA Regulations 2014. These were in relation to person-centred care, ensuring people’s privacy and dignity and ensuring people consented to care and treatment. The provider was also not ensuring people received safe care and treatment, safeguarding people from risk of abuse and ensuring that people received the nutrition and hydration they needed. Additionally, the provider was not ensuring good governance of the home and appropriate staffing levels or that staff had appropriate skills for their roles.

At this inspection, we found the provider had not yet made improvements in a range of areas. These included ensuring people’s nutritional needs were met and staff complied in full with the Mental Capacity Act 2005 (MCA). Ensuring they had clear and accurate records to ensure staff unfamiliar with people knew how to meet their individual care and treatment needs. People’s assessments and care plans were not up to date and did not reflect a wide range of areas relating to their care and treatment. Whilst some staff were able to describe the care people needed others were not. Junior and agency staff did not have access to these care plans and relied on inaccurate brief information sheets, these did not outline the way they should be caring for people.

The acting manager had made considerable improvements in the last seven weeks and had a plan to improve further but not all their actions were in place to provide safe, effective and responsive care to people.

People commented on the continued use of agency staff which they felt affected their continuity of care. Some staff had not been trained in meeting people’s more complex needs, including using syringe drivers for pain control when someone is moving towards end of life, prevention of pressure damage and management of diabetes. We had been reassured at the previous inspection that staff had received this training. The acting manager had identified this and other areas that still required action. Although the acting manager had ensured staff were trained in areas including hygiene and infection control the provider had not taken timely action to ensure that staff had the training they needed to care safely for people and meet a breach in the regulation relating to staffing.

The acting manager had set up systems to support staff, including regular one to one staff supervision; this was not fully in practice at the time of this inspection.

People felt staffing numbers had improved. New staff were being employed. These new staff had been recruited in a safe way.

The acting manager had taken action to protect people against risk associated with medicines. The provider had appropriate arrangements in place to manage people's medicines safely. Medicines were safely stored. This was an improvement from the previous inspection.

The acting manager had improved systems to enable people to raise complaints or issues of concern. They had set up systems to improve feedback from people, their relatives and staff. People and staff said they were now more involved in developing improvements in service provision. Both people and staff said improvements had been made in key areas like cleanliness of the environment and the ordering of necessary equipment.

Staff we spoke with had a good working knowledge of how to safeguard people from risk of abuse. Staff had been trained in, and were aware of, their responsibilities under the Mental Capacity Act (2005). The acting manager had ensured the local authority had been contacted about all people who were at risk of being deprived of their liberty.

People said they enjoyed the meals. Mealtimes were social occasions and there were sufficient staff to support people during meals. People were actively supported in choosing what they ate and drank.

There was a new activities coordinator in post who was developing the service to ensure all people had the range of activities they felt they wanted, and which suited their needs.

People said they were supported by caring staff. Staff had a caring approach to people and interacted with them as individuals.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The overall rating for this provider remains ‘Inadequate’. This means that it will remain in ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

12, 13 and 14 October 2015

During a routine inspection

Sunrise Operations Sevenoaks Limited provides accommodation, nursing and personal care for up to 102 older people. There were 84 people living at the service during our inspection, the majority of whom were living with dementia. A number of people had other conditions including Parkinson’s disease, epilepsy, diabetes, and sensory impairment. Some people had reduced or impaired mobility and used wheelchairs to move around. There were also people who lived independent lives, continuing to drive and come and go as they chose.

Sunrise is a large building with accommodation provided over three floors and communal areas on each floor. The third floor, known as ‘the reminiscence neighbourhood’ is designed to accommodate people who are living with dementia which has progressed. During our inspection 27 people were living in the reminiscence neighbourhood. The ground and first floors are known as ‘the assisted living neighbourhood’ and although some people on these floors were independent and active, many people were living with dementia and physical challenges. During our inspection there were 57 people living in the assisted living neighbourhood.

The service had not had a registered manager since December 2014. 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. Since the previous registered manager there has been interim management cover until the current manager took up post in May 2015. The current manager was in the process of submitting an application to be registered with us at the time of this inspection.

We inspected Sunrise in December 2014 and rated the service as inadequate at that inspection. The Care Quality Commission (CQC) issued five Warning Notices as the provider had not ensured people were protected from harm through the effective management of risks or making sure there were suitable and sufficient, trained and supervised staff. People’s needs were not assessed or reviewed, care plans were not maintained accurately and care was not delivered in such a way as to ensure their needs were met. Action was not taken to address people’s complaints and quality assurance systems were not effective in identifying and improving shortfalls in the service. The provider sent us an action plan which detailed when different areas would be addressed.

We undertook an inspection on 13 and 14 April 2015 to follow up on the actions we had asked the provider to take and that they had assured us would be taken to make the improvements needed. During that inspection we found that the provider had made significant improvements and people, their relatives and health and social care professionals we spoke with, told us about the

improvements they had noticed. We rated the home as requires improvement because although improvements had been made, further improvement was required and we needed to see that where improvements had been made these would be consolidated and sustained.

At this inspection we found that many of the improvements had not been sustained.

All apart from three people told us they felt safe. However, 10 of the 13 relatives we spoke with told us of concerns they had about their family member’s safety. The provider had safeguarding systems and processes in place but we found that people were not always protected from harm. The provider had not taken appropriate action to reduce risks to people’s safety and staff did not consistently follow safe practices, putting both staff and people at risk of harm and injury.

Staff were not effectively deployed to meet people’s needs in a timely manner. The provider had not ensured that all staff had the skills and support they needed to deliver safe, effective and responsive care. We observed times where staff did not always offer an explanation of the care they delivered or seek the agreement of people.

People were not consistently protected by safe systems for managing, recording and storing medicines. People did not have their nutrition and hydration needs effectively monitored. Although charts were used when there was a need to monitor concerns, we found that these were not always completed effectively.

People received medical assistance from healthcare professionals such as the local GP. However, staff did not consistently follow guidance regarding people’s health needs. Where people were at risk of pressures sores records did not show that people received the topical medicines they had been prescribed or had been repositioned as required.

Some staff were polite and respectful in their approach to supporting people. However we also observed occasions where people who were living with advanced dementia were not treated with compassion or respect.

Care records did not consistently provide staff with up to date and accurate information that would ensure they could effectively respond to people’s individual needs.

There were a variety of communication systems in place but these were not being used fully and the majority of relatives, staff and healthcare professionals told us that communication needed to improve. We found that where improvements had been made such as the reduction in falls, infections and incidents of aggression themes and trends were not explored in order to influence quality.

There was an activity programme that offered a range of events and people told us that liked the choice of activities and entertainers who visited the home. However, people who required the most care and support were not always given the support they needed to ensure they had meaningful occupation during the day.

Complaints were dealt with as individual issues rather than being used to assess if there were common themes and therefore lessons that could be learnt. Relatives we spoke with did not have confidence in the provider to respond in a favourable way when they made a complaint. We have made a recommendation about this in the main body of our report.

We did see and hear some individual examples of staff treating people with compassion and kindness. People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed.

Robust recruitment processes were followed to ensure new staff were not unsuitable to work with people.

A comprehensive menu was in place that offered a wide range of choices at all meal times that were nutritionally balanced to promote good health. People who were more able had a positive dining experience and told us that on the whole they were satisfied with the meal choices available.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

13 & 14 April 2015

During an inspection looking at part of the service

We carried out an inspection at the service on 15, 16 and 22 December 2014 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. The provider had not ensured people were protected from harm through the effective management of risks or making sure there were suitable and sufficient, trained and supervised staff. People’s needs were not assessed or reviewed, care plans maintained or care delivered in such a way as to ensure their needs were met. Action was not taken to address people’s complaints and quality assurance systems were not effective in identifying shortfalls in the service. We issued five warning notices and asked the provider to take action to meet a further five breaches of regulations.

This inspection was carried out on 13 & 14 April 2015 and was unannounced. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received. Following our inspection in December 2014 the provider sent us an action plan to show how they intended to improve the service. They gave us a range of dates between February and April 2015 within which they told us they would meet various aspects or the the regulations. During this inspection we found the provider had made significant improvements. People, their relatives and health and social care professionals who we spoke with told us about the improvements they had noticed.

Sunrise Operations Sevenoaks Limited provides accommodation, nursing and personal care for up to 102 older people. There were 78 people living at the service during our visit, some of whom were living with dementia. Some people had reduced or impaired mobility and used wheelchairs to move around. There were also people who lived independent lives, continuing to drive and come and go as they chose. Accommodation was provided over three floors with communal areas on each floor. The third floor, known as ‘the reminiscence neighbourhood’, was for people who were living with dementia which had progressed and impacted on their daily lives. The ground and first floors were known as ‘the assisted living neighbourhood’, some people who were living with dementia also lived on these floors. There was a passenger lift between floors and all areas of the accommodation were accessible to people who used wheelchairs.

The service did not have a registered manager. The previous registered manager had resigned in December 2014. An interim general manager was in place and a new general manager had been appointed. 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 majority of concerns people told us about related to the competence, commitment, knowledge and approach of agency staff. The provider was actively seeking to recruit more permanent staff. We have made a recommendation about this.

A minority of people were not satisfied with the overall communication in the service. They felt that they were not told about changes in a timely manner such as the recruitment of the new manager.

Residents and relatives’ meetings had been held to inform people about changes in the service. People took part in focussed discussion groups about different aspects of the service such as meals and activities. This showed that people were consulted and their views taken into account in the way the service was delivered. We have made a recommendation about this

The provider followed safe recruitment procedures to make sure staff were suitable to work with people. There were enough staff employed in the home to meet people’s needs and respond in a timely manner when people called for assistance. People told us staff spent time chatting with them as well as providing the care or treatment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider was aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Appropriate applications had been made to the local authority. Most of the staff had received training in MCA to make sure they understood how to protect people’s rights. There were procedures in place and guidance in relation to Mental Capacity Act 2005 (MCA). People were asked for their consent before staff carried out any care or treatment.

The provider had taken steps to make sure that people were protected from abuse. The provider reported safeguarding incidents to us and to the local authority. Most of the staff had been trained in safeguarding people and all staff had access to information about how to report abuse.

Risks to people were identified and updated following any changes in their safety and welfare needs, including when they had experienced falls. Staff had the guidance they needed to take appropriate action to keep people safe. Medicines were administered safely so that people got their medicines when they needed them and as prescribed

Most staff had received the essential training and updates required. Staff had also attended training in caring for people with specific needs such as Parkinson’s disease. Care staff and nurses received the supervision, appraisals and support they needed to enable them to carry out their roles effectively. Staff told us that morale had improved because they felt supported by their managers and were involved in decision making through supervisions and regular team meetings.

People’s weights were monitored and recorded regularly to make sure they were getting the right amount to eat and drink to protect them from the risk of malnutrition. People told us they were satisfied with the meals and that all the food was good. Staff made sure that people’s dietary needs were catered for.

People were supported to manage their health care needs. Pressure ulcers were managed effectively to make sure these wounds were prevented. A GP told us they had seen significant improvements in the service in the two months before our inspection.

Ways to enable people living with dementia or other conditions, to remain as independent as possible, had been improved through dementia friendly signage and adaptations to the environment. Further work was required in this area. We have made a recommendation about this.

All the staff were kind, caring and patient in their approach and had a good rapport with people.

People’s dignity was protected. People’s information was treated confidentially.

People were assessed before they moved into the service to make sure the service was suitable for them. Reviews had been carried out of each person’s needs to make sure they were receiving the treatment and support they needed. Staff felt confident they understood and could meet people’s needs because they had up to date information about people.

Improvements had been made to the way activities were organised for people living with dementia to make sure they were meaningful for them. People enjoyed the wide range of activities on offer. People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service. There were links between the home and the local community. Children from the local school visited from time to time to provide concerts for people.

People knew who to talk to if they had a complaint. A log of written and verbal complaints was maintained together with the action taken to address any issues. People and their relatives told us that communication had improved. They spoke positively about the interim general manager and the improvements they had made.

Quality assurance systems had improved. Regular audits were carried out of all aspects of the service. Action plans were drawn up whenever shortfalls were found to make sure improvements were carried out.

15 - 16 December, 22 December 2015

During a routine inspection

Sunrise Operations Sevenoaks Limited provides accommodation, nursing and personal care for up to 102 older people. There were 94 people living at the service during our visit, some of whom were living with dementia, Parkinson’s disease and other complex needs. A number of people had other conditions including stroke and diabetes, and some people had reduced or impaired mobility and used wheelchairs to move around. There were also people who lived independent lives, continuing to drive and come and go as they chose. Accommodation is provided over three floors with communal areas on each floor. The third floor, known as ‘the reminiscence neighbourhood’, was for people who were living with dementia which had progressed and impacted on their daily lives. The ground and first floors were known as ‘the assisted living neighbourhood’, some people who were living with dementia also lived accommodated on these floors. There was a passenger lift between floors and all areas of the accommodation were accessible to people who used wheelchairs.

The service did not have a registered manager. The previous registered manager had resigned the week before our inspection and interim management arrangements were in place to cover the service whilst recruitment to the post was in progress. 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.

This inspection took place on 15, 16 and 22 December 2014 and was unannounced. The previous inspection was carried out in May 2014 when we found the service met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Some people made complimentary comments about the service they received. People felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Relatives who we spoke with before and during our inspection raised a number of concerns about the service their family members’ received.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The former registered manager had submitted four Deprivation of Liberty Safeguards (DoLS) applications, one of which had been authorised by the local authority. The management understood when an application should be made and how to submit one and were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Less than half the staff had received training in MCA to make sure they understood how to protect people’s rights. There were procedures in place and guidance in relation to Mental Capacity Act 2005 (MCA). People were asked for their consent before staff carried out care or treatment, although

The provider had not taken adequate steps to make sure that people were protected from abuse. There had been numerous incidents of abuse, some of which the local authority safeguarding team had investigated and found that abuse had taken place. Staff training in safeguarding people was not up to date and staff did not have access to all the information they needed about reporting abuse.

The risks to people had not been updated following changes in their safety or welfare including when they had experienced falls. Staff did not have the guidance they needed to take appropriate action to keep people safe.

The provider did not always follow safe recruitment procedures to make sure staff were suitable to work with people because full employment histories were not always obtained. There were not always enough staff employed in the home to respond in a timely manner when people called for assistance.

Safe medicine administration procedures were not always followed so that people got their medicines when they needed them. Medicines were stored safely.

Staff had not all received the essential training or the updates required. This included training in safeguarding adults and managing behaviour that may challenge the service. Staff had not attended training in caring for people with specific needs such as Parkinson’s disease, sensory impairment and other conditions.

Care staff had not received the supervision, appraisals and support they needed to enable them to carry out their roles effectively. Staff told us that morale was “Very low” because they did not feel supported by the management and were not involved or consulted in decision making as they did not have supervisions, or regular team meetings.

Staff told us that they felt people were moved into the service when there were not enough staff to meet their needs. A GP told us they were concerned that people were moved into the service without adequate assessment.

A number of people had complex needs which staff did not feel they were equipped or resourced to meet. Staff said they did not have time to read care plans and the written information they were given was inaccurate and out of date.

People’s weights were not monitored and recorded regularly to make sure they were getting the right amount to eat and drink to protect them from the risk of malnutrition. There were mixed views about the meals provided. Some people were complimentary but most people told us the food was bland and not to their liking. Staff made sure that people’s dietary needs were catered for. Staff did not consistently respect people’s dignity. People who needed support to eat were not always helped in a dignified way. People’s information was treated confidentially. Staff made sure that any personal care people needed was carried out in private.

People were not supported adequately to manage their health care needs. A relative told us that an appointment had been missed because a letter from a health professional was not given to the person or their relative in time. Relatives also gave examples of infections and injuries which had gone unnoticed until relatives pointed them out to staff. Pressure ulcers were not managed effectively to make sure these wounds were prevented. A GP shared concerns with us about how the staff managed people’s health and communicated with the GP surgery.

Some relatives expressed concern about the general care of their family members and told us that poor communication meant they were not always kept informed about changes and decisions, or listened to when they expressed concerns about the way their family members’ care was being delivered. One relative told us they had removed their family member from the service because they were not getting the care they needed.

Ways to enable people living with dementia or other conditions to remain as independent as possible had not been explored such as dementia friendly signage and adaptations to the premises and equipment people used. Staff were very busy carrying out tasks and mostly did not have time to initiate conversations with people other than when they were providing the support or treatment people needed. Most of the staff were kind, caring and patient in their approach and had a good rapport with people.

People did not always know who to talk to if they had a complaint. Relatives told us that the manager had not been around for weeks and there were always different faces. They did not know if concerns they raised were passed on to the right people and gave examples of complaints they had made that had not been addressed. The changing management team meant that staff, people and their relatives did not know who to go to with any concerns.

The approach to activities was to entertain, do to, rather than support people to participate in activities. There were no individual activity programmes to ensure people living with dementia were provided with meaningful activities to promote their wellbeing. People told us they enjoyed the activities they were able to choose from but their individual needs had not been considered in planning the activities.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and people were able to spend time with family or friends in their own rooms and other areas. There were links between the home and the local community. Children from the local school were giving a Christmas concert for people during our inspection.

People and their relatives had raised concerns about the leadership of the service. They had not been kept informed about changes in the management team and did not know who was in charge. There had been no recent residents or relatives’ meetings or customer satisfaction surveys to show that people were consulted and their views taken into account in the way the service was delivered.

There was an interim manager at the service. At other times during each week, relief managers and other senior managers were present at the service. Communication was not always effective in ensuring that important information was passed on to appropriate people to make sure that action was taken in a timely manner to address issues relating to people’s safety, care and welfare.

Quality assurance systems had not been effective in recognising shortfalls in the service. Although some shortfalls had been recognised and an action plan had been developed, improvements had not been made in response to accidents and incidents to ensure people’s safety and welfare were promoted. Records relating to people’s care and the management of the service were not well organised or adequately maintained.

6 May 2014

During an inspection looking at part of the service

The inspection was conducted by two inspectors. The home was divided into two separate units. People who were experiencing dementia were mainly cared for on the second floor Reminiscence unit. During our visit we spent time with people in both units. We also followed up on an area of non-compliance from our last inspection on 09 October 2013. The provider sent us an action plan following that visit in which they told us about improvements they had made. During our visit we saw that the shortfalls we had found had been addressed and compliance had been achieved.

There were eighty six people living in the home at the time of our visit. Some of the people were experiencing dementia. This meant they were not always able to tell us about their experiences. The report is based on our observations during the inspection, talking with people who used the service, their relatives, and staff who were working in the home, and reviewing records.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and staff told us there were enough staff on duty at all times to make sure people who lived in the home were protected from harm. There were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and the risks associated with the environment. Risks to people's health and welfare were identified and managed to ensure people were protected from risk of harm.

There were personal emergency evacuation plans for staff to follow in the event of a fire.

We looked at staff rotas, People's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience of staff required on each shift. This helped to ensure that people's needs were always met.

Is the service effective?

People's health and care needs were assessed with them, and they, or their representatives were involved as far as possible in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans.

Medication systems ensured that people received the medicines they needed at the right time.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. We saw that people were comfortable with the staff who were working with them.

Staff knew people well and were able to describe people's preferences, interests and diverse needs. This meant that care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities regularly. An activities coordinator provided a programme of activities for people to choose from. The home had access to an adapted minibus, which meant that people were able to take part in outings.

Staff responded promptly when people needed support or reassurance.

Is the service well-led?

The service had an effective quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The management team were accessible and approachable. We saw that people were comfortable talking with the manager. Staff told us the management team were supportive and they were able to raise any concerns and were confident these would be addressed.

30 September and 9 October 2013

During an inspection looking at part of the service

We carried out this most recent inspection to determine whether improvements had been made following our inspection on 1 and 2 July 2013 and to follow-up on the areas of concern that we had been told about.

We spent time observing care on both Assisted Living and the Reminiscence Unit. We spoke with 13 people who lived at the home. We also spoke with the relatives of 9 people who used the service, 10 members of staff and the Home Manager.

Comments from people included 'Things are improving day-by-day", 'Everybody tries to be helpful. The staff are very kind', 'If I am in my room, the staff check on me' and 'The staff are very busy at breakfast time, they manage, but seem to be rushing around'.

We found that the Provider had taken action to resolve the staffing issues which had occurred during the preceding six months.

We identified that improvements were still required in relation to the assessment of people's needs.

At the time of this inspection the Registered Manager was unavailable and the service was overseen by a manager from another of the Provider's locations. Where we refer to "The Manager" within this report, we are referring to the person who was overseeing the day-to-day activity of this location and not the Registered Manager.

1, 2 July 2013

During an inspection in response to concerns

We carried out this inspection because we had been contacted by someone who had raised concerns about the care and welfare of people who used the service. The concerns were related to insufficient staffing levels.

We spoke with members of the senior management team including the Nominated Individual and also with people who used the service. We reviewed staff rotas and individual care plans as well as carrying out a structured observation (SOFI) on the second day to assess the interactions between staff and people who used the service.

During this inspection we spoke with twelve staff members and nine residents regarding staffing levels and their perception of the quality of care that was being provided.

We saw some positive interactions between staff and the people living at the home and the relatives we spoke with were generally happy with the care being provided to their family member. However, we observed some poor practice which meant that people's needs were not always being met effectively.

There were not always enough staff available to meet people's needs effectively.

At the time of this inspection the Registered Manager was unavailable and the service was being overseen by a manager from another of the Provider's locations. Where we refer to "The Manager" within this report, we are referring to the person who was overseeing the day-to-day activity of this location and not the Registered Manager.

30 January 2013

During a routine inspection

Overall, we found that Sunrise Operations of Sevenoaks was providing an efficient service which met the needs of the people using the service.

People told us that they were happy living at the home and that the care and support they received was good.

We saw several examples where people were supported by staff in an appropriate manner. We also spoke to three relatives who told us that they felt that the care that people received was "excellent".

One person living at the home said that staff were 'very professional and so kind; I feel like I have found myself another family'.

There were systems in place for ensuring that the quality of services provided at Sunrise Sevenoaks was reviewed on a frequent basis, and where necessary, improvements were made to ensure that a high level of care was provided to every service user.

14 October 2011

During an inspection looking at part of the service

We carried out this review to follow up Improvement and Compliance Actions given at a previous review in June 2011. This was mostly in regards to medication management, and associated staff training and support. We did not, therefore, spend much time talking with people living in the home, except for brief conversations with four people, who spoke positively of their care and treatment.

We saw that people in the Reminiscence Unit were being attended to by staff in a gentle and sensitive manner. This included guiding them to places where they wanted to go, assisting them with eating their lunch, and helping them to carry out their choice of activities.

Some people living in the Assisted Living Unit had been taken out shopping, and said that they had enjoyed this experience.

We saw people in the lounge and dining areas who were smiling and talking together, and showing evident enjoyment in each other's company.

6 June 2011

During a routine inspection

A person living in the home said that the staff were 'very pleasant and patient, and do everything for us'. They confirmed that they had had an assessment at home prior to their admission, and had been asked lots of questions, and had been fully involved in all the processes of moving into the home. One person said that they had had 'forms, forms and more forms' to complete with staff on their admission. People said that they were involved in talking with staff about their day to day care. One person said that they were very pleased that they had a medical check each month by one of the nurses, and had not expected this.

A conversation with three other people living in the home included comments that they felt free to do whatever they liked, and their wishes were respected in regards to their lifestyles and activities.

People in the Assisted Living unit said that it was 'a very happy home', and talked about the different things that they enjoyed. They said there was 'lots of entertainment' and this included listening to a local person playing the piano; having social times in the ground floor bistro area; taking part in flower-arranging, quizzes and crosswords; and enjoying films, entertainments, and trips out. Another person said they 'liked it very much here'.

People in the Reminiscence Unit were observed to be smiling and laughing, and one also did some dancing. People were chatting together, and there was a generally relaxed atmosphere. Several people were seen to appear stressed, looking anxious and unsettled.

People said that the 'food was excellent' and 'very good' and that 'there is always a choice for each course'. They said that the food was 'well-cooked', and 'the home-made cakes are delicious'. One person said there were always drinks and snacks available in the Bistro bar.

People living in the home said that it 'was always kept clean'.

Another person said that they liked to go out into the garden.