Archived: Sunrise of Bramhall

This inspection was prompted by information we received from Greater Manchester Police regarding a serious incident; we are making further enquiries in relation to this incident. The provider had notified us of the incident and during the inspection we saw invites to disciplinary meetings and records of discussions about recent issues linked to this incident which had led to formal disciplinary action. This demonstrated the provider addressed any staffing issues raised in a prompt manner.

Sunrise of Bramhall provides personal and nursing care and accommodation for up to 98 older people. Sunrise of Bramhall 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. Two providers, Sunrise Senior Living Limited and Sunrise Operations Bramhall II Limited have dual registration for Sunrise of Bramhall. This means both providers have joint and equal responsibility for the care and support provided at this home.

The service, which is known as a 'community', is divided into two separate neighbourhoods, the 'assisted living' neighbourhood and the 'reminiscence' neighbourhood. The assisted living neighbourhood provides nursing and residential care for up to 72 older people. The reminiscence neighbourhood provides residential care and support for up to 26 older people living with dementia.

The purpose built community is located in Bramhall Stockport. Accommodation is provided over three floors and some accommodation provides single studio suites that can be shared by up to two people.

Reminiscence rooms have a similar layout to those in assisted living and are situated on the ground floor. All bedrooms are single rooms with en-suite facilities and extensive car parking adjoins the building. At the time of this inspection 69 people were living in the assisted living community, 24 people in the reminiscence community.

At the time of inspection there was a manager in post, however they had not yet formally registered with CQC. 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.

Regular audits were carried out in a number of areas.

People living at Sunrise of Bramhall told us they felt safe and said staff were kind and caring. Staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. Staff had access to a wide range of policies and procedures regarding all aspects of the service.

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place. Staff told us they had sufficient induction and training and this enabled them to feel confident when supporting people.

We saw there were individualised risk assessments in place to identify specific areas of concern. The care plans were person-centred and covered essential elements of people’s needs and preferences. Staff sought consent from people before providing support. People’s health needs were managed effectively and there was evidence of professional’s involvement.

Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs.

There was evidence of robust and safe recruitment procedures.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences. The home had been responsive in referring people to other services when there were concerns about their health.

People told us the food at the home was good. There was a seasonal menu in use and this was displayed. People’s nutritional needs were monitored and met.

People told us staff treated them well and respected their privacy and dignity. We observed positive interactions between staff and people who used the service.

When people had undertaken an activity this was recorded in their care file information and there was a range of activities available for people to choose from.

The service aimed to embed equality and human rights though good person-centred care planning and people were provided with a range of useful information about the home and other supporting organisations.

The service was supported by other relevant professionals when providing end of life care. Several relatives had commended the home for the quality of its end of life care provision.

There was a complaints policy and procedure in place. This clearly explained the process people could follow if they were unhappy with any aspects of their care. There was a service user guide and statement of purpose in place.

Formal feedback from people who used the service and their relatives was sought and there were regular meetings with them.

The service worked in partnership with other professionals and agencies in order to meet people's care needs.

There was an up to date certificate of registration with CQC and insurance certificates on display as required. We saw the last CQC report was also displayed in the premises as per legal requirements.

We last inspected the service 9 January 2017 when we rated the service as requires improvement. At that time we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to person centred care, medicines management, governance and staffing. This inspection was to check improvements had been made following the last inspection and to review the ratings.

Sunrise Operations Bramhall ll Limited is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 98 older people. The community is owned and managed by Sunrise Senior Living, an American based operator which provides independent living, assisted living, nursing and dementia care services for older people. The service, which is known as a ‘community’, is divided into two separate neighbourhoods, the ‘assisted living’ neighbourhood and the ‘reminiscence’ neighbourhood. The assisted living neighbourhood provides nursing and residential care for up to 72 older people. The reminiscence neighbourhood provides residential care and support for up to 26 older people living with dementia.

The purpose built community is located in Bramhall Stockport. Accommodation is provided over three floors and some accommodation provides single studio suites that can be shared by up to two people. Reminiscence rooms have a similar layout to those in assisted living and are situated on the ground floor. All bedrooms are single with en-suite facilities. Car parking is at the front of the building. At the time of this inspection 80 people were living in the Sunrise Bramhall community.

Systems to make sure the safekeeping and administration of medicines were followed and monitored were in place and reviewed regularly. Medicines were stored safely and administered by designated trained care workers and nurses. Any specific requirements or risks in relation to people taking particular medicines were clearly documented in their care records. At Sunrise of Bramhall a care record is known as an individual service plan (ISP).

Care workers we spoke with confirmed they had received safeguarding and whistleblowing training (raising a concern about a wrong doing in the workplace) and knew who to report concerns to if they suspected or witnessed abuse or poor practice. We saw records to show care workers received regular supervision to help make sure they were carrying out their duties safely and effectively.

During both days of the inspection we saw people were supported by sufficient numbers of care workers. Care workers we spoke with told us they had undergone a thorough recruitment process and had undertaken employee induction and training appropriate to their job role. This helped to make sure the care provided was safe and responsive to meet people’s identified needs.

People lived in a clean and well maintained environment. We saw that the community was decorated to a high standard; there was a warm and relaxed atmosphere. Appropriate equipment and health and safety checks were carried out to help maintain a safe environment for people to live in.

People who used the service and their relatives were complimentary and positive about the care and support provided and the attitude of the care team and management. They felt that the overall care provided was very good and the environment was furnished and maintained to a high standard.

We saw positive and caring interactions between care workers, nurses and people who used the service, which helped to make sure their dignity was respected and their wellbeing was promoted.

Complaints were addressed and recorded appropriately by the management team. People who used the service and their relatives told us they knew how to make a complaint and felt confident to approach any member of the staff team if they had any concerns.

Accurate and complete records in respect of the care and treatment provided to people were being maintained. Systems were in place to monitor the quality and safety of the service provided to people living in the community.

We last inspected the service 26 and 27 January 2015 when we rated the service as requires improvement. At that time we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to the supervision and appraisal of staff, delivery of person centred care, meeting people’s nutritional and hydration needs and records being stored confidentially. We found that the provider was now meeting some of the requirements of these regulations. However we identified other areas where the provider was not meeting the legal requirements. We identified breaches of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to the delivery of person centred care, safe management of medicines, doing all that is practicable to mitigate risk, the effectiveness of governance systems in place, maintaining accurate, complete and contemporaneous records, supervising and ensuring the competency of agency staff. You can see what action we have told the provider to take at the back of this report.

Sunrise Operations Bramhall ll is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 99 older. 73 people receive care in the main part of the home, an ‘assisted living’ neighbourhood. The home also provides residential care and support to 26 older people living with dementia within a separate ‘reminiscence' neighbourhood.

The purpose built home is owned and managed by Sunrise Operations Bramhall II Limited. The home is located in Bramhall Stockport. Accommodation is on two floors and is divided into ‘community’ areas. Assisted living accommodation provided some single studio suites that could be shared by up to two people such as a married couple. Reminiscence rooms had a similar layout to those in assisted living and were situated on the ground floor. All bedrooms were single and had en-suite facilities available. Car parking is at the front of the building. At the time of this inspection 97 people were living at the home.

A registered manager was not in place however a interim manager and ‘pipeline’ (temporary) general manager were in place at the time 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 location has a condition of registration that it must have a registered manager. However steps were being taken by the provider to recruit one within a reasonable timescale.

Prior to our inspection we had received information of concern in relation to the management of medicines, a lack of sufficient numbers of staff, activities for people who use the reminiscence service, call buzzer response times and the general management of the home. The provider was addressing these issues prior to and during the inspection.

Medicines were not always managed safely and we did raise a number of safeguarding alerts with the local authority. These were progressed formally under safeguarding procedures and passed to the local authority’s quality assurance team to follow –up. The registered provider had taken action prior to and during the inspection to address concerns identified.

We saw that people were supported by sufficient numbers of staff, although a high number of them were agency staff. Care staff and registered nurses we spoke with told us they had undergone a thorough recruitment process. They told us following their employee induction, training appropriate to the work they carried out was always available to them. Recruitment procedures were in place to help make sure staff had the appropriate skills to protect the safety of people who used the service.

Accurate and complete records in respect of the care and treatment provided to people were not always maintained. Care delivered did not always meet the needs of the person.

Staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

Arrangements were in place to help protect people from the risk of abuse. The service had an up- to-date safeguarding policy and procedure in place and staff members spoken with were able to give a good account of the risks associated to vulnerable adults, the safeguards in place to minimise these risks and explain how they would recognise and report abuse.

We found that agency nurse and carers who were block booked to work at the home, did not receive regular formal supervision, training and work monitoring checks during the course of their employment to make sure they were competent to carry out their role.

People’s nutritional and hydration needs were being met. People had choice about what they wanted to eat and where required they were supported to eat their meals with prompts from staff.

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 helped to support this practice.

We saw positive and caring interactions between the permanent staff and people who used the service. These staff had developed a good rapport and understanding of the people who used the service and treated the people and their belongings with respect.

There was a consistent level of staff in place to deliver care and support to people who used the service.

Staff members were aware of people’s different cultural and religious backgrounds and were able to demonstrate a basic understanding people’s diverse needs.

People were supported to take part in hobbies and interests and individual or group daily leisure activities were provided for people who used the service.

A complaints policy was in place and copies of the policy were displayed in communal areas in the home. We examined the services complaints log and found where complaints or comments had been made records were kept of the actions taken to resolve the issue to the satisfaction of the complainant. We recommend the provider reviews the complaints procedure to include the contact details of the local government ombudsman.

A registered manager was not in place however a district support general manager and ‘pipeline’ (temporary) general manager were in place at the time 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 location has a condition of registration that it must have a registered manager. However steps were being taken by the provider to recruit one within a reasonable timescale.

Systems in place to ensure the quality of services provided were not always robust and effective.

People spoken with told us they had no concerns about the care being provided and they felt safe and protected by the staff from potential harm.

We observed staff administering medicines and saw that these were handled safely, securely and appropriately.

We saw there were sufficient numbers of skilled and qualified staff to meet people's needs.

We saw there were procedures that were being followed to ensure people's records remained confidential.

We looked at the assessments and care plans for some people and they were appropriate and up to date. Staff were knowledgeable about the people they were looking after and we saw they treated people properly.

We looked at the home's arrangements for protecting people against the risk of infection and we saw that they had proper policies and procedures and that staff were trained. The home was kept clean and hygienic.

The premises were suitable for the service provided and kept in a good state of repair. Vital equipment such as lifts and fire systems were properly looked after by outside contractors.

The home had procedures to ensure that people they recruited were suitable and these were adhered to. Checks were made into people's backgrounds as required by the regulations. Staff received induction training when they first started work and were kept updated through a yearly training program.