Archived: Sunrise Operations Bassett Limited - Sunrise of Bassett

At the previous inspection in May 2015 we found the registered person had not ensured that people received all the nursing and health care they required. We reassessed this in May 2016 and found that whilst improvements had been made these changes were not embedded in practice and did not always ensure people received effective care. We told the provider they must take action to ensure people received effective health care. At this inspection we found that action had been taken and people were receiving effective personal and nursing care.

Also at the previous inspection in May 2015 we found that an effective system to regularly assess and monitor the quality of services provided was not in place and that procedures to protect people’s legal rights were not followed. The provider sent us an action plan telling us how they would improve. At this inspection we found that action had been taken and effective quality monitoring systems and procedures to ensure people’s legal rights were in place.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

There were not always enough staff to ensure people’s needs were promptly met and call bells were not always responded to in a timely manner. Recruitment practices had not ensured that all pre-employment checks were completed before new staff commenced working in the home. Staff received appropriate training and were supported in their work.

People were positive about the service they received. They were also positive about meals and the support they received to ensure they had a nutritious diet and about the activities available. People were supported and encouraged to be as independent as possible and their dignity was promoted.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People and visitors’ views about the service were sought in a formal and informal way and were acted on.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed.

Medicines were managed safely and people received these as prescribed. At the end of their life, people received appropriate care to have a comfortable, dignified and pain free death.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

Quality assurance systems were in place using formal audits and through regular contact by the provider’s representative and registered manager with people, relatives and staff.

The home did not have a registered manager; however, the provider had appointed a new general manager for the service who had submitted an application to become the home’s registered manager. 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 our last inspection, in May 2015, we told the provider to take action to make improvements in relation to keeping people safe and ensuring people received the nursing and medical care they required. We took enforcement action and required the provider to make improvements by 21 February 2016. The provider had identified a need to make changes to the home’s senior management team; however the new team had not been in place long enough to ensure all the fundamental standards of quality and safety we assessed were being met.

At this inspection we found improvements had been made but further work was required to ensure people received effective care to meet their nursing and medical needs. Staff had not acted when routine observations indicated a change in a person’s condition. They were not following the provider’s policy or national guidance for monitoring people following head injuries and were not always managing wounds appropriately. New systems had been put in place to ensure action was taken following blood and other medical tests and to improve the quality of care plans and risk assessments for specific health care needs.

The provider’s policy for the safe management of medicines helped ensure people were safe although staff had not always followed these consistently.

The provider and staff were aware of their responsibilities to safeguard people. Systems were in place to monitor incidents and where possible action was taken to reduce the risk of recurrence.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

We considered eight outcomes during this inspection. These being

Outcome 4 Care and welfare of people who use services

Outcome 5 Meeting nutritional needs

Outcome 7 Safeguarding people who use services from abuse

Outcome 8 Cleanliness and infection control

Outcome 10 Safety and suitability of the premises

Outcome 11 Safety, availability and suitability of equipment

Outcome 13 Staffing

Outcome 16 Assessing and monitoring the quality of the service

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

People told us they were happy with the service they received. They said they had continuity of care staff who knew what support they required. We spoke with relatives and visitors who were also positive about the service and said they felt their relatives were safe.

However, we found people were not always receiving the nursing and personal care they required. Care was not always planned and delivered in an appropriate way to ensure the welfare and safety of people. Care plans contained conflicting information about people's needs and how these should be met. Records could not confirm people had received all the care they required. The home was clean and well maintained. Systems to protect people from the risk of infection were in place.

Staff were unclear whether Deprivation of Liberty Safeguards (DoLS) had been authorised for one person. People's legal rights were not always protected as mental capacity assessments and best interest decisions had not been held where necessary.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people are protected from abuse.

Is the service effective?

People had individual care plans however these lacked details as to how people's needs should be met. Records viewed could not confirm people had received all nursing and personal care they required. For example, two people with wounds had not had these redressed as required and a third person had not had essential care of a suprapubic catheter. The service was therefore not effectively meeting their nursing care needs. People did not receive consistent support with meals and the lunchtime environment was not conducive to ensuring people living with dementia ate well. Activities were organised which many people chose to join in.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people receive the nursing and personal care they required and receive appropriate support with eating and drinking.

Is the service caring?

People were supported by kind and attentive staff. People made positive comments about the service they received. One person said 'I like if here and have lots of independence'. Another person said they had chosen the home because they could bring their dog with them. People were also positive about the meals stating 'the standard is good'.

Staff said they had time to meet people's identified needs and could provide care at times people wanted it. We observed staff interacting in a warm and friendly way with people. Before staff began to provide any care they always told people what was to happen.

Is the service responsive?

People said the service could respond to their requests for example one person told us about the meals and said 'if you don't like what is available you can order something else'. However, we found call bells were not always responded to in a timely way with some bells taking in excess of fifteen minutes to be answered on the day of our inspection. We were told on average it took 10 minutes for call bells to be responded to.

We also found the home was not able to respond to people's individual seating needs. This meant people were left sitting in wheelchairs or other unsuitable chairs which did not meet their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's needs are met in a timely way and equipment they require is available.

Is the service well-led?

There were a number of ways in which people and staff views about the service were sought. Following the inspection, the provider sent us an action plan showing how concerns identified by this feedback were to be addressed.

A range of audits and procedures to monitor the quality of the service were undertaken. However, these were not effective in identifying concerns with the service provision. They had not identified that people's nursing and personal care needs were not being met. The quality indicators which provided information in graphical form relating to trends were discussed at the provider's regional level. However, staff were unclear how this information was used to improve the service at this home. People and relatives were able to raise concerns and complaints, which were responded to in a timely way.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the quality of the service provided.

You can see our judgements on the front page of this report.

Appropriate consent was obtained from people about the decisions or information that would be shared with appropriate health professionals. People experienced care, treatment and support that met their needs and protected their rights. They were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People were supported by, suitably qualified and experienced staff, who delivered care and treatment safely and to an appropriate standard. There were systems in place to enable the quality of service provided to be regularly assessed and monitored. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.