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Sundial Lodge Care Home Requires improvement

We are carrying out checks at Sundial Lodge Care Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 July 2016

Sundial Lodge is a residential care home registered to provide accommodation and personal care for up to 48 older people. There were 44 people living there at the time of our inspection, a small number of whom were living with dementia.

This inspection took place on 20th and 21st April 2016 and was unannounced. We last inspected in October 2013. There were no concerns identified with the care being provided to people at that time.

The service had a 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.

The home is arranged into self-contained apartments which include a bedroom, bathroom, dining and sitting area and kitchenette. Most of these apartments are situated within the main building with some apartments behind the main building, known as the Stables and the Mews. A lounge area is available for everyone to use. Meals are provided to people’s rooms on trays by staff. People can also cook simple meals themselves as there is a kitchenette and fridge in each apartment. The home is set in gardens and is close to Torquay seafront and town centre. Two minibuses are available to ensure people can get out and about to medical appointments, supermarket and the town.

The home works well for people who are more independent and everyone we met spoke highly of the service. People and relatives all felt the care and support at Sundial Lodge was safe. However, we found a number of areas requiring improvement. Some people’s health care needs had increased recently and these were not always being managed safely. For example, in relation to choking and dehydration. We also found medicines were not always managed safely in relation to how they were recorded or how they were stored. Staffing levels were not always safe because there were not enough staff available to meet the number and needs of some people living at the home at all times.

Staff did not always deliver care in line with professional guidance in relation to supporting people to eat and drink enough. Some people who were losing weight needed extra calories in their meals or snacks offered, but records did not demonstrate this was always happening. Systems for recording what people were having to eat or drink were not effective or being reliably followed.

Staff and the registered manager had knowledge of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, however assessments and decisions had not been recorded fully or in line with legal requirements.

Information in care plans sometimes lacked detail or was incorrect, conflicting or out of date. This meant that staff did not always have clear or up to date guidance from which to work in order to meet people’s needs and preferences. However, there was good verbal communication between staff about people’s care needs. All care staff attended handover meetings in the morning, afternoon and evenings where information was shared about any changes to people’s health or any other important changes or appointments. The registered manager was actively working towards making care plans more person centred and involving people in this.

People and relatives expressed a high level of satisfaction with food at Sundial Lodge. One person said “there is beautiful food here” and “the food is super here”. People made their meal choices a week in advance which most were happy with. Everyone received a copy of their menu choices. However, this did not suit people living with dementia. A relative said they were concerned that they regularly found evening meals left in the fridge that their family member had forgotten about. This meant staff may be unable to determine if people living with dementia were eating sufficiently. The lack of communal dining facilities at the home meant not everyone could have their preference to eat together met and this could lead to social isolation.

We have made a recommendation about setting up a system that helps assure the service that people are eating sufficiently. Since the inspection the registered manager has informed us that as well as everyone being weighed, intake charts showing how much people have eaten have been improved and implemented.

People spoke highly of the care they received. One person said “I am very happy here. I like the staff and the food”. Another said “It’s the best of what there is – the staff are so good” There were numerous cards and notes in the compliments book, thanking staff for their support and care. Relatives also spoke highly of the service “Staff here are wonderful, nothing is too much trouble” “Sundial Lodge is home from home”.

People’s right to privacy and dignity was respected in the home. One person said “It’s not regimented here; you have your privacy”.

Many people living at Sundial enjoyed a full and active social life. People were in and out of the home all of the time we were there; visiting friends or going out for walks. They made good use of the minibus service that took them to the shops and town and valued the support the home offered that enabled them to remain as independent as possible. However for those who were less independent there were limited activities on offer. People did not benefit from individual activity plans to promote their wellbeing. People sitting in the lounge area told us they were bored. Staff said they no longer had time to sit and talk with people. This meant not all people benefitted from meaningful activity in their lives.

The home used quality assurance processes but these had not identified the concerns we recognised through the inspection. Survey’s showed a high level of satisfaction from people living at the service and families. No complaints had been received and the registered manager operated an open door policy where any concerns could be raised informally and resolved at an early stage.

Staff had a good understanding of safeguarding and how to protect people from possible harm. Safe recruitment practices were in place to ensure that staff with the right attitudes and skills were recruited. The environment was clean and well maintained and there were regular fire safety checks and testing of other equipment.

People had access to health services. GP’s and other healthcare professionals were contacted where necessary to discuss people’s care needs. Health professionals told us the home was good at asking for advice and support.

Staff were very happy with the level of support they received from the management team. This allowed them to develop their learning and consider career progression. Most were involved in studying for diplomas in health and social care. Training was provided to ensure that staff had the skills needed to provide suitable care for people. However this was all currently through e-learning. The manager wanted staff to have face-to-face training too and was looking for a suitable training provider. Since the inspection we have been informed that training from an external provider is in place.

Staff said there had been considerable improvements made at the home since the registered manager started two years ago. They felt that they were operating more professionally and working as a team. People, families and staff all expressed a high level of confidence in the registered manager. The registered manager told us they had worked hard to introduce changes, such as new risk assessments, a stronger team and better communication systems in the home. They had a good relationship with the provider and felt well supported. However they sometimes missed having the support of another professional from a care background. They told us that they would be resuming contact with other manager’s from the local provider care forums to gain this support.

During the inspection we identified a number of concerns about the care, safety and welfare of people who lived at Sundial Lodge. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 6 July 2016

The service was not always safe:

Risks to people’s health, safety and wellbeing were not fully assessed or managed.

People’s medicines were not always recorded or stored in a way that protected them from errors.

There were not enough staff to ensure that people always received care when they needed it.

People felt safe and secure living at the home. They were protected because staff understood signs of abuse and how to report any safeguarding concerns.

Effective

Requires improvement

Updated 6 July 2016

The service was not always effective:

There was ineffective monitoring and management of some people’s eating and drinking.

Where people lacked capacity to make decisions, capacity assessments and decisions taken in their best interests had not been fully documented.

People spoke highly of the food at the home

People were supported to have access to health professionals including GP’s and district nurses to help them have their health needs met.

Caring

Good

Updated 6 July 2016

The service was caring:

People spoke highly of the care they received and the caring attitude of staff

Families felt welcome and could visit their relative whenever they liked

People’s right to privacy and dignity was respected

People were encouraged and supported to maintain their independence

Responsive

Requires improvement

Updated 6 July 2016

The service was not always responsive:

Information in care plans sometimes lacked detail or was incorrect, conflicting or out of date. They did not always provide staff with sufficient guidance to support them to meet people’s needs and/or preferences.

People did not benefit from individual activity plans to promote their wellbeing. There were limited activities available for people who could not leave the home independently.

The lack of communal dining facilities meant some people had to eat alone leaving them at risk of social isolation.

No formal complaints had been raised. People and relatives felt able to speak out if they did have a concerns and were confident that their concerns would be taken seriously and addressed

Well-led

Requires improvement

Updated 6 July 2016

The service was not always well led:

There were systems in place to monitor the quality of the service, but these had not identified the issues we found at the inspection.

Survey outcomes showed a high level of satisfaction from people and families about the care at Sundial Lodge.

People and relatives had a high level of confidence in the registered manager. Staff also spoke highly of them and confirmed they were approachable and supportive.