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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 carried out on 20 April 2016

During a routine inspection

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 carried out on 14 October 2013

During a routine inspection

On the day of our inspection 45 people lived at Sundial Lodge. We spoke with six people who lived at the home. We also spoke with seven members of staff including the owner, the manager, the cook, and four care workers. People were satisfied with Sundial Lodge. One person told us it had “A high standard of staffing, accommodation, cleanliness, maintenance and friendliness”

People who lived at the home felt respected and involved in their care. People pursued hobbies and engaged in regular activities at the home. One person told us “I go to town, we have transport that takes us for two hours, sometimes twice a week.”

People’s needs had been assessed and were delivered in line with their care plan. There was a variety of healthy and nutritious food and drink for people. However, feedback about the food was mixed. One person said "it's not as good as it used to be."

People were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. Care workers understood their responsibilities and knew how to identify and raise concerns. People told us they felt safe at Sundial Lodge.

We found that medication was being managed well and was stored securely at the home. Appropriate and accurate medication administration records were kept.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and sought regular feedback.

Inspection carried out on 12 March 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. For example we saw people using the service had signed forms consenting to having photographs taken, care planning and ongoing assessment of needs.

People experienced care, treatment and support that met their needs and protected their rights. We spoke with four people using the service. People told us that they were happy with the care they received. One person said "I am looked after very well" another person said "all the staff are lovely, I can’t complain at all".

People were cared for in a clean, hygienic environment. Each individual’s apartment was clean and staff we spoke with were aware of the standards they were to maintain.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We checked the premises and saw that the building and décor were in a good state of repair and appropriately maintained.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

Inspection carried out on 13 February 2012

During a routine inspection

We carried out an unannounced visit to Sundial Lodge on Monday 13 February 2012. On the day we visited there were 45 people residing at the home. We met and spoke with eight people living at the service. We also spoke with relatives, a visiting health professional, care and ancillary staff and the registered manager and representative of the company.

The atmosphere within the home was relaxed and friendly, with people spending their time as they wished. People said they felt safe at the home. People told us that the staff respected their privacy and dignity, and helped them to retain as much independence as possible. One person told us, “I can’t speak highly enough of the staff”. Another person said, “Staff are lovely, very polite and caring…”

We asked people if they found there were enough staff on duty at all times to support them each day. The majority of people told us that in their opinion there were, and that they did not have to wait for long periods for staff to respond to requests for support if they called or rang their bells. One person felt that staffing levels could be improved and that in their experience it wasn’t always easy to find staff.

Overall people told us that they were “very happy” living at this home. Other positive comments include; “Things couldn’t be better”, “This is the best place around”, “I have freedom and independence here” and “Anything I want is available to me here”.

During the inspection we observed care and read a range of documents used to plan and evaluate care. Overall we found that the majority of people were experiencing good outcomes at the service. People were supported by caring and friendly staff who had the skills and knowledge to meet their needs.

Reports under our old system of regulation (including those from before CQC was created)