Background to this inspection
Updated
11 May 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 11 March 2016 and was unannounced. The inspection was undertaken by two inspectors.
We reviewed the information that we had about the service including statutory notifications. Notifications are information about specific important events the service is legally required to send to us.
Some people who used the service were able to tell us of their experience of living in the home. For those who were unable we made detailed observations of their interactions with staff in communal areas.
We spoke with six people that used the service, two relatives and eight members of staff. We also spoke with the deputy manager, the quality support manager and the regional manager.
We reviewed the care plans and associated records of six people who used the service. We also reviewed documents in relation to the quality and safety of the service, staff recruitment, training and supervision.
Updated
11 May 2016
This inspection took place on 11 March 2016 and was unannounced. The last full inspection took place on 2 February 2015 and, at that time, two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to safe care and treatment and good governance. These breaches were followed up as part of our inspection.
Sunnymead is registered to provide personal care and nursing care for up to 76 people. The service has two units, Hollies and Poplars. Poplars unit provides care and support to people living with dementia. At the time of our inspection there were 36 people living in the service.
There was no registered manager in place on the day 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 deputy manager had the current responsibility of running the service.
In February 2015 we found that people’s care records were not always maintained accurately and completely to ensure full information was available. At this inspection the provider had not made sufficient improvements.
In February 2015 people’s medicines were not always managed and administered safely. At this inspection the provider had not made sufficient improvements.
People were not always safe as there were not always sufficient numbers of suitably qualified and skilled staff to support their needs. Staffing levels were not maintained in accordance with the level determined by the provider’s dependency tool.
The provider had inconsistent arrangements in place for reporting and reviewing incidents and accidents. Records showed some incidents were clearly audited and actions were followed up and support plans adjusted accordingly. Other incidents were processed but there was not a clear audit trail of the investigation and the outcome.
Staff were not consistently supported through an effective training and supervision programme.
Staff demonstrated a basic understanding of how to recognise and report abuse. Although the majority of staff confirmed they had received safeguarding training, not all were able to describe what abuse was or how they would report it.
The provider had not consistently protected people against the risk of poor or inappropriate care as accurate records were not being maintained. Not all records were completed accurately to manage and ensure that people’s on-going needs were met and risks mitigated.
People’s nutrition and hydration needs were not consistently met.
People’s rights were not being upheld in line with the Mental Capacity Act (MCA) 2005. This provides a legal framework to protect people who are unable to make certain decisions themselves.
The service was not consistently responsive to a person’s needs. We found that the care plans did not reflect people’s individualised needs. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement.
Since the previous inspection conducted in February 2015 the provider had failed to fully implement the actions in their plan to ensure they were no longer acting in breach of the regulations. As well as not fully implementing the stated actions in the plan we found that the number of breaches of regulations has increased.
The provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. This resulted in poor practice across the service.
The majority of staff demonstrated kind and compassionate behaviour towards the people they were caring for.
Records showed a range of checks had been carried out on staff to determine their suitability for the work. For example, references had been obtained and information received from the Disclosure and Barring Service (DBS).
People were cared for in a safe, clean and hygienic environment. The home was free of odours and daily cleaning schedules were completed throughout the building.
People had their physical health and mental health needs monitored. The care plans showed people had access to healthcare professionals according to their needs. We noted that people had access to their GP, speech and language therapists, tissue viability nurses and the dementia well-being team.
Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.
People were encouraged to provide feedback on their experience of the service.
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 this report.