Archived: Sun Court Nursing Home

Sun Court Nursing Home is a residential care home providing personal and nursing care to up to 29 people. The service provides support to younger adults and older people, some of whom may be living with dementia, have a mental health condition, a physical disability or a sensory impairment. At the time of our inspection there were 19 people using the service. The home is a converted period building over three floors accessed by a lift

People’s experience of using this service and what we found

The service had made improvements since our last inspection however further development was required. Some care records contained contradictory information and were not accurate; correct records were particularly important given the home was using a high number of agency staff.

Although staff demonstrated knowledge through discussion, not all had received the training the provider deemed necessary to meet people’s needs. For example, nurses were applying dressings without the correct training in place.

The provider had identified the shortfalls within the service and had a robust action plan in place. However, due to the volume of actions required, not all had been completed at the time of this inspection. Other stakeholders had visited the service prior to this inspection and made recommendations which the provider had been responsive to.

People told us they were well cared for, listened to and respected. Whilst care plans did not consistently cover all aspects of people’s lives, they told us these were mostly considered in practice. However, activities and entertainment had not resumed to the level they were prior to the pandemic and people told us they wanted more of this.

The home was running on a high number of agency staff due to nationally recognised shortages in social care staff although the provider had a recruitment drive in place. Agency staff were block booked meaning the same staff attended. People told us all staff, including agency staff, were kind and caring but they voiced the preference to receive care and support from permanent staff that were fully familiar with them and their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Care plans were person-centred and had mostly been regularly reviewed. Although care plans did not consistently show people had been formally involved in them, they told us that in practice they were consulted, and their consent sought.

Systems in place helped protect people from the risk of abuse and they had access to a wide range of health professionals. People received their medicines as prescribed and were protected from the risks associated with infectious diseases. For example, we saw that the home was visibly clean, and that staff wore personal protective equipment (PPE).

People’s nutritional needs were met, and we saw they had choice in what they ate as well as support as required. Independence was encouraged and we saw that people’s dignity was maintained. The wishes people had for the end of their lives had been discussed and recorded and a health professional we spoke with told us the home was adept at providing this care.

Although the manager had only been in post for four weeks at the time of this inspection, people spoke positively about him and his plans for the home. Staff told us the culture within the home was positive and nurturing and that teamwork was good; staff told us they felt supported and involved in making the home the best it could be.

People acknowledged there were still improvements required at the home but told us the care was good and that people were happy living at Sun Court Nursing Home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (report published on 17 August 2021) and there were breaches of regulations. We imposed conditions on the provider’s registration meaning they were obliged to submit regular monthly updates showing what improvements they had made. At this inspection we found improvements had been made although the provider remained in breach of one regulation.

This service has been in Special Measures since 17 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make further improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sun Court Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the provider’s governance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request regular action plans from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sun Court Nursing Home is a nursing home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection in one adapted building. The service can support up to 29 people.

People’s experience of using this service and what we found

People were placed at risk of harm. Care planning and records of daily care provided were incomplete and inaccurate. Improvements were required to the premises and ongoing servicing and monitoring had not taken place in line with requirements. Infection prevention and control practice needed to be improved. Staffing levels were insufficient, resulting at times in people not receiving the level of support expected and required. Staffing pressure impacted the ability of the registered manager to complete parts of their role that promoted people’s safety. There was not a culture of using lessons learned to reduce the risk of incidents happening again.

Staff training was insufficient. Registered nurses who required training to carry out clinical tasks had not received updates to ensure they were able to do this safely. The quality of food provided was poor at times and choices were limited or not promoted to people. The serving of meals to people did not ensure they were hot and appetising and hygiene standards needed improvement. Staff did not recognise when people needed help to eat or when they needed to provide food at different times if the person was sleeping.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff did not always treat people with dignity and respect. Care provided was task focussed and did not fully involve the service users or encourage independence. People reported they often waited long periods to receive care. Peoples life histories hobbies and areas of interest were not fully explored. Staff did not have the time to sit and converse with people or take an interest in what was important to them. Staff wanted to provide more person-centred care and spend time with people but were unable to do so due to staffing pressures.

People were unable to access activities that enhanced their well-being and quality of life. There was a culture of care that did not encourage staff to be creative in trying to improve people’s daily living. Although formal complaints were managed in line with the providers procedures, concerns and feedback was not openly sought from people or their relatives to improve care. Nursing staff who provided clinical care to people at the end of their lives were not fully compliant with the required training to do so.

Improvements had not been made since our last inspection and the services quality of care and management of safety and risk had continued to decline. The provider had not been proactive or effective in addressing longstanding known shortfalls in staffing and the quality of care provided. A negative culture amongst staff had developed which had adversely affected peoples experience of living at the home because conflict between them was taking place publicly. The registered manager was highly regarded by people and staff who felt that despite their dedicated service, was unable to make the improvements required without further support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 October 2020) where we found breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, infection control and management of the home. A decision was made for us to inspect and examine those risks. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sun Court Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to, safe care and treatment, staffing, nutrition and hydration, dignity and respect, person centred care and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sun Court Nursing Home is a residential nursing home providing personal and nursing care to up to 29 people, in one adapted building. At the time of our inspection there were 25 people using the service, some of these people were living with dementia.

People’s experience of using this service and what we found

People and staff told us they felt there were not enough staff to meet their needs. The provider was in the process of addressing this. This included work to reduce the times the registered manager was working ‘on the floor’ to enable them to undertake their registered manager duties. Staff told us morale was low and they did not always feel listened to. People’s care plans and records were not person centred and did not provide guidance for staff on how people’s specific needs were being met. We found breaches in Regulations 18 (staffing) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a comprehensive action plan in place which identified improvements required and actions being undertaken to address them, with timescales and regular monitoring of improvement by the provider management team. There were systems to assess and monitor the service provided and these were continuously being improved. However, at the time of our inspection, not all of these improvements had been fully implemented and embedded in practice.

The systems for keeping people safe were not robust, this included how risks were assessed and mitigated, this was in the process of being addressed. The service had systems to identify when people had not received their medicines when required and addressing it. Infection control processes were in place and issues were addressed when required. Systems were in place to recruit staff safely and learn lessons when things had gone wrong.

People told us the staff were kind and caring, which confirmed in our discussions with staff who were committed to provide good quality care to people.

There were systems in place to receive feedback from people using the service and their comments were being addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service when registered under the previous provider was good (published 07 June 2018). Sun Court Nursing Home was registered with the current provider 30 September 2019, this is the first inspection of this service under the current provider.

Why we inspected

The service was due for a planned inspection based on the registration date of the current provider. In addition, we had received notifications from the service and information from members of the public which concerned us that people were not always being provided with safe care. As a result, a decision was made to undertake a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sun Court Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.