Sunnyside

Sunnyside is a residential care home providing personal care to up to four younger people with a learning disability, mental health condition or sensory impairment. At the time of this inspection, the service was supporting two people.

The home had been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support. For example, the home was small and located in a village location that assisted the people who lived there to participate easily in their local community.

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

The service had made improvements since our last inspection although further improvements were required, particularly around risk management and infection prevention and control. For example, we found some areas of the home not as clean as expected and staff were not always following the government’s guidance on social distancing and the use of personal protective equipment. Further consideration was also needed in relation to managing people’s risks and staffing gender and levels at night

However, the outcomes for the two people who used the service were good and staff had supported them to live independently. One person said, “I feel happy here, the staff are kind to me.” The relatives we spoke with confirmed this as did the health and social care professionals. Staff supported and engaged with people and helped them live meaningful lives with the support of professionals.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

All those we spoke with talked positively of the management team and the improvements they had made. Staff felt valued and supported and relatives told us the home was good at communicating with them. The manager understood their regulatory responsibilities and the importance of leading their staff team. However, the quality monitoring system had not completely identified and rectified the few concerns we found during this inspection.

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 1 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since our last inspection in October 2019. 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

We received concerns in relation to the management of risk. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

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

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.

Sunnyside is a residential care home providing personal care and support for adults with learning disabilities, autism and mental healthcare needs. The service is registered to accommodate up to four people and there were four people living at the service at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. However, not all of the principles had been applied to the service provided, to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service should also receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Thematic Review

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service did not always support people effectively in line with positive behaviour support principles. Staff were not all suitably trained to support people using positive behaviour support. The service was not able to demonstrate that use of physical restraint was appropriate to manage peoples distressed behaviours.

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

People were not always supported by enough suitably trained staff. This was confirmed by feedback from people’s relatives.

We identified significant environmental risks and concerns impacting on the standards of safe care being provided. Leadership and governance arrangements within the service had further deteriorated since the last inspection.

We identified breaches of regulation and the provider, in the absence of a registered manager, was not meeting their legal regulatory responsibilities to ensure people received good standards of care.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible; policies and systems in the service were not followed to support good practice or reflecting the principles and values of Registering the Right Support.

Feedback from people’s relatives raised concerns around levels of activities and social stimulation. The service had not put in place end of life care planning, and care records did not consistently contain protected characteristics in relation to personal choice and preferences.

The care environment was clean, and people had the option to personalise their bedrooms. The manager was working with staff to improve morale and staff cohesion, with changes to staffing rotas and supervision structures.

Rating at last inspection

The last rating for this service was Good overall with Requires Improvement in the well-led key question of the report, (published 17 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment, safeguarding people from harm, consent to care and support, provision of person-centred care and having good governance systems and processes in place.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will arrange to meet with the provider. We will work alongside the provider and 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.

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.

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

There was not currently a registered manager in post. The manager was in the process of submitting their application to become the registered manager. For the purpose of this report they will be referred to as ‘the manager’ rather than 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.

Registration requirements were not always met. We had not been notified that the service was without a registered manager for over 28 days.

There were systems in place to monitor and assess the quality of service being delivered. The manager carried out weekly and monthly audits on every area of the service. The service manager also carried out an in depth monthly audit on all areas of the service. The audits were not always effective.

There were gaps in staff training. Not all staff had received training in food hygiene and infection control. Not all staff had up to date training in the safe handling and administration of medicines, nor were staff’s competency in this area regularly assessed. However, we found that medicines were stored and administered safely. Regular audits of people’s medicines were carried out and these highlighted any shortfalls in the safe management and administration of people’s medicines.

Risks to people’s health and wellbeing had been identified and risk assessments detailed what steps should be taken to mitigate the risks. Staff had received training in safeguarding and knew the procedures for reporting any suspicions of abuse. Safe recruitment practices were in place to ensure that suitable staff were employed to work in the home.

Staff were supported in their work through regular supervisions and training appropriate to their role. Staff were able to access specific training which related to people’s complex support needs.

People’s mental capacity had been assessed and best interests decisions had been clearly documented where people were not able to make decisions about certain things. Most staff had received training in the Mental Capacity Act (MCA) 2005 and understood the principles of the MCA.

People were supported to be as independent as possible. They were involved in making decisions about their care and their views and preferences were listened to. People were able to cook for themselves and were supported to go food shopping. Relatives were able to visit without restrictions and people were supported to visit their family. People’s interests were supported and they were able to pursue their hobbies and go on regular activities away from Sunnyside.

Staff treated people with kindness and compassion and knew people’s needs well. Staff knew how to communicate with people using their preferred method of communication. People’s right to privacy and dignity was consistently upheld and staff treated people with respect. People were able to access healthcare professionals where concerns had been identified about their health or wellbeing.

Individualised care plans for people were in place and they were updated and reviewed regularly. People were encouraged to talk about their wishes and aspirations and what support they needed from staff.

There was a complaints procedure in place and staff knew how to support people with making a complaint. People and their families were asked for feedback about the service and, where necessary, changes and improvements would be made as a result. Regular meetings took place for people living in Sunnyside which also gave people the opportunity to put forward their ideas about how the service could be improved.

The manager and general manager were a visible presence and people living in Sunnyside and the staff felt that they were approachable and open to discussion. There was open communication from the manager about any changes they intended to make to the service and regular staff meetings took place.

We reviewed the evidence we had obtained during our inspection and used this to answer five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

The service was staffed appropriately to ensure that people's needs were met. We found that as well as undertaking the provider's mandatory training, staff had undertaking training in specific areas relevant to the people they supported. For example, staff had been trained in 'signalong'. Signalong is a sign-supporting system, based on British Sign Language, designed to help people with communication difficulties. We noted a staff member using this method to communicate with one person.

People and staff could be assured that their records were accurate, held securely and remained confidential.

Is the service effective?

During our visit we observed that people receiving care seemed content. Staff were responsive to people's behaviours and familiar with people's differing methods and meanings of communication. This helped ensure that people were supported effectively.

People's dietary preferences were taken into account when meals were planned. People were supported to have adequate nutrition and hydration.

Is the service caring?

We observed that people were supported by kind and attentive staff. Staff were patient and encouraged people to do things for themselves.

A relative we spoke with told us that staff seemed genuinely fond of their family member. Staff had invited the family to a trip out to the circus which been enjoyed by everyone. The relative added that Sunnyside had provided '..a huge amount of joy' to their family member's life.

Is the service responsive?

The rigorous assessment process undertaken before people moved in to the home ensured that the service had planned in advance how to meet people's needs and support their transition to living at Sunnyside.

Staff supported people to participate in meaningful activities in the home and in the local community. The activities included ones people could enjoy as a group and others were tailored more to people's individual needs. For example, one person had a dislike of large crowds so activities were planned for them individually or as part of a smaller group which helped reduce their anxiety levels.

Is the service well-led?

The manager was clear about the ethos of the service. They ensured that knowledge, they and other experienced staff had, and access to helpful information was shared with other staff. Staff we spoke with were very positive about working at Sunnyside and told us that the manager was very supportive and approachable.

Quality assurance processes were in place. This meant that people could be sure that the service was monitored effectively by the manager and provider to ensure that the service continually improved. The service worked effectively with people, their relatives and other healthcare professionals to make sure people received their care in a joined up way.