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Sunrise Care Home Requires improvement

Reports


Inspection carried out on 12 August 2020

During an inspection looking at part of the service

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

Risks to people had not consistently been mitigated. We identified concerns around fire safety and infection control. Peoples individual risk assessments were not reviewed regularly to ensure the information was current and relevant in mitigating risk.

The provider and management team had not consistently maintained effective oversight of the safety and quality of the service and lessons had not consistently been learnt when things went wrong.

Medicine records were not consistently completed to ensure people received their medicines as prescribed. Medicines were stored safely and were administered safely by senior members of staff.

Some improvements were required to the recruitment process to ensure staff were recruited in line with current legislative requirement. Criminal record and barring checks were completed. There were enough staff available to meet people’s needs and people and their relatives spoke positively of the staff and management team.

Staff knew people well and demonstrated a person-centred approach to care that supported choice and decision making but relatives did not consistently feel involved in the planning of care.

Improvements were required in record keeping for people to ensure oversight of people’s health and to allow for early recognition of a decline of health. There was evidence of partnership working with professionals to support people’s healthcare needs.

The home was not consistently clean and was visually unkempt. Further refurbishments were required to ensure a homely environment.

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; however, the policies and systems in the service did not support this practice. Deprivation of liberty safeguards had not consistently been applied for. Mental capacity assessments were not completed and best interest decisions were not recorded.

People were protected from the risk of abuse. People and their relatives knew how to raise concerns or make a complaint if needed.

PPE (personal protective equipment) was readily available, and staff used this appropriately.

People, staff and relatives spoke highly of the provider management team. Staff told us they felt well supported.

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

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 19 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and people’s safety. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

During the inspection the provider took action to mitigate some of the risks, further improvements were needed to ensure risks all were mitigated.

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 the safety and managerial oversight of the service at this inspection. Please see the a

Inspection carried out on 7 January 2020

During an inspection looking at part of the service

About the service

Sunrise Care Home is a residential care service that was registered to provide personal care for up to 20 people. On the day of our inspection, the service was supporting 14 people. Some people using the service, were living with dementia.

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

No registered manager was in post during the focused inspection at Sunrise Care Home, but the provider and deputy manager were working closely together to manage the service until an appropriate registered manager could be recruited.

The provider was open and transparent throughout the inspection. Whilst some improvements had been made, these need time to become embedded and sustained so they become part of normal practice.

We have made a recommendation about the submission of CQC notifications.

People told us they received safe care. Staff we spoke with understood safeguarding procedures and were trained in this area.

The provider had improved their systems to ensure people were protected from avoidable harm. Risk assessments were in place to manage risks within people’s lives, and staff understood how to follow them and provide safe care to people.

The provider had undertaken a programme of refurbishment to modernise the facilities for people being cared for at Sunrise Care Home. Improvements had been made to the infection control of the service.

The service was clean, tidy and well maintained, and people confirmed that staff followed infection control and food hygiene procedures effectively. The management team had an overview and cleaning schedules were in place.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Medicines were stored and administered safely.

Staffing support matched the level of assessed needs within the service during our inspection, and people we spoke with said that staffing levels were sufficient.

The management team continued to work in partnership with outside agencies to improve people’s support when required. Audits of the service were in place and were detailed. Any issues found were addressed promptly.

Staff felt supported by the deputy manager and responsible person. Staff had received formal supervisions, to ensure they were supported.

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 23 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 and the provider was no longer in breach of regulations. However, we would need to see a consistent level of sustained good care before changing the rating.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 and 8 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, Good governance, Premises and equipment and Receiving and acting on complaints.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same, requires improvement. 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 Sunrise Care Home on our website at www.cqc.org.uk.

Enforcement

Since the last inspection we recog

Inspection carried out on 7 August 2019

During a routine inspection

Sunrise Care Home is a residential care home that was registered to provide personal care for up to 20 people. On the day of our inspection, the service was supporting 16 people. Some people using the service, were living with dementia.

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

The provider did not have robust systems in place to ensure people were protected from avoidable harm. Risks to people's health and safety were not always assessed and managed. Investigations into incidents and accidents were not always analysed to learn lessons and prevent future occurrences.

Some people, relatives and staff raised concerns that the service needed some redecoration. We found the service was undergoing a programme of refurbishment. The environment was not always kept clean and was not dementia friendly. The providers complaints procedure was not clear and there was no evidence to demonstrate how the provider appropriately deals with complaints.

Arrangements were in place for the safe administration of medicines, however the medicine management system was not always safe. End of life care was provided in close consultation with specialist agencies; people were supported to access to a range of local healthcare services. Relatives were complimentary about the quality of care provided by the staff.

There were suitable numbers of staff, who were recruited safely and in line with current legislation. Staff were undertaking mandatory training, staff told us they had enough training to meet people's needs. Consent to care was sought and recorded. Daily activities were organised which some people enjoyed. However further action was needed to ensure people were not at risk of isolation and lacked meaningful engagement.

Initial assessments were undertaken which reflected choices and needs. The person receiving support, was 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.

Staff felt supported by the acting manager and seniors, however formal supervisions and staff appraisals were not consistently taking place to ensure staff were supported. The service had established links in the local community and worked in partnership with key organisations including local authorities and other agencies to improve the service for people. Staff at the service worked with health and social care professionals to ensure good outcomes for people.

No registered manager was in post, but an acting manager had been at the service since January 2019. The acting manager was open and transparent throughout the inspection. Whilst some improvements had been made, these need time to become embedded and sustained so they become part of normal practice. There was a failure to meet the regulations.

Rating at last inspection: The last rating for this service was Good (published 4 March 2017).

Why we inspected: This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make 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.

During the inspection the provider made some improvements that were effective to mitigate some of the risks identified and improvements are still ongoing.

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

Enforcement

We have identified breaches in relation safety, complaints and governance.

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

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 l

Inspection carried out on 19 January 2017

During a routine inspection

Sunrise Care Home accommodates and cares for up to 20 older persons with a range of mainly age related dependencies, including people with dementia care needs. There were 14 people in residence when we inspected.

At the last inspection, the service was rated ‘Good’; at this inspection we found that the service remained ‘Good’.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were kept safe by sufficient numbers of conscientious staff that knew their job. They had the skills and training they needed to care for older people with a range of predominantly age related needs, such as dementia and physical frailty. Staff were compassionate and kind as well as knowledgeable about people’s individual needs. Staff were supported through regular supervision and undertook training which helped them to understand the needs of the people they were supporting.

People were safeguarded from harm and poor practice by care staff that knew what action they needed to take if they suspected this was happening. There were appropriate staff recruitment procedures in place to protect people from receiving care from staff that were unsuited to the job.

People’s care needs had been assessed prior to admission and they each had an agreed care plan. Their care plans had been reviewed; reflected each person’s needs, and provided staff with the information they needed to be mindful of and act upon when caring for people. Care plans informed staff of people’s needs, their likes and dislikes and preferences. Risks were assessed and acted upon to minimise the likelihood of accidents. People were, however, supported in the least restrictive way. They were encouraged and enabled to do things for themselves and make choices in keeping with their capabilities so that they retained a sense of independence. People’s individual preferences for the way they liked to receive their care and support were respected.

People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration. People’s healthcare needs were met in a timely way and they received treatment from other community based healthcare professionals when this was necessary.

People that needed support with eating and drinking received the help they required. They were provided with varied diet and enjoyed mealtime portions of food that suited their appetite and nutritional needs. Appropriate guidance from healthcare professionals qualified to advise on diet was sought and acted upon when required.

People, and where appropriate, their representatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

The quality of the service provided at the home was monitored by the manager on a day-to-day basis as well as over time using the quality assurance systems in place.

Inspection carried out on 26 May 2016

During a routine inspection

This unannounced inspection took place on the 26 and 27 May 2016.

Sunrise Care Home accommodates and cares for up to 20 older persons with a range of mainly age related dependencies, including people with dementia care needs.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People benefited from being cared for by sufficient numbers of experienced staff that had received the training they needed to do their job safely. Staff knew what was expected of them when caring for older people, including those with dementia care needs, and they carried out their duties effectively and with compassion.

People’s care needs had been assessed prior to admission and they each had an agreed care plan. Their care plans were regularly reviewed, reflected their individual needs, and provided staff with the information and guidance they needed to do their job. People’s individual preferences for the way they liked to receive their care and support were respected. People were enabled to do things for themselves by staff that were attentive to each person’s individual needs and understood their capabilities.

People had enough to eat and drink and received the care they needed. People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon when required. People who needed support with eating and drinking received the help they required.

People’s healthcare needs were met and they received treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People were safeguarded from abuse and poor practice by care staff that knew what action they needed to take if they suspected this was happening. There were appropriate staff recruitment procedures in place to protect people from receiving care from staff that were unsuited to the job.

People, and where appropriate, their representatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

Inspection carried out on 17 April 2015

During a routine inspection

This unannounced inspection took place on the 17 April 2015.

Sunrise Care Home provides accommodation for up to for up to 20 older people who require care. There were 17 people in residence during this inspection, most of whom had some degree of dementia care needs.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were protected from unsafe care. There were robust recruitment procedures in place that protected people from being cared for by staff that were unsuited to the job. Sufficient numbers of trained and experienced staff were deployed to meet people’s needs. People’s rights were protected.

People received their support from care staff that were attentive and responded in a timely way to their needs. Care workers understood their duties and carried them out effectively. Their manner was friendly and they encouraged people to retain as much independence as their capabilities allowed. There were activities to stimulate people’s interest.

People’s care plans reflected their individuality and their needs were regularly reviewed. People’s healthcare needs were met. They had access to a wide range of community based health professionals. Community based healthcare professionals were appropriately consulted, and their advice and prescribed treatments acted upon, to help sustain people’s health and wellbeing.

People were supported to maintain a balanced and varied diet. They said they enjoyed their meals and had enough to eat and drink. There was variety of foods to suit people’s tastes and nutritional needs.

People’s medicines were securely stored and appropriately administered by competent staff. There were suitable arrangements for the disposal of discontinued medicines.

People’s quality of care was effectively monitored by the audits the provider carried out on a regular basis. Care staff listened to and acted upon what people said, including the views of people’s relatives or significant others.

People’s complaints or concerns were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary.

Inspection carried out on 16 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 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 2012, and to pilot a new inspection process being introduced by the Care Quality Commission which looks at the overall quality of the service.

The inspection was unannounced.

Our last inspection of this service was on the 4 November 2013. We found that the standards we checked had all been met.

Sunrise care home is a care home that provides care and support for up to 20 older people, some of who are living with dementia.  At the time of the inspection, there were 19 people living in Sunrise care home.

There was a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was absent on the day of our inspection.

Staff did not always engage effectively with people who had dementia and people were not always given adequate choice about what to eat, drink or where to reside within the service. This meant that some people were not treated with respect. This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and you can see what action we have told the provider to take at the back of the full version of this report.

Some relatives felt that their loved ones required more stimulation to enhance their quality of life. Similar comments had been received from a healthcare professional and the local authority prior to our inspection, particularly in relation to people who had dementia. During our observations throughout the day, we saw that some people spent a lot of time sitting in the same chairs either asleep or gazing around the room. The provider had not ensured that people living with dementia had adequate stimulation or support to help them maintain their hobbies or interests to enhance their wellbeing. This was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and you can see what action we have told the provider to take at the back of the full version of this report.

The staff had a good knowledge of what care they needed to provide to meet people’s basic personal care needs. However, the provider had not made sure that they had received adequate training in dementia to give them the  knowledge and skills required to care for people who were living with this condition effectively.  Staff had not received training in other important subjects such as infection control and health and safety although we were advised after the inspection, that plans were in place for this training to be completed. The provider was not following their own policy regarding how often staff should receive supervision from their manager. This was in breach of Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010  and you can see what action we have told the provider to take at the back of the full version of this report.

Staff did not understand the principles of the Mental Capacity Act (2005) even though they had received training in the subject. This meant that we were not assured that people who lacked capacity to make decisions for themselves had their rights fully protected.

The service was meeting the requirements of the Deprivation of Liberty safeguards (DoLS) which meant that authorisation had been sought from a specialist independent body before depriving someone of their liberty.

Relatives told us that they felt their loved ones were safe and were in the main, happy about the care that was being received. There were enough staff to keep people safe and their medication was given to them correctly. People were protected from the risk of abuse and their care needs had been assessed. People had access to specialist advice when they needed it to keep them healthy and they received adequate nutrition.

The staff were happy working at the service and told us that the management team and the provider were supportive, that they listened to them and that changes in care practice were implemented where concerns had been raised. The provider monitored the quality of the service provided. However, we saw that staff concentrated on meeting people’s physical needs rather than taking the time to engage with them on a personal level. Staff engaged with people who could communicate with them on occasions during the inspection, but we saw little interaction with people who were living with dementia and/or who had communication difficulties.

Inspection carried out on 4 November 2013

During an inspection looking at part of the service

Our inspection of 23 September 2013 found that there were issues with care planning, safety around medicine administration and quality assurance which might have resulted in people�s needs not being fully met. We did not speak with anyone living in the home on this occasion.

The provider wrote to us and told us that they would be compliant by 04 November 2013 and have all the outstanding work to ensure the details in the warning notice had been complied with.

We visited with a specialist pharmacy inspector to ensure the provider had made improvements to the medication system. He found that the provider had complied with the warning notice and noted improvements to the storage, administration and risk assessments around medicines and judged the provider had improved the arrangements for the safe use and management of medicines.

We also noted improvements in the way that care plans and risk assessments were compiled. These were better detailed and had supplementary information which backed up and confirmed what staff needed to know when caring for people.

We also looked at the changes around quality assurance (QA) and how these had been implemented since our last visit. The provider had commenced using updated versions of a number of different forms used in the monitoring process. These are now used more effectively to monitor accidents and incidents, and inform planning for risks in caring for people.

Inspection carried out on 23 September 2013

During a routine inspection

We made a planned return to the home, and also looked at the outstanding compliance actions from our last visit. We were also accompanied by a specialist pharmacy inspector to assess any changes to the medication system. They looked in detail at the system and found that a number of improvements are still required in this area.

Care plans and risk assessments had been updated but still require more work to enable staff to use these as a working document. Staff also need to look at the consistency of record keeping as we saw a number of discrepancies in the files we looked at.

We also looked at quality assurance and how this had been used to monitor the progress and changes since our last visit. We found that although the provider has introduced new QA initiatives these have been unsuccessful. This was due to the introduction of the forms being poorly thought through, lacked back up knowledge and operational know how.

We found there had been improvements in the recording of people�s nutritional needs, meal choices, and the environment in and around the home and staffing.

Inspection carried out on 1 July 2013

During a routine inspection

We spent time and spoke with people using the service and their relatives in the lounge area of the home. People appeared relaxed and interacted with staff members in a positive way. When we spoke with people about the home and staff one person replied �They do me very well here� �If you want any (shopping) they (the staff) will bring it for you�.

When asked about the catering another person said �the food is awful, you get a lot of sprouts� and �I would like to see some homemade soup and stew on the menu�, another person said �it�s (the food) mundane, lots of oven chips� and �the pork today was nice, they give you too much�. Another person stated �there are sandwiches most days for tea, a bacon sandwich would be a welcome change�.

We asked people about their care plan. No one we spoke with had seen or been involved in compiling or reviewing their care plan. We observed staff talking with and assisting people throughout the day, this was done with the peoples� privacy and dignity in mind.

We looked at how care planning and risk assessments are completed and noted improvements are required in both these areas. We noted improvements are also needed to the fabric and upkeep of the building and staffing numbers.

We also looked at how medicines are managed and noted that improvements are also needed to this area.

Inspection carried out on 9 May 2012

During a routine inspection

There were 20 people living at the service when we visited on 9 May 2012. We spoke with two people who lived at the home who told us they received the support they needed. One person said, �I�m happy with what I�m getting here�. Another person told us that they had �no complaints�.

One relative who was visiting told us �I can�t find any fault� with the home. They also said that they could get involved with activities with their family member such as bingo and trips out.

We used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

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