Archived: Sun Woodhouse Care Home

Sun Woodhouse is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides residential care for up to 24 people. It consists of one building with two floors. People’s rooms are on both floors, near shared bathroom and toilet facilities. On the ground floor there is a communal lounge and separate dining area.

On the first day of inspection there were 15 people living at the home. On the second day, one person was admitted for respite care.

Sun Woodhouse was last inspected in July 2017. This was a focused inspection, which meant we only inspected and rated the key questions of Safe, Effective and Well-led. We found breaches of the regulations relating to safe care and treatment, consent and good governance, although the service evidenced work to address these breaches was completed within four days of the inspection. Prior to this, we inspected all five key questions in May 2017, and rated the home as ‘Requires Improvement’ in the key questions of Safe, Effective and Well-led, and ‘Good’ in Caring and Responsive.

A manager was registered for the home; however, they had left the service in November 2017 and were in the process of deregistering. A registered manager is a person who has registered with 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.

In September 2017 the registered provider went into administration. The administrators had employed a care company to run the home while a buyer was sought and had oversight of their management.

An area manager for the registered provider was acting manager at the home; a new manager had been recruited and was due to start two weeks after the inspection. A senior care worker had been promoted acting deputy manager, and a regional manager for the care company employed by the administrators visited weekly. There had therefore been significant changes in management at the home in the months preceding this inspection.

Records showed appropriate checks were made on the home’s facilities, utilities and equipment. Risks to people had been assessed and managed. Staff could describe the different forms of abuse people may be vulnerable to and said they would report any concerns.

Medicines were managed and administered safely.

Due to various factors, a number of staff had left the service since the last inspection. Recruitment was underway, although this had been challenging due to the registered provider’s administration status. People and relatives said there were enough staff, although they were busy.

People and relatives told us the home was clean, but could benefit from redecoration. The regional manager for the care company employed by the administrators described plans to make corridor areas of the home more dementia-friendly.

Despite the challenges posed by the registered provider’s administration status and loss of the registered manager, staff received the training and supervision they needed to provide effective care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems of the service supported this practice. This was an improvement from the last inspection.

Feedback about food and drinks served at the home was positive. Catering and care staff could describe people’s specific dietary needs and preferences.

The care staff worked as a team to support people, and worked in partnership with external healthcare professionals to help meet people’s wider health needs. We saw practice at the home was based upon national guidelines and standards.

People told us, and we observed, staff were kind and caring, and often went the extra mile to meet people’s needs. Relatives told us they were always made to feel welcome at Sun Woodhouse.

Care staff supported people to remain independent, and were respectful of people’s privacy and dignity. Records showed people and their relatives had been involved in care planning.

People’s care plans were individualised and contained person-centred details about their preferences. Records showed, and we saw, people were supported in accordance with their care plans.

People had access to a range of activities at the home. We received positive feedback about a new activities coordinator; they were in the process of getting to know people and finding out their activity preferences.

No complaints had been made since the last inspection in July 2017. People and their relatives told us they would go to the acting home manager and acting deputy manager if they had any concerns.

Changes at the home due the registered provider going into administration had been communicated sensitively to people, relatives and staff. Feedback about the management team in place at the time of this inspection was positive.

The care company employed by the administrators had put measures in place to improve staff retention and we found staff morale was good.

A range of audits were in place to monitor safety and quality at the service. The acting home manager and regional manager for the care company employed by the administrators had good oversight of the home and reported their findings to the administrators.

The home had an open and inclusive culture. People, their relatives and staff were encouraged to feed back their suggestions and ideas for improvement.

This report therefore only covers our findings in relation to these aspects. You can read the report from our last comprehensive inspection in May 2017, by selecting the 'all reports' link for ‘Sun Woodhouse Care Home’ on our website at www.cqc.org.uk.

Sun Woodhouse is a residential care home registered for up to 24 people. It consists of one building with two floors. There were 15 people living at the home at the time of this inspection; three of these people were using the service for respite care.

At our last comprehensive inspection in May 2017, Sun Woodhouse was rated as Requires Improvement overall, as it was judged to be Requires Improvement in the key questions of Safe, Effective and Well-led, and, Good in Caring and Responsive. As a result of this rating the home was taken out of special measures.

At this inspection in July 2017 we identified continuous breaches of regulation 11 (consent) and regulation 12 (safe care and treatment). We also identified a new breach of regulation 17 (good governance).

The home had a registered manager. A registered manager is a person who has registered with 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.

Carpeting in a communal area still presented a trip hazard. Since the last inspection in May 2017 it had been re-fitted and glued down, but had come loose again in the two weeks prior to this inspection in July 2017. Following this inspection, the carpet has been replaced.

Records showed hot water in one hand-basin was found to exceed the maximum recommended temperature 10 days prior to this inspection and appropriate action had not been taken to fix it. We also found regular checks on the temperature of hot water in baths and showers were not made.

Records to evidence people’s topical creams were applied as prescribed were now in place.

Mental Capacity Act 2005 (MCA) assessments and best interest decisions for people thought to lack capacity were still not in place. Work to assess people’s capacity in accordance with the MCA had not commenced after the last inspection as outlined in the action plan provided by the registered provider. Decision-specific MCA assessments and best interest decisions were put in place for the people who needed them within three days of this inspection.

The registered manager and registered provider had failed to resolve continuous breaches of the regulations identified at previous inspections. They also lacked oversight of safety checks at the home.

People told us they thought the service was well managed and gave positive feedback about the atmosphere at the home.

A range of audits were in place, although this inspection highlighted they were not always effective. The home had an action plan where all actions were logged and progress recorded.

Staff meetings and meetings for residents and relatives were held regularly and provided opportunities for attendees to feedback to managers.

Statutory notifications had been made and the ratings of the last CQC inspection were displayed at the home and on the provider’s website, as is required by the regulations.

We found continuing breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We are in the process of taking enforcement action against the registered provider. Details will be added to this report when the process has concluded.

Sun Woodhouse is a residential care home for up to 24 people. It consists of one building with two floors.

At the time of this inspection there were 15 people living at the home; three of these people were using the service for respite care.

Sun Woodhouse was last inspected in January 2017. At that time it was rated as ‘Inadequate’ overall. It was judged to be ‘Inadequate’ in domains of Safe, Effective, Responsive and Well-led, and, ‘Requires Improvement’ in the domain of Caring. Previously the home had been inspected in August 2016 when it had initially been rated ‘Inadequate’ overall and placed in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The home had a registered manager; she had registered with the Care Quality Commission (CQC) in April 2017. Prior to this there had not been a registered manager in post since April 2015. A registered manager is a person who has registered with 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.

At the last inspection in January 2017 we identified continuous breaches of the regulations relating to safe care and treatment, good governance and person-centred care. We also found new breaches of the regulations relating to consent and the registered provider’s responsibility to report incidents to CQC.

At this inspection we identified continuous breaches of the regulations relating to safe care and treatment and consent. The other breaches from the previous inspection had been resolved.

We found carpeting in a communal area presented a trip hazard and the temperature of water in some people’s bedroom hand basins was too hot. The registered manager and provider were quick to take action to manage both risks.

Mental Capacity Act 2005 assessments and best interest decisions for some people living with dementia were still not in place. Work to assess people’s capacity in accordance with the Mental Capacity Act commenced the week following this inspection. There was no evidence people were being restricted or received care that was not in their best interests.

Medicines were administered and managed safely at the home, although we identified one concern relating to how the application of people’s topical prescribed creams were documented.

Risks to individuals had been assessed, and measures were in place to minimise them. This was an improvement from the last inspection.

People, their relatives and care staff told us sufficient staff were deployed to meet people’s needs. Records showed the home’s recruitment process was robust.

Care workers could describe how they ensured people were safeguarded from abuse and neglect. People told us they felt safe and their relatives agreed.

At the time of this inspection the home was clean, tidy and odour-free.

People who experienced behaviours that may challenge others received person-centred support from care staff. Triggers and distraction techniques were described in their care plans.

Appropriate referrals had been made for people at risk of weight loss and pressure ulcers. Care plans had been updated and daily records evidenced people were receiving the support they needed to minimise their risk. This was an improvement on the last inspection.

People and their relatives gave us positive feedback about the meals and drinks provided at the home. Care workers and kitchen staff were knowledgeable about people’s food preferences and dislikes.

People told us, and records showed, they had access to a range of healthcare professionals to help maintain their wider health. People’s relatives said staff at the home kept them updated when their family member had appointments or was unwell.

Staff told us, and records showed that they received the training and supervision they needed to provide people with effective care and support. All staff described the registered manager as supportive and approachable.

People and their relatives described the staff at Sun Woodhouse as caring. We observed numerous interactions between staff and people which were kind and respectful, and demonstrated staff knew people well as individuals.

People were well dressed and appeared well groomed. Care staff could describe how they promoted people’s privacy and dignity, and people told us they could have a bath or shower whenever they wanted to.

People and their relatives had been involved in designing and reviewing their care plans. We saw people’s personal histories had been used to individualise their care plans so staff could better meet their needs.

At the last inspection we identified a breach of the regulation relating to person-centred care, as people’s care plans did not always reflect their current needs and preferences. This had also been a breach of regulation at the previous two inspections. At this inspection we found all but one person’s care file had been fully revised and updated. The week following this inspection the registered manager confirmed the final care file had been updated.

People’s care plans now contained information which was detailed and person-centred. Many contained photographs to illustrate the equipment people used or what their preferences were. Care plans had been evaluated monthly and daily records evidence people’s assessed needs were met by care staff.

People told us activities were offered and they had enough to keep them occupied. Care staff provided activities in the afternoon and the registered manager had just employed a new activities coordinator to work 25 hours a week over five days.

Complaints and concerns had been investigated and responded to appropriately by the registered manager. Records showed action had been taken to make improvements as a result of feedback received.

A system was in place to assess potential new admissions to the home which ensured the needs of the new person, and those of existing people at the home, could be met if the admission went ahead.

At the last inspection in January 2017 we identified a breach of the regulation relating to good governance as the audit and monitoring systems in place did not include trend analysis or identify the concerns we raised with care plans and record-keeping. At this inspection we saw sufficient improvement had been made such that the breach had been resolved.

The registered manager and area managers for the provider had worked with staff to improve aspects such as care planning, documentation and communication. Care workers told us morale at the home was better.

The registered manager planned to stay at the home until all the required improvements had been made and a suitable replacement for her was found. This planned change in management meant the trajectory of continued improvement at the home may not be sustained in the long term.

People, their relatives and staff at the home had regular meetings with the registered manager and area managers for the provider. They were asked for feedback at this meeting about the various issues discussed.

Statutory notifications had been made and the ratings of the last CQC inspection were displayed at the home and on the provider’s website, as is required by the regulations.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We are currently taking enforcement action and will update the section at the back of this report once the process has concluded.

Sun Woodhouse was last inspected in August 2016. At that time it was rated as ‘inadequate’ in the Effective and Well-led domains of care, and therefore ‘inadequate’ overall. We placed the home in special measures and took enforcement action. This inspection found some improvements had been made at the home, but not sufficient to change the ratings from the last inspection. The home is therefore still inadequate and remains in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At the time of this inspection, 18 people were living at the home; two of these people were there for respite care.

The home did not have a registered manager. The last registered manager left in April 2015. The home manager in place at the last inspection in August 2016 was not registered with the Care Quality Commission (CQC) and had subsequently left the home. At the time of this inspection the registered provider had installed a peripatetic manager who would register with CQC and run the home until a new registered manager could be appointed.

A registered manager is a person who has registered with 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.

Some issues associated with the assessment and management of risk to people identified at the last inspection in August 2016 had not been rectified.

The home was compliant with the Deprivation of Liberty Safeguards but people’s capacity to make other decisions had not been assessed. Evidence of relatives’ legal right to make decisions on their family members’ behalf was not contained within care files.

People were happy with the food and drinks offered at the home. Issues with the management of people’s nutritional risk identified at the last inspection in August 2016 had not been addressed. This included the poor quality of diet and fluid intake records.

Issues relating to the updating of people’s care plans to reflect their current level of need identified at our inspections in August 2016 and July 2015 had still not been addressed.

A system of regular audits and monitoring was now in place at the home. However, we found audits did not always result in action plans to drive improvement and information was not analysed as a whole to identify trends or lessons learned.

Issues relating to the safe administration and management identified at the last inspection in August 2016 had been resolved, although we found stock levels for one controlled drug did not reconcile with the amount recorded by care staff.

Issues with confidentiality noted at the last inspection in August 2016 had been addressed. However, the home had tried to engage relatives in planning people’s end of life care in a way which might seem disrespectful to those it concerned.

We received mixed feedback from people and their relatives as to their involvement in planning and reviewing people’s care. Most said although they had not been consulted this was not an issue which concerned them. People had been provided with information about advocacy services.

The home’s building risk assessment and fire safety procedures had been improved since the last inspection. Routine checks on the building, utilities and equipment had been made. People now had personal emergency evacuation plans in place. The home was clean and odour-free.

Care workers could describe how they kept people safe from harm and abuse. We saw safeguarding concerns had been documented and responded to appropriately.

People and their relatives told us there were enough staff deployed to meet people’s needs. Our observations supported this. Records showed the home’s recruitment process was robust.

People had access to a range of other healthcare professionals in order to help maintain their general health.

People told us the staff were caring and relatives said staff always made them feel welcome. They also said staff respected people’s dignity and privacy and our observations on inspection supported this. Staff described how they ensured the home was inclusive to all.

People’s access to meaningful activities and social interaction had improved. Various measures had been put in place and people told us they had enough to keep themselves occupied.

No complaints had been received by the home since our last inspection. People and their relatives told us they felt confident to raise any concerns if they needed to.

People and their relatives were now asked regularly to feedback about the quality of the service they received. Staff at the home now had monthly staff meetings and said they felt better supported by management as a result. They also told us they enjoyed supporting the people at Sun Woodhouse.

We found new and continuous breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

At the last inspection in July 2015 we rated the home as ‘requires improvement’ overall and as inadequate in the effective domain of care. We identified breaches of the regulations so at this inspection we checked to see whether the issues had been resolved.

Sun Woodhouse provides residential care and accommodation for up to 24 older people. Accommodation is arranged over two floors and there is a lounge and dining room on the ground floor. All bedrooms are single occupancy and a stair lift on the main staircase is used by some of the people to access their bedrooms upstairs. At the start of this inspection there were 15 people using the service and one more person was admitted for respite during the inspection.

The service did not have a registered manager in post; the last manager to be registered with the Care Quality Commission (CQC) left in April 2015. The current home manager had been appointed in March 2016 but had yet to de-register from their previous home and apply to be registered manager at Sun Woodhouse. A registered manager is a person who has registered with 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.

At the time of this inspection the home manager was on annual leave for 27 days and a senior care worker was acting manager. The area manager, home manager and nominated individual had considered various options to cover the home manager’s annual leave before approving the senior care worker’s acting manager status. We saw the acting manager was receiving support, however no risk assessment or support plan had been produced for this period and CQC had not been advised of the home manager’s extended period of absence.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspecting again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate in any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We saw medicines were administered in a person-centred way; however, we did find issues with the way they were managed. The home did not have protocols in place for ‘as required’ medicines, the application of topical creams was not recorded and the temperature of the clinic room where medicines were stored was not monitored.

There were issues with the way some risks were assessed and managed at the home. A risk assessment had not been done for a person with bedrails and no risk assessments had been undertaken for the people who used a hoist to access the bath. Personal emergency evacuation plans or PEEPs would not be useable in an emergency as they were kept in people’s care files which were locked in a cupboard.

People said there were enough staff to support their basic care needs. However, staff told us and we observed, the care workers did not have time to provide activities for the people, which was also part of their role.

The accidents and incidents that had occurred were recorded; however, we found that one person who had experienced numerous falls in the five months prior to the inspection had not been referred to their GP or had their care plan reviewed.

Not all of the staff had received the training they needed to support people safely. There was no central record of when care staff last had supervision and records we saw showed this was not happening regularly.

Feedback about the food was positive and we saw people were given choices over what to eat and drink. However, care files for people at risk of weight loss showed they were not weighed according to their care plans and their food and fluid charts were not completed with sufficient detail to make them meaningful.

People’s confidentiality was not always respected by staff. We found boxes of people’s care plans and staff personnel files unsecured in a communal area and meetings involving discussion of people’s personal health and wellbeing were not held in private.

Care was not always person-centred. Care plans were not evaluated regularly and people did not have appropriate access to meaningful activities.

The home manager had not undertaken regular audits of the safety and quality of the service since they started in the role in March 2016. Residents and relatives were not asked to feedback on the service so that improvements could be made.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Care workers’ knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had improved and applications for DoLS authorisations had been submitted to the local authority for people who needed them. However, no assessments of people’s capacity to make other decisions had been made.

People’s care plans were person-centred, however not all people said they had been involved in designing them and few people had signed them. People’s relatives told us it had been over a year since they had last been asked about their family members’ care plans.

Most interactions we saw between care workers and people were respectful, although we did observe some care workers providing support to people without speaking to them.

People still did not have end of life or future wishes care plans in place. The acting manager said people had been asked but had not wished to speak about this aspect of their care. They said in future if people were consulted but chose not to discuss their future wishes, it would be documented in their care file.

Records showed regular safety checks had been made on the building, equipment and utilities to make sure they were safe.

Care workers could describe the different forms of abuse and explain how they would report any concerns appropriately.

Recruitment documentation we saw showed the home made the right checks to make sure new staff employed were suitable to work with vulnerable people.

Care workers supported people to maintain their dignity and independence. We saw, and people told us, staff also respected their privacy.

People had access to advocacy services and staff could describe when and how to refer people to independent advocates if they needed them.

The complaints policy was displayed at the home and none of the people or relatives we spoke with said they had complained since the last inspection.

We went back on this visit to see what improvements had been made. We found that the home was clean and odour free and staff were completing audits of the environment that identified where improvements needed to be made.

Due to the focussed nature of this inspection visit; we did not, on this occasion seek the opinions and experiences of people who lived at the home.

"The staff are lovely"

" They come to help me when I press my buzzer. Sometimes they are busy and take a long time but if I press it twice they come very quickly"

"The staff are very kind, they do everything I want them to do, I just wish they had a bit more time to be with me"

"The food is satisfactory"

"I would like to go outside"

We spoke with one person who was looking forward to an arranged shopping trip with the acting manager.

We saw that staff treated people with respect and kindness. Staff told us that they enjoyed working at the home. The acting manager spoke with great enthusiasm about her commitment to meeting the needs of the people who lived at the home.

We found that required standards of cleanliness had not been met and that quality auditing processes had not been managed effectively. We also found that there were not enough staff available to meet people's needs.