The Bernard Sunley Nursing and Dementia Care Home

We found the following examples of good practice.

The provider took a range of positive steps to enable people to have visitors in line with the national guidance. For example, staff rearranged one of the rooms for a visitor testing and screening area with direct entry from the car park. Another room was equipped with safety screens and intercom to allow additional non-contact visits. The management also took additional steps to facilitate safe garden visits in good weather and there was clear signage and guidance for visitors.

The provider made environmental changes in the home to ensure effective infection prevention and control (IPC) and to support people’s wellbeing. Staff created additional seating and sensory areas in the garden surrounding the building where people could enjoy activities and socialise outdoors. The provider purchased specialist equipment to disinfect the indoor spaces and we saw an allocated member of staff did this regularly. The management increased the availability of the hand disinfecting gel around the building, a mobile handwashing sink was purchased for garden visits and there was plenty of the required personal protective equipment (PPE) available for staff around the home. We saw staff wearing PPE correctly.

The management and nursing team successfully followed safe outbreak management plans when people tested positive for COVID-19. Staff adhered to strict IPC protocols and the management implemented effective zoning of the service and cohorting of staff which prevented the infection from spreading further. Staff told us they felt supported by the management and senior nursing staff and were provided with reminders on how to keep safe, how to observe good IPC practice or how to access wellbeing support if they needed it. Staff who fell ill with COVID-19 told us they were supported by the management throughout their self-isolation, for example by having regular contact with the registered manager.

Staff had access to regular testing as per the national testing program and were encouraged to come forward for COVID-19 vaccinations. The registered manger took into consideration staff’s equality and diversity needs and consulted with the NHS to bring forward the second dose vaccination appointments. This was to support staff so any possible side effects would not negatively impact their ability to practice their religion.

The Bernard Sunley Nursing and Dementia Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Bernard Sunley Nursing and Dementia Care Home provides residential care for people with a range of needs such as dementia and Parkinson’s Disease. The service accommodates up to 62 people across two floors. At the time of our inspection, the service was supporting 53 people.

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

People felt safe at the service, and risks to people were appropriately managed and recorded. Accidents and incidents were recorded and action taken to prevent reoccurrence and staff were aware of their responsibility to safeguard people. There were sufficient numbers of effectively trained and safely recruited staff members to meet the needs of the people living at the service.

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 did support this practice.

People received care that was kind and compassionate from staff and their privacy and dignity were respected at all times. People’s independence was maintained where safe to do so to ensure they did not become deskilled. People were involved in decisions around their care and were given regular opportunities to feedback on their care experience in the service. There was a variety of engaging activities available to people, as well as people being supported by staff to achieve goals that were personal to them.

Referrals were made to healthcare professionals to ensure people received holistic care. The service worked to national standards and any new guidance received was distributed to staff. Checks on the quality of the service were completed regularly, and any issues identified were resolved in a timely manner. Complaints were appropriately recorded and responded to.

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 was Good (published 30 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

A registered manager was in post. 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

The Bernard Sunley Nursing and Dementia Care Home is a care home which provides accommodation and nursing care for up to 60 older people, some of whom are living dementia. At the time of our inspection there were 48 people who lived there. The home is purpose built and set over two floors, with a passenger lift to all floors. The home is split into three units and had a variety of communal areas including lounges, dining rooms, quiet areas and a garden.

At our previous inspection on 22 December 2016 and 5 January 2017 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the failure to assess and act upon risks to people. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 1 June 2016. We also made one recommendation to the provider in regard to the requirements of the Mental Capacity Act (2005).

During this inspection we found that improvements had been made. People were as safe as possible because risks associated with their health or care had been assessed and monitored. Staff were aware of the risks and what action to take to protect people from harm.

Staff had been trained and understood their responsibilities to protect people's rights under the Mental capacity Act 2005. Further training has taken place shortly after this inspection.

People’s care had been planned and the staff knew people well. Although a few care plans required some updating this did not affect the care people received. The provider has informed us in their action plan how they intend to ensure care plans always reflect the most up to date information and we will assess the effectiveness of this at our next inspection.

People were protected from being cared for by unsuitable staff because safe recruitment processes were followed.

There were sufficient numbers of staff deployed to meet people’s needs safely. Staff responded to people in a timely way.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP or psychiatrist and administered appropriately.

Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a contingency plan that identified how the home would function in the event of an unforeseeable emergency such as fire, adverse weather conditions, flooding or power cuts.

The provider ensured staff had the skills and experience which were necessary to carry out their role. Care was provided to people by staff who were trained and received regular supervisions and appraisals from their line manager. People told us they felt supported by staff.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, dietician or district nurse.

The provider had a number of ways of checking the service and making improvements. This included listening to people and their relatives and taking action to improve.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People were cared for by staff who were kind, caring and supportive. People and relatives were happy with the care provided and they were made to feel welcome when they visited.

People and staff were involved in the running of the home and complaint procedures were available to people should they feel the need to complain. Any complaints had been responded to according to the provider’s complaints procedure.

The Bernard Sunley Nursing and Dementia Care Home is a care home which provides accommodation and nursing care for up to 60 older people, some of whom are living dementia. At the time of our inspection there were 54 people who lived there. The home is purpose built and set over two floors, with a passenger lift to all floors. The home is split into three units and had a variety of communal areas including lounges, dining rooms, quiet areas and a garden.

At the time of our visit there was a registered manager in post. 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.’

Although risk assessments were in place we noted inconsistencies in the recording of information on risk assessments which could put people at risk of harm. Arrangements in place to identify and support people, who were nutritionally at risk, were not up to date or monitored to minimise risk. This meant that people were placed at risk of harm as appropriate guidance and best practice was not always followed.

There were inconsistencies with how staff were effectively deployed to meet people’s needs. The staff levels deployed had an impact on the care and support people received.

People had enough to eat and drink throughout the day and night.

People’s care and support needs could be affected due to records not being fully completed or kept up to date. Although there were systems and arrangements in place, they were not robust or effective enough to monitor, reduce risks or escalate identified issues.

Staff had understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments were not always fully completed and DoLS applications had been submitted in accordance with current legislation. We made a recommendation that the provider reviews their systems and ensures information is completed in line with the requirements of the Mental Capacity Act 2005.

People were cared for by caring staff. People’s privacy was respected and promoted. We did see examples of caring practice from staff. People’s preferences, likes and dislikes had always been taken into consideration and support was provided in accordance with people’s wishes.

People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The home worked effectively with healthcare professionals and was proactive in referring people for treatment.

People told us they felt were safe at the home, one person told us, “I feel safe here and the girls look after me and I do not have to worry about anything.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

Fire safety arrangements and risk assessments for the environment were in place to keep people safe. There was a business contingency plan in place to minimise the risk to the home in the event of an emergency such as fire, adverse weather conditions, power cuts and flooding.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted a good quality of life.

People received their medicines when they needed them and the administration and storage of them were managed safely. Any changes to people’s medicines were prescribed by the person’s GP.

People told us if they had any issues they would speak to the staff or the registered manager. People were encouraged to voice their concerns or complaints about the home and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service provision.

People had access to activities that were important and relevant to them. People were protected from social isolation with the activities, interests and hobbies they were involved with. Staff supported people with their interests and religious beliefs in their local community. Religious services were conducted weekly at the home. People’s relatives and friends were able to visit.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the home. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager. Staff told us the manager of the home were very good and supportive.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that care plans were fully completed, detailed and had been recently reviewed.

We saw that people's needs had been fully assessed and that care had been delivered in accordance with the findings of that assessment.

We also found that people were cared for in a manner which ensured their safety.

The provider was in the process of changing their care planning documentation for people. We found however, that, whether people had the old or the new care planning paperwork there were gaps in their care planning records and there was not always written evidence that people's care needs had been fully assessed and regularly reviewed. We observed people's care and reviewed records that demonstrated that people's care had been provided, despite the lack of care planning documentation.

People had been provided with a choice of foods that met their dietary needs and they had received appropriate support.

We found that the environment was clean and that there were infection control measures in place.

We saw that people's medicines had been managed appropriately.

We found that staff had undergone appropriate checks before they started work.

There was a complaints system in place which people had been made aware of.

We saw that people had care plans and risk assessments and the provider was re-designing the documents to make them simpler.

The provider had taken steps to safeguard people. Staff had received both training and supervision. We spoke with relatives who told us that they felt that people were safe at the home.

There were sufficient staff to meet people's needs. There was currently a higher use of agency staff than the provider preferred but they were actively recruiting to the vacant posts and had taken measures to try and ensure continuity for people who used the service.

The provider was monitoring the quality of the service they provided in a variety of ways that included questionnaires, audits and meetings.

The provider had been completing and submitting the required notifications to the Care Quality Commission however due to an administrative error they had not been received. The provider has begun the process of re-submitting them.