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Inspection carried out on 8 February 2019

During a routine inspection

About the service:

Sunningdale is a 41 bedded residential care home for older people and. At the time of our visit there were 38 people using the service.

People's experience of using this service:

The last inspection November 2017 the overall rating for the home was 'requires improvement'. There were two breaches of regulation at the last inspection. During this inspection we found some improvements had been made to medicines management and quality audits.

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 in the service supported this practice. We saw evidence people had given their consent to the care and support they were receiving. Mental capacity assessments and best interest decisions were in place.

Staff were caring. Everyone we spoke with was very complimentary about the service and said they would recommend the home. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion and love.

Activities were on offer to keep people occupied both on a group and individual basis. Activities were organised in line with people's preferences.

A system was in place to ensure medicines were managed in a safe way for people. Staff were trained and supported to ensure they were competent to administer medicines. People received support with meals and drinks if this was part of their care plan. Staff knew how to access relevant healthcare professionals if their input was required. The service worked in partnership with other organisations and healthcare professionals to improve people’s outcomes.

Staff were recruited safely and there were enough of them to keep people safe during the day and to meet their care needs. The new manager had identified the need for another staff member during the night shift and was having discussion with the provider to organise this. Staff were receiving appropriate training which was good and relevant to their role. Staff were supported by the manager and were receiving formal supervision where they could discuss their on-going development needs.

Individual needs were assessed and met through the development of detailed personalised care plans, which considered people’s equality and diversity needs and preferences. Care plans were up to date and detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People told us they knew what to do if they had any concerns or complaints about the service and the manager had responded appropriately to resolve them. Systems were in place to ensure complaints were encouraged, explored and responded to.

The new manager provided staff with leadership and was very approachable. Audits and checks were carried out and used to drive continuous improvements to the service people received.

People's feedback was used to make changes to the service, for example, to the menu's and activities.

More information in Detailed Findings below:

The overall rating of the home at the last inspection was requires improvement November 2017.

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of good in all five areas.

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

Inspection carried out on 19 September 2017

During a routine inspection

The inspection took place on 19 September 2017 and was unannounced. There were 39 people living at the home on the day of our inspection.

Sunningdale 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 home accommodates 41 people in a single adapted building in mixture of single and shared room.

The home has a registered manager who has been in post for over six years. 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.

The last inspection report was published on 17 August 2016. At the last inspection the overall rating for the home was ‘requires improvement’. There were no breaches of regulation at the last inspection. During this inspection we found some improvements had been made however we also identified areas where further improvements were needed.

People told us they felt safe. Staff knew how to recognise and report any concerns about people’s safety and welfare.

Everyone we spoke with told us there were always enough staff available. We found staff were well trained and knew how to meet people’s needs. However, we found the correct recruitment procedures were not always followed. While criminal records checks were always carried out other checks such as references were not always obtained.

People told us they received their medicines at the right time. Overall people’s medicines were managed safely. However, we recommended the provider review their policies and procedures to make sure staff were working in line with up to date guidance on good practice.

Risks to people’s safety and welfare were identified and managed. The home was clean and well maintained and people had access to safe outdoor space.

People had confidence in the staff. They felt the staff were well trained. Staff told us they felt well supported in their roles. The provider had a continuous training programme and we saw new staff had received a lot of training. Some of the longer serving staff were overdue to attend training updates of safe working practices. Some of this, for example, moving and handling had already been booked.

The service was working in line with the requirements of The Mental Capacity Act 2005 (MCA) which helped to make sure people’s rights were promoted and protected. This had improved since our last inspection.

Everyone was very complimentary about the food and we saw improvements had been made to give people a better meal time experience. People had access to drinks and snacks throughout the day. However, we found some improvements were needed to the recording of people’s dietary intake.

People had good access to health care services. Staff worked with other health care professionals to make people got the support they needed to meet their health care needs.

We found staff were caring and treated people with dignity and respect. We saw they knew people well and were patient with people. They asked for permission before they started to support people and explained what they were doing. People were supported to maintain their independence.

The registered manager promoted a person centred approach which helped to make sure people were cared for as individuals.

Before people moved in they were encouraged to visit the home and their needs were assessed. This helped to make sure the home had the right resources to meet their needs.

People had care plans to guide staff on how to meet their needs. However, we found care plans were not always put in place quickly enough when people moved in and this created a risk they would not receive

Inspection carried out on 12 July 2016

During a routine inspection

This inspection took place on 12 July 2016 and was unannounced.

During our last inspection which took place on 11 January 2016 we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued four warning notices in relation to person centred care, safe care and treatment, staffing and good governance. The warning notices stated that the registered provider and registered manager had to take action to ensure they became complaint with these legal requirements by 29 April 2016.

We also issued requirement notices for the breaches relating to consent, dignity and respect, and meeting nutritional and hydration needs. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Sunningdale EMI Care Home provides residential care for up to 41 people. On the day of our inspection 37 people were living at the home. The home specialises in providing care and support to people who live with dementia. The building is a large Victorian house which has been extended to provide additional single en-suite bedrooms. Accommodation is on two floors with passenger lift access. Some of the larger rooms in the older part of the house are shared between two people. There is a garden area with seating which people can access freely.

The home has a registered manager who has been in post for over six years. 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.

Since our last inspection significant improvements had been made to the environment and cleanliness of the home.

Systems were in place to make sure staff were recruited safely and staff knew how to raise any concerns they had about people’s safety and wellbeing. Staffing levels had improved and new staff roles had been developed. Care staff received the training they needed to deliver person centred care safely and appropriately.

Improvements had been made to the way medicines were managed to make sure this was done safely.

The service was working in accordance with the requirements of the Mental Capacity Act but more robust procedures were needed to make sure DoLS authorisations were managed appropriately.

People had access to health and social care professionals and staff made timely referrals as and when the support of these professionals was needed to promote people’s health and wellbeing.

People enjoyed the meals at the home and we saw significant improvements had been made in the way people were supported to enjoy good nutrition. Some improvements were still needed in the way mealtimes were managed and the monitoring of people’s nutritional intake.

Staff had a good understanding of people’s individual needs and used their knowledge to deliver person centred care. People were treated with respect, dignity and sensitivity.

People told us staff were responsive to their needs although more formal systems needed to be established to enable people to comment about their individual care needs.

A programme of activities was available although this needed some development to make sure it met with the needs and preferences of people living at the home.

A number of positive improvements had been made to the quality assurance systems and whilst further improvements were needed, the manager demonstrated a positive and committed attitude to ensure the changes which had been made were sustained and built upon.

People who used the service, staff and relatives told us there had been improvements in the management of the service.

We found the improvements made were sufficient to meet with the requirements of the warning noti

Inspection carried out on 11 January 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 11 January 2016 and was unannounced.

During our previous inspection on 24 June 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to; the management of medicines, care records and governance systems and processes. During this inspection we checked improvements had been made in these areas and re-rated the quality of the service provided.

Sunningdale EMI Care Home provides residential care for up to 41 people. The home was full on the day of our inspection. The home specialises in providing care and support to people who live with dementia. The building is a large Victorian house which has been extended to provide additional single en-suite bedrooms. Accommodation is on two floors with passenger lift access. Some of the larger rooms in the older part of the house are shared between two people.

The home has a registered manager who has been in post for over six years. 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.

We saw some improvements had been made to the systems and processes for managing medicines. However, further improvements were needed to ensure accurate and complete records were maintained.

We found poor standards of hygiene throughout the home. We found communal areas, people’s bedrooms and bathrooms had not been thoroughly cleaned and some beds were made with stained bedding.

Risks to people’s health and safety had not been appropriately assessed, monitored and mitigated. Many risks were managed through a collective approach, rather than adopting an individualised and person centred approach to risk management.

Staff told us they had completed safeguarding training and could identify the different types of abuse. A new safeguarding policy had been introduced however we found this needed to be reviewed to ensure it was fit for purpose.

People told us they felt safe living at the home. However, our observations and other evidence showed there were not enough staff to ensure people were kept safe and that they received responsive care.

The provider operated recruitment procedures to ensure the staff they employed were suitable for the role and safe to work with vulnerable people. We found some improvements were needed to ensure their recruitment procedures were consistently followed.

Staff told us and records showed that staff received supervisions and regular training updates. However, our observations showed that staff did not always apply their training to ensure their caring practices were appropriate and person centred.

The environment and care practices adopted in the home were not always appropriate to the specific needs of people who lived with dementia. We found many care practices were based on routine and a common approach about how staff thought they should care for people living with dementia. Such approaches to care delivery meant that people were not being supported in a person centred manner.

People were not always offered and explained choices in an appropriate way. This meant people were not empowered to make decisions about their care and treatment. We saw examples where staff did not take appropriate action to ensure people’s dignity was maintained. People who lived with dementia did not always have a voice and where they did express their views these were not always heard and acted upon.

Regular checks of the building and equipment took place to ensure it was safe.

People told us the food was good. However, where people were at risk of malnutrition or dehydration we identified concerns that staff were not always ensuring that their needs met. There was also a lack of monitoring of people’s daily food or fluid intake to establish if they had received sufficient food and fluids. We found meals lacked attention to detail and a person centred approach.

Assessments and applications had been made to ensure the rights of people with limited mental capacity were protected in line with the legal framework of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. However, we found an absence of appropriate documentation and staff knowledge to ensure that people were protected from the risk of being unlawfully deprived of their liberty.

Staff supported people to access other health professionals to help maintain their health and wellbeing. Health professionals told us that staff listened to their advice and knew people well.

People who used the service told us they felt safe and that staff were kind. The feedback provided by people and staff about the registered manager was also positive.

There was a lack of stimulating and meaningful activities for people to engage with. People told us they were often bored and relatives told us they had raised this with the provider but nothing had been done to address this.

Feedback about the registered manager was positive. However they were also managing another home which we saw impacted upon the quality and frequency of the management checks they completed.

The governance systems and processes in place were not effective and did not consistently improve the quality of the service provided. Robust improvements had not been made to address issues previously identified by the Commission with regards to care records and quality assurance systems. Where people provided feedback this was not always appropriately acted upon to improve the quality of the service.

We identified seven breaches 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 the report.

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 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.

Inspection carried out on 24 June 2015

During a routine inspection

This inspection took place on 24 June 2015 and was unannounced.

Sunningdale EMI Care Home is a 41 bedded home which specialises in providing accommodation and personal support to people who live with dementia. At the time of our visit 40 people used the service. The building is a large Victorian house which has been extended to provide additional single en-suite bedrooms.

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 2008 and associated Regulations about how the service is run.

Care records were not always accurate and did not always contain complete information to demonstrate that risks to people’s health and wellbeing were fully assessed, monitored and managed. Medicines were not being managed in a safe and appropriate way. These issues had not been identified prior to our inspection which showed us systems in place to monitor, assess and improve the quality of service provided were not robust.

All the people we spoke with told us they felt safe living at the home. No one raised any concerns regarding their families safety. Accidents and incidents were being monitored and action was taken to help reduce risk. However there was not an overall monitoring system to ensure trends and patterns could be identified and responded to.

We found the premises to be well maintained, clean and secure. The home was decorated in a way which sought to promote the wellbeing of people who lived with dementia. Staff demonstrated a good awareness of how to keep people safe and the correct procedures to follow in the event of an emergency.

We found sufficient numbers of staff on duty to meet people’s needs. People told us there was enough staff available to provide care and they did not experience having to wait. There was effective recruitment procedures in place which ensured people were supported by appropriately experienced and suitable staff.

Most staff were trained in key areas to enable them to provide effective support. However, our observations showed that on-going competency based assessments of staff knowledge and care practices were required. We recommend the provider ensures they incorporate a system to assess staff’s competency to ensure they have understood their training and continue to adhere to best practice.

People spoke positively about the food and we saw dietary needs and preferences were catered for. However, care records did not always contain complete information to ensure nutritional risks were effectively managed. Improvements were needed to ensure everyone received a person centred meal time experience.

People told us care staff were kind, helpful and treated them with respect. Staff demonstrated a practical awareness of how to respect people’s privacy and dignity and how to support people to retain their independence. Staff had a good understanding of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and their role in protecting the rights of people with limited mental capacity.

People told us they felt involved in making decisions about their daily lives and relatives told us staff kept them well informed and they felt included. The service used a variety of ways to seek people’s feedback. These views were used to help improve the quality of care provided. There was an open and honest culture and staff at all levels were open to challenge and used reflective practice to ensure the quality of care people received improved.

We identified two breaches 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 the report.

Inspection carried out on 15 July 2014

During an inspection in response to concerns

The inspection visit was carried out by two inspectors and an expert by experience. We considered all the evidence the inspection team gathered from reviewing records, speaking with people and looking around the premises.

We used the information to answer the 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 what we found. The summary describes the records we looked at and what people who used the service and the staff told us.

Is the service safe?

At the time of our visit there were 40 people who lived at the home. We spoke with 19 people who all told us they felt safe. People also told us they found the home was kept clean, tidy and was appropriately furnished. One person told us “It feels like home; it’s the best place I have ever lived”.

We spoke with three visitors, they told us they were pleased with the standard of care and facilities provided by the service. One relative said “I am sure my mum is quite safe here, staff care about people.”

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage these risks.

Staff demonstrated good knowledge and awareness of their responsibilities for infection prevention and control and there were relevant procedures in place to reduce the risk of infection.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support.

Is the service effective?

The home had a good working relationship with other healthcare professionals and followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in within their care plan.

Is the service caring?

Overall people said they were pleased with the standard of care provided. Our discussions with people and the records we looked at told us that individual wishes for care and support were taken into account and respected.

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered. Overall we found the atmosphere within the home was warm and friendly and we saw that most staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Is the service responsive?

Care records were reviewed and any changes made either when people’s needs changed or as part of the monthly review process. We saw evidence of this within the care records we reviewed. The staff we spoke with told us they would immediately alert the manager if they noticed a change in people’s needs.

We found people knew how to make a complaint if they were unhappy. We saw evidence that the service took complaints seriously and looked into them quickly.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

People who used the service told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.

Inspection carried out on 14 June 2013

During a routine inspection

We found people’s needs and risks were appropriately assessed and peoples' plans of care were suitable to ensure their needs were met. We found staff treated people with dignity and respect and understood the specific needs of people who used the service. We also found the home was clean and infection control practices were safe. We found staffing levels were adequate and staff had the necessary knowledge and experience to meet the needs of people. Staff could be very busy at times if the home was close to full capacity but we were assured staffing compliments were increased when the home was full. We found complaints were managed effectively and were not a common occurrence.

We spoke with three people who used the service and one person said they were happy at home and found the staff friendly. Another person said they liked the home and “couldn’t grumble” about the food. A third person at the home felt the food was good and enjoyed having their own room. We spoke with a person’s marital partner and they were pleased with the care and support provided and found the carers very kind.

Inspection carried out on 25 September 2012

During a routine inspection

We spoke with five out of the 39 people who live at the service, they told us that they were happy and comfortable living at Sunningdale EMI Care Home and that they got the care and support they need.

People we spoke with told us they received care that was appropriate to their needs. One person told us “It’s brilliant, they are doing their best.”

People told us their individual needs were met. One person told us “Yeah its good here”.

Visitors told us they were involved in making decisions about their relatives care and treatment. They also said they were kept informed of any changes in their relatives needs. One person told us "The staff are very nice here.”

Staff we spoke with told us they felt supported and had the knowledge and skills to support people who lived at the home. One staff member said “We pull together here, it’s not just a job, we care about the residents”.

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