Archived: Sunningdale Lodge

Sunningdale Lodge is a residential home providing personal care and accommodation to 40 people. At the time of our inspection, 36 people were using the service. The home is situated in a residential area in Yeovil. Bedrooms are for single occupancy and are arranged over three floors. A lift and stairs provide access to the floors above ground level.

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

Some areas of medicines management needed to be improved. We received some mixed feedback from staff relating to staffing levels and managers helping out when they felt they were short-staffed. Two people told us they didn’t always received support when they needed it. The service had a tool to determine staffing levels which evidence staffing levels were met, the tool was under review by the provider.

The provider’s systems for sharing learning had not ensured information was acted upon promptly following an incident in another service. Statutory notifications were not always submitted in line with regulation. The systems in place to monitor the quality and safety of the service were not always effective in ensuring shortfalls were identified and addressed.

People, their relatives and staff told us people were safe living at Sunningdale Lodge. Staff knew how to recognise and report abuse. Staff were recruited safely. There were infection prevention control measures in place. Risks to people were assessed and mitigated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were happy living at Sunningdale Lodge, we received positive feedback about the service and the staff team. Staff told us they felt supported by the registered manager and deputy manager.

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 01 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led section of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to good governance and notification of incidents at this inspection.

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

We have made a recommendation in relation to the management of medicines.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the time of the inspection there were 39 people living at the home. This included three people who were receiving treatment in hospital.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. When asked, one person said “I do feel safe here; yes.” Another person said “This is my home now. The staff take good care of me.” People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of pressure damage to their skin.

People continued to receive 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 in the service supported this practice. One person said “I can do as I please. Nothing is forced here.” Another person who was in their bedroom told us “I prefer to stay in my room. It’s my choice. I like to sit here and read. I do go down to lunch though.”

People told us their healthcare needs were met. One person said “If you feel unwell they [the staff] would be there in a flash and would certainly get the doctor for you.” Another person told us “The physiotherapist is coming to see me soon to see if I can get moving again.” A visiting healthcare professional told us that staff always listened and acted on any recommendations they made.

The home continued to provide a caring service to people. One person said “I am very happy here and I don’t want for anything. All the staff are very kind.” Another person described the home as “perfection itself.” They said “I mean that. I couldn’t be happier and the staff are marvellous.” People could see their visitors whenever they wanted and the visitors we met with told us they were always made to feel welcome. Staff treated people with respect and respected their right to privacy.

The home continued to provide a responsive service. The management team made sure people’s needs and aspirations could be met before a person moved to the home. Care plans contained information for staff about people’s needs and preferences and how these should be met. The management team acknowledged that care plans relating to people’s mental health needs could be improved and they agreed to address this.

People could take part in a range of social activities and designated activity staff were employed to support people. Care had been taken to ensure people experienced a pleasant and sociable mealtime experience. Any complaints about the service were taken seriously and responded to. The people we met with told us they felt comfortable in raising any concerns. One person told us “I have no complaints at all. I’ve never had to complain but I would certainly tell the staff if something was bothering me.”

The service continued to be well led. The registered manager was supported by a deputy manager and the skill mix of staff meant experienced staff were available to support less experienced staff. The management team were described as open and approachable. People’s views were valued and responded to. The provider operated an initiative called ‘You said. We did.’ Where people who lived at the home, their representatives and staff could make suggestions about any part of the service provided. Posters were displayed around the home detailing the action that had been taken in response to suggestions made. For example people had requested sharper knives as they were finding it difficult with the current knives. We saw these were ordered the same day and were now in place. Another suggestion made was to be able to have a cup of tea in the garden whatever the weather. In response to this, a summerhouse had been built and equipped as a tea room. There continued to be an effective quality assurance system in place to monitor care and plan on-going improvements.

Further information is in the detailed findings below

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People's care was planned and delivered in line with their care plan and personal choices, however, some records about how people's needs were being met were not maintained or were incomplete. For example, on one chart we found an entry of two sips of tea taken at 4pm but no entries of any drinks offered or taken either before or after this time for the entire day. This showed that gaps found in daily fluid charts meant it was unclear whether drinks had not been offered or had been offered and given but not recorded. Following the inspection the manager told us that people's fluid was recorded both in their care plan and on separate charts in their rooms. However, the charts in people's rooms were not accurately updated. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff showed they knew people well and followed their individual care plans when providing support. For example, one person told us that staff had applied sun lotion to their skin and a hat to prevent sunburn. People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were aware of the risk of abuse to vulnerable adults through training and development.

Senior staff had met with the Deprivation of Liberty Safeguards (DoLS) Officer from the appropriate authorities and discussed plans about the application process for people likely to need a DoLS assessment.

Is the service effective?

There were effective arrangements in place to deal with foreseeable emergencies. A list of relevant telephone numbers of staff and emergency services for staff to call was available in the office. Staff responded effectively and promptly to people's needs. One person said, "When I call for help, they always respond quickly."

Staff received effective training and development to carry out their roles. One worker described their moving and handling training which included the use of hoists and slings. They told us this had improved their understanding of hazards and safety issues.

Is the service caring?

In one care plan we read that the person required support and assistance from staff to reduce the risk of falls. We observed staff provide care and assistance compassionately to the person as they moved about the home. For example, we heard a worker say, "Take it slowly." This meant staff demonstrated how to reduce risks while carrying out care. Comments from people included, "A good team," "very attentive," and "I want to be independent; carers let me do that; nothing is too much trouble."

Is the service responsive?

People's health needs were met because staff responded to people's needs and liaised with relevant professionals about people's well-being. For example, one person was taking antibiotics for an infection and someone else saw the podiatrist for diabetic foot care. One person could not remember how their care plan was arranged. However, they felt they received the right care. When asked who had arranged care, another person said, "I don't know; it must have been my daughter." Both people felt they could discuss their care with staff who would listen.

Is the service well-led?

The provider had systems in place to monitor the quality and safety of the service, however, the provider may find it useful to note that some external checks and audits were not always followed up. For example, in a medicines check one entry had no date, signature or identifying information about the staff member or the person it was about and the action plan had not been signed by senior staff for this and other outstanding actions. Following the inspection we were told by the acting manager that the care plan audit file we were given was a copy folder and not the original and that original audits had been previously signed by the registered manager. The provider sent us information relating to some of this.

People, their representatives and staff were asked for their views about their care and treatment and they were acted on. In May 2014, the provider sought people's ideas and suggestions which included inviting the music entertainer back to the home, film choices and a special afternoon tea with buffet foods, popcorn and ice cream, which several people enjoyed.

We spoke with the operations manager, the deputy home manager, five staff and two people living in the home. We found that improvements had been made and that care was now being planned and delivered in a way that was intended to ensure people's safety and welfare.

People were supported by staff who were caring, friendly and respectful, but risks were not assessed effectively and care was not always delivered in line with individual care plans.

Staff knew how to identify abuse but management plans put in place following a safeguarding concern in the home were not effective in keeping people safe.

There were enough staff to meet people’s needs.

Staff were not being supported to deliver care and treatment safely and to an appropriate standard.

The home regularly involved staff, and people living in the home, in monitoring quality. However, there were gaps in these systems that led to them being ineffective in both monitoring the quality of the service, and assessing and managing risks to people living in the home.

Care records were not completed or accurate.

You can see our judgements on the front page of this report.

Relatives and loved ones were actively encouraged to take part in all aspects of the home's daily activities. The home made all reasonable efforts to keep people engaged with the local community and the information board in the entrance indicated a range of things it was planning.The 'You say, we do' suggestions board showed a range of ideas that had been put forward and acted on by the home.

People were involved in all aspects of their own care and wellfare. The home tries to involve people as much as possible. People told us "we've been involved in reviews, and we know who we can talk to if we've any problems".

One person using the service told us "it's my home" and that the staff "are lovely". We saw that people were encouraged to decorate and have their rooms as they liked. People were seen to be actively going about things as they wished and staff encouraged independance.

The home had visitors calling allday and has a relaxed feel about it. Relatives of people who use the service told us "I'm never worried when I leave" and "the staff are always friendly". Relatives were seen to be involved in activities and interacting with staff in a friendly way.