Archived: Sunningdales Care Home

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service caring?

People were supported to eat and drink. We saw that people were offered drinks regularly throughout the day. We looked at three people's care records which indicated the level of support they required to eat and drink. For example, one person needed staff to feed them their meals. We saw staff supported people at a pace appropriate to them and checked that they had finished what they were eating prior to offering more food. The provider may find it useful to note that we saw staff stood over people while supporting them to eat rather than sat beside them. Staff also did not always give their full attention to the people they were supporting to eat and we saw occasions when they assisted others with non-urgent needs. This meant that there was a risk that people's mealtimes were interrupted.

People and their relatives spoke positively about the service provided. We spoke with one person and the relatives of two people. One person said, 'We are very well looked after. You only have to ask if you want something and they will do their best to help you.' One person's relative said, 'They look after them well and treat them with respect. They make sure they are toileted properly.' Another relative commented, 'The staff are lovely and very welcoming. They know and understand (my relative).'

Is the service responsive?

People's agreement was gained before care was given. We saw that staff sought people's permission prior to providing care. For example, we saw that one person was approached by staff and discretely offered support to access the toilet. The person voluntarily took the staff member's hand and accompanied them to the toilet. Another person was being assisted to eat by a member of staff. The member of staff gained the person's agreement before offering spoonful's of food. Where people did not have the capacity to consent to aspects of their care people significant to them were consulted.

The provider may find it useful to note that there was risk that decisions were made by people without the legal authority. Consent forms for taking people's photograph and the giving of the influenza vaccine were present in people's care records. These consent forms were signed by people's relatives. The registered manager told us that they asked whether the relative had a 'Lasting Power of Attorney' as part of the admission assessment. However, the registered manager told us that they were unsure of whether or not the person held a LPA for personal and welfare decisions.

Is the service safe?

People's needs were not always appropriate assessed and care was not always planned and delivered to meet people's needs. For example, we saw one person assisted to transfer to a chair in the lounge by two members of staff. This person was assisted by staff using an underarm lift. We raised this with the registered manager as this type of assistance can cause pain and injury. We saw this technique used again with the same person, who on the second occasion had fully lifted their feet from the floor and therefore was being carried under their arms by staff. We saw another person had slipped down in their chair. Two staff assisted this person to an upright position again using an under arm lift.

People's moving and handling needs were not appropriately assessed and care was not planned to ensure their safety. We looked at three people's care records. Two people were assessed as requiring a hoist and two staff to assist them to safely change position. These plans did not contain details as to the equipment staff should use to assist the people change position, such as the size of hoist sling. The sling we were shown was a medium sized sling which we were told was the correct size for both people. We saw that there were hoists in the home available for use. We spoke to the two members of care staff on duty. Both staff told us that the two people assessed as requiring a hoist to transfer were not always supported to change position using this equipment and they could stand sometimes. This meant that people were at risk as care was not appropriately planned and delivered to meet their assessed needs.

People who may be at risk of malnutrition were not monitored appropriately. For example, one person's care records indicated that they were reluctant to eat and drink. There was no risk assessment or plan in place to monitor this person's weight. The registered manager told us that this person was monitored visually for weight loss as they did not like to use the scales and that staff recorded how well the person had eaten on a daily basis. The provider had not considered the use of malnutrition screening tools or alternatives to assessing people's weight, such as measurement of their arm circumference.

The provider had made Deprivation of Liberty Safeguards (DOLS) applications to the local authority for all people living at the home. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

Is the service effective?

People told us that their eating and drinking needs were met. We spoke with one person and two people's relatives. One person told us, 'The food is very nice. I have never had anything I don't like. I think the food is very good.' One person's relative said, 'They will mash her food up as she won't have her teeth in.' Another person's relative commented, 'The food is very good.'

Is the service well led?

People's care records did not always contain accurate information. For example, one person's care record stated that they should have a pressure-relieving mattress. This mattress was not present on the person's bed. The registered manager told us that this person no longer required this piece of equipment and it had been removed the week previous. Another person's care record indicated that they required a sugar free diabetic diet. However, the registered manager told us that this person no longer required this type of diet and was no longer receiving one.

People's views of the service were sought and acted upon. The provider undertook a survey of people's views of the service. The survey looked at topics such as privacy and food provision and also included a section for people to add any additional comments. The provider considered the responses from the survey and had developed an action plan. For example, a respondent had commented that there was not enough privacy when they visited. The registered manager told us that they had told staff to raise people's awareness that they could use the conservatory if they required privacy. One person's relative told us, 'They always offer the conservatory for privacy.'

We spoke with the registered manager about how they monitored the quality of the service. The registered manager told us that they were present in the home every day and walked around looking at issues such as cleanliness and maintenance. The registered manager told us that issues were identified and rectified at the same time, for example if a light bulb needed replacing this would be done there and then. The registered manager said that they spoke with staff and people's relatives daily to get feedback. We spoke with the two members of staff on duty who told us that they felt able to raise concerns and make suggestions.

We found that the provider needed to make some improvements in obtaining and acting on people's decisions and the processes they followed when people lacked the mental capacity to make decisions and/or give their consent.

A person's relative told us "the personal care our relative receives is excellent". We found that people's needs were assessed and that care was planned and delivered to meet their needs. We found that people's care was planned to ensure their safety and welfare.

We found that staff had completed training in safeguarding people from abuse and knew how to act if they had concerns. Information was available about who to contact if visitors or staff had any concerns.

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A person's relative told us about the "caring and niceness" of the staff. We found that staff were supported through a process of supervision, appraisal and training to carry out their role effectively.

We have asked the provider to make some improvements to their quality monitoring system and to ensure that people and their representative are regularly asked about their experiences of the care and treatment provided in the home.

When individuals were unable to make decisions, their family or representatives had been involved in the process.

People's needs had been assessed and a care plan had been drawn up from this information. Risk assessments were in place and covered areas such as falls and isolation due to confusion.

Medicines were administered, handled and stored safely in the home and appropriate records maintained.

People were supported by adequate numbers of staff who had received training and supervision to carry out their role.

The provider sought views of people or their representatives on the running of the home.