Archived: Signature at Esher

Updated 1 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 January 2018 and was unannounced.

The inspection was carried out by three inspectors and two experts-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we gathered information about the service by contacting the local and placing authorities. In addition, we reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection.

We did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

As part of our inspection we spoke with 15 people, two relatives, the manager and nine staff members. We looked at the care plans for 10 people, medicines records, accidents and incidents, complaints and safeguarding. We looked at mental capacity assessments and applications to deprive people of their liberty. We reviewed audits, surveys and looked at evidence of activities taking place at the home.

We looked at four staff recruitment files and records of staff training and supervision, appraisals, a selection of policies and procedures and health and safety audits. We also looked at minutes of staff meetings and evidence of partnership working.

Updated 1 November 2018

Sunrise of Esher is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sunrise of Esher provides care and accommodation for people some of whom have a diagnosis of dementia. The home is registered for 88 residents and is a purpose built home. The building consists of three floors. The ground and first floor of the building are called the Assisted Living Neighbourhood. The care provided in the Assisted Living Neighbourhood includes minimal support for peoples care. The second floor of the building is called the Reminiscence Neighbourhood. The Reminiscence Neighbourhood provides care and support to people who live with dementia as their primary care needs.

At our inspection of 15 December 2016 we found the service was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The assessments and care plans were not personalised. During this inspection we found the provider had met this Regulation.

There was not a registered manager in place. However the current manager was going through the process of applying to be the registered manager with the Care Quality Commission. The manager supported the inspection team throughout the day. 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 inspection looked into how risks to people were managed following an incident where a person using the service sustained a serious injury. Following this the local safeguarding adults board decided to look into the circumstances of the incident by undertaking a Safeguarding Adults Review (SAR). The purpose of the SAR is to identify learning and good practice for all agencies involved in people’s care and to promote areas where improvements can be made. At the time of the inspection the SAR, and any learning from this, had not been completed.

People and their relatives told us they felt the home was safe. They told us they had no concerns about being safe. All staff had received training about safeguarding and they were knowledgeable about the processes to be followed when reporting suspected or actual abuse. Medicines were managed in a safe way and recording of medicines were completed to show people had received the medicines they required. Risks to people had been identified and documentation had been written to help people maintain their independence whilst any known hazards were minimised to prevent harm. People were protected against the spread of infection within the service. The environment was clean, tidy and free from malodours. Infection control processes were followed by staff to minimise the risk of cross infection. The management of the home and staff had learned lessons from when things had gone wrong and put systems in place to help prevent a repeat of these.

There were sufficient numbers of staff on duty at all times to ensure that people’s assessed needs could be met and these were reviewed on a daily basis. The provider had carried out appropriate recruitment checks so as to ensure that only suitable staff worked with people at the home. Staff had a good understanding about people’s life histories, their preferences and how to attend to their needs.

Where there were restrictions in place, staff had followed the legal requirements to make sure that this was done in the person’s best interest. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that decisions were made in the least restrictive way. People were supported to ensure they had enough to eat and drink to keep them healthy. Healthcare professionals were involved with people’s care that ensured their healthcare needs were met. The environment was suitable for people living with dementia.

People’s visitors were welcomed at the home and there were no restrictions on the times of visits. People’s privacy, dignity and independence were promoted by staff who showed kindness and understanding of people’s needs. People were able to make choices about how they received their care, support and treatment.

A variety of activities were available for people to take part in both internally and externally on trips to places that interested them. Documentation that enabled staff to support people and to record the care they had received was up to date and reviewed on a regular basis. People received person centred care and they or their representatives had signed their care records that signified their involvement in their care, treatment and support. People’s likes, dislikes and preferences were recorded and known by staff. Staff were knowledgeable about people’s needs and had received training that helped to attend to the assessed needs of people. People’s end of life care was attended to in a sensitive and caring way that encompassed their preferences and needs.

Complaints were taken seriously by the provider and staff and addressed within the stated timescales to the satisfaction of complainants. A complaints procedure was available to people, relatives and visitors.

The provider and staff undertook quality assurance audits to monitor the standard of service provided to people. An action plan had been produced and followed for any issues identified. People, their relatives and other associated professionals had been asked for their views about the service through surveys and resident meetings.

The interruption to people’s care in the case of an emergency would be minimised. The provider had a Business Continuity Plan that provided details of how staff would manage the home in the event of adverse incidents such as fire, flood or loss of gas or electricity.

The provider was aware of their responsibilities with regard to reporting significant events to the Care Quality Commission Accidents and incidents were recorded and monitored to by staff to help minimise the risk of repeated accidents.