Archived: Sunrise of Mobberley

Sunrise of Mobberley 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.

Sunrise of Mobberley accommodates up to 108 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.

There was a registered manager in place. 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.

People were very positive about the care and support that they received at Sunrise of Mobberley. People were cared for in a clean and very well maintained environment. We found that the focus of the service was very person centred. We found that the service supported people to express their views and were involved in making decisions about their care. There was a residents’ council meeting held every month.

Improvements had been made to staffing and recruitment. From our observations and a review of the rotas, we saw there were sufficient staff to safely meet the needs of people living in the service. People told us that there were enough staff to meet their needs, although people had noticed the impact of staff changes. The use of agency staff had decreased.

We saw that staff employed by Sunrise had been through a thorough recruitment process before they started work to ensure they were suitable and safe to work with the people who lived at the service.

We found that improvements had been made to the management of medicines and the provider had put appropriate arrangements in place to help maintain the safe management of medicines at the service. We noted that further improvements could be made around the recording of topical medicines and creams.

We found that the registered manager and staff understood their responsibility to keep people safe. Staff were able to tell us about the provider’s safeguarding policies and procedures and knew what to do if they suspected that a person was at risk of abuse.

We saw individual risk management plans were in place to keep people safe and the actions needed to minimise risks to people’s safety had been identified. However at times we found that people’s care plans did not always fully document all the actions that had been taken to mitigate some risks.

We found that staff were knowledgeable and had the appropriate skills to carry out their roles effectively. Staff undertook appropriate induction and training. Staff were supported to continually develop their skills and knowledge.

Staff understood and followed the principles of The Mental Capacity Act (2005). We observed that staff sought consent from people to provide care and treatment. Where necessary MCA assessment and best interest decisions had been made.

People were very positive about the food at Sunrise of Mobberley. The dining room had a restaurant feel and the food was of a high quality. People were consulted about their preferences. We saw that people’s nutritional needs were met. There was an effective system in place to ensure that all staff had up to date information about people’s nutritional needs.

We found that the service was very caring. There was a strong person centred culture and staff were motivated to treat people with kindness, respect and compassion. Staff members had good understanding about the people they were supporting and were able to meet their various needs. People told us that they were treated with dignity and respect.

People's needs had been assessed before they moved into the service. The assessment was then used to complete an individualised service plan (ISP) for the person, which enabled people to be cared for in a person centred way. Overall the ISP’s provided person centred information and had been regularly reviewed, we also found one example where the information had not been reviewed on a monthly basis and the level of information contained within the review of the ISP was brief and some relevant information had not been included. We noted that the template of the ISP meant that there was minimal space for staff to record updates and reviews of the different sections within the plan.

Through feedback to the service the operations director told us he had identified areas where they could improve the service further. They had plans to make improvements to general communication with relatives and ensuring that where appropriate, relatives had regular updates about their relative’s care.

There was an extensive activities programme, with several events and activities offered on a daily basis. People were supported to go out on trips. The service had good links with the community. A “Memory Café” was held at the service once per month in conjunction with the Alzheimer’s Society.

The service was well led. Staff told us that improvements had been made to the management of the service. Staff felt supported and told us that the registered manager was approachable.

We found that the management team demonstrated good knowledge about all aspects of the service, including quality issues and priorities for the service. The registered manager had a development plan in place including who was responsible for the areas of improvement and explained that she was keen to promote best practice and sought guidance from health and care professionals as required.

Quality assurance arrangements were robust and identified current and potential concerns and areas for improvement.

Sunrise of Mobberley is a large care home in Mobberley, East Cheshire. It is registered to support up to 108 people. The home is split into two areas; The Assisted Living Neighbourhood which provides residential and nursing care and The Reminiscence Neighbourhood which provides residential care for people who have dementia.

During the inspection there were 88 people living at the home. There were 30 people living within the Reminiscence Neighbourhood and 57 within the Assisted Living Neighbourhood. Of these people, 28 were in receipt of nursing care.

There was a registered manager in post at the time of our inspection. 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 identified two breaches of the relevant legislation, in respect of staffing and medicines. You can see what action we told the provider to take at the back of the full version of the report.

We found that there had been a period a time when the home had depended upon agency staff to ensure that there were sufficient staff and this meant that there was less consistency of care. There had been a recent focus on the recruitment of new staff and the registered manager told us that the home was now fully recruited with several staff awaiting start dates pending necessary recruitment checks. The registered manager told us that where possible they used regular agency staff to ensure consistency of staff. However during the inspection we found that people's needs were not always met in a timely manner. We saw that people sometimes waited a long time for a response to calls for assistance. Staff had not always responded promptly to sensor mats being alerted. Staff also told us that they were short staffed at times and could not always respond to people quickly enough. There were certain times of the day and night when this had more of an impact on people. People were also concerned about the lack of support and supervision available to people within the bistro area in the evening.

Medicines were not always managed safely. The local authority told us about a number of medication errors that the home had reported and investigated. The management team were taking action to address any poor practice. We saw that an action plan had been developed. At the time of the inspection, we found that a significant number of staff had not fully completed the training required by the company for staff to administer medication safely. There had been a recent audit which had highlighted a significant amount of recording errors, this indicated that staff had not always followed the company's medication policy. The registered manager informed us that action was being taken to ensure that all the required staff had completed this training within the next few weeks.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Staff knew where they could report safeguarding concerns to outside of their organisation. Risk assessments were completed to guide staff in how to minimise risks and potential harm.

People lived in a clean and very well maintained environment. We saw that the home was decorated to a high standard, there was a warm and relaxed atmosphere. Appropriate equipment and health and safety checks were carried out to ensure that people lived in a safe environment.

Records demonstrated that staff had completed a thorough induction before commencing their employment at the home and staff completed on-going mandatory training. People were able to access bespoke training where required. Although as noted above not all staff had fully completed medication training and competency assessments.

Not all staff had received regular supervisions meetings and some staff told us that they did not always feel supported by the senior management at the home.

Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to care or treatment. Not all people had signed consent to their care within the care records. We also found the recording of MCA assessments and best interest decisions were inconsistent. Where a person was being restricted or deprived of their liberty, some applications had been made to the supervisory body under the Deprivation of Liberty Safeguards. However, the management team were aware that they had focused on the Reminiscence Unit and that applications may also be required for people living in the Assisted Living Unit.

We saw that people were well cared for and very comfortable in the home. The people and visitors that we spoke with were positive about the care they received and told us that the staff were kind and caring. We observed that staff were skilled and patient, treating people with dignity and respect.

Care records were personalised and up to date, they reflected the support that people needed so that staff could understand how to care for the person appropriately. We saw that staff responded to people’s changing needs and sought involvement from outside health professionals as required. We found that in some care records and daily charts there were gaps in the information recorded and they had not always been completed at the time that the care had been provided.

People had access to activities both within the home and local community. A full activities and entertainment programme was available to all residents, as well as one to one support for people who stayed in their bedrooms. People were very positive about the activities that were organised.

There was a clear management structure in place. The registered manager and staff team had clear lines of responsibility. Staff were familiar with the needs of the people they supported. There were comprehensive quality assurance processes in place and people's feedback was sought about the quality of the care.

During our visit we focused our attention specifically on the Reminiscence Neighbourhood. We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs. We spoke to five family members who told us they were happy with care that the home provided. Comments we received included: 'They support (my relative) and me very well' and 'They are open and honest with me and always put (my relative) first.'

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We also spoke with five people who lived in the home and all told us, as far as they were able, that they were supported by staff and they engaged in the activities provided.

We found that systems were in place to monitor the quality of the service provided. This included a complaints procedures and a residents committee. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

We spoke with seven care staff who all told us that they had sufficient time to support people with their needs and that they received appropriate training and development activities to enable them to deliver safe and effective care.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs. We spoke to five family members who told us they were happy with care that the home provided. Comments we received included: 'I am extremely happy with the way she is being looked after' and 'I have no concerns.'

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

We spoke with four members of staff who all told us that they enjoyed working at the home and that they felt well supported in their roles. They told us that they received appropriate training and development activities to enable them to deliver safe and effective care.

We spoke to five people who lived in the home and they all told us they thought that the home was very good. One said; "The manager is brilliant - as are all the staff." Another person said; "I can voice my concerns at any time." We also spoke to six relatives during our visit who were all pleased to inform us that the home was very good and provided quality care.

We spoke to five members of staff who all told us that they enjoyed working at the home and that they felt well supported in their roles. They expressed confidence in the manager and her abilities to manage the home well. They told us that they received lots of training on a regular basis.

We looked at four care files and other documentation relating to the management of staff and quality assurance procedures. We also looked at the procedures relating to medication administration as part of the inspection.