4 August 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
The inspection was undertaken by three inspectors and an Expert 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.
Service and service type
This service 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. We sought feedback from health and social care professionals. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
Some people were not able to fully share with us their experiences of using the service. Therefore, we spent time observing interactions between people and the staff supporting them in communal areas. We spoke with eight people who used the service and eight relatives. We also spoke with the registered manager, deputy manager, operations manager, a care quality manager and ten staff across all roles.
We reviewed four people’s care records, reports relating to the management of people’s medicines, four staff files and a variety of other records relating to the management of the service.
After the inspection
Four health and social care professionals provided feedback about the service. We also continued to seek clarification from the provider to validate evidence found.
4 August 2021
About the service
Sunnybank House is a care home providing personal and nursing care to up to 60 people. There were 38 people using the service when we inspected. The accommodation is arranged over three floors. The Rose Unit is on the ground floor and provides residential care for people with less complex needs. Dahlia Unit is on the first floor and is a registered nurse led unit supporting people with a range of more complex clinical needs. Nemesia Unit is on the top floor. This unit had only recently reopened after being redeveloped as a specialist unit for people living with dementia.
People’s experience of using this service and what we found
People were safe and we observed care being provided in a caring and unhurried manner. However, we also received feedback which indicated that there were times when staff were not able to be fully responsive to people's needs. Medicines were not always administered as planned due to not being available or out of stock or because staff had not always been sufficiently proactive about overcoming other barriers to administration. Risks to people’s care had been assessed and planned for. A range of health and safety checks were taking place to ensure that the building and the equipment within it were safe to use and had been serviced and maintained regularly. As part of CQC's response to the coronavirus pandemic we conducted a review of infection prevention and control (IPC) measures in the home and were assured by the systems in place. There were systems and processes in place to safeguard people from the risk of abuse and to learn from safety related events. We did identify one potential safety related concern in relation to how food for people who required a modified diet was being prepared.
We have made a recommendation about how the International Dysphagia Diet Standardisation Initiative (IDDSI) is used within the service.
Staff completed a suitable induction and undertook a wide range of training, relevant to their role.
Assessments were completed to establish people’s needs and to ensure these could be fully met. People’s nutritional needs were met. Staff worked with other agencies to ensure people had access to healthcare services. The design and layout of the building was suitable and had been developed with the needs of people living with dementia in mind. Staff were well informed about the principles of the Mental Capacity Act 2005.
We have made a recommendation that the service develop specific DoLS care plans which show how the liberty of people, with a DoLS authorisation, is being promoted.
People told us that staff were kind and caring and treated them with respect. People were supported to maintain their independence and autonomy where able. Staff sought people’s consent before delivering care and care plans included information about people's preferences and wishes and the relationships that were important to them.
People had access to a range of events and activities which helped to boost their well-being and keep them engaged and entertained. The number of agency staff used had reduced which helped to ensure that people received care from staff that knew them and their needs well. People’s communication needs continued to be identified and planned for. Complaints had been responded to appropriately. Staff worked with local health care professionals to provide responsive and compassionate end of life care.
People benefited from a well led service and the registered manager and provider had shaped a culture where staff strived to provide person centred care. The registered manager maintained a visible presence within the home and actively supported staff and interacted with people on a daily basis. Staff were clear about their role and responsibilities and spoke positively about the registered managers leadership and their impact on the service since their appointment. There were effective quality assurance systems in place that lead to improvements that had positive outcomes for people. People were encouraged to give feedback about the care they received.
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 ‘Requires Improvement’ (published October 2019).
Why we inspected
This was a planned inspection based on the previous rating.
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.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.