Archived: Sunningdale Nursing Home Limited

We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches.

We undertook a focused inspection on 23 November 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This covered four questions we normally asked of services; whether they are 'safe', ‘effective’, ‘responsive’ and ‘well led’. Was the service ‘caring’ was not assessed at this inspection.

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

We found the service had made improvements and all but one of the breaches we had previously found in May 2016, had now been met. Although medicines management had been improved overall, we still had some on-going concerns and medicines remains in breach of regulation.

Sunningdale Nursing Home caters for the nursing needs of older people. It can accommodate up to 32 people.

There was a registered manager in post. 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.

At this inspection we reviewed the management of medicines. We found improvements overall but there were still areas of concern and therefore the service had not fully met this requirement. We found improvements were needed to record and monitor the application of creams and the thickening agents for fluids.

At our last inspection in May 2016 we found people’s care planning lacked sufficient detail to help ensure their care needs were being effectively monitored and evaluated. In some instances people’s care needs was not included or updated in the care planning.

We found people’s care planning had improved. Care plans had sufficient detail to help ensure people’s care needs were being effectively monitored and evaluated.

At our last inspection in May 2016 we found staff were not fully supported in their roles and responsibilities.

We reviewed the training and support for staff to prepare and support them in their role. We found support was better planned and staff were up to date with their training needs being met. Staff told us there had been a lot of work completed to meet the breach of regulation and that they felt well support to carry out their work. They described a positive learning culture in the home.

At our last inspection in May 2016 we had concerns around the systems in place to monitor the service.

We found action had been taken to improve the management and governance of the service. There were clearer and more effective systems to monitor standards and to further develop the service.

We however made a recommendation that there were more rigorous auditing of medicines so as to improve the overall management of medicines in the home.

You can see what action we told the provider to take at the back of the full version of this report.

Sunningdale Nursing Home is a large converted Victorian property, located close to the promenade in Southport, Merseyside. It is registered to provide accommodation for 32 people who need nursing care.

A registered manager was in post. 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.

During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines, staff support, care planning and the home's governance arrangements.

Staff told us they felt appropriately trained and supported. We found however that staff were not always being provided with training they needed to undertake their job role safely and effectively.

Care plans did not always provide information to inform staff about people's support needs. This placed people at risk of receiving unsafe care.

Medicines were not managed safely. For example, people did not have a plan of care for their medicines and medicines prescribed had not always been given by the staff.

Quality assurance systems were in place but did not operate effectively enough to ensure people received a well-managed service.

People said they felt safe living at the home and were supported in a safe way by staff.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. An adult safeguarding policy and the Local Authority’s safeguarding procedure was available for staff referral.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

People living at the home and staff told us that the majority of the time there were sufficient numbers of staff on duty to care for them.

Risks to people’s health and wellbeing had been assessed in accordance with people’s needs.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff made referrals to healthcare professionals for advice and support at the appropriate time.

People’s individual needs and preferences were respected by staff. People told us staff were kind, caring and respectful in their approach. We observed positive interaction between the staff and people they supported.

A varied social programme led by an activities organiser was available for people to participate in.

People told us they enjoyed the meals and were able to choose what they would like to eat. We found the dining experience chaotic on the first day of the inspection, however on the second day lunch was better organised and a more pleasant experience for everyone.

People we spoke with and their relatives told us that staff had the skills and approach needed to

ensure people were receiving the care and support they needed. People told us they were invited to give feedback about the home through meetings and daily discussions with the staff.

The culture within the service was and open and transparent. Staff and people said the home was ‘well run’ and the registered manager approachable.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it.

A complaints’ procedure was available and people living at the home were aware of how to raise a concern in the home.

There was a maintenance programme and arrangements in place for checking the environment was safe. Risks associated with hazards such as slips, trips and trailing wires were recorded as part of the service’s health and safety measures to keep people safe. We however identified some risks during the inspection. The registered manager undertook a health and safety audit of the home and took prompt action to address these areas.

The manager was aware of their responsibility to notify us Care Quality Commission (CQC) of any notifiable incidents in the home.

You can see what action we took at the back of this report.

Since the last inspection a Registered Manager had been appointed.

At this inspection we spoke with the Registered Manager about the changes that had been made since the last inspection in April 2014. We looked at staff records and saw evidence appraisals had taken place.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The people we spoke with told us staff were caring and treated them with kindness and respect. People told us they felt safe and well cared for at Sunningdale Nursing Home.

The home was clean, hygienic and odour free.

Measures were in place to ensure the environment was safe and suitable for the people who were living there.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection there was a Deprivation of Liberty Safeguard in place to keep a person safe. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People's health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's care plans reflected their current needs.

Where specialist support was needed, for example, with a person's nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people's health, well-being and independence

Is the service caring?

The people we spoke with told us the staff were kind and helpful. People's comments included, 'The staff look after me well'.

Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. Care and support was given when people requested and needed it. The staff ensured people's comfort and dignity at all times.

Staff had a good knowledge about people's care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirement.

People who lived at the home and their relatives had the opportunity to participate in and regular satisfaction surveys and could also provide feedback via the residents' and relatives' forum.

Is the service responsive?

Following our last inspection in January 2014 we had made two compliance actions (requirement to improve) that the service needed to respond to and address. We found that these had been addressed and the improvements made.

From our discussions with staff and looking at a number of care records we could see that people's plan of care was revised to meet any change in need. For example, deterioration in a person's medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

Staff we spoke with said they received good quality training. We did, however, find that staff had not received supervision or annual appraisals for at least 12 months. The manager agreed to address this issue and commence staff appraisals in May 2014.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

The home did not have a Registered Manager in place at the time of our inspection. We informed the manager of the importance of being registered with the Care Quality Commission [CQC]. They agreed to submit the application as soon as they were able to do so.

We spoke with two people who were able to tell us their views and experiences of the service. Both expressed satisfaction with the care and support provided to them. We spoke with one person who was visiting their relative who lived in the home. They said 'I don't know how the staff do what they do here. They are wonderful and make you feel very welcome whenever you come.'

We reviewed three people's care records and found they contained the majority of information staff required to provide care in a way which met people's individual needs. However, suitable arrangements were not in place to deal with foreseeable emergencies.

We were shown around the building and checked maintenance records. The building had been well maintained. However we found appropriate measures were not in place to monitor and reduce risks associated with the water system.

The staffing levels in place were satisfactory at the time of the inspection.

An effective complaints system was in place within the home.

Following our inspection, we were happy that concerns raised during our previous inspection, around the management of medicines, had been addressed.

At the time of our inspection there were a number of people with high dependency nursing and care requirements.

During our inspection we asked relatives for feedback on care provided to their family member. One person told us that the standard of care delivered was "Faultless." Another said they were relieved that their family member was in a "Caring, considerate and supportive home." Relatives said they felt comfortable asking questions about day to day care of their family member, and they found the staff and manager highly approachable.

We asked people at Sunningdale who could express their views, what they thought about the care they were given, and if it met their needs. One person said "They are so good to me, they chat to me and they are really friendly."

Staff at Sunningdale Nursing Home were seen to practice person centred care allowing people to make choices and respecting their wishes. For example whether people wished spend their morning in a T.V. room or a quiet room, whether they wanted to take part in any planned activity later that day. Peoples care plans also evidenced this. For example peoples preferences for a bath or shower, whether this was in the morning or the evening, whether they would like to take part in a particular event in the run up to Christmas. We observed staff present in sufficient numbers providing care in a warm friendly way.