Sunnycroft Care Home

Sunnycroft Care Home is a residential care home that can provide accommodation and personal care to up to 59 people. Care is provided over two floors, each having their own separate communal areas for people to access. At the time of the inspection, 33 people were residing in the home, most of whom were living with dementia.

People’s experience of using this service and what we found

The provider’s governance systems had failed to robustly monitor the quality of care provided to people. Risks to people's safety had not always been adequately assessed and managed and the systems in place to protect people from the risk of abuse were not effective.

There were enough staff working in the service to keep them safe but not to provide them with adequate stimulation to enhance their wellbeing. The provider had recognised this prior to our inspection, and plans were in place to improve this area.

Relatives were happy with the care provided to their family members. They felt the culture was open and that the management team and provider was approachable. However, not all staff felt this way with some telling us they did not feel confident to raise concerns for fear of reprisals. Furthermore, external organisations such as the local authority and CQC had not been notified of incidents when they should have been, to enable them to have adequate oversight of the care people received. This did not demonstrate a truly open and transparent culture.

Most of the required checks had been completed to ensure staff working in the service were safe to do so. People received their medicines when they needed them, and the service and equipment people used was clean. There were good systems in place to prevent the spread of infection including COVID-19.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for the service was Requires Improvement (published 16 May 2019) and there were two breaches of regulation. The provider completed an improvement plan to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding people from the risk of abuse and the culture within the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing and managing risks to people’s safety, protecting people from the risk of abuse, monitoring the quality of care provided and for not notifying CQC of certain incidents as is required by law.

Following the inspection, and the identified breaches, we had serious concerns about the quality monitoring systems of this service and so we took enforcement action. The provider is now required to send us a report each month to tell us the actions they are taking to monitor the service, ensure people receive safe care and treatment, and make the necessary improvements.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ Risk assessments were not always individualised. However, people said they felt safe living in the home.

¿ There were no assessments of people’s mental capacity when they needed support with making decisions.

¿ People were supported to access healthcare professionals, however care plans were not always updated with their more relevant information and recommendations.

¿There was limited oversight of the daily records of people’s care. Staff had not always recorded people’s food accurately, and what care they had received.

¿ Care staff did not always uphold people’s dignity, but people we spoke with told us they felt staff respected their privacy.

¿ There were enough staff to meet people’s needs.

¿ Medicines were stored and recorded safely, and administered as prescribed.

¿ There was a choice of meals on offer which people said they enjoyed.

¿ There was a range of activities on offer and people were engaged in hobbies and interests as much as possible.

¿ People were involved in their care and consulted appropriately.

¿ The staff team worked well together and communicated about people’s needs.

¿ Although there were some improvements since our last inspection, for example in the oversight of cleanliness and personalised care, there were other areas which required further work to achieve an overall rating of Good.

Rating at last inspection: Requires Improvement (published 12 March 2018). This service has been rated Requires Improvement at the last two inspections. At the last inspection, there were three continued breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected: Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. They sent us an action plan with this information, and we met with the providers to discuss our concerns about the home.

Enforcement: Following the last inspection, we took action to impose conditions on the provider’s registration which meant they were required to send us regular updates about their oversight of particular areas of service provision. This included infection control and person-cenred care. We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. They provided this to us, and whilst we noted some areas had improved since our last inspection, we found some areas had not improved sufficiently.

Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor the service according to our schedule for returning to locations rated requires improvement.

At our last inspection carried out on 26 and 27 October 2016, we found three breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014 in relation to person centred care, assessment of risk and governance.

During this inspection on 11 December 2017, although some improvements had been made, we found the service to be in continued breach of the same three regulations. You can see what action we took at the back of the full version of the report.

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.

The registered manager at the service had been registered with CQC since 26 October 2016. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe, responsive and well-led to at least good. They provided this to us, and whilst we noted some areas had improved since our last inspection, we found some areas had not improved sufficiently, and we found new concerns such as environmental risks.

People's health, safety and well-being were at risk because the registered manager and provider had failed to identify where safety was being compromised. Infection prevention and control procedures were ineffective and we found that hygiene in the service was poor.

Quality assurance and auditing mechanisms were not sufficiently robust to identify the concerns we found during the inspection.

The provider needed to develop their approach to ensure that it was consistent in delivering care in a way that supported a positive and person centred culture. People did not always receive the time and attention they needed to fully meet their needs, and some practices in the service did not take account of people’s individual needs. This had an impact on providing care which was consistently dignified and respectful.

Staffing levels met people’s physical needs, but did not always allow staff to take time to support people’s emotional needs.

We observed some interactions between staff and people were poor, and in some cases was lacking. Staff received relevant training to care for people living in the service, but were not applying the learning in an effective way. The registered manager had identified this as an area requiring improvement. However, where some staff had been identified as needing to improve, action plans were not in place to ensure improvement was made in a timely manner.

The provision of activity was not meeting the individual or specialist needs of all people using the service. We observed people sat for periods of time, disengaged with their environment.

Improvements were needed in people's mealtime experience, and we have made a recommendation about this.

People were not always fully supported by their environment. The provider had not considered how to maximise the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

Appropriate arrangements were in place to ensure people's medicines were obtained, stored and

administered safely.

People were referred to other health care professionals to maintain their health and well-being.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

The inspection took place on 26 and 27 October 2016 and was unannounced.

Sunnycroft provides care for up to 37 people. The home supports older people many of whom are living with some forms of dementia. The accommodation comprised of a purpose built property connected to a bungalow and a house.

The current manager had received confirmation of being the registered manager on the day of our visit. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report the registered manager will be referred to as the manager.

People’s medicines were not always stored in a safe way. This posed a risk to certain people who lived in the home. People didn’t have thorough risk assessments and reviews. Some risks to the people who lived in Sunnycroft had not been fully explored.

There was no robust system to assist staff to respond to emergencies in the evenings and weekends. The manager and the provider did not have effective systems to test the quality of the service provided. There was a lack of action plans to enable the development of Sunnycroft.

The service was not fully responding to people’s social needs that lived in the home. There was a lack of social stimulation for many people in the home. Staff did not have the time to spend talking with people. The service had not considered ways to engage with people and seek their views on the service.

There was a lack of monitoring and testing that staff had the knowledge and skills to meet people’s needs.

These issues all contributed to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People benefited from being supported by staff who were safely recruited, trained and who felt supported by the manager. There were enough staff to meet people’s physical care needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. Most staff were aware of people’s health needs and followed guidance to meet these needs.

Staff assisted people with kindness. People’s dignity and privacy was maintained and respected.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team and was working within the principles of the MCA.

The service encouraged people to maintain relationships with people who were important to them. People’s relatives and friends were welcomed to the service and encouraged to visit.

There was a positive culture and a friendly atmosphere at Sunnycroft. The manager was motivated to make positive changes.