Sunnymede

The care home is over three floors of a converted Victorian style home. Bedrooms can be found on all floors. There are multiple communal areas on the ground floor including a living room, dining room and separate quiet lounge. The quiet lounge had also been converted to a visitor’s room during the COVID-19 pandemic.

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

People were still not being supported by a staff team that had been through safe recruitment. This was despite a new system put in place by the provider. People were supported by enough staff to keep them safe. Although the fulfilment of their day was impacted by the provider’s struggle to employ an activities coordinator.

Improvements had been made since the last inspection in the quality auditing systems completed by the management. Quality assurance systems were now in place for a range of areas in the home. However, the system was not always being completed and analysed effectively.

Care plans and risk assessments were personalised. However, there were inconsistencies in the amount of detail provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by kind and caring staff who respected them and knew them well. People could choose where to spend their day. Those in their bedrooms had access to a call bell.

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 this service was requires improvement (published 26 March 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations except around recruitment of staff. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe recruitment of new staff at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sunnymede is a residential care home providing personal care without nursing, for up to 35 people aged 65 and over. At the time of the inspection the service was supporting 20 people. People had mixed ability to verbally communicate with us. Their views were also captured through observations. During the inspection, due to the COVID-19 pandemic, most people were spending time in their bedrooms to remain safe.

The home is a large converted house. There were a range of shared, communal areas such as lounges and a dining area. There was work going on to redecorate parts of the home. These were not accessible by the people.

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

We spoke with people who told us they were happy living at Sunnymede, other people we observed appeared happy because they were laughing and smiling. However, relatives had mixed views about the home.

Improvements were found in some areas including medicine management and the management of infections spreading. However, repeated concerns were found in other areas such as recruitment of staff and call bells being out of reach. New concerns were found around health and safety and how staff monitored people who were at high risk of pressure ulcers.

As part of this inspection we looked at the infection control and prevention measures in place in relation to the COVID-19 pandemic. We found systems were in place and staff had access to enough personal, protective equipment (PPE) such as gloves, masks and aprons. However, on one occasion we witnessed a staff member go between bedrooms where people were isolating for safety without changing their PPE. No impact was found. Following the inspection, the provider updated us on actions taken to rectify the issues.

The home was still not always well led. Systems were now in place to monitor the care people received. However, these had not always identified concerns found during the inspection or repeated concerns. When issues had been found they were not always rectified. Staff and the management were not always following the provider’s own policies and procedures. Although notifications had been made to the Care Quality Commission these were sometimes delayed. There were occasions when incident records did not match records the provider shared with CQC.

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 this service was requires improvement (published 7 May 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. There were breaches in regulations.

The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection we followed up the concerns in relation to the Safe and Well Led domains to minimise risks to people during the pandemic.

At this inspection, we found improvements had been made in some areas and the provider was no longer in breach of regulations in relation to safe care and treatment. However, a breach remained in Well Led, and we found a new breach in relation to a repeated concern.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance, assessments of people’s needs, infection control, staffing levels and person-centred care.

We undertook this focused inspection to check they had followed their action plan and to confirm if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which have some of those requirements.

We also 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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating has remained the same. This is based on the findings at this inspection.

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

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 recruitment and good governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

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. 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.

Sunnymede is a care home that provides personal and nursing care for up to 34 older people. The service is provided in accommodation over three floors. At the time of the inspection, 24 people were living at the home.

What life is like for people using this service:

Since our last inspection, improvements had been made to the management of people’s medicines, although shortfalls remained. We found further shortfalls relating to the reporting of incidents that affected the health, safety and welfare of people, accuracy of records, storage of records, person-centred care, infection control, staffing and quality assurance.

People were not always protected from the risks of infection, because staff did not always follow published infection control guidance.

People were not always safeguarded from abuse because incidents such as unexplained bruising were not reported to the local authority.

Sufficient numbers of qualified staff were not always deployed to meet the needs of people who needed support, for example, with pressure ulcer management and catheter care.

A range of quality monitoring checks were completed. However, they did not always identify shortfalls, so actions were not always taken to mitigate risks and make improvements.

Whilst there were improvements in the personalising of people’s care records that provided guidance about how they wanted to be cared for, there was a lack of opportunity for people to participate in meaningful activities.

People who used the service and relatives spoke positively and told us they felt safe in the home.

We have made a recommendation with regard to staff recruitment practices.

People were supported to access a range of health care services and regular visits were undertaken by the GP.

People’s dietary needs were assessed, and actions taken when people lost weight or their nutritional needs changed.

We have made a recommendation that the provider ensures that all people have access to the most appropriate equipment to help them eat and drink independently.

Staff were caring and respectful. There were good interactions between staff and the people they were supporting.

The service met the characteristics of Requires Improvement in the key questions, Safe, Effective and Responsive. The service met the characteristics of Inadequate in the key question, Well-led. The service met the characteristics of Good in the key question, Caring. Therefore, our overall rating for the service after this inspection has remained Requires Improvement.

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

Rating at last inspection: Requires Improvement (report published in March 2019). This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected:

Services rated “requires improvement” are re-inspected within one year of our prior inspection. This inspection was brought forward. This was prompted in part due to anonymous concerns relating to the quality and safety of care people were receiving.

We found evidence that the provider needs to make improvements. Please see the safe, effective responsive and well-led sections of this full report.

Follow up:

We have identified breaches of the regulations in relation to safe care and treatment, infection control, staffing, person-centred care and good governance at this inspection.

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.

Sunnymede 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. Sunnymede accommodates up to 34 people. At the time of the inspection there were 25 people using the service.

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's medicines were not always managed safely. Medicine administration records were not consistently signed.

Systems to monitor food storage were not always effective

The systems in place to monitor people's care delivery were not consistently effective.

Records of care delivered were not always completed as required as stated in people's care plans.

People had their needs assessed but further improvements were needed to how this informed people's care plans.

People were not always receiving support to be stimulated with activities and to follow their individual interests.

There was not enough information for people to be supported in a way that met their wishes and effectively at the end of their life .

People had their rights protected and the principles of the Mental Capacity Act 2005 were always followed.

People were supported by suitably trained and experienced staff.

Staff provided dignified care. Staff training was up to date and competency was checked.

The building was not always designed to meet people's needs; in particular people with dementia.

People's care plans were up to date but did not have much personalised information.

People were supported by knowledgeable staff.

People were safeguarded from potential abuse.

People received support from staff that were caring and people were involved in decisions and had their choices respected by staff.

People understood how to make a complaint.

Notifications were submitted as required and the provider understood their responsibilities for notifying us of specific incidents which had occurred at the service.

We found people, their relatives and staff felt supported by the registered manager.

We identified two 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 this report.

This inspection took place on 12 and 13 June 2017 and was unannounced.

At the last inspection, the service was rated good.

At this inspection we found the service rated as requires improvement. This was because shortfalls were found relating to incomplete and missing records. Care plans were not always current and up to date relating to parkinson’s and changes to fluid intake. Where people were at risk of their skin breaking down the care provided was not always being recorded.

Medicines were stored and administered safely although records relating to medicines administered and topical creams were incomplete and missing.

People had mixed views about their meals and choices. Snacks were not always provided in line with people's specific dietary requirements. People did not always have access to adequate tables to eat their meals from.

Systems and audits in place did not always identify shortfalls found during this inspection.

Staffing levels were safe to meet people’s needs although we received mixed views from people.

People’s care plans confirmed if people were unable to make decisions relating to their care and treatment. The principles of the Mental Capacity Act were being followed. Where people had restrictions on their liberty authorisations were in place.

People’s care plans were personalised and included important information relating to their wishes and personal preferences. Feedback was sought from people and relatives.

The staff team were trained and received support from the management. Staff were knowledgeable about how to safeguard people from abuse.

People had access to an outside patio and garden area. This had various plants and flowers that people could enjoy. Some areas of the home had been updated including the tables and chairs in the dining area.

The service had a complaints policy in place. People and relatives felt able to raise any concerns with the registered manager.

People’s health needs were met and people benefited from support from staff relating to all medical and well-being appointments.

Staff were kind and caring. Positive feedback was received about the registered manager from people, relatives and staff.

We found one breach 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.

We informed the provider they were not compliant with these essential standards and asked them to submit an action plan. This action plan was submitted on 18 December 2013 and set out the actions which would be taken to achieve compliance. On this visit we reviewed these actions.

We spoke with six people who used the service and two relatives. People who lived at Sunnymede had varying levels of dementia, so not everyone was able to tell us about their care and support. One person 'they are very nice and helpful'. Both relatives told us they were happy with the care and support provided.

We saw registered nurses had sought advice and guidance from health care professionals when people had or were at risk of losing weight. People were provided with calorie dense meals, snacks and food supplements as required. This meant that staff understood how to support and care for people with dementia with their nutritional needs. During this inspection we found improvements had been made to the handling of medicines. However some further action was need to ensure that people were better protected from these risks.

We spoke with eight people who used the service. All the people we spoke with told us staff were approachable and treated them with respect and maintained their dignity. One person told us 'even though they know me they don't take it for granted. They are very good'. People told us they could make choices about their day to day lives such as what time they wanted to get up or go to bed or if they wanted to take part in the activities in the home.

People we spoke with were happy with the care provided. One person who lived at the home told us "I'm very happy, the staff have been very good, and they do things the way I want things to be done ".

We observed care staff were attentive, polite and sought consent before providing care and support.

Although most people told us they were satisfied with the care they were getting in the home, we found there were minor issues which could impact on people. For example, provider did not have appropriate arrangements in place for the recording, safe keeping and safe administration of medicines.

We saw people were responsive to the company of staff and smiled as they walked through the home at different times. We observed people drinking tea and coffee and chatting with staff and each other. People were not rushed and were supported to do things in their own time. One person told us 'they work so hard and they have more time to talk to us, they don't rush around anymore'. People said they felt safe using the service.

We saw the provider had a policy on safeguarding people from abuse. Staff had attended training to help ensure that people who lived in the home were protected from the risk of abuse.

We saw there were sufficient numbers of suitably qualified and experienced staff at all times in the home to support the people who used the service.

People said they were aware of the complaints procedure and would let the manager know if they were unhappy. One person said 'I am ok I have no complaints'.

We saw the environment was suitably designed and adequately maintained. To provide care for people who used the service.

We saw the provider had effective systems in place to regularly monitor the quality of service that people received.

We saw that the provider had a policy on safeguarding people from abuse and that staff had attended training to ensure that people who live in the home were protected from the risk of abuse.

We saw that the provider had an effective system in place to regularly monitor the quality of service that people received.

We found from speaking to the people living in the home, staff and looking at the staff rota that that there were insufficient numbers of suitably qualified, skilled and experienced staff at all times to meet the needs of the people who used services.