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Sunnymede Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 18 November 2020

During an inspection looking at part of the service

About the service

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 ke

Inspection carried out on 13 November 2019

During a routine inspection

About the service:

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.

Inspection carried out on 20 August 2018

During a routine inspection

This inspection took place on 20 August 2018 and was unannounced. At the last inspection the service was rated 'Requires Improvement' overall. We issued one requirement notice for a breach of Regulation 17, good governance. 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. You can read the report from our last inspection, by selecting the ‘All reports’ link for Sunnymede, on our website at www.cqc.org.uk.

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.

Inspection carried out on 12 June 2017

During a routine inspection

Sunnymede is a care home which provides accommodation, nursing and personal care for up to 34 older people. At the time of our inspection 27 people were living at the home.

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.

Inspection carried out on 26 March 2015

During a routine inspection

Sunnymede is a care home which provides accommodation, nursing and personal care for up to 34 older people. At the time of our inspection 28 people were resident at Sunnymede.

This inspection took place on 26 March 2015 and was unannounced. We returned on 30 March 2015 to complete the inspection.

At the last inspection on 26 February 2014 we identified that the service was not meeting Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because of the way staff recorded the medicines people were supported to take. The provider sent us an action plan and said they were taking action to address the issues. During this inspection we found that medicines were managed safely.

There was no registered manager in post at the service. 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 and associated Regulations about how the service is run. The manager reported that she would be submitting an application for registration in the month following the inspection.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “You get the help you need” and “Staff are very good, they’re all interested in you”. People told us they felt safe when receiving care and were involved in developing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were supporting. People told us that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. One person told us, “If we had any complaints they would listen to us”. A relative said, “I have not had any serious complaints, but have had discussions with the manager when things were not quite right. They have always been very open and have resolved any problems straight away”.

The management team assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

Inspection carried out on 26 February 2014

During an inspection looking at part of the service

We visited Sunnymede to follow up compliance actions made following our visit in October 2013. At our last inspection we had found there were shortfalls to care planning which put people at risk of receiving unsafe care. We also found that the provider did not have appropriate arrangement in place for the recording, safe keeping and safe administration of medicines.

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.

Inspection carried out on 14 October 2013

During a routine inspection

The purpose of the inspection was to review areas of concern which had been raised with the Commission in relation to the care and welfare of the people who lived at Sunnymede Nursing Home. Other areas of expressed concern included how people�s consent was obtained before care was given and medicine administration.

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.

Inspection carried out on 9 April 2013

During a routine inspection

We spent some time talking with people and observed interactions between people and staff during the inspection. We saw staff reassuring people, listening to what they were asking or saying and acting on it. We saw staff kept people engaged in different activities throughout the home.

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.

Inspection carried out on 18 October 2012

During a routine inspection

People we spoke with told us that they were happy with the care and support provided by the home. People told us that they were assess before they came to live at Sunnymede. They said they were involved with developing their care and support plan and that staff treated them kindly and politely. For example one person said �I feel safe here there is nothing to worry about. I have no complaints. Another person said if I am not happy I will let staff know but I am ok�.

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.

Inspection carried out on 12 November 2011

During a routine inspection

People looked relaxed and comfortable in the company of the staff. People were being supported by the staff team with their range of needs. The staff were polite and respectful when helping people with their care. We found that there were not consistently enough staff on duty to support people so that all of their needs were met. One person who uses the service told us, �you feel like you are in a queue, there are not enough staff these days�.

The newly introduced care plan format was comprehensive in the areas of a person�s life that it looked at. We saw that the care plan format included people�s physical, psychological and spiritual needs, as areas staff should consider when planning what care they required.

People were cared for by staff who knew what to do to protect them from abuse. There was guidance information for staff to follow if an allegation of abuse was made.

The environment was mostly adequately maintained. There was a strong offensive odour in the main lounge. There was a window that was marked as dangerous in an occupied bedroom. The window was loose in the frame and could have been a risk to people. We contacted the providers during our inspection .They have taken action to make the window safe.

We saw a system that the providers were in process of using for monitoring and checking the overall care and services for people at the home. People would benefit if the quality monitoring process included an action plan, with realistic timescales to show how the service will be improved and developed at Sunnymede.