About the service Sunrise of Frognal is a residential care home registered to provide personal and nursing care for up to 131 people in two adapted buildings. There were 115 people using the service at the time of our inspection.
Sunrise Senior Living Limited and Sunrise UK Operations Limited are dual registered and both providers are jointly responsible for service delivery at Sunrise of Frognal.
People’s experience of using this service and what we found
At our comprehensive inspection of 22 and 23 March 2018, we found the provider had not acted to make sure medicines were managed safely and we issued a requirement notice.
At this inspection, we found the provider had not made sufficient improvements for managing medicines since the last inspection. Medicines were still not always being managed safely.
At our comprehensive inspection of 22 and 23 March 2018, we found some improvements were needed to have an effective quality assurance system and processes.
At this inspection, we found the provider had not made sufficient improvements to monitor the quality of the service being delivered.
The falls management was not effective, people were at risk of receiving unsafe care and support.
People and their relatives gave us positive feedback about their safety and told us that staff treated them well.
The registered manager and staff understood what abuse was, the types of abuse and the signs to look for.
Senior staff completed risk assessments for every person and they were up to date with clear guidance for staff to reduce risks.
There were enough staff on duty to support people safely and in a timely manner. Staffing levels were consistently maintained to meet the assessed needs of people.
The provider carried out comprehensive background checks of staff before they started work.
Staff kept the premises clean and safe.
The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.
Staff carried out pre-admission assessments of each person’s needs to see if the service was suitable and to determine the level of support they required.
Staff received appropriate support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach their line manager, and the registered manager, at any time for support.
Staff assessed people’s nutritional needs and supported them to have a balanced diet. People told us they had enough to eat and drink.
The provider had strong links and worked with local healthcare professionals in a timely manner.
The provider met people’s needs by suitable adaptation and design of the premises.
Staff completed health action plans for everyone who used the service and monitored their healthcare appointments.
The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care.
People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.
Staff showed an understanding of equality and diversity. They supported people with their spiritual needs where requested.
Staff involved people or their relatives in the assessment, planning and review of their care.
Staff respected people’s choices and preferences.
People told us staff treated them with dignity, and that their privacy was respected.
Staff recognised people’s need for stimulation and supported them to follow their interests and take part in activities. People responded positively to these activities.
Staff had developed care plans for people based upon their assessed needs.
Care plans were reviewed on a regular basis and reflective of people’s current needs.
People told us they knew how to make a complaint and would do so if necessary.
The provider had a clear policy and procedure for managing complaints.
The provider had a policy and procedure to provide end-of-life support to people. However, no-one using the service required end-of-life support at the time of our inspection.
The service had a positive culture, where people and staff told us they felt the provider cared about their opinions and included them in decisions.
The registered manager had knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements through periodic meetings.
The provider had worked effectively in partnership with a range of healthcare professionals.
Rating at last inspection – The last rating for this service was requires improvement (report published on 18 July 2018). The provider completed an action plan after the last inspection 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.
Why we inspected - This was a planned inspection based on the rating at the last inspection.
Enforcement – We have identified breaches in relation to the provider was not making sure always there was proper and safe management of medicines and making sure risks from all falls were assessed and action taken to mitigate them, and the quality assurance system and process was not effective as the provider had not always identified issues we found at this inspection and acted upon in a timely manner. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk