Archived: Sunnyside Rest Home

At our inspection of 7 and 8 August 2017, we found four breaches of the regulations - there were issues in relation to the assessments of risks to people that had not always been updated in line with their needs; care plans were not always accurate and up to date; assessments of people's capacity to make decisions about their care and treatment were not undertaken in line with the Mental Capacity Act 2005 and the provider had not operated an effective complaints procedure. In addition, there was no organised programme of activities and there was no registered manager in place. This was a requirement of the provider’s registration.

At this inspection we found that improvements in all these areas. People’s care plans and assessments reflected their up to date condition and support they required. People were assessed as to their mental capacity and these assessments dealt with people’s ability to make decisions about their care and support. A complaint’s system was in place and people were confident about the process and the ability to raise concerns.

Sunnyside Rest Home is a care home located in the county of Lancashire in the village of Whitworth. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide accommodation and support for up to eight older people some of whom are living with dementia. At the time of our inspection seven people were using the service.

There was a manager in place who, at the time of the inspection, was going through registration process with the Care Quality Commission. They subsequently became registered with the CQC on 6 August 2018. A registered manager is a person who has registered with the CQC 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 were receiving their medicines as prescribed by health care professionals, medicines were securely stored, and the administration of medicines was recorded appropriately.

People received care, food and fluids in line with their care plans and as advised by health care professionals. Action had been taken to support people where risks had been identified and there were arrangements in place to deal with foreseeable emergencies. Peoples care plans were up to date and included detail about their needs and preferences. People using the service said they felt safe and that staff and the manager treated them well. Staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available for staff and they told us they would use it if they needed to.

Recruitment of employees was robust with good record keeping and checks including DBS and ID procedures. These checks ensure that staff are not barred from working with vulnerable people and have a right to work in the UK.

Staff had received training in order to meet the needs of people using the service. They had also received regular supervision and an appraisal of their work performance. The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

There was enough staff on duty to meet people’s needs safely. We saw that staff respected people’s privacy, dignity and independence and engaged with them in a caring manner. They understood and responded to people’s individual needs and were familiar with people’s histories and preferences.

People and their relatives had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

At the time of the inspection we noted that the home’s décor was tired in places but a new purpose built home was in the process of being completed at the time of the inspection. People and their relatives had been thoroughly consulted about a transfer to the new home that was a short distance away from the current home. It was hoped that the move would be finalised in the autumn/early winter of 2018. The provider’s representative said that people and their relatives had agreed that it would be pointless to spend monies on refurbishments at the current home. This was confirmed when we spoke with people and they said that they had had active involvement in the choices of décor and facilities at the new home.

Sunnyside Rest Home is registered to provide accommodation and personal care for up to eight older people. Accommodation is provided on one floor in single bedrooms. Communal space is available in a lounge, conservatory and dining room. The home is situated in a residential area in Whitworth. At the time of the inspection, there were seven people accommodated in the home.

The registered manager had left the service on 14 July 2017. 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 the time of the visit, the home was being managed by the deputy manager who was appointed on 5 June 2017 and the nominated individual.

This was the first inspection of the home since the registration of a new provider.

During the inspection, we found there were four breaches of the regulations, in respect of the management of risks, the recruitment of new staff, care planning, the implementation of the Mental Capacity Act 2005 and the management of complaints. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation about ensuring people’s care plans fully reflected the care they were receiving.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. Whilst risk assessments had been carried out, they had not always been revised and updated in line with people’s needs.

People were supported by a sufficient number of care staff. However, we noted the care staff were expected to complete other household duties when the cook and cleaning staff were not on duty. The provider had not followed a robust procedure in respect to the recruitment of one new member of staff. We saw that the staff member had been employed on the basis of a Police criminal records check which was over two years old. Whilst an application had been made for a new check, there had been no check of the barring list for vulnerable adults at the time the staff member started working in the home.

The staff were given ongoing opportunities to complete training, in order to update their knowledge and skills. Whilst we saw evidence of the training on staff member’s files, the training matrix was out of date. This meant it was difficult to determine if all staff had completed the training programme in a fast and timely manner.

Staff were supported in their roles via a system of supervision and appraisal. All staff had the opportunity to attend meetings and provide feedback on the service. Staff spoken with told us they were well supported and had confidence in the management team.

People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA). However, people’s mental capacity to make their own decisions had not been assessed and recorded in line the requirements of this legislation.

There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them. There were no restrictions placed on visitors and they were made welcome in the home.

Staff treated people in a respectful and dignified manner and people's privacy was respected. We observed people were happy, comfortable and relaxed with staff. People were offered the opportunity to participate in social activities. The arrangements for activities were informal and staff told us it depended how much time they had available in the afternoon. The nominated individual acknowledged this was an area for development and told us the provider had designated champions within the organisation in order to develop activities in the home in a more structured manner.

People’s care plans had not always been updated on a regular basis, which meant people were at risk of receiving inconsistent care.

There was a complaints process in place and people felt confident to raise concerns. However, people had raised concerns at residents’ meetings which had not been escalated through the complaints procedure to be formally managed under this process.

There were systems in place to monitor the quality of the service which included feedback from people living in the home. Whilst we found a number of the breaches in the regulations, the nominated individual had identified the shortfalls and had devised an action plan.