Sunningdale House is a care home which offers care and support for up to 36 predominately older people. Some of these people were living with dementia.

The service was last inspected in July 2017 and was rated as Good. In February 2018 we received serious concerns from health and social care professionals about the care that people received. The concerns were in relation to end of life planning, personal care needs not being met, medication, medical concerns not being escalated to health professionals in a timely manner, staffing levels, staff culture, infection control practices, lack of confidence in record keeping, and a higher than expected number of deaths. Due to these concerns we brought our inspection forward.

This comprehensive inspection took place on 26 March and 3 April 2018 and was unannounced. Two inspectors and a Specialist Advisor visited the service on the 26 March 2018. At that time 19 people were living at the service. Two inspectors visited the service on the 3 April 2018, at that time 6 people were living at Sunningdale house.

Due to the high level of concerns commissioners reviewed all people they funded. Prior to the inspection 11 people were moved to nursing home provision so that their health and social care needs could be met. From the 26 March 2018 a further 16 people were moved to other care provision.

The service is required to have a registered manager. The registered manager handed in their notice in January 2018. On being informed of the concerns, the provider promptly deployed their operational management team to address the concerns and support the service. On the 3 April 2018 an interim manager was appointed at the service.

Care staff had not received training in safeguarding and had limited or no knowledge about the safeguarding process and how to recognise potential signs of abuse or mistreatment. They were unable to tell us who they would report concerns to outside of the service. A staff member commented “People have been unsafe but we didn’t know. Even the things we thought we were doing right we weren’t.”

Care records were kept electronically and stored securely on computers and laptops. Staff recorded on hand held electronic devices when they had supported people with personal care. The devices were also used to update any monitoring records such as food and fluid charts and repositioning records. All staff were required to record on the devices when they had completed a task which sometimes meant tasks were recorded twice if two staff had been involved in the delivery of care.

Some people’s care plans, were not effectively updated to ensure they were reflective of people's current care needs. Following commissioner’s reviews of people’s care needs, it was evident that some people’s health needs had changed. This meant that people’s health needs had not been reviewed appropriately by the service to ensure they could continue to meet the person’s current health and care needs.

People’s risks were not safely managed at the service. For example, a number of people were at risk of falling out of bed. There was no relevant risk assessment in place or documentary evidence to support how the risks could be minimised to keep the person safe. Consultation with those involved with the person was not evident. Therefore we were not assured that risks had been properly considered and addressed.

The operations manager had developed a new handover system as they were aware that, due to the lack of accurate care plans, staff had limited guidance, information or direction in how to meet people’s needs. The operations manager was aware that this needed to be developed further.

Arrangements for the management of medicines were ineffective. There were some gaps in Medicine Administration Records (MAR) charts. The management of Controlled Drugs (CD) were not robust. This meant that it was not always possible to identify if people had received their medicines as prescribed.

There was no e

Sunningdale House is a residential care home that can accommodate up to 35 older people, some of whom have a diagnosis of dementia. On the day of the inspection there were 34 people using the service.

We carried out this inspection on 3 July 2017. At the last inspection, in April 2015, the service was rated Good. At this inspection we found the service remained Good.

People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. People commented, “Staff are lovely” and “Staff are attentive.” In respect of their experience living at Sunningdale House people told us “It’s a lovely, quiet home. So friendly”, “I never thought I’d end up in a home but this is wonderful” and “It’s all great here, there is nothing they could do better.” Relatives echoed the positive comments from people who lived at the service. Relatives said, “[Person’s name] is cared for by staff that genuinely care. All of the family are happy with the care [person name]) gets. It’s amazing, Staff are always smiling and that makes a difference to [person’s name]” and “My wife is so well looked after. I can go home and not worry as I know she is safe and being cared for by staff that genuinely care.”

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

We saw a number of compliment cards that praised the caring nature of staff. A person using the service wrote. ‘One of the best care homes I’ve ever lived in over my 20 years.’

In talking with staff their caring nature, passion and approach was evident in that people’s care came first. Staff said, “You have to put a little bit of love in everything you do” and “They are my family when I am here.” Staff on their days off “pop” into the service to sit down with people who do not have many visitors to have a cup of tea with them. This showed the commitment and approach that staff had to the people they supported.

Sunningdale House had undergone a major refurbishment. The registered manager had attended a year’s dementia training course. This resulted in changes to the environment so that it met the needs for people who have dementia. This had improved the living environment for people. Sunningdale House used to have one large lounge and a dining room. These had been separated into four lounge/dining areas and each lounge/ dining area was decorated to a theme. The themes were then in keeping with the different stages of dementia. For example, there was a sensory lounge for people who wanted quieter time, and a lounge which was larger and ‘more busy’. Residents were involved in the choosing of the themes and décor of the home. For example, the male residents said they wanted a ‘man’s cave’ so one lounge had been decorated to reflect this. This demonstrated that people were actively involved in how their home would look.

Likewise the corridors in the service had been themed. For example, one person’s interest was fishing, to help them know where their bedroom was the corridor wall of their bedroom door was painted to reflect fishing themes as well as some fishing equipment on display. Key themes about the person’s interests had been written and were on display so that staff and visitors could open conversations with people who may at times be struggling with their memory. This showed that the areas in the service were personalised to reflect the person’s character, tastes and preferences.

The registered manager had found that people used to become anxious around the front lobby of the service. A wall covering has been placed on the lobby doors to represent a book case. People no longer cho

We carried out an inspection visit on 9 September 2013 at which we made compliance actions regarding two areas: respecting and involving people who used the service and records. These are actions a provider must take so that they achieve compliance with the essential standards.

Since the last inspection we received concerns from two people regarding the care and welfare of people, the equipment provided to staff and the management of Sunningdale House.

At this inspection we had only brief, limited conversations with people who lived at Sunningdale, due to people’s care needs at the time of the inspection. We spent time in the communal areas of the home, which allowed us to spend time watching what was happening and see how people spent their time, the type of support they got and whether they had positive experiences.

We saw that the staff were kind and helpful to people who used the service and took time to chat with them in a warm and friendly manner.

We found, from records and discussion with staff and people who used the service, that people’s identified care needs were not always provided. This was in part due to the equipment in the home not being in good working order. Risk assessments had not always been completed to ensure people were safe from hazards.

We spoke with people who lived at Sunningdale and observed how people were cared and supported. We spoke with the provider, area manager, deputy manager, care staff, housekeeping staff and the chef.

We found, people’s privacy, dignity and independence was not always respected.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for in a clean, hygienic environment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We spoke with three people who lived at Sunningdale to seek their views about what it was like to live at Sunningdale. We were told “I like it here and the staff are nice”, “the staff are okay, they are nice to me” and “everybody is kind and helpful and I join in [activities] when I want to”.

We spoke with four visitors who were visiting their relatives at Sunningdale. All were satisfied with the care their relative received and one visitor told us "I know they are looked after well and when I can’t be here I don’t worry”.

We saw the people who lived at Sunningdale were offered choices regarding how they spent their day.

We observed the care staff were attentive to people and spoke with them in a kind, caring and understanding manner. We observed some people who used the service liked to joke with the staff and the staff responded appropriately and respectfully, while having fun.

We found the environment was tidy and decorated well, but there were odours around the building, both in communal areas and in people's own bedrooms. Carpets in the lounges and corridors were stained.

We observed systems in the home did not always ensure the control of infection and reduce the risk to people from cross infection.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The confidential and personal information relating to people who used the service and staff was not stored securely.

We were able to speak to some people who use the service and four relatives. All told us that they were either satisfied or very satisfied with the service that Sunningdale House provided. All said that their individual care needs were met to a ‘good’ or ‘high standard’. All felt that they were involved in planning the care that they need. People who use the service and relatives told us that they felt that if their care needs changed then staff would respond to them.

People who use the service were complimentary about the staff group. Comments received were that staff were ‘kind’, ‘flexible’, ‘approachable’ and “staff give 100%”. No one had any issues about receiving personal care from male or female members of staff. People who use the service appreciated that in the main they had regular carers to assist with their care which meant that they got to know the care staff well, and vice versa. This consistency of care helped to develop a positive working relationship with the person.

In discussions with the people who use the service and their relatives, they could not identify any improvements needed to the service. They told us they had no complaints but could easily raise issues with staff or the registered manager if the need arose.

Sunningdale House questionnaires completed as part of their quality assurance survey showed people using the service, and their representatives were happy with the service and according to the survey, they had not suggested any improvements.

We observed during our visit, staff interacting with people who use the service in a patient and relaxed manner. We saw staff knocking on peoples doors before entering their rooms, speaking to people at their pace and at their level. We saw staff assist people, for example walking around the home, talking to the person and guided them confidently.

Sunningdale House provides care for primarily older people, some of whom have a form of dementia. The home can accommodate up to a maximum of 36 people. On the days of the inspection 34 people were living at the service. Some of the people at the time of our inspection had physical health needs and some mental frailty due to a diagnosis of dementia.

We carried out this unannounced inspection of Sunningdale House on the 28 and 29 April 2015. Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and that their mobility was supported appropriately.

The service is required to have a registered manager and at the time of our inspection there was no registered manager in post. 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 and associated Regulations about how the service is run. The provider reassured us that the registered manager’s post would be advertised and recruited to promptly. During the absence of the registered manger the deputy manager had taken on the responsibility to manage the service.

The manager had not had a sufficient handover of information, and was unclear how long they would remain in this new position. However the manager had commenced reviewing some of the systems in place at the service. Care plans had been updated and reviewed and staff said the care plans were more specific and informed, guided and directed staff in how care was to be provided. This allowed a consistent approach from staff in meeting people’s needs.

The manager identified that staff supervisions and some training needed to be reinstated and had started a programme to do this. Dementia care training had not occurred for some staff and this would support staff to care for people with dementia at the service.

The provider had a quality assurance service to assess and monitor the quality of service that people received. The manager was aware that the service had a quality assurance system in place however she was not able to find the quality assurance documentation. Some audits took place at the service and were monitored to identify if any further action was needed. The audits included medicines, refrigeration temperatures for both food and medicines fridges, and maintenance of the service. Further audits were carried out in line with policies and procedures. For example we saw fire tests were carried out weekly and emergency lighting was tested monthly.

People told us they felt safe living at Sunningdale house. Relatives told us they felt their family member was cared for safely. One commented: “Safe, absolutely” Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People told us staff were; “Kind,” “Caring,” “Marvellous” and “They really look after me well”. They told us they were completely satisfied with the care provided and the manner in which it was given. One relative told us they found staff to have: “Great skill.” A healthcare professional commented staff were: “Competent and professional.”

We found that there were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs during the day and at night. On the first day of our visit we discussed staffing levels, particularly around lunch time. The manager reviewed people’s dependency needs and the following day had permanently increased staffing levels at this time. One person told us: “When I press my buzzer there is some waiting, but some people need a lot of help.” People felt overall staff were “busy” but responded to their needs. Relatives commented staff were always available if they had any queries at any time.

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person so that they could; “Really get to know them, their likes, dislikes, interests they wanted to know all about their life.” Relatives felt this gave staff a better understanding of their family member and how they could care for them. People chose how to spend their day and a range of activities were provided. Visitors told us they were always made welcome and were able to visit at any time.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the service involved family and relevant professionals to ensure decisions were made in the person’s best interests. The manager had made applications to the Deprivation of Liberty Safeguards team but stated that more guidance for her and the staff in this area would be beneficial.

Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all staff. People and relatives told us they were invited and attended care plan review meetings and found these meetings beneficial.

People told us staff were very caring and looked after them well. People told us; “Staff are lovely.” We saw staff provided care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a good knowledge of the people they supported.

Peoples' privacy, dignity and independence were respected by staff. At this visit we undertook direct observations using the SOFI tool to see how people were cared for by staff. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw examples of kindness, patience and empathy from staff to people who lived at the service.

The service’s complaint procedure provided people with information on how to make a complaint. The policy outlined the timescales within which complaints would be acknowledged, investigated and responded to. It also included contact details for the Care Quality Commission, the local social services department, the police and the ombudsman so people were able to take their grievance further if they wished. People and relatives told us they had; “No cause to make any complaints” and if they had any issues they felt able to address them with the management team.