This inspection took place on 4 January 2017 and was unannounced. When we last visited the home on 18 March 2016 we found the service was not meeting all the regulations we looked at. We found that risk assessments were not comprehensive and did not show how the risks to people addressed. The provider had also not notified us regarding the outcomes of Deprivation of Liberty Safeguards (DoLS) applications. Following the inspection the provider sent us an action plan telling us how they would address this.

Sunbridge is a service for older people who require assistance with personal care. Sunbridge is registered to provide accommodation to a maximum of 43 people some of who may have dementia. There were 41 people using the service on the day of our inspection.

The home had a registered manager. 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 and staff told us that there had recently been times when there were not enough staff available to meet people's needs as staff shortages had not been covered. We saw that staff were not always available to meet people's needs and were rushed when assisting people at lunch time. The staff rota showed that there had been occasions when there had been shortages of staff.

Systems were in place to ensure that people received their medicines safely, and as prescribed. However, we identified areas where the provider needed to make improvements to the recording of the administration of creams and how regularly controlled drugs were monitored.

People were confident that their concerns would be addressed as the provider had procedures for detecting and protecting people against the risks of abuse. People told the felt safe and they knew how to raise concerns about their care. Staff understood what abuse was and how they should respond to an allegation of abuse.

Risk assessments identified the risks to people associated with receiving care and appropriate actions had been identified to mitigate these risks. Staff had the training and support they needed to meet people's needs.

People were supported to engage in activities met their needs. Activities had been developed to support people living with dementia.

People were treated with dignity and respect. People and relatives told us that were kind and responded to their needs. People were able to spend time alone if they choose to, as staff respected their privacy.

Care plans were person centred and care was delivered so that people's preferences and needs were met. Care plans included life histories and information about people's interests. People were supported to practice their culture and religious beliefs.

People and relatives told us they knew how to make a complaint and were confident that the provider would respond appropriately to any concerns they raised. Complaints had been investigated and where necessary action had been taken to so that the issues in complaints had been addressed.

People told us that staff always sought their consent before providing care. Where people were not able to consent to their care and treatment the provider had carried out best interest assessments and when necessary applied for a DoLS. Staff could explain when best interest decisions were needed. Staff had training and understood the process for applying for DoLS.

People, relatives and staff told us that the registered manager was approachable. The provider had sought the views of people who used the service and their relatives and action had been taken to respond to any suggestions they had made. The registered manager carried out regular audits of the service. Action taken to address issues highlighted in these audits to make sure that quality of care wa

This inspection took place over two days 18 March 2016 and 29 March 2016 and was unannounced. When we last visited the home on 10 July 2014 we found the service was not meeting all the regulations we looked at. We found that people were not always protected from the risk of unsafe administration of medicines and were not maintaining people’s privacy, dignity and independence. The provider sent us an action plan telling us how they would address this.

Sunbridge is a service for older people who are in need of personal care. Sunbridge provides accommodation to a maximum of 43 people some of who may have dementia.

The home did not have a registered manager. However, an interim manager was in place and was present during our inspection. A new manager has been appointed and is in the process of registering with the Care Quality Commission as a registered manager. 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.

We found a number of breaches of regulations at this inspection. Risk prevention plans had not been developed to address the risks that had been identified to people’s safety. The provider had not told us about some important changes to the care and support provided to people who used the service.

People were treated with dignity and respect. There was an accessible complaints policy which the interim manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt confident to express any concerns, so these could be addressed.

People were kept safe from the risk of abuse. Staff understood people’s rights to make choices about their care and the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed. Sufficient staff were available and they had the necessary training to meet people's needs. Staff responded to people’s needs promptly.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People using the service, relatives and staff said the interim manager was approachable and supportive.

At this inspection there were breaches of regulations in relation to the need for safe care and treatment, and notification of other incidents. You can see what action we told the provider to take at the back of the full version of the report.

Sunbridge is situated in a residential area of Edmonton. It provides care home accommodation (without nursing) in purpose-built premises for up to 43 people, many of whom live with dementia. Most of the people who use the service are long stay residents, but the home also offers respite care.

We found an enthusiastic and motivated management team and, with some exceptions, a care team in need of more support and guidance. The new manager was determined to set high standards, but these had not filtered through to all care staff at the time of our inspection. There had been a high turnover of managers in the two years prior to this inspection.  A real strength of the home was the presence of a number of people who used the service with plenty of ideas to contribute.

The provider was not effective in maintaining people’s privacy, dignity and independence. Therefore we found the home to be in breach of Regulation 17(1)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.  You can see what action we told the provider to take at the back of the full version of this report. A recurring theme during the inspection was that people were bored, they did not have enough to do and some people did not receive enough support to engage with activities or other people in a positive way.  People who used the service believed that many staff were tired and stressed and this impacted on their ability to care.

People told us that their possessions kept going missing or being re-arranged. They thought this was mainly due to people living with dementia accessing other people’s bedrooms. The staff we spoke with acknowledged that this could be a problem. As a result, there was sometimes friction between those living with dementia and other people resident in the home.

There was understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had been appropriately applied for and implemented for one person. We found the home met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted in this area.

Some aspects of medicines administration were carried out satisfactorily, however, we found inconsistencies in staff practice. The number and frequency of these inconsistencies led us to find the home in breach of Regulation 13 in relation to medicines. You can see what action we told the provider to take at the back of the full version of this report.

People were promptly assessed for admission to the home when a referral was received. Care plans and risk assessments were in place, but we identified some inconsistencies and omissions. Food and fluid charts were completed to a high standard.

We found that there were good systems in place for management oversight of the home. This meant that the management team was aware of many of the issues we identified and they were already taking steps to address some of them.

People's needs were assessed and support was delivered to meet their individual needs. People said that they received the care and support they needed. A typical comment was, "I feel well cared for here.” There were effective systems in place to reduce the risk and spread of infection. We observed that the home was clean. We saw staff carrying out cleaning around the home. People told us that the home was kept clean. One person said, "the home is always clean."

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form, interviews and references being taken up from their former employers. People felt that staff knew how to meet their needs. We saw that staff understood people’s needs.

People told us and we observed that they felt that staff listened to them. Staff responded to any suggestions they made about the service. Regular audits had been carried out covering a range of areas such as infection control, medications management and care planning. These showed that the quality of service provision was assessed and monitored. Where issues were identified improvements were made.

We used a number of different methods to help us understand the experiences of people using this service. We talked to staff and looked at storage and record keeping of medication.

We met one person who was staying for a short stay and he said that careworkers always brought his medicines to him on time. He said he did not know the names of the medicines but knew why they were needed.

People said that they received the care and support they needed. We observed that when care staff were working with people with dementia they did not engage with them. Therefore people who have dementia may not receive the support they need to maintain their well-being.

People said they liked the food. A person said, “The food is nice.” Staff were available to meet the individual needs of people. A person said, "The staff are always helpful.” Enough staff were available to meet the needs of people.

People told us that they felt confident to raise concerns or complaints about the home with staff. However, people and relatives did not know the procedure to do this formally. This could mean that people's complaints may not be fully addressed.

The seven people spoken with told us that staff involved them in decisions about care and treatment. One person said about the staff, “they treat me fine”. Another person told us, "there's a choice of meals." We observed that people were offered a choice of meals at lunch.

We observed medicines given to five people and saw that the care worker was professional and patient and explained the medicines that they were giving. People said to us that staff were available to help them. We observed that enough staff were available to meet people’s needs.

People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals. Staff we spoke with had a good understanding of the importance of keeping records safe and secure.