About the service:

Sunhill Court Nursing Home is a ‘care home.' Sunhill Court Nursing Home accommodates 40 people in one adapted building. At the time of this inspection 37 people lived at the home. People were supported who lived with different long-term conditions. Most people at the home lived with dementia. The home also supported people with diabetes and Parkinson's disease.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

People were not always kept safe from avoidable harm. Diabetes management and the management of medicines were not always safe.

Other risks to people were assessed, although lacked personalised detail for each person living at the home.

People enjoyed meals that appeared appetising, varied and of their choosing. The mealtime experience was not rushed and there were enough staff to support people’s individual needs.

People had access to healthcare support outside of the home. Although the timeliness of this was being addressed by the home and procedures were being implemented to ensure that these services were followed up by the home promptly.

Staff were seen to be very caring and compassionate towards people. People received appropriate emotional support from staff who knew them well. Agency staff were sometimes used to cover shifts at the home. The electronic records for people did not always provide sufficient person-centred details about their needs. This was being explored and improved by the home’s registered manager.

People were not always fully supported to have maximum choice and control of their lives. Staff aimed to support people in the least restrictive way possible; the policies and systems in the service supported this practice. However, people’s ability to make choices in their best interests was not always reviewed appropriately when their ability to do this changed. Staff ensured that they asked people for their consent before they supported them with any activities of daily living.

Staff had some basic understanding of the Mental Capacity Act [2005] and Deprivation of Liberty Safeguards [DoLS], but records for people were not always updated to reflect when their needs had changed regarding their ability to make decisions for themselves.

Safeguarding reporting procedures were understood by staff on a basic level. Staff had access on their hand-held devices that enabled them to find out information about how to report safeguarding concerns should this be required.

However, staff did not always receive sufficient training to enable them to fully understand the individual and specific needs of people they supported at the home. Such as diabetes care.

People were supported with individual, stimulating and engaging activities which were led by a highly motivated and dedicated activities coordinator. The home had linked up with a local children’s nursery and had participated in ‘intergenerational’ activities which involved four people visiting the nursery to enjoy activities with the children. This was very beneficial to all involved.

People had access to the complaints procedure. A board containing ‘you said, we did’ information was displayed in the communal lounge area. This showed actions the provider had taken to respond to people’s feedback. The provider understood the duty of candour process.

People were supported at the end of their lives to receive dignified, pain free care. The registered manager had completed detailed training with a local hospice which enabled them to identify and meet people’s needs at the end of their lives. Relatives felt supported and involved when their loved ones passed away.

The home was not always well managed. Systems and processes were not always effective and had not always identified some areas of concern regarding medicines management and diabetes care.

Rating at last inspection:

The service was rated as ‘Good’ at our last inspection

The inspection took place on 18 April 2017 and was unannounced.

Sunhill Court Nursing Home provides nursing care for up to 40 older people with dementia care needs and/or mental health needs. At the time of our inspection, there were 32 people living at the home. Sunhill Court Nursing Home is a large Edwardian building on the outskirts of Worthing and overlooks the South Downs. There are several communal areas – a large lounge, dining area and conservatory on the ground floor and a smaller lounge on the first floor. A passenger lift provides access between the floors. On the ground floor is a private room which is used when the hairdresser visits on a weekly basis. We also observed other seating areas along the hallways where people could rest and where dementia friendly activities were placed for people to engage in. People have their own rooms and have access to a large garden at the rear of the property.

There was a registered manager in post. 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. The registered manager was not available on the day of the inspection. The operations director made themselves available to assist with the inspection.

The last inspection took place on 24 and 26 February 2016. As a result of this inspection, we found systems and processes had not been established to prevent abuse of service users. This was a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had rated the service as Requires Improvement overall, because although significant improvements had been made to address previous shortfalls raised at the inspection in June 2015, where the service was rated as Inadequate, these improvements were yet to be embedded and sustained. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider had met all the legal requirements.

People were cared of by staff who understood the importance of making sure they were safe and protected from harm. People were protected against the risk of abuse; staff had a good understanding of how to recognise abuse and what action they should take if they suspected it had taken place. Staff demonstrated they were clear about how to report any concerns. The service had systems in place to notify the relevant authorities when concerns were identified. Staff were confident that any allegations made would be fully investigated to ensure people were protected. People and their relatives said they would speak with staff if they had any concerns and seemed happy to go over to staff and indicate if they needed any assistance. We observed staff to be vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia.

Systems were in place to identify risks and protect people from harm. Care records contained guidance and information to staff on how to support people safely and mitigate risks. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. Accidents and incidents were accurately recorded and were assessed to identify patterns and trends. Records were detailed and referred to actions taken following accidents and incidents.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

The

The inspection took place on 24 and 26 February 2016 and was unannounced.

Sunhill Court Nursing Home provides nursing care for up to 40 older people with dementia care needs and/or mental health needs. At the time of our inspection, there were 34 people living at the home. Sunhill Court Nursing Home is a large Edwardian building on the outskirts of Worthing and overlooks the South Downs. There are several communal areas – a large lounge, dining area and conservatory on the ground floor and a smaller lounge on the first floor. People have their own rooms and have access to a large garden at the rear of the property.

There was a registered manager in post. 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.

The last inspection took place on 30 June 2015. As a result of this inspection, we issued five Warning Notices in August 2015. We asked the provider to take action to address areas of concern relating to safe care and treatment, nutritional and hydration needs, good governance, dignity and respect and staffing. The provider was required to take appropriate action to meet these Warning Notices by 18 September 2015. In addition, we found the provider in breach of a number of regulations and asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken, the majority of which would be completed by the end of September 2015. At this inspection we found that the provider and registered manager had taken appropriate action to meet the Warning Notices and were now meeting required standards. However, we identified that further time and action was necessary to ensure the improvements continued and were embedded consistently into staff practice.

Some staff did not have a good understanding of safeguarding and how to protect people from the risk of abuse. Other staff were able to explain the different types of abuse and what action they would need to take. The provider had failed to alert the local safeguarding authority to a series of incidents that had occurred and had failed to notify the Commission.

Risks to people were identified and assessed appropriately. Care records contained guidance and information to staff on how to support people safely and mitigate risks. Medicines were managed appropriately, although the refrigerator did not work effectively and the packaging of some medicines was damp.

There were sufficient staff in place to meet people’s needs, although a dependency tool employed by the provider to assess staffing levels based on people’s needs, was out of date. There had been a high turnover of staff in recent months and there was a heavy reliance on agency staff, especially registered nurses, to ensure staffing levels were safe. Robust recruitment practices ensured that new staff were vetted appropriately and checks were undertaken to confirm they were safe to work in a caring profession.

Improvements had been made to staff training and opportunities were available to staff. However, not all staff had completed the mandatory training and attendance by staff at training sessions was not consistently high, so some staff were not up to date with their training in specific areas. Staff received formal supervision and annual appraisals from their managers. Some staff, who did not have English as a first language, were unable to communicate effectively and people living with dementia may have found it difficult to understand them. All staff had a good understanding of the implications and requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards.

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The inspection took place on 30 June 2015 and was unannounced.

Sunhill Court Nursing Home provides nursing care for up to 40 older people with dementia care needs and/or mental health needs. At the time of our inspection, there were 39 people living at the home. Sunhill Court Nursing Home is a large Edwardian building on the outskirts of Worthing which overlooks the South Downs. There are several communal areas – a large lounge, dining area and conservatory on the ground floor and a smaller lounge on the first floor. People have their own rooms and have access to a large garden at the rear of the property.

There was a registered manager in post. 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.

Risks to people were not identified or assessed adequately to prevent them from harm. Carpeting which had lifted away from the floor in one area posed a trip hazard to people. There was a lack of ventilation in the conservatory during the hot weather. Care staff were observed drag lifting one person rather than using a hoist. Staff were not fully conversant with the requirements of local safeguarding procedures and requirements. Accidents and incidents were not used to update people’s care plans. Monitoring of one person’s pressure ulcers was inadequate. There was a lack of suitable staff to keep people safe at all times and meet their needs. People did not always have access to their call bells when they wanted to summon help. Medication Administration Record (MAR) charts showed a large number of omissions where staff had not signed to say people had received their medicines. Medicines were not stored, audited or managed safely. However, people told us they felt safe.

Staff did not receive adequate supervision or appraisals and were not asked for their feedback. Not all staff had received the training they needed to meet people’s needs effectively. The majority of staff did not have English as a first language and workbooks were supplied in English. There were no systems in place to identify specific training needs to ensure that staff were able to meet people’s needs overall. Staff had no understanding of person-centred care. Consent to care and treatment was not always sought in line with legislation and staff had a limited understanding of the requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards. People were not assessed on their capacity to make decisions. People were not always supported to have sufficient to eat and drink and to maintain a healthy diet. People did have access to healthcare services and professionals when needed. The physical environment of the home was not always conducive to people who lived with dementia.

Some care staff treated people with kindness and understanding, whilst other staff were more task orientated. People were not always treated with dignity and respect and there was a lack of empathy from some staff. People and relatives thought staff were kind and caring and that they were looked after well.

Care plans did not record people’s life histories, their hobbies or interests. There was a lack of activities organised that reflected people’s preferences. Mental stimulation was limited and some people were sitting idly or distressed. People were not always responded to or supported in a positive manner by care staff. Complaints were logged, but were poorly managed, with no recorded evidence to show how they had been responded to.

Quality assurance and governance systems were not fit for purpose. The provider had failed to identify areas of concern such as gaps in medication records. There was no robust system in place to drive continuous improvement and a lack of good management and leadership. Staff were unsure of what was expected of them. Residents’ meetings were held monthly and relatives were asked for their views about the home.

We found a number of 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve;
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We spoke with ten people who used the service and one relative. We also spoke with four staff members, the manager and the provider.

The majority of people we spoke with were happy with the care they received and found staff to be kind and accommodating. Not everyone was able to comment on their level of consent but some people indicated that they were given choices and that staff listened to them. We found that people's care was planned and delivered in line with their needs.

We found that people's medicines were stored and administered safely. The service had systems in place for ordering medication and destroying unused drugs. People's medicines were administered as prescribed by trained members of staff.

We found that staff received appropriate training and support. Nursing staff maintained their professional registration and all staff received mandatory training updates. Staff also had supervision meetings, appraisals and spot checks to help ensure their work was of a good standard.

The service had systems in place to monitor their own quality. If issues or complaints were raised, the service took clear action to improve the service and learn from incidents.

We spoke with five people living in the home and three relatives. People expressed a high satisfaction with the care they received and with the staff who supported them. People living in the home described the staff as "very good," "amazing," "caring," and "very kind." People told us they had choices in how they spent their days and said they felt safe living there. One person said, "I'm very happy indeed . . . I don't want to move from here." Another person commented, "I'm quite happy with it."

A relative told us the staff treated their family member "as an individual" and remarked that the family "could see the difference, she was relaxed." Another relative said, "We think it's wonderful. We are lucky, very lucky." A further relative commented that their relative was "much safer now than she was in the community." They added that their relative "Still has choices and quality of life."

We found that people were treated with respect and dignity. People and relatives were involved in discussions about people's care. People living in the home were protected from the risk of abuse or neglect. We found there was enough qualified and skilled staff who had received training and support. There were procedures to capture complaints, concerns, or comments and people felt confident to raise any issues with the staff. We found that the home had not followed vetting procedures which meant that some members of staff had incomplete checks prior to starting employment.