Sunningdale is situated to the east of the city of Hull, near to public transport facilities and there are local shops within walking distance. The service is registered to provide accommodation and personal care for a maximum of 49 people, some of whom may have nursing needs and be living with dementia. All the rooms are for single occupancy. There are sufficient communal areas, bathrooms and toilets on both floors. There is an accessible garden and car parking at the front and rear of the building.

At the last comprehensive inspection on 7 and 8 October 2015 we found the registered provider was in breach of one of the regulations we assessed regarding the management of medicines. The service was rated ‘Requires Improvement overall.’ We undertook a focused inspection on 12 February 2016 to check the registered provider had made improvements and found they met legal requirements.

During this comprehensive inspection on the 24 April 2017, we found improvements had been made in three of the questions we ask about services and have changed the rating for the questions –Is the service ‘Safe’, ‘Effective’ and ‘Well-led?’ to Good. We have kept the rating for ‘Responsive’ and ‘Caring’ as Good. The overall rating for the service has improved and changed to ‘Good’. At the time of the inspection there were a total of 44 people living in Sunningdale.

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.

People felt safe at the service. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people from harm. Accidents and incidents were managed appropriately by the service and reviewed regularly by the senior management team. The premises were well maintained. Checks of equipment had been completed.

Recruitment processes were thorough and helped the registered provider make safer recruitment decisions when employing new staff. The recruitment of more qualified staff had improved the consistency of care support and staff morale. Staff were deployed in suitable numbers to meet the assessed needs of the people who used the service.

Overall, we found the improvements in medicines management had been sustained. People’s medicines were stored safely and administered as prescribed. A recent shortfall in stock control had been addressed and ordering procedures had been reviewed and strengthened.

People were supported by staff who had been trained to carry out their roles effectively. Staff told us they felt supported by the registered manager and confirmed they had received formal supervision and appraisal from their line manager.

We found communication systems were more effective. Information was shared at regular staff, resident and managers meetings.

Consent was gained before care and support was delivered and the principles of the Mental Capacity Act were followed within the service.

Staff worked closely with health and social care professionals to ensure people were supported to maintain good health. People received a well-balanced diet that offered variety and choice. People liked the meals provided to them and their nutritional needs were met.

People told us they were supported by kind and caring staff who knew their preferences for how care and support should be delivered. During observations it was clear caring relationships had been developed between the people who used the service and staff. People’s privacy and dignity was respected by staff who encouraged them to be independent and make choices and decisions in their daily lives. Private and sensitive information was stored confidentially.

People were involved with the initial asses

We carried out an unannounced comprehensive inspection of this service on 7 and 8 October 2015. A breach of legal requirements was found regarding the management of medicines; we issued a warning notice and the registered provider had to be compliant with this by 20 November 2015. We undertook this focused inspection on 12 February 2016 to check the registered provider had made improvements and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sunningdale on our website at www.cqc.org.uk.

The findings from this inspection did not affect the overall rating of the service, which was ‘Requires Improvement’; it also did not affect the rating of the specific question ‘Is the service Safe’ which was also ‘Requires Improvement’ at the last inspection. This is because we want to make sure improvements are sustained over a period of time and we will check this out again at the next full comprehensive inspection. Just prior to the inspection we were notified by the local safeguarding team that they had received information of concern about pressure area care for three people who used the service and a bed rail issue for another person. A safeguarding officer accompanied us on the inspection to check this out.

Sunningdale is situated to the east of the city of Hull, near to public transport facilities and there are local shops within walking distance. The service is registered to provide accommodation and personal care for a maximum of 49 people some of whom may be living with dementia. All the rooms are for single occupancy. There are sufficient communal areas, bathrooms and toilets on both floors. There is an accessible garden and car parking at the front and rear of the building.

The service has 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 there were improvements in the management of medicines. People who used the service received their medicines as prescribed. We found medicines were obtained in a timely way, they were stored securely and stock control was managed effectively. The recording of medicines had also improved. We observed medicines were signed for when they were received into the service and when they were administered to people.

The safeguarding officer found the records of one person who used the service did not indicate pressure relief had been carried out during the night. Staff had recorded the person was asleep and comfortable. However, the district nursing team had requested two hourly turns day and night for the person to help in the treatment of a sore area. The registered manager is to meet with the district nursing team to discuss options for the person. The safeguarding officer found there were no concerns with the three other people mentioned in the initial alert and appropriate action had been taken to meet their needs.

During the inspection visit we completed a tour of the home with the administration manager. We found that individual bedrooms and communal areas were clean and free from any malodours.

Suitable hand wash facilities, paper towels and pedal bins were available in all bathroom and toilet areas. All hand washing facilities had posters available for staff to follow on good hand washing techniques.

The administration manager told us, ”We have hand hygiene training booked for 16 October 2013 and as many staff as possible will be attending the training.”

We spoke with eight people who used the service and five relatives. We also spoke to six staff, the maintenance manager, the cook and the manager.

A relative told us, “The staff are nice and friendly and seemed to want to help and I do not have any complaints about the level of care my relative receives.”

A person who used the service told us that “I can have a good laugh and rapport with the staff and I can say what I like to them” and “I feel safe here and I don’t want to go from here as I have been here from the beginning and staff always ask me if I am comfortable or need any personal care.”

We spoke to relatives of people who used the service who told us they were happy with the way the food was being served in terms of portions and that the staff preserved the dignity of people when assisting at mealtimes.

The overall building maintenance was kept to a high standard and the grounds outside were sufficiently well kept to offer outdoor activity to existing people who used the service and their relatives.

Records showed that there were annual checks on gas, fire and electrical fittings.

Staff commented that they feel that they have enough time to do their job. Another staff member commented, “Everyday is different and we all work as a team and get the job done as it needs to.”

We looked at records to confirm that the home had systems in place to monitor staff, resident and relative comments and concerns.

People who lived in the home told us they felt supported in their every day needs and were involved in making decisions about their care. They also told us they knew how to make a suggestion or make a complaint. Comments included, "Staff work really hard here and all credit to them" and "My room and choice of food is really good and I am lucky being in a place like this."

People told us they felt safe in the home. They also said they liked their room and the home was clean and tidy. During our visit we also spoke with visiting relatives who confirmed the home offered excellent care and support for their relatives. A relative commented that, "The family feels that our mother is safe here" and "My mother is in a bigger room and it is personalised to her choice." Relatives also told us that, "Staff are always helpful and I visit my mother every day and when I couldn't visit due to me being ill, the staff called me to see if I was ok."

We saw from documentation that people had their needs assessed and were involved in the planning of their care. We looked at staff appraisal and training records which showed us that not all staff had undertaken an appraisal to ensure that staff training and development needs were assessed.

Sunningdale is situated to the east of the city of Hull, near to public transport facilities and there are local shops within walking distance. The service is registered to provide accommodation and personal care for a maximum of 49 people some of whom may be living with dementia. All the rooms are for single occupancy. There are sufficient communal areas, bathrooms and toilets on both floors. There is an accessible garden and car parking at the front and rear of the building.

The service has 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 undertook this unannounced inspection on the 7 and 8 October 2015. At the last inspection on 3 December 2014, the registered provider was non-compliant in the safe management of medicines and records. We issued compliance actions for these areas and received an action plan which told us what the registered provider was going to do to address these issues.

We found there were improvements in records but an on-going concern with the management of medicines. Some people had not received their medicines as prescribed. Although we could not see there was a direct impact on the people who used the service, for example, there had been no complaints that people had been left in pain, there was the potential for this. You can see what action we told the registered provider to take at the back of the full version of the report.

We found the quality monitoring system, for example audits regarding medicines had not been wholly effective. It had not identified or, when they had been identified had not addressed, errors in medicine management. We also found some issues in how information was communicated to staff and how they worked together as a team in periods of high need.

We found staff were recruited safely and were employed in sufficient numbers to meet people’s needs, although there were still shortfalls in nursing staff which were currently filled by agency nurses. Recruitment was continuing for permanent nursing staff. We found there had been some instances when the deployment of staff at peak times could have been managed more effectively. This was mentioned to the registered manager to address.

We found there were policies and procedures to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to report concerns. Risk assessments were completed to guide staff in how to minimise risk and potential harm.

Staff had access to induction, training, supervision and appraisal to help them develop their skills. There had been an incident reported to the Care Quality Commission of staff not adhering to training and policies and procedures regarding moving and handling and infection prevention and control. The registered manager was dealing with this with the individual staff involved.

We found people’s nutritional needs were met and menus were varied. The food provided to people was well-presented and in good portions.

People had their health needs met and received additional treatment and advice from a range of health care professionals in the community.

People were treated with respect and supported to make their own decisions and choices. When they had been assessed as lacking capacity to make their own decisions, staff acted within the law and held best interest meetings with relevant people present. We observed staff support people and their relatives in a kind and compassionate way. There was a range of activities for people to participate in and links had been made with the local community.

People felt able to make complaints. There was a policy and procedure to guide staff.

We found the environment was suitable for people’s needs and was clean and tidy.