Sunnybank House is a care home. People in care homes receive accommodation and their 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. Sunnybank House provides accommodation for up to 60 older people. The accommodation is arranged over three units. Rose unit is on the ground floor and provides residential care for people with less complex needs. Dahlia unit is on the first floor and cares for people living with dementia. Nemisia unit is on the upper floor and provides nursing care for people with more complex needs. At the time of the inspection there were 47 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

Our last inspection had identified concerns regarding the safe and proper management of medicines. This inspection found that overall the required improvements had been made and the legal requirements were now being met.

We did however identify some new concerns.

There had been a failure to assess and mitigate risks to some people.

Improvements were needed to the management and governance arrangements in the service. There were instances where the safety and quality of the service had been compromised. Staff were not always following risk management plans and were not clear on their roles and responsibilities. Staff lacked understanding on the accountability for decision making.

Staff had not always been deployed in a safe manner and the high use of agency workers had impacted upon the continuity of care people received.

Some of the records relating to people’s care and support could still be improved. For example, daily records did not consistently show that people’s care was being delivered in line with their care plan.

The service were making improvements to ensure that staff were always acting in line with the Mental Capacity Act 2005 and relevant guidance.

Environmental risks were managed.

Recruitment practices were safe and relevant checks had been completed before staff worked in the service unsupervised.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

Each of the people we spoke with felt that the home was clean. Throughout our visit, we did not find any malodours and we observed that staff used appropriate personal protective equipment (PPE).

Improvements to the induction of new staff and with the supervision programme were being embedded. Staff had completed a range of training.

People were mostly positive about the food. A selection of hot and cold drinks was available throughout the day.

A range of healthcare professionals including GP’s, community mental health nurses, occupational therapists and physiotherapists had been involved in planning peoples support to ensure their health care needs were met.

Overall the design and layout of the premises met people’s needs.

People were cared for by kind and compassionate staff. It was clear that the permanent staff and the longer-term agency staff had developed meaningful relationships with people.

People were encouraged and supported to make decisions about their care and support and staff tried to promote people’s independence wherever possible.

People were treated with dignity and respect.

Care plans recorded people’s individual preferences and the permanent staff and longer-term agency staff knew people well.

Improvements were being made to the activities programme provided.

Information about how to complain was readily available within the service and the provider maintaine

This inspection took place on 01 and 07 March 2017 and was unannounced. The home provides accommodation for up to 60 older people. There were 48 people living at the home when we visited, some of whom were living with dementia and some of whom required nursing care. The home was organised over three floors, with one floor dedicated to people living with dementia and one floor designated for people who required nursing care.

A registered manager was not in post at the time of our inspection. 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 service had appointed a new manager whose intention it was to register with CQC. However, the home had had numerous changes in management over the past two years. People and staff felt the frequent changes in management had a negative effect on the quality and running of the home.

The manager had identified areas for improvement within the service and was working towards completing an action plan, which identified where changes were required. People and staff spoke positively about the initial changes the manager had made to the running of the home. The manager had recently implemented a series of cyclical audits, which would monitor and assess the quality of the care and the safety of the home. The improvements needed to be embedded and sustained to ensure people received high quality care over an prolonged period of time.

Systems to safely manage people’s medicines were not always effective. People did not always receive their medicines as prescribed and recordings of medicines given were not always accurate. The manager had made changes to the home’s medicines management system, which had resulted in improvements being made in these areas; however, improvements were in the initial stages and could not be evidenced as sustained.

People’s care plans did not always reflect people’s most up to date needs. The manager had identified these issues and assigned staff to complete the areas which were outstanding. The manager had also arranged for staff to complete training which gave them knowledge and skills in effective care planning. People’s care plans which were completed were detailed; person centred and met people’s needs. Risks to people were identified and incidents were analysed to look for ways to reduce future risks and likelihood of reoccurrence.

People were supported to access healthcare services and were supported to follow a diet in line with their preference and dietary requirements.

The provider had not implemented systems and processes to gain formal feedback from people using the service or their relatives. A questionnaire was due to be sent out to people asking for their feedback about the quality of the care being provided, but the provider was unable to locate the results of any previous feedback sought. A complaints policy was in place, which the manager followed. Records of investigations were thorough and transparent, with lessons learnt from mistakes and people fed back to about findings.

There were sufficient numbers of staff available to support people. However, there were shortages of permanent staff, which meant that agency staff were required to complete full staff allocation. People, relatives and staff felt that agency staff did not always provide effective and compassionate care. The provider was in the process of recruiting additional permanent staff.

Permanent staff were caring and understood people’s needs well. Staff had received training in safeguarding and understood the steps required in order to keep people safe. Staff had also received training in The Mental Capacity Act (2005) and understood how to promote and respect people’s rights.

We identified a breac

This inspection took place on the 9 November 2015 and was unannounced. The home provides accommodation for up to 60 people, including people living with nursing, dementia and mental health care needs. There were 45 people living at the home when we visited, but two of those were in hospital.

Sunnybank House is a purpose built home which is spread out over three floors. The top floor was for people who required nursing care, the middle floor for people living with dementia but did not yet require nursing care and the ground floor was for people who required residential care.

There was a new manager in post who was in the process of applying to become registered with CQC. 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.

Arrangements to manage medicines safely were not robust. For three days one person was not given their medicine as they were asleep. The service had not recorded whether any attempts had been made to give the medicine at a different time.

The infection control practices in the home put people at risk of cross infection. The provider had not taken adequate precautions to ensure infection control practices were safe and measures put into place to minimise the spread of infection. We found the clinical waste areas were not secure and bags of waste were left on the floor and on top of overflowing bins. This was identified to the manager, who took immediate action.

We found accident and incidents were recorded, action had been taken to reduce the risk of recurrence. There were appropriate risk assessments in place, but people were put at risks where store cupboards containing hazardous items were left unlocked.

Staff were supported through formal supervision, were able to approach the manager with any concerns and felt they would be acted on. The home had adequate staffing levels and all new starters had completed a training programme during their induction. All staff had completed updates in dementia training and safeguarding adults training in accordance with the provider’s policy. Staff were also able to identify different types of abuse and what actions they would take.

Assessments of people’s needs were completed. Care plans had been developed to identify the care and support people required and how to meet those needs. People’s healthcare was managed appropriately and specialist advice sought when required.

People’s needs were reviewed regularly. If the reviewed identified a need for nursing care, then a discussion was held with the person (if possible) and their family members.

People were treated with privacy and dignity at all times. Staff kept relatives informed of any changes in people’s health.

Consent documents within the people’s care files, had not always been completed and a decision had not been made by staff to show that the care and support planned was in their best interests. Staff sought verbal consent from people before providing care or support and were able to explain the principles of the Mental Capacity Act, 2005 (MCA).

There were systems in place for monitoring the quality of the service provision and regular audits were completed. The service had a system in place for responding to complaints. Complaints were recorded along with information about the investigation and outcome as well as any feedback which had been provided.