About the service: Sunnycroft is a residential care home that was providing personal care to 35 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

¿ Risk assessments were not always individualised. However, people said they felt safe living in the home.

¿ There were no assessments of people’s mental capacity when they needed support with making decisions.

¿ People were supported to access healthcare professionals, however care plans were not always updated with their more relevant information and recommendations.

¿There was limited oversight of the daily records of people’s care. Staff had not always recorded people’s food accurately, and what care they had received.

¿ Care staff did not always uphold people’s dignity, but people we spoke with told us they felt staff respected their privacy.

¿ There were enough staff to meet people’s needs.

¿ Medicines were stored and recorded safely, and administered as prescribed.

¿ There was a choice of meals on offer which people said they enjoyed.

¿ There was a range of activities on offer and people were engaged in hobbies and interests as much as possible.

¿ People were involved in their care and consulted appropriately.

¿ The staff team worked well together and communicated about people’s needs.

¿ Although there were some improvements since our last inspection, for example in the oversight of cleanliness and personalised care, there were other areas which required further work to achieve an overall rating of Good.

Rating at last inspection: Requires Improvement (published 12 March 2018). This service has been rated Requires Improvement at the last two inspections. At the last inspection, there were three continued breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected: Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. They sent us an action plan with this information, and we met with the providers to discuss our concerns about the home.

Enforcement: Following the last inspection, we took action to impose conditions on the provider’s registration which meant they were required to send us regular updates about their oversight of particular areas of service provision. This included infection control and person-cenred care. We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. They provided this to us, and whilst we noted some areas had improved since our last inspection, we found some areas had not improved sufficiently.

Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor the service according to our schedule for returning to locations rated requires improvement.

The inspection took place on 11 December 2017 and was unannounced. Sunnycroft is a ‘care home’ for up to 59 people. The service supports older people, many of whom are living with dementia. The accommodation comprised of a purpose built property connected to a bungalow and a house. When we inspected, the bungalow was not in use as there were repairs and refurbishment on-going. There were 36 people living at Sunnycroft when we inspected on 11 December 2017.

At our last inspection carried out on 26 and 27 October 2016, we found three breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014 in relation to person centred care, assessment of risk and governance.

During this inspection on 11 December 2017, although some improvements had been made, we found the service to be in continued breach of the same three regulations. You can see what action we took at the back of the full version of the report.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The registered manager at the service had been registered with CQC since 26 October 2016. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe, responsive and well-led to at least good. They provided this to us, and whilst we noted some areas had improved since our last inspection, we found some areas had not improved sufficiently, and we found new concerns such as environmental risks.

People's health, safety and well-being were at risk because the registered manager and provider had failed to identify where safety was being compromised. Infection prevention and control procedures were ineffective and we found that hygiene in the service was poor.

Quality assurance and auditing mechanisms were not sufficiently robust to identify the concerns we found during the inspection.

The provider needed to develop their approach to ensure that it was consistent in delivering care in a way that supported a positive and person centred culture. People did not always receive the time and attention they needed to fully meet their needs, and some practices in the service did not take account of people’s individual needs. This had an impact on providing care which was consistently dignified and respectful.

Staffing levels met people’s physical needs, but did not always allow staff to take time to support people’s emotional needs.

We observed some interactions between staff and people were poor, and in some cases was lacking. Staff received relevant training to care for people living in the service, but were not applying the learning in an effective way. The registered manager had identified this as an area requiring improvement. However, where some staff had been identified as needing to improve, action plans were not in place to ensure improvement was made in a timely manner.

The provision of activity was not meeting the individual or specialist needs of all people using the service. We observed people sat for periods of time, disengaged with their environment.

Improvements were needed in people's mealtime experience, and we have made a recommendation about this.

People were not always fully supported by their environment. The provider had not considered how to maximise the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

Appropriate arrangements were in place to ensure people

The inspection took place on 26 and 27 October 2016 and was unannounced.

Sunnycroft provides care for up to 37 people. The home supports older people many of whom are living with some forms of dementia. The accommodation comprised of a purpose built property connected to a bungalow and a house.

The current manager had received confirmation of being the registered manager on the day of our visit. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report the registered manager will be referred to as the manager.

People’s medicines were not always stored in a safe way. This posed a risk to certain people who lived in the home. People didn’t have thorough risk assessments and reviews. Some risks to the people who lived in Sunnycroft had not been fully explored.

There was no robust system to assist staff to respond to emergencies in the evenings and weekends. The manager and the provider did not have effective systems to test the quality of the service provided. There was a lack of action plans to enable the development of Sunnycroft.

The service was not fully responding to people’s social needs that lived in the home. There was a lack of social stimulation for many people in the home. Staff did not have the time to spend talking with people. The service had not considered ways to engage with people and seek their views on the service.

There was a lack of monitoring and testing that staff had the knowledge and skills to meet people’s needs.

These issues all contributed to 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 the report.

People benefited from being supported by staff who were safely recruited, trained and who felt supported by the manager. There were enough staff to meet people’s physical care needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. Most staff were aware of people’s health needs and followed guidance to meet these needs.

Staff assisted people with kindness. People’s dignity and privacy was maintained and respected.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team and was working within the principles of the MCA.

The service encouraged people to maintain relationships with people who were important to them. People’s relatives and friends were welcomed to the service and encouraged to visit.

There was a positive culture and a friendly atmosphere at Sunnycroft. The manager was motivated to make positive changes.