This inspection took place on 6 February 2018. It was unannounced.

Sunnymeade is a care home. 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.

Sunnymeade is registered to accommodate and provide personal care to up to 50 people. At the time of the inspection only 44 rooms were in use and 43 people were living there. The home specialises in the care of older people. The building is divided into five smaller units each with their own kitchenette and lounge diner. All accommodation is located on the ground floor.

The registered manager has recently left the home. A registered manager from another home owned by the same provider is currently managing Sunnymeade and has applied to change their registration to this location. 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 were supported by staff who were well trained and competent in their roles. People told us staff were kind and caring and treated them with respect.

The provider has systems which minimised the risks of abuse to people. People told us they felt safe at the home. One person said, “The staff are really good to me. Yes I feel safe.”

People’s care and support was discussed and planned with them and they received personalised care. People were able to mix with other people or spend their time in the privacy of their rooms. One person told us, “I have no interest in joining in with things. They [staff] help me when I ask for it but they respect my privacy.”

Staff worked in partnership with other professionals to ensure people’s healthcare needs were effectively met. Staff assisted people to see doctors and district nurses if they were unwell. One person told us, “They are very good at getting the doctor. If I don’t feel well I tell them straight away and they sort out a visit.”

People were supported to keep in touch with friends and relatives. Visitors were always made welcome and staff helped people to stay in touch with friends or family who were not able to visit. Some visitors told us they went to the home every day and were always made to feel welcome.

There were effective quality monitoring practices in place which made sure people received a good standard of care in a safe environment. People’s feedback was listened to and acted upon where possible.

This inspection was unannounced and took place on 14 and 15 January 2016.

Sunnymeade is registered to provide care and accommodation to up 50 people. The home specialises in the care of older people. The building was divided into five small units which each had a communal area including a small kitchen. At the time of the inspection there were 35 people living at the home.

The last inspection of the home was carried out in August 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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.

All care plans for people were stored on a computer system with hard copies of some information. On the second day of the inspection the system was not available due to some technical difficulties. This highlighted that improvements were needed to make sure staff always had access to up to date information about each person. We have recommended that the provider reviews the information kept in paper format.

People were cared for by staff who were extremely kind and caring. Comments from people and our own observations showed staff treated people with respect and dignity at all times. A visiting relative said “Kindness goes such a long way and they really do show kindness. It gives us great peace of mind to know they are being so well looked after.” People told us staff often went the extra mile to make sure they received the care and support they needed. One person told us “I can’t fault anything. The way they speak to you and treat you is beyond any standard I have ever encountered.”

People received effective, safe care from staff who had the skills and experience to meet their needs. There was a staff structure that meant people always had access to senior staff and less experienced staff were always supervised.

People felt safe at the home and with the staff who supported them. The provider had systems in place which minimised the risks of abuse to people. This included a robust recruitment procedure and training for staff on how to recognise and report abuse.

Staff monitored people’s health and well-being and sought advice from healthcare professionals when they had concerns about a person. People’s nutritional needs were assessed and monitored to make sure people received a diet in line with their needs and wishes.

People were able to make choices about all aspects of their daily lives. Staff encouraged people to make choices and maintain their independence. One person commented “There are no times to do things. I go to bed when I want to and there’s always staff to help.” Where people did not have the mental capacity to make a decision staff knew how to make sure people’s legal rights were protected.

People knew how to make a complaint and said they would be comfortable to do so. All complaints made were fully investigated and action was taken to improve practice if a complaint highlighted shortfalls in the service.

The provider had a quality assurance system which included seeking people’s views. When people made suggestions about the running of the home action was taken to make changes if appropriate to do so. For example some people had said they did not know who their keyworker was. In response to this leaflets had been made for people with a photo of their keyworker and information about the keyworker role.

Our inspection set out to answer five questions: is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. It is based on our observations during the inspection, discussions with people living at the home, and with the staff supporting them, and on looking at records.

Is the service safe?

People told us they felt safe. We saw that staff treated people with respect. Safeguarding procedures were in place, and staff knew how to recognise and report abuse. Arrangements were in place to make sure that the registered manager and staff learnt from incidents and investigations. Safeguarding incidents were reported to the appropriate authorities.

People who lived in the home were only deprived of their liberty when this had been authorised by a Supervisory Body under the Deprivation of Liberty Safeguards. This meant that the provider only restricted people’s liberty if they needed to be kept safe and did not have capacity to make decisions.

Is the service effective?

The service provided care in line with people's wishes and individual needs. This was recorded in care plans. People’s health and care needs were assessed with them, and where possible they signed to show that they were involved in deciding the best care to meet their needs.

Staff were trained to give the care that was needed. The quality of care was monitored to make sure that it was effective.

Effective emergency evacuation procedures were in place.

Medicines were administered by trained staff according to written protocols. This meant that people received the medicines they needed.

Is the service caring?

People were supported by kind and caring staff. We saw staff speaking to people in a kind and considerate way. One person told us, “They respect my privacy – that’s very important.” Another person said, “The food is good, the care is good, I’ve no complaints.”

Staff were trained to understand people’s needs. One staff member told us, “I think listening is very important.”

Is the service responsive?

The service responded to people’s changing needs. When people were unwell or they needed a specialist assessment, the provider asked community professionals to undertake assessments.

There were residents’ meetings where people could suggest changes. We saw notes of these meetings that showed that the provider listened and made changes where they could.

There was an effective complaints procedure. Complaints were fully investigated and responded to.

We saw one example of a person who had to wait a long time for a call bell to be answered. We reported this to the registered manager. We judged that they responded appropriately to our concerns, and will take steps to ensure that call bells are answered promptly in future.

Is the service well-led?

The service had a system of regular quality assurance that monitored care and showed where it could be improved. All aspects of care were reviewed on a rolling basis. The provider compared quality outcomes across all its homes so that areas of improvement could easily be identified.

Staff were clear about their roles and responsibilities. The registered manager kept them fully informed and involved in quality improvement activities. This helped to ensure that people received a good quality service.

Sunnymeade was divided into five small living areas. There was also a communal lounge and dining room that could be used by everyone. This enabled people to choose where they spent time. Each living area had a kitchen where drinks and snacks could be made. All communal areas of the home were accessible to people with all levels of mobility including wheelchair users.

People who lived at the home and visitors we spoke with were all very complimentary about the care provided. One visitor said “I just can’t speak highly enough of the place. When I go home I am confident that they are in the very best hands.” A person who lived at the home told us “I get all the help I need and have no complaints at all.”

Throughout the day we observed that people were assisted in a manner that promoted their dignity and independence. We saw that staff offered support but allowed people to make choices about how they would like to be assisted.

We looked at the personnel files for four members of staff. The files gave evidence of a robust recruitment process which ensured that new staff had the relevant skills and were of good character. The recruitment procedure also minimised the risks of abuse to people who lived at the home by making sure that all staff were thoroughly checked before beginning work.

There were systems in place to effectively monitor the quality of the service offered and ensure the safety of people who lived at the home.

Throughout the inspection we noted that people were treated with respect and dignity. We saw that staff interacted with people in a friendly and polite manner. People spoken with said that staff who supported them were always polite. One person told us “staff are always kind and they respect my privacy when helping me with personal care.” Another person commented “the staff are very sensitive when they help me with washing and bathing.”

We observed that people were very relaxed with the staff who supported them. Everyone we asked said that they always felt safe at the home. One person said “I feel safe and comfortable with all the staff.” Another person told us “the staff make you feel safe, you can sit down and talk to any one of them if you have any worries.”

Other comments about staff included; “the staff are very helpful,” “staff are very kind” and “there’s always someone there to help you.”

People felt that there was usually enough staff on duty although some commented that there had been "some staff shortages recently." We were told that staff assisted people in an unhurried manner. One person said “There’s no pressure you can do things in your own time.” All staff we observed demonstrated patience when assisting people and did not rush anyone.

People told us that they would be comfortable to make a complaint if they were unhappy about any aspect of their care. One person told us “I did make a complaint, I went to the senior and they sorted it all out.”

People living at the home were happy with the care that they received. Comments included; “I can’t fault the care I get and they always ask you about everything” “I am very well looked after” and “It couldn’t be better and I’m very happy here.”

People told us they were able to make choices about their day to lives. People said they were able to choose what time they got up, when they went to bed and how they spent their day. Staff spoken with said that they assisted people to get up at a time of their choosing and were able to make breakfast for people in the small units at any time.

People said that they gave consent to the care that they received. One person said “They don’t forget anything, they always remember just how you like things done.”

Other people said that they had input into their care plans and signed each review to ensure that staff knew how they wished to be cared for.

One person said “You can do anything you like, it couldn’t be better.”

People were very complimentary about the food. Everyone said that the quality was very good and that there was always plenty to eat.

People living at the home said that they felt safe with the staff who supported them. We observed that everyone appeared relaxed with the staff on duty. Everyone asked said that they would be comfortable to speak with a member of staff if they were unhappy about any aspect of their care. People told us that staff were “Friendly and approachable.”

We heard lots of compliments about the staff at the home. One person said “The girls look after me wonderfully, I can’t begin to say how good they are” another person said the staff were all “Excellent.” Everyone agreed that staff were always kind and polite when offering assistance.

There was a mixed response when people were asked if they felt there was always sufficient staff on duty. One person living at the home said “There are always staff shortages,” another person said “I wish they had a bit more time to spend with us.” One visitor said that they did not feel there were enough staff to meet the needs of people currently living at the home but another visitor said that they had no concerns about staffing levels. Everyone asked said that staff came in a “reasonable” time if they rang for assistance.