This inspection was unannounced and took place on 16 and 17 March 2018. At our last inspection on the 26 February 2016 and 01 March 2016, the service was rated overall as good the safe domain was rated as requires improvement to improve the medication procedure so that it was safe and effectively managed.

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 responsive to at least ‘good’. At this inspection, we found that they had not fully met this requirement and medication records were not audited effectively to meet the needs of the people living at the home.

Based in a residential area of Liverpool, Sunnyside Residential Home is a care home without nursing and provides support for up to twenty two people. Accommodation is provided in single bedrooms, twenty of which have en-suite facilities. 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.

There was a registered manager in place who had worked at the service for over ten years. 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 breaches in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. These breaches related to having no effective system in place to ensure that the assessing and monitoring of the service was taking place.

Staffing levels were insufficient at times to meet the care and support needs of the people living there. Records of staff duty rotas, the signing in logs and talking to people and staff evidenced this.

The medication procedures were not correctly adhered to as there were incorrect recordings and the safe storage of medication was not adequate.

We saw that the care documentation was designed to be person centred, it had been correctly completed and there were new up dated care plans being introduced. Monitoring records including food and fluid charts and repositioning charts had not been completed appropriately by staff or monitored by the provider to confirm that the care and support had been provided as required in the care plans.

The risk assessments accurately reflected the risks people faced and were recently up dated in the new system called ‘Krona’.

Peoples’ nutritional needs were met by the service. The chef told us that they provided meals based on people’s dietary needs and we saw that they had detailed information regarding the nutritional needs for people with varying religious, medical or cultural requirements.

Although the management had completed audits the outcomes did not reflect the findings of this inspection. The registered manager told us that she would initiate a quality assurance programme to complete all audits again including medication, care plans and monitoring records. This was to address the issues raised from this inspection.

There was a good partnership working with external health professionals visiting the home. The records indicated that communication was in place to ensure safe treatment practices shared, were followed by staff.

The provider was following the Mental Capacity Act 2005 and its guidance although records showed that some people’s records required up dating.

We found overall through observation and talking to people living at the home and a relative that the care was good. Staff treated people with kindness and respect.

There was a good range of activities available and some innovative practices were being followed by the provider.

A system was in place to ensure p

his inspection was carried out on 26 February 2016 and 01 March 2016. The first day of the inspection was unannounced.

Sunnyside Residential Home is registered to provide accommodation and support for up to 22 people. At the time of our inspection there were 21 people living at the home. It is owned and operated by Mr & Mrs A Wood.

The home had 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.

During the inspection we met the majority of the people living at Sunnyside and spoke in depth with six of them. We also looked around the premises and spoke with seven members of staff and three visiting health care professionals. We examined a variety of records relating to people living at the home and the staff team. We also looked at systems for checking the quality and safety of the service.

At this inspection we found a breach of regulations. This was because medication had not always been safely and properly managed.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at Sunnyside. Systems and training were in place to help staff identify and deal with any allegations of abuse that arose.

Staff were aware of the actions they should take in the event of an emergency occurring. The building was safe and work had commenced on upgrading en-suite facilities.

The people who lived at Sunnyside liked and trusted staff who supported them. There were enough staff working at the home to meet people’s support needs and spend time interacting socially with people. Suitable systems were in place for recruiting, training and supporting staff, this helped to ensure they were suitable to work with people who may be vulnerable.

People received the support they needed in all areas and stages of their life. This included support to manage their personal care and mental and physical health as well as support with their hobbies and social interactions.

People’s legal rights were protected and people had received the support they needed to make decisions for themselves or with appropriate support as applicable.

Staff had built meaningful relationships with the people living at Sunnyside and were able to adapt their communication methods and the support the provided to meet people’s individual needs and preferences.

People were confident to raise any concerns or suggestions they had with the staff team and said that they had always been listened to and staff had taken appropriate action to resolve any issues.

People living and working at the home had confidence in the manager and management team who acted as role models within the home. Systems were in place for checking the quality of the service provided and obtaining people’s views. These systems were not always recorded clearly.

During our inspection we spoke with eight of the people living at Sunnyside Residential Home. We also spoke with five members of staff who held different roles within the home.

The people living at the home told us that they liked living there. Comments we received included. “It’s great here,” and “I like it here.” They told us that they were supported to make decisions for themselves, with one person explaining, “You don’t get bossed about.”

We found that people had received the support they had needed with their care and welfare. When people were unwell staff had monitored them and obtained health advice if needed. We also found that the home offered people the opportunity to engage in different activities throughout the week.

People told us that they liked and trusted the staff team with one person explain, “Nothing is too much trouble.” We found that there were sufficient staff working at the home to provide the support people needed.

We found that the home was clean, tidy and safely maintained. Systems were in place for monitoring the quality of the service provided and for obtaining the views of people living there.

During our visit we spoke with ten of the people living at Sunnyside Residential Home and with four members of staff. We examined a sample of records and spent time observing the support provided by staff.

One person told us that in their opinion, “it’s like being at home only you get waited on” and another, ”I like it here”. Several people commented that the building was kept clean and tidy and had no unpleasant odours.

The people living there told us that staff had regularly asked them their opinion of the service they had received with one person explaining, “It’s good, if you ask for anything they try to get it”. They told us that staff had listened to them and acted on their wishes. People also told us that they had received the support they need with their health and personal care and that they had confidence in the staff team. They said they had felt safe living at Sunnyside Residential Home and had felt confident to raise any concerns they had had with staff. One person explained, “I’m safe here, you don’t’ have to worry”.