Archived: Sunnyside Residential Home

Sunnyside Residential Home is a care home providing personal and nursing care for up to 27 people over three floors. At the time of the inspection, 19 people were living at the home

People’s experience of using this service and what we found

People were not always kept safe from the risk of harm. We identified at our last inspection in June 2021 appropriate steps had not been taken following a serious safeguarding incident. At this inspection some action had been taken, however, training to improve the managements’ understanding of how to support the person involved in the incident had not been undertaken. Other safeguarding concerns were identified at this inspection. Feedback from a consultant involved with supporting the service and from staff raised concerns about a ‘closed culture’ at the home. Medicines were not managed safely, while we were unable to identify impact, continued gaps in medicine records were identified. People’s dependency had not been assessed and staffing levels were not sufficient to meet people’s needs. While some staff training had been arranged and undertaken since our last inspection, significant gaps remained; this included gaps in the management team’s training, learning and development. Infection control practice had improved slightly but remained unsafe.

Audit and governance systems had not been developed since our last inspection and the registered manager acknowledged audits were not always completed. Staff reported feeling unsupported by the management team. The consultant contracted by the provider to work with the management team to improve compliance with regulations raised concerns regarding the registered manager’s integrity, ability and motivation. We identified inconsistencies in people’s records, including monitoring charts, risk assessments and care plans, this has continued to be unaddressed. The provider had failed to display their most recent rating on their website. The rating was displayed in the home but not was not accessible to visitors.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider supported people who would need to be supported in accordance with ‘Right Support, Right care, Right Culture’ guidance. Their statement of purpose and registration had not been updated to reflect this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 16 August 2021) and there were breaches of regulation. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve; we monitored progress through regular meetings with the local authority. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 6 March 2021. During this inspection the provider was unable to demonstrate that improvements have been made. The service continues to be rated as inadequate overall and in the key questions of Safe and Well-Led. This service remains in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service remains inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sunnyside Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Following our inspection in January 2021, we started enforcement proceedings against the provider and decision was made to cancel the providers registration. We have inspected the service on three occasions since then, including this inspection and found practice related to the safe and well-led key questions has consistently deteriorated.

We have identified breaches in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance, staffing and the need to display performance assessments.

The provider withdrew their appeal against the notice of decision to cancel their registration.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sunnyside Residential Home is a care home providing personal and nursing care for up to 27 people over three floors. At the time of the inspection, 20 people were living at the home.

People’s experience of using this service and what we found

People were not always kept safe from the risk of harm, we identified appropriate steps had not been taken following a serious safeguarding incident. The local authority had requested the provider undertake a formal investigation into the incident and specialist training be identified and implemented for staff. Neither of these had been actioned. Medicine records had gaps and people’s medicines were not always stored safely; however, we found no evidence of impact on people and felt this was an issue around auditing and quality assurance. We found concerns within the environment and building relating to fire and legionella’s disease safety. In the home’s external areas, which could be accessed by people who use the service, we found significant levels of uncleanliness which could’ve potentially caused harm. People’s dependency to ensure the appropriate level of staffing had not been assessed for several months, although this had been started recently. Some staff had not received appropriate levels of supervision or training and the provider had not carried out appraisals with the management team. Infection control practice within the home had improved since our last inspection but remained unsafe.

The registered manager had implemented new auditing systems; however, in some cases these were ineffective and didn’t reflect the findings on this inspection. The provider had failed to implement their own quality assurance processes and staff consistently felt more support and management of the internal management team was needed. There were inconsistencies across several records, including monitoring charts, risk assessments, care plans and incident reports. The provider had failed to inform CQC and relevant partners of notifiable incidents. Records were not stored or disposed of securely, we found a person’s medication care plan in the car park, on arrival at the service. The provider had failed to display their most recent inspection report and rating both in the home and on their website.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staff had not been provided with specific training around supporting people with autism. One person had been recorded as being non-compliant with engaging with services from other professionals and in leaving the home. We discussed this with the registered manager to understand what steps had been taken to support the person with this; however, no plans had been implemented, despite one member of staff telling inspectors, “Yes we could try that, because he used to love walking.” This was in response to the inspector signposting to relevant services and support that could help and enable the person to access activities, treatment and the local community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (31 March 2021) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to harm caused to a person in relation to specific support needs not being met or understood. Other concerns raised included an unsafe environment, insufficient support for people with behavioural needs and cleanliness. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained as Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

In January 2021 we inspected the service and found issues relating to infection control, we sought immediate reassurance which was provided. In March 2021, we received further concerns relating to infection control, so decided to carry out a targeted inspection where we identified further non-compliance with infection control guidance. We took enforcement action, which included a notice of decision to add conditions to the providers registration stating the management and practice of infection control needed to be improved. We received reassurances risk had been mitigated so withdrew the conditions from the registration. However, we have found further concerns relating to infection control practice at this inspection.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing, notifications of incidents and requirement as to display of performance assets at this inspection.

The provider submitted an appeal against our notice of decision to cancel their registration.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sunnyside Residential Home is a care home providing personal and nursing care for up to 27 people over three floors. At the time of the inspection, 21 people were living at the home.

People’s experience of using this service and what we found

Infection control practices were not robust, which presented a high risk to people’s welfare and safety. We issued a letter of intent requesting an action plan from the provider, to evidence steps they would take to mitigate the immediate risk. An action plan was provided in a timely manner and evidence was provided to show new systems being implemented.

People’s risk assessments did not always provide clear guidance, with vague terminology used rather than clear instructions for staff to follow. Staff did not always follow guidance recorded in risk assessments. In some instances, risk assessments had not been completed at all. Daily records provided limited information about what people had done throughout each day. Gaps in daily checks, such as room temperatures were significant. Accidents and incidents were not always recorded to evidence what the cause and what actions had been taken and why. People reported feeling safe at the home and staffing levels were sufficient to meet people’s needs; staff had been recruited safely.

Medication records did not consistently have the correct information recorded in them. Care plans did not always reflect how often medications should be administered. Medication stock amounts, recorded on people’s medication administration records (MAR), did not always reflect the actual amount of medication people had.

Quality assurance and auditing systems were not robust and did not reflect our findings at this inspection. Audits were not in place in several areas such as safeguarding and daily records. The provider had no quality assurance policy and oversight of the management of the home was limited. Staff unanimously reported support and oversight was needed at provider level, to ensure guidance, support and auditing was in place for the registered and deputy manager.

Analysis of accidents and incidents was not completed; this meant learning had not been identified to improve people's care when things had gone wrong.

People and relatives felt well supported; the management team and care staff received praise for providing person centred care and communicating with transparency. Notifications had been sent to relevant bodies in a timely manner and the management team had been proactive in seeking support from colleagues across health and social care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 18 June 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. A targeted inspection was carried out on 21 August 2020 and the provider was found to have made improvements and they were no longer in breach of regulations. At this inspection we found that improvements had not been sustained and the rating has deteriorated to inadequate.

Why we inspected

We received concerns in relation to the building looking unkempt, lack of heating and areas of the home being dirty, people were reported to be wrapped in blankets and cardigans due to the cold. Concerns were also made regarding staff not wearing personal protective equipment (PPE) appropriately and having limited interaction with people throughout the day.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sunnyside Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance. We issued a notice of proposal to cancel the providers registration to carry out their regulated activity at Sunnyside Residential Home. The provider did not submit any representations against this proposal.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

People's experience of using this service and what we found

We found that governance of infection control practices were ineffective. Systems had been implemented to check staffs use of personal protective equipment (PPE), however, these had not ensured staff compliance. The registered manager had begun to take disciplinary action against staff identified as not using PPE correctly; this had not been carried out in a timely manner and the identified staff had continued to provide support to people.

In some areas of the home, stock levels of PPE were limited; auditing of PPE stock had not been carried out. Staffs PPE use was not carried out in accordance with long-standing government guidance.

COVID-19 risk assessments had not been carried out for staff, visitors or some people living at the service. Checks were in place but not always used for visitors. Lateral Flow Device (LFD) tests were completed for visitors, however, there was no system in place to ensure tests were completed without risk of cross contamination. LFD tests were not registered on the governments website or recorded formally. The registered manager addressed internal recording of tests following the inspection and implemented an LFD record sheet.

The management team had worked closely with colleagues across health and social care, such as the local infection control team. However, feedback provided by those colleagues had raised concerns as to how training and advice had been used to inform improvement, relating to infection control, within the home.

Overall, we were not assured that good infection control practices were being followed; this placed people at a serious risk of harm.

Rating at last inspection

The overall rating for the service has not changed following this targeted inspection and remains inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check on specific concerns we had about staff’s use of PPE and management of infection control practices. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sunnyside is a care home for up to 27 older people over two floors. The home is situated about two miles away from Bolton town centre. At the time of the inspection there were 23 people using the service.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Improvements had been made around the storage of products and cleaning materials. These were all stored safely and securely within the home. Confidential records were stored securely.

Care plan records had improved and were complete and up to date. People’s weights and food and fluid intake were recorded where a risk had been identified in this area. The records were audited and any issues identified were followed up with appropriate actions.

The home was clean and tidy and appropriate cleaning schedules were followed. Extra support had been given around the Covid-19 pandemic and staff used Personal Protective Equipment (PPE) as required.

Governance systems had improved and quality assurance audits were in place. Records around environmental and health and safety monitoring were complete and up to date.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 August 2019) and there were breaches of regulations with regard to safe care and treatment and good governance. The provider was issued with a warning notice and completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the requirements of the warning notice had been met. The service was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the warning notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We found the requirements of the warning notice had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on warning notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sunnyside is a care home for up to 27 older people. The home is situated about two miles away from Bolton town centre. At the time of the inspection there were 24 people using the service.

People’s experience of using this service:

At this inspection we found three breaches of The Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to safe care and treatment and good governance.

Some improvements had been made in the area of medicines management, though thickening agents for drinks and creams for external use were not always stored correctly. We also found a number of issues with regard to safe storage of items that could cause harm.

The service did not have a current legionella certificate in place, to show that water was being monitored for bacteria. This could place people at risk of harm. Some cupboards and rooms containing dangerous or harmful substances were not secured, placing people at risk of harm.

Record keeping, and quality assurance were poor. Recording of people’s weights and food and fluid intake was not always up to date. Some audits and checks were not up to date and there was no oversight from the provider in evidence. Quality assurance issues had been raised at the previous inspection.

The provider had put in a building improvement plan to be implemented over the next two years. This was in response to the previous fire risk assessment which had identified some significant risks within the ceilings of the premises. The provider was keeping two vacancies at the home so that the work could be done area by area, moving people who used the service to the vacant rooms when needed.

Medicines systems were mainly appropriate, and medicines were given safely.

There were some issues with regard to people’s confidential information not being kept as securely as required.

Water temperatures varied considerably around the home and there were no radiator covers in use. These issues could pose a risk of injury to people who used the service. The manager agreed to address water temperatures and request radiator covers be fitted by the builders who carried out their general maintenance, immediately following the inspection.

Wardrobes were not fastened to the wall in people’s bedrooms, which could result in a person who used the service suffering injury. This was actioned immediately following the inspection.

Safeguarding concerns were followed up appropriately and people felt safe at the home. Staff understood how to raise a concern.

Staff recruitment systems had been improved and the manager was still working through staff files to ensure they included all relevant information. All staff had current Disclosure and Barring Service (DBS) checks, although one member staff appeared to have worked prior to the DBS check being obtained, which was discussed with the manager. Staffing levels were good and there were sufficient staff to meet the needs of people who used the service effectively.

The service had an infection control policy and procedure and a file with information and guidance. Their latest audit had been poor, and they were currently receiving support with improving their infection control and prevention procedures within the home from the local infection control team.

The care plans included health and personal information and there was evidence of partnership working with other health and social care professionals and agencies. There was evidence within the care files of people’s involvement in care planning and reviews, where they had capacity.

New staff were required to complete the Care Certificate on induction and there was on-going training and refresher courses.

There was some signage around the home to assist people to orientate themselves to the building. Staff were seen to respect people’s dignity.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff were able to explain about protected characteristics and how people were treated equally with respect for their diversity.

People were supported to follow their interests, hobbies and beliefs. There was a programme of activities on offer and outings were being arranged for the summer.

Complaints were logged and responded to appropriately and the home had received a number of compliments.

People’s wishes for when they were nearing the end of their lives were recorded within their care files, if they had made these known.

People who used the service and staff felt management were approachable and supportive. The manager was relatively new and not yet registered with the CQC. The manager and deputy manager were working through an improvement plan, implemented with the local authority Quality Monitoring Team. The Quality Monitoring Team reported some progress with the plan, but some requirements remained outstanding.

The manager had begun to attend local care home forums to discuss updates and current good practice.

Rating at last inspection:

The service was last inspection on 7 and 13 March 2018 and the report was published on 21 April 2018. At the last inspection the service was rated Requires Improvement in safe and well-led and good in the other domains. This was because medicines systems were not robust and quality assurance systems were poor. The service was therefore rated Requires Improvement overall.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Inspection timescales are based on the rating awarded at the last inspection and any information and intelligence received since we inspected. As the previous inspection was Requires Improvement this meant we needed to re-inspect within approximately 12 months of this date.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme. If any concerning information is received, we may inspect sooner. Sunnyside Residential Home will complete an action plan detailing how they plan to meet the breaches of Regulation laid out in this report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Sunnyside 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.

Sunnyside accommodates up to 27 older people in one adapted building. The home is situated about two miles away from Bolton town centre.

There was a registered manager in place at the home. 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance.

Over the previous year the service had experienced some difficulties following changes within the structure of the ownership personnel. This had resulted in the registered manager finding some of the paperwork incomplete or difficult to access and having to take on extra administrative duties. Some of the quality assurance systems, which had previously been maintained at a provider level, had not been maintained. The systems which were in place were poor and did not include issues identified and actions to address them. Staff files were incomplete and did not include all the information required. We discussed this with the registered manager who agreed to implement new systems where previous systems could not be located or were lacking in detail.

People told us they felt safe and we observed a staff team that was very caring and proactive in providing support throughout the day. Some health and safety certificates could not be produced on the day of the inspection, but we saw evidence of new checks being undertaken following the inspection.

Safeguarding policies and procedures were available but needed updating. Staff were aware of how to recognise and report any abuse or poor practice. Individual risk assessments were in place within people’s care files. Staffing levels were flexible and were sufficient to meet the needs of the people who used the service.

Medicines policies required updating, there was a lack of staff guidance and systems were not robust or clear. Accidents and incidents were recorded and reported appropriately. However, there was no overview to enable monitoring on a general scale.

Care files included a good range of health and personal information and were reviewed and updated regularly. We saw evidence of a thorough induction programme. There was a range of training offered on a regular basis and mandatory training was updated when necessary.

The home had recently gained a 4 Star rating from the national food hygiene standard rating scheme. There were plentiful supplies of fresh and frozen food. There was some signage around the premises to help people living with dementia to orientate them around the home.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us they were well looked after and the staff were kind and caring. During the inspection we observed warm and friendly interactions between staff and people who used the service.

People who were able were involved in their own care planning and reviews. Relatives were encouraged to be involved where appropriate.

The service produced a service user leaflet and there was also an up to date statement of purpose. The service was committed to the principles of equality and diversity. People were encouraged to be as independent as possible and the service had good access to advocacy services and used these appropriately when people needed someone to speak on their behalf.

Care files included a range of personal information about people’s backgrounds, family circumstances, friends, interests, choices and preferences. There were a number of activities on offer at the home.

There was a complaints policy in place and people were aware of how to make a complaint if they needed to. No recent complaints had been received, but there was no log in place to monitor concerns and complaints as and when they were received. We saw a number of compliments received by the service recently.

Care files included information about people’s wishes for the end of their lives, if they had expressed these wishes. The service worked in conjunction with the local district nursing team to help ensure people could remain at the home, if this was their wish, at the end of their lives.

People felt the registered manager was approachable. The registered manager had notified CQC of any accidents, serious incidents and safeguarding allegations as they are required to do.

Policies and procedures required updating. Following the first day of the inspection the registered manager approached a company to produce new policies and procedures, which would be tailored to the service. The key policies were to be made available to staff to consult for guidance.

We saw that the service had links with the wider community and the registered manager tried to attend care home manager meetings when possible.

Sunnyside provides residential care for up to 27 older people and is situated about two miles away from Bolton town centre. On the day of the inspection there were 24 people using the service as two were currently in hospital and one had passed away recently.

There was a registered manager at the service. 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 said they felt safe at the home. The premises were safe and secure, but the internal fire escape staircase was in need of some improvement. Health and safety measures were in place.

There were sufficient staff to meet the needs of the people who used the service. The recruitment procedure was robust.

There had been no recent safeguarding concerns but staff demonstrated knowledge of the procedures and were confident to report any concerns.

Systems relating to medicines were robust and medicines were administered safely.

The home had been audited by infection control three times in the last year. Actions had been put in place following the first audit and the second audit had shown significant improvements. A third audit was undertaken by a specialist nurse on the day of the CQC inspection and the home had continued to improve in this area, achieving a score of 85%.

There were robust induction procedures and staff training was thorough and on-going.

Care plans included appropriate health and personal information and referrals were made appropriately to other agencies.

People’s nutritional and hydration needs were addressed and people were given a choice of food and drinks. Monitoring was carried out where there were nutritional risks to ensure these were addressed in a timely way. People’s specific dietary needs were catered for.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated an understanding of both MCA and DoLS.

Without exception people who used the service, relatives and friends and health and social care professionals we spoke with were positive about the care and treatment at the home.

We observed care interventions and interactions between people who used the service and staff throughout the day. The atmosphere was friendly and relaxed and staff were kind, caring and polite.

People’s privacy and dignity was respected.

People were given choices around their daily routines, such as when they wanted to get up and go to bed and what they wanted to wear, do and eat.

There were a number of activities on offer and people were frequently taken out of the home if they wanted this.

The care was person-centred and each file included information on the individual’s personality, moods, background, interests and preferences.

There was a complaints policy, but no complaints had been received recently. The home had received a number of thank you cards.

Notifications were sent in to CQC appropriately.

The registered manager had an open door policy and people who used the service, relatives and staff all felt comfortable to speak to her at any time.

Staff supervisions were undertaken regularly. A member of the management team was on call at all times, when not on shift, to ensure support and assistance was given as required.

A number of quality audits and checks were carried out to help ensure continual improvement in service delivery.

During the inspection we looked at respect and dignity, care, nutrition, equipment and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking with visiting professionals and looking at records:

Is the service caring?

We saw people being cared for by staff who showed kindness and compassion in their interactions. One person said, 'All the girls are really caring'. A visitor told us, 'The girls are all wonderful, every one, there is not a bad one amongst them. They take their time to get to know the person and their particular needs. They are kind and gentle with everyone'.

We saw evidence within the care records of people's individual choices being noted and followed.

Is the service responsive?

People received an assessment prior to being admitted to the home. The care records included a large amount of information about the person's needs, wishes and preferences. We spoke with two professional visitors to the home who told us the home had considerable success in providing individual care for people who were difficult to place in other residential homes, due to particular issues or difficulties.

People's mental capacity was taken into consideration with regard to decision making and meetings were held to ensure decisions were made in the person's best interests. Professionals were consulted for advice and appropriate referrals were made to others services.

Is the service safe?

Risk assessments were in place in the care records, along with clear guidance for staff to follow. These risk assessments were reviewed and updated regularly to ensure people's needs were met safely.

There was evidence that equipment used to transfer people was used correctly and appropriately. Equipment was in good working order and was regularly serviced.

Staff wore the correct personal protective equipment, such as white aprons and gloves, to administer personal care and blue to serve food.

The kitchen staff were aware of hygiene and safety procedures and produced food in line with these practices..

Is the service effective?

We observed staff interacting well with people who used the service. We spoke with four care staff who demonstrated a good

understanding of people's individual needs. People were well presented and looked well cared for.

There were a number of activities on offer within the home and people were encouraged to join in at a level which was within their own capabilities and skills.

Is the service well-led?

There was evidence that communication between management and staff was good and effective. Handovers were clear and staff had knowledge of their roles and responsibilities.

There were quality assurance systems in place to ensure any issues were identified and addressed in a timely and appropriate manner.

We looked at three care files and saw that they included relevant information about people's health, care needs, background, likes and dislikes. Appropriate risk assessments and monitoring charts were held within the files and were reviewed and updated on a monthly basis.

We spoke with two people who used the service. One person said 'The food is good, they cut it up for you. If you ring the buzzer they come quickly.' They went on to say 'I know what good care is ' I used to be a carer.' Another person told us 'There's always something going on if you want to join in. It is a happy place, the staff are all lovely.'

We also spoke with three professional visitors to the home. They all felt the home communicated well, made appropriate referrals and administered excellent care to people who used the service.

We looked at three staff files and saw that robust recruitment and induction procedures were used. Staff were appropriately qualified and training and development were ongoing.

We saw that the home had some systems in place to assess the quality of their service and were working towards further ways to monitor service delivery and try to continually improve the service. There was a complaints policy and complaints were followed up appropriately.