Archived: Sunnyside Residential Home

Sunnyside Residential Home is a care home providing personal care and specialises in providing care to people living with dementia. The service can support up to 22 people, at the time of inspection they supported 21 people.

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

People's medicines were not consistently managed in a safe way.

There have been consistent failings in previous inspections where robust monitoring systems have not developed. This was a repeat issue found within this inspection with a lack of evidence to show robust checks in place for improving medicines management, improving records, fire risk assessments, managing risks within the environment and checks on quality of care.

Following the inspection, managers have described various actions they have taken to improve their management and oversite of the service to manage safety, medicines and care practices covering personal care, access to fluids and access to call bells when people choose to stay in their rooms.

The recruitment of staff was safe. A range of pre- employment checks were carried out on applicants to assess their fitness and suitability for the role. Although some records needed updating and improving. The deployment of staffing levels needed evidence of regular reviews to enable appropriate oversite to always meet people's needs.

We were assured that Infection prevention and control measures were followed to minimise the risk of the spread of infection, including those related to COVID-19.

People provided positive feedback about the service. They told us they enjoyed living at the service. Staff were very positive and felt supported by the managers and provider.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk. The last rating for this service was requires improvement (published 1 august 2019.) You can read the report from our last inspection, by selecting the ‘all reports’ link for Sunnyside Residential Home on our website at www.cqc.org.uk.

Why we inspected

We carried out a direct monitoring assessment with the service on the ninth September 2021. We identified some issues with the lack of oversite of auditing medicines and analysis of accidents and incidents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Our report is only based on the findings in those areas at this inspection.

The ratings from the previous inspection for the effective, caring and responsive key questions were not looked at during this visit. 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 to calculate 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 changed from requires improvement to inadequate. This is based on the findings at this inspection

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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/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 managing risks and safety, managing medicines and the governance of the service. Please see the safe and well-led sections of this full report.

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..

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 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.

We found the following examples of good practice:

• The home was clean and well-presented. Frequent and systematic cleaning was carried out by staff throughout the day.

• Staff and people living at the home accessed regular COVID-19 testing and appropriate action was taken if anybody received a positive test result.

• Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant national guidance.

• Hand sanitiser and PPE was available throughout the home.

• Staff had supported people to keep in touch with their loved ones during the pandemic via telephone, video calls and window visits. Staff had also set up screened visits with appropriate infection prevention and control measures in a designated part of the home.

• Staff had made changes to the layout and use of communal areas in the home to maintain social distancing. For example, the number of chairs in the main lounge area had been reduced and set up with sufficient space between them.

Further information is in the detailed findings below.

Sunnyside Residential Home is a care home providing personal care to 19 people. The service can support up to 22 people and specialises in providing care to people living with dementia.

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

People’s medicines were not consistently managed in a safe way. After the inspection we received information from the registered manager about immediate action taken to address the shortfalls. We were reassured by this. The registered manager had not competency-tested staff responsible for the administration of medicines. Staff had received training in other areas of health and social care to support people in an effective way.

The provider supported people to lead a fulfilled life and considered positive risk taking. Staff assessed people in a person-centred way and record keeping in relation to monitoring of known risk had improved. The environment was clean and well maintained.

People told us they felt the service was sufficiently staffed; staff responded to people in a timely way. The provider had robust systems to protect people from bullying, harassment and abuse.

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.

There were robust systems to assess and monitor risk associated with nutrition and hydration. People who lived at the service told us they were satisfied with the food and meal time service. People had access to a wide range of healthcare services and were supported to maintain good health.

Staff interacted with people in a kind and dignified way. People and their representatives provided consistent positive feedback about their satisfaction in relation to the support they received. Staff and people had built trusting relationships and the staff team understood the needs and preferences of people they supported.

Staff encouraged people to maintain important relationships with their friends and relatives. The service had good links with the local community and provided stimulating activities. Staff supported people to discuss their end of life preferences and had a good understanding about dignity in dying.

People received person-centred care. Records showed information about people’s past hobbies, achievements and things important to them. People living with dementia had been supported to maintain their identity and staff took pride when assisting someone with personal care.

There was a complaints procedure and people told us they felt confident to raise concerns with the provider and registered manager. The providers were regularly at the service and continued to be involved in the everyday running of the home.

The registered manager worked in partnership with external professionals and was open to suggestions and feedback throughout the inspection. Staff told us the management team were approachable and responsive.

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 31 May 2018). 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 sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report. During and after the inspection the provider took steps to mitigate the risks identified around medicines management.

You can see what action we have asked the provider to take at the end 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 have identified breaches in relation to safe use of medicines and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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 people knew how to complain if they needed to and we found that complaints had been dealt with appropriately.

A range of policies and procedures were in place however some were seen to be outdated. The registered manager told us that they were in the process of updating all of the policies.

The management team were open and transparent during our inspection and worked with us proactively.

Ratings from the last inspection were displayed outside and within the home and on the provider’s website as required.

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

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.

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.