The Care Quality Commission
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  • Care home

Archived: Sunrise Operations Sonning Limited

Overall: Good read more about inspection ratings

Sunrise of Sonning, Old Bath Road, Sonning, Berkshire, RG4 6TQ (0118) 944 4300

Provided and run by:
Sunrise Operations Sonning Limited

Important: The provider of this service changed. See new profile

All Inspections

18 August 2015

During a routine inspection

This inspection took place on 18 August 2015 and was unannounced. This was a comprehensive inspection which included follow-up of progress on the non-compliance identified in the reports of the previous inspection on 8 and 10 December 2014 and at the ‘Warning Notice’ follow-up inspection on 11 May 2015.

At the previous comprehensive inspection we identified non-compliance against Regulations 9 (Care and welfare of service users), 10 (Assessing and monitoring the quality of service provision), 12 (Cleanliness and infection control), 13 (Management of medicines), 14 (Meeting nutritional needs), 18 (Consent to care and treatment), 20 (Records), 21, (Requirements relating to workers) and 22 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

From April 2015, the 2010 Regulations were superseded by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider was meeting the requirements of the comparable current regulations. Regulations 9 (Person-centred care), 17 (Good governance), 12 (Safe care and treatment), 14 (Meeting nutritional and hydration needs), 11 (Need for consent), 19 (Fit and proper persons employed) and 18 (Staffing).

The service provides care or nursing care to up to 103 older people, some of whom are living with dementia. The building is divided into two units. The ground and first floors (known as assisted living), accommodate people with care and nursing needs, some of whom may be living with the early stages of dementia. The second floor (known as reminiscence), accommodates people living with dementia. Communal areas are available for people on all floors. At the time of this inspection the service was supporting 83 people and a further two people were in hospital.

The service is required to have a registered manager but had not had one since the departure of the previous registered manager in May 2014. The current general manager was in the process of applying to become 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.

Significant improvements had been made in the areas previously highlighted to be of concern. Permanent staffing levels were improving and staff were more enthusiastic and motivated. People, relatives and staff reported positively on the changes made in the service and the new management. People felt safe and told us staff were more attentive and quicker to respond.

We saw that people’s care plans and associated records had improved and were now maintained up-to-date by regular interim updates in between reviews. Where people needed additional support around wound care, hydration or nutrition, this had been identified and records were used effectively to monitor changes. Medicines management was managed effectively and any errors or omissions were identified in a timely way so they could be addressed.

Support was sought from external health agencies and others in a timely way. The service had engaged with the local authority care home support team for advice and development. Where issues had arisen with external agencies the manager was actively addressing these. Staff training had improved and support through supervision, appraisal and regular meetings were all improving.

People were involved in planning their care and were encouraged to make decisions about their day-to-day care. People’s dignity, privacy and rights were protected. People’s consent was sought by staff before care was provided. A wide range of activities and opportunities for social interaction were provided and people’s views about the service were sought and acted upon.

The service was well led with staff knowing what was expected of them. The operation of the service was effectively monitored by the general manager and the registered provider and action was taken to address identified shortfalls.

11 May 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 8 and 10 December 2014. Breaches of legal requirements were found. We issued warning notices for breaches in relation to medicines, care and welfare and assessing and monitoring the quality of service provision and compliance actions for the remaining breaches. Which related to: staffing, requirements relating to workers, cleanliness and infection control, meeting nutritional needs, consent to care and treatment and records. The provider was required to meet the requirements of the warning notices by 27 February 2015. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements of the remaining breaches. They are due to complete their action plan by 15 June 2015. We will make further checks to ensure the provider has taken action to become compliant with the remaining breaches when they have completed their action plan to address them.

We undertook this focused inspection to check that they had met the requirements of the warning notices and to confirm that they now met legal requirements in relation to medicines, care and welfare and assessing and monitoring the quality of service provision. This report only covers our findings in relation to those requirements and the relevant domains of is the service safe? Is the service effective and is the service well-led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sunrise Operations Sonning Limited on our website at www.cqc.org.uk.

The provider had made an appointment to the post of General Manager and the new post holder had commenced their role two weeks prior to the inspection. The new General Manager informed us they were in the process of making their application to become the registered manager for the service.

People told us the timing of medicine rounds had improved although on occasions they could still be late finishing. People’s medicines were ordered on time and were available for them. Any changes made by the GP to people’s medicines were documented and implemented. Further improvements could be made to ensure in the event of any discrepancy in stock levels for people who self-medicated discussions were documented. This would provide evidence that consideration had been given regards whether people who self-medicated required any additional support, following stock level checks. People’s medicines were properly and safely managed.

People’s wound care was being provided more effectively by the nurses. The provider had met with the community nursing staff to ensure there was clarity about the responsibilities of the provider’s nurses and community staff in relation to people’s care and treatment. Systems had been implemented to enable staff to monitor more effectively the provision of people’s wound care. People received the equipment and support they required to manage the risks of them developing pressure areas and the delivery of this care had been documented.

Actions had been taken by the provider to improve the documentation used to record the provision of people’s care. Monitoring to ensure staff completed forms was more robust. However, there were still some areas for improvement to ensure people’s charts were completed contemporaneously and completely. People’s care plans recorded their needs but one person’s care plan had not been updated to reflect their current needs. Although there was no evidence this had impacted upon the delivery of their care, their records required improvement to ensure staff had up to date written guidance to follow. Care records were not always easy to locate as they were kept in a number of places and handwritten entries on people’s care plans were not always easy to understand. The provider was due to introduce a new care planning process to support staff in the delivery of people’s care. This would streamline people’s records as they would be kept in one file.

The General Manager had oversight of people’s weights and actions taken to manage risks to people related to their weight. Systems used by the General Manager to monitor on-going risks to people could be improved through more rigorous cross-referencing of records. Audit systems were in place and incidents had been identified and actions taken in response to reduce the risk of their re-occurrence. Auditing and monitoring processes could be used more effectively to identify any underlying trends in relation to incidents, in order to proactively protect people from potential risks rather than being reactive and responding to incidents once they had occurred.

Improvements had been made to ensure communication between staff about people’s needs within the service was more effective and to ensure staff received relevant information about changes to people’s needs.

The provider had taken sufficient action to meet the requirements of the warning notices in relation to safe medicine management, effective pressure and wound care and systems to manage risks to people.

8 and 10 December 2014

During a routine inspection

We carried out this inspection on 8 and 10 December 2014. It was unannounced, which meant that people, staff and the provider were not aware we would be visiting.

Sunrise Operations Sonning Limited provides residential and nursing care for up to 103 older people with nursing and other care needs, including dementia care. At the time of our inspection 101 people were living in the home.

The home consisted of three floors, with individual ensuite bedrooms and shared bathrooms on all floors. The top floor, known as the reminiscence unit, cared for people with dementia needs. The first and ground floors, known as assisted living, accommodated people with personal and nursing needs, and also catered for people in the earlier stages of dementia. Communal lounges and dining rooms were available for people on the top and ground floors. Stairs and a lift provided access between floors. People had access to the garden, and a range of communal areas on the ground floor, incuding a large dining room, function rooms and a bistro area. The front door and exit from the top floor were secured, to ensure people were protected from dangers that could affect their safety. People able to leave the home or floor safely knew the codes to do so independently, or were escorted to leave as they wished.

A registered manager was not in post at the time of our inspection. This report contains the name of a manager who left the home in May 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The provider had kept us informed of manager changes, and the Director of Operations told us a person would be applying with CQC shortly to take up the post of registered manager.

At our previous inspection on 4, 5 and 7 August 2014 the provider was not meeting the requirements of the law in relation to the care and welfare of people, meeting people’s nutritional needs, managing medicines, requirements relating to and supporting workers, and assessing and monitoring the quality of the service. Following the inspection the provider sent us an action plan stating they would make the required improvements by 26 October 2014. During this inspection we looked to see if these improvements met the requirements of the law. We found that they had for some of the concerns identified, but not for all of them.

Risks to people’s health and wellbeing had not always been identified. Where people’s risks such as developing pressure ulcers had been identified, care and treatment provided did not always effectively reduce these risks. Wounds were not always managed in accordance with health professionals’ guidance. Some people had experienced delays in the treatment of their wounds.

People were not always protected against the risks associated with unsafe use and management of medicines. Medicines were not always in stock when people required them. People did not always receive their medicines at the required times to manage their health and wellbeing.

The provider’s arrangements to monitor the quality of care provided (including the use of feedback and learning to improve) were not always robust. Information about people had not always been updated to provide an accurate record of people’s needs. Audits had not ensured all areas of improvement had been identified, or that required actions had been effectively implemented to drive and sustain these improvements.

People’s safety had been protected through appropriate measures to safeguard them, such as staff training and notification of incidents.However, the provider had not taken appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff available to meet people’s needs safely.

People had not been protected from the risk of unsuitable staff caring for them, as the provider’s recruitment process was not sufficiently robust to meet all the requirements of the law. The provider had not always identified or investigated gaps in applicants’ employment history, or verified that applicants’ conduct in previous relevant employment was appropriate to ensure people’s safety.

The provider followed appropriate guidance and trained staff in infection control measures. However, people, staff and visitors were at risk of infection, because staff did not always follow the guidance provided. Staff did not always take effective measures to reduce the risk of cross-contamination, such as wearing protective gloves whilst handling soiled waste.

The provider’s systems did not always effectively identify people at risk of malnutrition or dehydration. People’s daily intake of foods and fluids was not always effectively monitored when risks had been identified. People were provided with a range of food choices, and those identified with dietary needs were given support to eat or provided with suitable meals to meet their health needs.

People had been supported to consent to their care and treatment, and their wishes were clearly documented. However, it was not always clearly documented that this consent had been lawfully provided when others had consented to people’s care provision, or that actions taken to support decisions and people’s best interests were lawful. The provider was meeting the requirements of the Deprivation of Liberty Safeguards.

People were mostly cared for respectfully, and their dignity and independence were usually promoted. Most people and their relatives spoke positively about their experience in the home. People told us the managers were prompt to address any areas of concern raised, and the provider’s complaints policy guided staff on the appropriate actions to take to resolve these. People were involved in decision-making in the home, such as refurbishments, meals and activities, through resident meetings and forums. A wide range of activities supported people to maintain their links with the local community, and engage in meaningful activities such as painting and gardening.

Staff received training and support to ensure they had the skills required to meet people’s needs. A daily communication meeting ensured staff in all roles understood identified issues and the required actions to support people’s daily needs effectively. Equipment such as fire alarms, lifts, hoists and pressure mattresses, had been maintained and serviced regularly to promote people’s safety in the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

4, 5, 7 August 2014

During a routine inspection

The inspection team consisted of an adult social care CQC inspector, a pharmacy inspector, and a specialist advisor with clinical expertise. Our inspection was conducted over three days, during which 101 people used the service on a daily basis. We spoke with ten people and three people's relatives, seven care workers and two registered nurses. We also spoke with ancillary staff including a chef, kitchen assistant and activities coordinator. We spoke with management, including the area coordinator, care and training support nurse, general manager, and director of operations. We also spoke with two district nurses supporting the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this service at the time of the inspection. Their name appears because they were still the registered manager on our register. The general manager was managing the service at the time of our inspection. They told us they had started the application process to become registered manager with CQC.

Prior to our inspection we received information of concern relating to poor standards of food, equipment, activities and the lack of respect for people's personal belongings. We observed how staff supported people, and looked at documents including care plans and management reports. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; is the service caring, responsive, safe, effective and well led?

This is a summary of what we found.

Is the service caring?

We observed that staff were caring. One person told us 'Staff are accommodating, respectful, helpful, and patient beyond belief'. All the people we spoke with told us staff were kind. One person told us 'The care is good, and it's a nice place. I'm glad I came here'.

We observed that staff treated people with kindness. Staff understood the impact of dementia on people's lives, and supported them to ensure they enjoyed meaningful activities. One care worker told us 'We learn to understand people, and treat them all differently'.

Is the service responsive?

The service was responsive to people's immediate needs. One person told us 'I have never had to wait for any length of time or been ignored'. A relative told us 'Staff listen and try things we suggest'.

We observed that people were encouraged to engage in a range of meaningful activities, and staff understood that for some people these had to be altered to meet their current mood.

However, we found that people's health needs were not always addressed. For example, wounds had not always been identified, assessed or treated promptly.

We have asked the provider to tell us what improvements they are going to make to meet the essential standards in relation to promoting people's care and welfare.

Is the service safe?

People told us they felt safe in the service. One person stated 'I am here for my peace of mind. I am very happy and satisfied with all that they [staff] do for us'.

Equipment had been well maintained and serviced to ensure it remained fit for purpose. Staff had been trained in its use to ensure that people and others were not put at risk through improper use of equipment. They told us there was sufficient equipment to meet people's needs.

However, we found that people had not been protected against the risks associated with medicines. This was because records did not always evidence if medicines had been administered in accordance with the prescribed instructions.

There were not always adequate recruitment checks undertaken on new staff to ensure that they were suitable to work with vulnerable people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff recruitment and administration of medicines.

People's liberty was safeguarded because the manager understood the actions required to meet the requirements of the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We found that the service was effective in some areas. One relative told us 'Staff deal with people really well. They are friendly and kind, and have a great amount of patience'.

Care plans did not always provide staff with clear information about people's needs. For example a care plan noted that a person was mobile. However, other documentation assessed them to be at risk of pressure sores and requiring assistance to mobilise.

We saw that people had a choice of daily meals, and staff offered choices in a way that effectively encouraged people to understand the options available. For example, people with verbal communication difficulties were shown two different plates of food from which to select their preference.

Some people were at risk of malnutrition due to ineffective management of their dietary needs. Where it had been identified that people were at risk, staff had completed food and fluid charts to monitor people's nutritional intake. However, these charts had not always been fully completed. We saw that kitchen staff had not been informed of the requirement for fortified meals for one person who had lost weight.

We have asked the provider to tell us what improvements they are going to make to meet the essential standards in relation to managing people's nutritional needs.

We noted that the provider required staff to complete mandatory training, and refresh this annually. They had systems in place to monitor that this training was updated.

Staff were not always effectively supported to reflect on and identify areas of strength or concern in their role. This was because staff had not received supervision meetings in accordance with the provider's policy of every two months. We saw that this had been identified in an audit in May 2014, but we did not see that action had been effectively implemented to address this issue.

We have asked the provider to tell us what improvements they are going to make to meet the essential standards in relation to supporting staff.

Is the service well led?

The service sought and responded to people's feedback. One person told us 'I couldn't fault the home'. A relative told us the service was 'well run. They must have decent management'. We saw that the provider had responded to issues identified in a feedback survey conducted in May 2013. They had also sought feedback through monthly residents meetings.

At the time of our inspection we saw that the management team were already taking actions to address some of the concerns identified during our inspection. A care worker told us 'We have a stable team at floor level, and are getting there with management'.

However, we noted that some issues had been identified in an audit report we saw dated May 2014. Actions taken had not substantially improved people's health. For example, it had been identified that training was required in order to improve wound care and standards of documentation. We found concerns with wound care and completion of records at our inspection in August 2014. This did not demonstrate an effective response to identified concerns.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring and assessing the quality of service provision, and addressing identified issues.

1 September 2013

During an inspection in response to concerns

We carried out this inspection on a Sunday afternoon in response to concerning information about staff shortages at the home. The concerning information particularly related to shortages of staff on the top floor where people with mental frailty were accommodated.

At the time of inspection we found there were sufficient numbers of staff on duty to cover all of the home's three floors effectively. We spoke with six staff during our visit. One staff member said “There is plenty of staff today. One of our staff is working upstairs.” Another said “Yes we have enough staff to provide good care to the residents.”

There was a quiet relaxed atmosphere on all floors and residents were content and cheerful. We observed that people were moving freely around the home and staff were supporting them appropriately. One person who was receiving a service told us “I’m very happy here, there are enough staff to look after me.” Another said “Staff come when I call them. I never wait long.”

9, 15 May 2013

During a routine inspection

At the time of our inspection, 93 people lived at the home. We spoke with eight people who use the service, one relative and eight members of staff. People were complimentary about the high standard of accommodation, the kindness and professionalism of staff, the choice of food and range of activities available. One person commented "who wouldn't be happy here, it's like the Ritz", "the staff team are very attentive and nothing is too much trouble for them". Another person told us "I have lived here for a while and can't fault it. The care and attention is second to none". They went on to say "it’s lovely here, the food is great, there is plenty of staff and everyone is very kind".

We also received feedback about the quality of services from a social care professional. They told us they had recently visited the home and had no concerns about the quality of care provided to people who live there.

We saw the service had systems in place to monitor their own compliance with regulations. People’s consent was appropriately sought, before care and treatment were provided. People experienced safe and appropriate care that was effectively documented. The home was clean and well maintained and had effective infection control systems in place to safeguard people from harm. There was sufficient staff on duty to meet the needs of people who live there.

4 September 2012

During a routine inspection

People were complimentary about the home. They told us that they were provided with appropriate care from kind and responsive staff. People told us staff maintained their dignity, privacy and independence when providing care. They said they were involved in making decisions and had the opportunity to say how they wished to be supported.

People who lived at the home said that the accommodation was clean, well maintained and comfortable. They told us that they were able to personalise their spacious bedrooms with small items of furniture, pictures and ornaments. People said the food was tasty and well presented and there was plenty of choice and variety.

7 October 2011

During an inspection looking at part of the service

People told us that staff treat them with respect and listen to what they have to say.

They told us that their care needs were being met and that staff knew what their needs were and how to meet them. They told us they were involved in the decisions made about their care and had no concerns or worries about the care they received. They said that they were kept fully informed and could approach staff if they were worried or concerned.

20 October and 8 December 2010

During a routine inspection

People told us about issues in relation to how their personal care was delivered and this led us to have concerns about the service. We received feedback from residents and carers and health and social care professionals. Concerns related to involving people in their care, their general care and welfare including nutritional needs, staffing, monitoring the quality of the service and record keeping.