Frognal House Care Home

Sunrise of Frognal is a residential care home registered to provide personal and nursing care for up to 131 people in two adapted buildings. There were 58 people using the service at the time of our inspection.

Sunrise Senior Living Limited and Sunrise UK Operations Limited are dual registered and both providers are jointly responsible for service delivery at Sunrise of Frognal

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

People and their relatives gave us positive feedback about their safety and told us that staff treated them well. The registered manager and staff understood what abuse was, the types of abuse and the signs to look for. Staff completed risk assessments for every person, and they were up to date with clear guidance for staff to reduce risks. There were enough staff on duty to support people safely and in a timely manner. Staffing levels were consistently maintained to meet the assessed needs of people. The provider carried out comprehensive background checks of staff before they started work. Medicines were managed safely.

Staff kept the premises clean and safe. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.

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.

Systems and processes to assess, monitor and improve the quality and safety of the service were in place. There was a clear management structure in place and staff were aware of the roles of the management team. The service had a positive culture, where people and staff told us they felt the provider cared about their opinions and included them in decisions. The registered manager had knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements through periodic meetings. The provider had worked effectively in partnership with a range of healthcare professionals.

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 September 2019) and there were multiple breaches of regulation. The provider 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 provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 and 14 June 2019 and breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion and were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Sunrise of Frognal on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service and if we receive any concerning information we may inspect sooner.

Sunrise of Frognal is a residential care home registered to provide personal and nursing care for up to 131 people in two adapted buildings. There were 115 people using the service at the time of our inspection.

Sunrise Senior Living Limited and Sunrise UK Operations Limited are dual registered and both providers are jointly responsible for service delivery at Sunrise of Frognal.

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

At our comprehensive inspection of 22 and 23 March 2018, we found the provider had not acted to make sure medicines were managed safely and we issued a requirement notice.

At this inspection, we found the provider had not made sufficient improvements for managing medicines since the last inspection. Medicines were still not always being managed safely.

At our comprehensive inspection of 22 and 23 March 2018, we found some improvements were needed to have an effective quality assurance system and processes.

At this inspection, we found the provider had not made sufficient improvements to monitor the quality of the service being delivered.

The falls management was not effective, people were at risk of receiving unsafe care and support.

People and their relatives gave us positive feedback about their safety and told us that staff treated them well.

The registered manager and staff understood what abuse was, the types of abuse and the signs to look for.

Senior staff completed risk assessments for every person and they were up to date with clear guidance for staff to reduce risks.

There were enough staff on duty to support people safely and in a timely manner. Staffing levels were consistently maintained to meet the assessed needs of people.

The provider carried out comprehensive background checks of staff before they started work.

Staff kept the premises clean and safe.

The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.

Staff carried out pre-admission assessments of each person’s needs to see if the service was suitable and to determine the level of support they required.

Staff received appropriate support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach their line manager, and the registered manager, at any time for support.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. People told us they had enough to eat and drink.

The provider had strong links and worked with local healthcare professionals in a timely manner.

The provider met people’s needs by suitable adaptation and design of the premises.

Staff completed health action plans for everyone who used the service and monitored their healthcare appointments.

The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care.

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

Staff showed an understanding of equality and diversity. They supported people with their spiritual needs where requested.

Staff involved people or their relatives in the assessment, planning and review of their care.

Staff respected people’s choices and preferences.

People told us staff treated them with dignity, and that their privacy was respected.

Staff recognised people’s need for stimulation and supported them to follow their interests and take part in activities. People responded positively to these activities.

Staff had developed care plans for people based upon their assessed needs.

Care plans were reviewed on a regular basis and reflective of people’s current needs.

People told us they knew how to make a complaint and would do so if necessary.

The provider had a clear policy and procedure for managing complaints.

The provider had a policy and procedure to provide end-of-life support to people. However, no-one using the service required end-of-life support at the time of our inspection.

The service had a positive culture, where people and staff told us they felt the provider cared about their opinions and included them in decisions.

The registered manager had knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements through periodic meetings.

The provider had worked effectively in partnership with a range of healthcare professionals.

Rating at last inspection – The last rating for this service was requires improvement (report published on 18 July 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 made and the provider was still in breach of regulations.

Why we inspected - This was a planned inspection based on the rating at the last inspection.

Enforcement – We have identified breaches in relation to the provider was not making sure always there was proper and safe management of medicines and making sure risks from all falls were assessed and action taken to mitigate them, and the quality assurance system and process was not effective as the provider had not always identified issues we found at this inspection and acted upon in a timely manner. Please see the action we have told the provider to take at the end of this report.

Follow up - We will request an action plan for 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.

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

Sunrise of Frognal is a ‘care home’ providing residential care for older people with dementia. 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. Sunrise of Frognal accommodates up to 131 people in two adapted buildings. There were 107 people using the service at the time of our inspection. This was the first inspection of Sunrise of Frognal, since their registration in August 2017, with a new provider Sunrise UK Operations Limited.

During this inspection, we found two breaches of the Health and Social Care Act 2008. The provider had not taken appropriate action to ensure that people received their medicines as prescribed in a timely way. Staff had not followed the provider’s medicines policy in relation to ordering and booking of medicines. Liquid medicines requiring opening dates had no date of opening. The medicines administration record (MAR) and medicines balance in stock reconciliation was not correct.

These shortfalls were a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quality assurance systems were in place to monitor and improve the service. However, improvements were required as they did not identify the issues we highlighted above.

These issues were a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We did see some areas of good practice with medicines. The provider had a policy and procedures which gave guidance to staff on their role in supporting people to manage their medicines safely. We saw the medicines room was found to be clean and tidy and the medicines trolley was locked at all times. We saw evidence that people's medicines were reviewed regularly by the GP.

We did see some areas of good practice with quality assurance system and processes. The service had system and process to assess and monitor the quality of the care people received. As a result of these checks and audits the service made improvements, for example, care plans and risk management plans were updated, and falls management had improved.

The service had a registered manager in post at the time of writing this report. 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.

The service sought the views of people who used the services, their relatives, and staff to improve the service. Staff felt supported by the registered manager. The service worked effectively with health and social care professionals, and commissioners.

People and their relatives told us they felt safe and that staff and the registered manager treated them well. Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks.

The provider carried out comprehensive background checks of staff before they started working and there were enough staff to provide support to people. The service had arrangements to deal with emergencies and staff were aware of the provider’s infection control procedures and they maintained the premises safely. The provider trained staff to support people and meet their needs. People and their relatives told us that staff were knowledgeable about their roles and that they were satisfied with the way staff looked after them. The provider supported staff through regular supervision and yearly appraisal.

The service had an effective system to manage accidents and incidents, and to prevent them happening again. The provider recognised people’s need for stimulation and social interaction. People had end-of-life care plans in place to ensure their preferences at the end of their lives were met. Staff completed daily care records to show what support and care they provided to each person.

The registered manager and staff understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care before they were delivered.

Staff assessed people’s nutritional needs and supported them to maintain a balanced diet. Staff supported people to access the healthcare services they required, and monitored their healthcare appointments. The registered manager and staff liaised with external health and social care professionals to meet people’s needs.

People or their relatives, where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, caring, and respectful. Staff protected people’s privacy and dignity.

The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.