Archived: Sundial Cottage Care Home

Sundial Cottage is a care home, without nursing, accommodating up to 22 people. At the time of our inspection there were 21 people using the service. The accommodation is arranged over two floors with both a passenger lift and a stairlift available to access the upper floor. Some rooms are ensuite. There is an accessible, mature garden surrounding the home and a patio area with seating areas. Many of the people using the service were living with dementia.

At the time we started our inspection, Sundial Cottage was owned by a partnership, who, throughout this report, are referred to as the provider. Before our inspection report was published, the legal entity, or ownership, of the service changed to a limited company. However, there has not been any change to whom is responsible for the day to day management of the service. Mr N Sykes as the nominated individual remains accountable, along with the registered manager, for how the regulated activity, and care provision, is provided at the service.

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

Some environmental risks had not been adequately managed or mitigated. Records relating to people’s care and support were not being stored securely. These shortfalls had not been identified and addressed through the provider’s own checks, but they have now taken action to address these. The registered manager had good oversight of people’s care and feedback about their leadership was positive. There was a friendly, supportive atmosphere at the service and staff cared for people with patience and kindness. Investigations or ‘learning opportunities’ had been completed following safety related incidents. The service worked in partnership with other organisations to help improve the health and well-being of people.

We have made a recommendation about how often some of the training is refreshed. We have also recommended that any refurbishment of the environment considers best practice guidance on the importance of design for people living with dementia.

There were systems and processes in place to safeguard people from the risk of abuse and to learn from safety related events. Overall, suitable risk assessments were in place which described the actions staff should take to mitigate risks to people’s health and wellbeing. Overall, medicines were managed safely, but improvements were needed to ensure that medicines were being stored within recommended temperatures. Three medicines available for staff to administer were either past their expiry date or the ‘in-use’ expiry date. There were sufficient staff deployed to meet people’s needs.

We have made a recommendation about the safe and proper use of medicines.

As part of CQC's response to the coronavirus pandemic we conducted a review of infection prevention and control (IPC) measures in the home and were mostly assured by the systems in place.

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 Good (Published November 2019).

Why we inspected

The inspection was prompted in part due to concerns we had received about the safety of some aspects of the service, institutionalised care practices and medicines.

We did look 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.

We reviewed all the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

The overall rating for the service has changed from good to requires improvement. 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 Sundial Cottage on our website at www.cqc.org.uk.

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

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sundial Cottage Care Home is a residential care home providing personal care and accommodation for up to 22 people aged 65 and over. The service was supporting 22 people at the time of the inspection. The care home accommodates people in one adapted building over two floors.

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

People were supported safely. Staff understood signs of possible abuse and how to raise concerns to appropriate people and authorities. The registered manager understood their responsibilities in relation to safeguarding. Risks to people were assessed and understood by staff. People were supported by staff who had undergone appropriate recruitment checks. Medicines were administered appropriately. Incidents and accidents were thoroughly investigated.

People experienced good outcomes because staff were skilled and involved the appropriate healthcare professionals. Staff experienced effective support by senior staff and the registered manager including ongoing supervision. This enabled them to provide good quality, effective care. People's hydration and nutritional needs were met.

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.

Staff provided caring and compassionate support. People were encouraged to remain as independent in their daily activities as possible. People were treated with dignity and respect.

People's needs were holistically assessed and met by the care provided. People were treated equally and without discrimination. People were able to participate in activities regularly, some of which were provided by external companies. Complaints were well managed and responded to appropriately. End of life care was not being provided at the time of the inspection, but staff understood how to provide this effectively and compassionately. We received positive feedback about end of life care and support that had been provided.

We received positive feedback about the management of the service. The provider and registered manager promoted a positive, open and honest culture within the service and understood their regulatory responsibilities. There were appropriate systems in place to monitor and improve the service. The service had some links with the local community for the benefit of people.

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

Rating at last inspection – The last rating for this service was good (published 31 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection was unannounced and was carried out on 20 September 2016 by one inspector.

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 home. 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 home is run.

People told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

The service was responsive to people’s needs and staff listened to what people said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People were confident they could raise concerns or complaints and that these would be dealt with.

People and, when appropriate, their families or other representatives were involved in discussions about their care planning. People were encouraged to provide feedback on the service provided both informally and through a satisfaction questionnaire.

The service was well led. Staff felt supported by the management to raise any issues or concerns. The quality of the care and treatment people experienced was monitored and action taken to promote people's safety and welfare. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

People's needs were assessed and care and support was planned and delivered in line with their individual care plan. Any concerns were followed up and appropriate action was taken. We observed that staff interacted well with people using the service, promoting a warm and inclusive atmosphere in the home. One person told us 'This is my home and it is very nice. I am well looked after and treated well'. Another person said 'They treat me well and I am happy here'.

People were supported to be able to eat and drink sufficient amounts to meet their needs. All of the people we spoke with told us that the food was good. One person commented 'We have a choice of food, it is all home cooked. I like it'. There was a system in place to monitor and respond to any concerns or complaints about the service. Most of the people we spoke with said they would talk to a member of staff if they had a complaint. There were effective recruitment and selection processes, which meant that people were supported by suitably qualified, skilled and experienced staff.

Some of the people using the service were not able to verbally communicate with us. We therefore spent time observing the care provided and people's interactions with staff. We saw that people were being spoken with and supported in a sensitive, respectful and professional manner.

We did not have the opportunity to speak with people who were visiting their relatives in the home on the day of our inspection, or with any visiting professionals. However, we saw evidence that family members are regularly invited to relatives meetings at the home, and that both relatives and professional feedback on services is regularly sought by the home.