Two inspectors carried out this inspection. We carried out this inspection to check whether Sunnycroft Care Home had taken action to meet the following essential standards:' Consent to care and treatment
' Care and welfare of people who use services
' Meeting nutritional needs
' Safeguarding people
' Staffing
' Assessing and monitoring the quality of service provision
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 safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
Below is a summary of what we found. The summary is based on our discussions with five people who used the service, one family member, twelve staff members and two people who were visiting a friend living in the home. In addition we looked at five people's care and support plans. If you would like to see the evidence that supports the summary, please read the full report.
Is the service safe?
People were able to indicate to us that they felt safe living at Sunnycroft Care Home. However, we saw that whilst the provider had made improvements to recruitment procedures, that shortfalls were still present. This meant that the provider could not ensure that only suitable people were employed to work with vulnerable adults.
The registered manager was able to tell us how they protected vulnerable adults. They told us how they responded to and reported safeguarding incidents to the relevant authorities. Other staff we spoke with demonstrated knowledge of safeguarding adults and how to respond to and report safeguarding issues.
We found a system of assessing risks designed to keep people living in the home, and staff, safe from harm. However, despite this we found that some of the risk assessments were not appropriate to people's needs and reviews of risks to people had not been completed to ensure their safety. We found this to be a breach of regulation 9 of the Health and Social Care Act 2008 and had a major impact on people who used the service. We have served a warning notice to the provider as a result. We did however establish that the provider was making improvements in how it identified people who were at risk.
There were not effective systems in place to reduce the risk and spread of infection. A recently conducted audit had identified 13 areas where action needed to be taken in order for the service to meet the Department of Health's code of practice on the prevention and control of infections. Shortfalls covered areas including equipment, environment and waste disposal. At the time of the inspection the provider was working to an action plan provided by the infection control team at the local county council, who had also found significant shortfalls in the home's infection control procedures.
Some people living in the home would decline to consent to certain aspects of their care and treatment. For example some people would refuse to accept personal care or take their medications. Where this happened we noted that staff recorded the refusal in the personal care record. This meant that staff relayed important information to other staff relevant to the person's care. People were provided with their medication when they needed it.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to people living in care services. At the time of the inspection no-one required these safeguards. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when DoLS should be implemented.
Is the service caring?
We noted staff used kind, attentive approaches towards people they supported. We noted that people living in the home, or family members, were consulted about care and support received. We observed that people were reassured in a kind and gentle way. No pressure was placed on people living in the home to accept care or treatment if they did not want to. Instead we saw staff carefully explain what they needed to do and why it was important.
People living in the home were given time to think about what it was they wanted to say or ask. We saw that people's likes and dislikes were respected by staff. For example we noted that if people did not want the door to their room closed, that staff did not do so.
We found that the provider took steps to ensure people were involved, as much as possible, in discussions about their daily living challenges. This included making sure people living in the home were provided with access to other sources of help and advice.
Is the service responsive?
People's care and social needs were assessed and reviewed on a monthly basis or as and when needed. However there were occasions where we found people's reviews had not been recorded in their care records. This meant that some people's changing needs might not have been managed appropriately. We noted that the service referred to other health and social care professionals for advice and guidance if required. All changes were documented and recorded.
A recently appointed activities co-ordinator was in place to ensure daily activities were made available for those wishing to take part if they wanted to.
We spoke with family members of one person living in the home. They told us, "They [the provider] seem to look after [person using the service] well. It can't be easy as they have such complex needs." When asked if they [family member] took part in reviews of their relatives care, they said, "No. I can't remember the last time I was asked my opinion."
Is the service effective?
People using the service that we spoke with said, or indicated to us, that the care and support provided was satisfactory. The majority of people we spoke with did accept that the care provided was in their best interests. From our observations we saw that care and support was effective and consistent. People were supported to be as independent as possible.
We saw that people's care needs were assessed by staff prior to and on their admission to the home. We saw people's care needs were monitored through a review system. However sometimes these reviews were either not carried out or not recorded as having taken place.
Is the service well led?
Views of people using the service and, where possible, their families were sought. This meant that the provider was obtaining feedback about services provided and how they might be improved.
Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged by the provider. This told us that the provider took reasonable steps to keep the staff updated and trained to a high professional standard. We found that the provider used agency staff. We noted that the provider had recently recruited a clinical lead nurse. This told us that the provider took reasonable steps to ensure sufficient, experienced staff were on duty day and night.
Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did. One member of staff told us that they had been employed with the provider for a very long time and did not wish to work anywhere else. Staff we spoke with had a good understanding of the whistleblowing policy.
The provider continued to be non-compliant in three of the eight outcomes we assessed during our previous inspection and was non-compliant in two new outcomes following this inspection. We have asked the provider to tell us how they will make improvements and meet the requirements of the law.