Sunningdale House

Sunningdale House is a residential care home for up to 13 people. The service provides support to people who live with mental health, learning disability and autism. At the time of our inspection 8 people were using the service.

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

Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: 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 were safely recruited in line with the provider's policy and legislative requirements. Enough staff were employed to spend quality time with people to develop skills and promote independence. Staff received supervision and appraisal along with spot checks to ensure they followed best practice. For example, when supporting people to take their medicines.

People received initial assessments of their needs with care plans in place to manage known risks.

People's care plans and risk assessments reflected their needs and preferences, and staff were knowledgeable about the level of support people required. Regular reviews ensured information remained relevant and up to date as an accessible point of reference for staff.

Right care: Care was person-centred and promoted people's dignity, privacy, and human rights;

Staff were respectful, caring and understanding around people’s emotional and physical needs.

People were involved in planning their care and support. Care was delivered following a robust assessment of needs to ensure people’s wishes preferences and any personal characteristics were recorded and supported. Regular reviews with people ensured adjustments were made to meet people’s changing needs and aspirations.

Where people received support to take their medicines this was done safely. Medicines management and administration followed best practice guidance. Risk assessments were reviewed to help staff to keep people safe, for example, when buying over the counter medicines.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive, and empowered lives; The culture of the service was open and empowered individuals to express their views and be in control of their lives with the support of staff. We saw people felt confident to approach staff and management and that their suggestions were listened to.

A range of quality assurance checks including regular audits were completed to manage and improve the service and to maintain compliance with required regulations.

Staff followed latest guidance to maintain effective infection prevention and control and had good access to any required protective equipment which helped to reduce the spread of any infections.

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 (06 October 2021) and there were 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.

At our last inspection we recommended that the provider review their staffing levels and the tools used to determine these, to ensure person-centred care in line with best practice. We recommended the provider reviewed the service model and delivery to ensure this was in line with current best practice. At this inspection we found the provider had acted on our recommendations and improvements had been made.

Why we inspected

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. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s medicines. This inspection examined those risks.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sunningdale House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sunningdale House is a care home for up to 13 people with mental health issues some of whom had additional needs due their learning disability and/or autism. When we inspected 11 people lived in the service.

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

Staff were not consistently recruited in line with the provider’s policy and legislative requirements. Staffing levels did not enable staff to have quality time with people to develop skills and promote independence. People did, however, provide positive feedback about staff.

The provider’s system of audits and checks had not been effective in identifying issues which could compromise the quality of the service. When issues had been raised these had not always been addressed in a timely manner. For example, there were long-standing concerns with the environment which had started to be addressed shortly before this inspection. Improvement had not been driven.

Staff understood the requirements related to the use of PPE (personal protective equipment) and visitors to the service were screened on arrival. Elements of infection and prevention control practices required addressing, including ensuring robust cleaning.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was limited evidence that people who used the service were involved in the approach and development of the service. Staffing levels did not promote person-centred care and the service model was not in line with best practice. People were, however, free to move around the service and not restricted from leaving.

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 8 January 2019).

Why we inspected

We had concerns relating to potential environmental risks at the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.

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 Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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 have identified breaches in relation to good governance and recruitment 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.

About the service: The service is a care home for up to 13 people with mental health issues some of whom had additional needs due their learning disability and/or autism. When we inspected 12 people lived in the service.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

The registered manager had worked to recruit, coach and develop the staff team in the past year. This had led to a motivated group of staff who worked to provider person centred care to people.

People told us they were happy and felt staff had a good understanding of their needs and preferences. That staff listened to what they wanted and acted quickly to support them to achieve their goals and aspirations.

People had good community networks which were personal to them. This included supporting to connect and maintain contact with family and friends.

Staff were well trained and skilled. They used their skills to protect people and promote their independence and rights.

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 supported this practice.

The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people’s lives.

The values of the organisation of offering choice, inclusion and respect were embedded. This supported people to receive the positive service described.

The service met all the values that underpin the 'Registering the Right Support' and other best practice guidance such as 'Building the Right Support' apart from the recommended size of a service. However, the values including choice, promotion of independence and inclusion were seen and people did receive a person-centred service. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.

A full description of our findings can be found in the sections below.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At the last inspection in July 2016 we found the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and was rated Requires Improvement. The breaches related to the safe delivery of care and treatment, staff supervision and appraisal and overall governance of the home. The provider sent an action plan following the inspection to outline how they were going to approach making improvements.

Although improvements had been made we found continued breaches in two areas relating to safe care and treatment and good governance.

This is the second time the service has been rated Requires Improvement. We will discuss this outside of the inspection process with the provider.

We discussed with the provider and the registered manager areas which still required improvement and they were open about challenges they had faced since the last inspection. This had involved a turnover of staff and slow recruitment, a new registered manager, a programme of complex change and refurbishment. Following the inspection the registered manager provided regular updates about action they had taken to continuously improve. We had confidence the provider was committed to making the improvements still required.

Sunningdale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 13 people who have mental health issues and or a learning disability/ autism in one adapted building.

The service had a registered manager in place. The registered manager had been recruited since our last inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

Systems in place to monitor the service provided had not consistently highlighted concerns which affected safety and quality. The issues we noted around refurbishment, cleanliness, responsiveness of staff to promote wellbeing for people were linked to the lack of resources and staffing levels the provider had implemented. The provider listened and immediately put plans in place to make improvements.

Risks to one person’s safety had been assessed but detailed plans had not been implemented to guide staff how to keep the person and other people safe. This had impacted negatively on the person’s wellbeing. For other people we saw appropriate risk assessments, care plans were in place which contained person centred detail about how the person preferred to be supported. People had been involved in developing their own care plans and we saw they were regularly reviewed.

There were systems and processes in place to protect people from the risk of harm. This included safe recruitment and selection processes carried out before staff began employment and appropriate checks of the building to ensure health and safety. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate systems were in place for the management of medicines so people received their medicines safely.

We saw staff had received supervision on a regular basis and an appraisal. Staff had received appropriate training to enable them to fulfil their role. They understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We saw positive interactions between people and staff. Staff treated people with dignity and respect. People told us they were happy and felt very well cared for.

People were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. They were supported to maintain good health and had access to healthcare professionals and services.

People’s independence was encouraged and each person had goals they wished to achieve. They were able to tell us the progress they had made towards them. People were supported to maintain positive relationships with friends and relatives when they chose to keep in touch with them. They accessed the local community to maintain links with support groups and friends.

People told us they were able to voice their ideas and concerns to the registered manager. Regular forums were made available for them to do this. The provider had a system in place for responding to people’s concerns and complaints. We saw any concerns raised had been dealt with appropriately.

The team of staff were complimentary about the support they received from the registered manager. They told us there was a positive culture and they enjoyed their work supporting people. People and their relatives agreed the registered manager was a good leader who listened and supported them well.

Breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the end of this report.

Sunningdale House is registered to provide personal care and accommodation for up to 13 adults who have mental health problems. The property is located in a pleasant residential area of Harrogate, close to local amenities. The property is made up of two adjoining older terraced houses that have been converted into one property and adapted for use as a care home. The accommodation is arranged over three floors. There is a garden to the front of the home and a courtyard to the rear. At the time of our inspection there were 13 people using the service.

The service is required to have a registered manager as a condition of their registration. 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. At the time of our inspection there was no registered manager, as the previous manager had left in January 2016. A new manager had started four weeks before our inspection but had not yet registered with the Commission.

We found that the absence of a registered manager since January 2016 had impacted on some management and governance systems. Quality assurance systems were in place and a range of audits were conducted, however some actions identified in audits and the service’s improvement plan had not been addressed.

We found that people’s needs were assessed and some risk assessments were in place to reduce risks and prevent avoidable harm. However not all risk assessments were up to date, and risks in relation to fire safety had not been adequately assessed or system tested.

Staff received an induction and completed a range of training to help them carry out their roles. The majority of training was completed on-line. Not all staff had received additional specialist training in order to further develop their understanding of the specific needs of some of the people they supported, such as mental health, autism and diabetes. The registered provider advised us they had additional specialist training booked to take place within the next three months. Staff had not received regular formal supervision in line with the registered provider’s policy and procedure.

The registered provider had an infection control policy and cleaning schedules were in place. Most of the home was clean, but we found some areas that were not clean and appropriately maintained and we have made a recommendation in our report about this.

Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the importance of gaining consent. However some care files lacked recorded evidence about people’s consent to particular restrictive decisions taken. We have made a recommendation about this in our report.

There were policies and procedures in place in relation to the management of medication, but these were not consistently followed and improvements were required in relation to the storage of medication. We have made a recommendation about this in our report.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers, although there was some inconsistency in how recruitment records were stored. On the day of our visit here were sufficient numbers of suitable staff to keep people safe and meet their needs, but there had been some staff sickness and turnover in recent months so the provider was taking action to recruit more permanent staff in order to address staff consistency.

People who used the service told us they were happy with the quality and variety of food available, and that they got sufficient to eat and drink. Care plans contained information about people’s nutritional needs.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with healthcare services, such as the community mental health team, optician and podiatrists.

People told us that the staff who supported them were kind and caring. We saw that interactions between staff and people who used the service were relaxed and friendly. Visitors were made welcome to the home and people were supported to maintain relationships with their friends and relatives. People accessed local community facilities of their choice.

The registered provider completed care plans which contained information about people’s needs, however these had not been consistently reviewed in the four months prior to our inspection. Staff were, however, able to demonstrate a good understanding of people’s needs and preferences. People also told us that they were happy with the care they received and that it met their needs.

There was a complaints procedure in place and people using the service told us they knew how they could raise a complaint if they needed to. People also had opportunity to raise concerns in resident’s meetings and during contact with their keyworkers.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, safe care and treatment and good governance. You can see the action we have asked the provider to take at the back of the full version of this report.

On the day of the inspection we met six people living at Sunningdale House. We spoke with four people about their experience of care. We spoke with three staff and looked at records. We subsequently spoke with the relative of one person by telephone following the inspection. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support people living there. Staffing levels were appropriate to meet the needs of people living in the service.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Staff spoke with pride about the progress that individual people had made whilst they had been living in the service. People were supported to cook their own food and staff also provided a cooked meal each day for people who chose to eat together. One staff member told us about the progress that one person who lived in the service had made. "He's recently made his own drinks with the help of staff, another resident has helped with cleaning. I feel happy when that does happen".

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. One person told us, "I'm happy here, I like my room and I like going to the library."

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included visiting local places of interest, attending places of work which provided specific supported activities and shopping. People knew how to make a complaint if they were unhappy and three people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The deputy manager told us that the service did experience occasional delays in responses from care managers from some local authorities and staff at Sunningdale House were concerned about the potential impact of this on some people who used the service. The service had a quality assurance system which included planned audits. People who lived in the service, staff and relatives were asked for their views. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. New staff had recently been appointed. A programme of refurbishment was underway and much of the planned work had been completed. The manager had introduced a more person centred care planning process which staff had started to implement. Staff told us that they felt well supported by the manager.

People's support plans contained detail on their likes and dislikes, and support needs. They contained sufficient information to enable appropriate care and support to be given, and staff were able to describe people's needs. Where people could not make their own decisions, the service worked in the person's best interest and involved other professionals as needed.

We found some issues with the maintenance and upkeep of the building, and have asked the provider to take action in relation to these.

The home operated recruitment procedures which included appropriate police checks and references for staff, although the home was not able to produce all the information we asked for.

There was a complaints procedure in place which was available in a format to meet people's needs.