Sunrise Operations Sevenoaks Limited provides accommodation, nursing and personal care for up to 102 older people. There were 94 people living at the service during our visit, some of whom were living with dementia, Parkinson’s disease and other complex needs. A number of people had other conditions including stroke and diabetes, and some people had reduced or impaired mobility and used wheelchairs to move around. There were also people who lived independent lives, continuing to drive and come and go as they chose. Accommodation is provided over three floors with communal areas on each floor. The third floor, known as ‘the reminiscence neighbourhood’, was for people who were living with dementia which had progressed and impacted on their daily lives. The ground and first floors were known as ‘the assisted living neighbourhood’, some people who were living with dementia also lived accommodated on these floors. There was a passenger lift between floors and all areas of the accommodation were accessible to people who used wheelchairs.
The service did not have a registered manager. The previous registered manager had resigned the week before our inspection and interim management arrangements were in place to cover the service whilst recruitment to the post was in progress. 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.
This inspection took place on 15, 16 and 22 December 2014 and was unannounced. The previous inspection was carried out in May 2014 when we found the service met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
During this inspection 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.
Some people made complimentary comments about the service they received. People felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Relatives who we spoke with before and during our inspection raised a number of concerns about the service their family members’ received.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The former registered manager had submitted four Deprivation of Liberty Safeguards (DoLS) applications, one of which had been authorised by the local authority. The management understood when an application should be made and how to submit one and were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
Less than half the staff had received training in MCA to make sure they understood how to protect people’s rights. There were procedures in place and guidance in relation to Mental Capacity Act 2005 (MCA). People were asked for their consent before staff carried out care or treatment, although
The provider had not taken adequate steps to make sure that people were protected from abuse. There had been numerous incidents of abuse, some of which the local authority safeguarding team had investigated and found that abuse had taken place. Staff training in safeguarding people was not up to date and staff did not have access to all the information they needed about reporting abuse.
The risks to people had not been updated following changes in their safety or welfare including when they had experienced falls. Staff did not have the guidance they needed to take appropriate action to keep people safe.
The provider did not always follow safe recruitment procedures to make sure staff were suitable to work with people because full employment histories were not always obtained. There were not always enough staff employed in the home to respond in a timely manner when people called for assistance.
Safe medicine administration procedures were not always followed so that people got their medicines when they needed them. Medicines were stored safely.
Staff had not all received the essential training or the updates required. This included training in safeguarding adults and managing behaviour that may challenge the service. Staff had not attended training in caring for people with specific needs such as Parkinson’s disease, sensory impairment and other conditions.
Care staff had not received the supervision, appraisals and support they needed to enable them to carry out their roles effectively. Staff told us that morale was “Very low” because they did not feel supported by the management and were not involved or consulted in decision making as they did not have supervisions, or regular team meetings.
Staff told us that they felt people were moved into the service when there were not enough staff to meet their needs. A GP told us they were concerned that people were moved into the service without adequate assessment.
A number of people had complex needs which staff did not feel they were equipped or resourced to meet. Staff said they did not have time to read care plans and the written information they were given was inaccurate and out of date.
People’s weights were not monitored and recorded regularly to make sure they were getting the right amount to eat and drink to protect them from the risk of malnutrition. There were mixed views about the meals provided. Some people were complimentary but most people told us the food was bland and not to their liking. Staff made sure that people’s dietary needs were catered for. Staff did not consistently respect people’s dignity. People who needed support to eat were not always helped in a dignified way. People’s information was treated confidentially. Staff made sure that any personal care people needed was carried out in private.
People were not supported adequately to manage their health care needs. A relative told us that an appointment had been missed because a letter from a health professional was not given to the person or their relative in time. Relatives also gave examples of infections and injuries which had gone unnoticed until relatives pointed them out to staff. Pressure ulcers were not managed effectively to make sure these wounds were prevented. A GP shared concerns with us about how the staff managed people’s health and communicated with the GP surgery.
Some relatives expressed concern about the general care of their family members and told us that poor communication meant they were not always kept informed about changes and decisions, or listened to when they expressed concerns about the way their family members’ care was being delivered. One relative told us they had removed their family member from the service because they were not getting the care they needed.
Ways to enable people living with dementia or other conditions to remain as independent as possible had not been explored such as dementia friendly signage and adaptations to the premises and equipment people used. Staff were very busy carrying out tasks and mostly did not have time to initiate conversations with people other than when they were providing the support or treatment people needed. Most of the staff were kind, caring and patient in their approach and had a good rapport with people.
People did not always know who to talk to if they had a complaint. Relatives told us that the manager had not been around for weeks and there were always different faces. They did not know if concerns they raised were passed on to the right people and gave examples of complaints they had made that had not been addressed. The changing management team meant that staff, people and their relatives did not know who to go to with any concerns.
The approach to activities was to entertain, do to, rather than support people to participate in activities. There were no individual activity programmes to ensure people living with dementia were provided with meaningful activities to promote their wellbeing. People told us they enjoyed the activities they were able to choose from but their individual needs had not been considered in planning the activities.
People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and people were able to spend time with family or friends in their own rooms and other areas. There were links between the home and the local community. Children from the local school were giving a Christmas concert for people during our inspection.
People and their relatives had raised concerns about the leadership of the service. They had not been kept informed about changes in the management team and did not know who was in charge. There had been no recent residents or relatives’ meetings or customer satisfaction surveys to show that people were consulted and their views taken into account in the way the service was delivered.
There was an interim manager at the service. At other times during each week, relief managers and other senior managers were present at the service. Communication was not always effective in ensuring that important information was passed on to appropriate people to make sure that action was taken in a timely manner to address issues relating to people’s safety, care and welfare.
Quality assurance systems had not been effective in recognising shortfalls in the service. Although some shortfalls had been recognised and an action plan had been developed, improvements had not been made in response to accidents and incidents to ensure people’s safety and welfare were promoted. Records relating to people’s care and the management of the service were not well organised or adequately maintained.