Archived: Sunnyfields

Sunnyfields is a small home on the Isle of Sheppey which provides accommodation and support for up to four people with learning disabilities. Four people lived at the home on the day of our inspection. Some people had difficulty communicating verbally and were unable to tell us about their views and experiences of living at the home.

At our previous inspection on 06 July 2016 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to assess and mitigate the risk of harm to people using the service. We also found a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. The provider and registered manager had not notified CQC about important events. We also made the following recommendations; that the provider and registered manager carried out required employment checks to ensure that staff are suitable to work with people. That the provider followed good practice guidance in relation to recording medicines. That the provider put adequate systems in place to track and monitor DoLS applications, authorisations and conditions and that mental capacity assessments were reviewed. That all people received adequate weight monitoring to ensure that they maintained good health. That registered person’s ensure all personal information is securely stored. That the provider reviewed and updated the complaints procedures to ensure that people and their relatives have clear guidance in a way they understand and a recommendation that the provider updated their website to ensure that the rating is clearly displayed. We asked the provider to take action in relation to the breaches of regulations.

The provider sent us an action plan on 15 September 2016 which stated that they would meet the Regulations by 01 October 2016.

There was a registered manager in place. The registered manager was registered for Sunnyfields and another local service owned by the provider. 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 and associated Regulations about how the service is run. As the registered manager was not based in the home on a daily basis the home manager provided us support during the inspection.

During this inspection we found that the provider and registered manager had made the improvements that they had planned to make, however we found new areas of concern.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led.

Some areas of the home and equipment required additional cleaning and maintenance. The fire service had visited the home to carry out an inspection on 12 June 2017. Timely actions had not been taken to meet the schedule or works required to meet The Regulatory Reform (Fire Safety) Order 2005.

Medicines practice had improved. Medicines records (MAR) were clear and accurate. Medicines stock counts were carried out regularly. Protocols were not in place for each ‘as and when required’ (PRN) medicine which was prescribed. We made a recommendation about this.

People’s rights within the basic principles of the Mental Capacity Act 2005 (MCA 2005) were not always considered and recorded. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The registered manager had carried out mental capacity assessments. These did not follow the principle of the MCA 2005.

People’s religious and cultural wishes and preferences in relation to food had not always been respected. One person did not eat beef but had been served meals containing beef. Staff had not given the person alternative choices to enable them to make an informed choice.

People’s information was not always treated confidentially. Their daily records, keyworker reports and activity records were stored on the sideboard in the lounge area, which meant they were accessible to everyone.

People were encouraged to take part in activities that they enjoyed, some people were more active than others. Two people appeared not to have much to keep them stimulated. We made a recommendation about this.

Systems to monitor the quality of the service were in place. Audits picked up a number of issues and concerns which the management team had completed and were continuing to work through. Audits had not picked up all the issues we found during the inspection.

Risks to people’s safety and wellbeing were managed effectively to make sure they were protected from harm. Risk assessments were in place for all areas of identified risks.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known.

There were enough staff deployed on shift to keep people safe. Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Staff had received training relevant to their roles. Staff had received regular supervision.

Relatives were encouraged to feedback to the service through surveys.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The home had a safeguarding policy in place which listed staff’s roles and responsibilities.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority.

People were supported and helped to maintain their health and to access health services when they needed them. People’s weights had been consistently monitored to ensure people remained in good health.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Relatives knew who to talk to if they were unhappy about the service.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the management team and the provider. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift took place to make sure all staff were kept up to date.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Sunnyfields is a small home on the Isle of Sheppey which provides accommodation and support for up to four people with learning disabilities. Three people lived at the home on the day of our inspection. People had difficulty communicating verbally and were unable to tell us about their views and experiences of living at the home.

We last inspected Sunnyfields on 23 and 31 October 2014. The service was rated as ‘requires improvement’ as an overall rating because they did not have a registered manager in place and had not completed or returned their provider information return (PIR). Actions from audits had not always been dealt with in a timely manner.

At this inspection Sunnyfields had a registered manager. The registered manager was registered for Sunnyfields and another local service owned by the provider. 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 and associated Regulations about how the service is run. As the registered manager was not based in the home on a daily basis the provider had put in place a home manager.

People were unable to verbally tell us about their experiences. Relatives gave us positive feedback about the service and the management of the home.

Risks to people’s safety had not always been adequately assessed. People were at risk because actions identified in the fire risk assessment had not been addressed. People were at risk of scalding when using baths and showers.

Medicines had been administered following the provider’s medicines policy and following good practice guidance. One medicines record was not accurate and complete. We made a recommendation about this.

The provider and registered manager had not notified CQC about important events such Deprivation of Liberty Safeguards (DoLS) applications in a timely manner. The home manager had let CQC know about other events such as serious injuries.

Recruitment practices were not always safe; one staff member’s employment history contained gaps that had not been explored. We made a recommendation about this.

There were enough staff on duty to meet people’s needs. Staff had undertaken training relevant to their roles. Staff had received regular supervision and support.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

People enjoyed the food; meals were served according to people’s assessed needs. People helped to choose the food on the menu.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA to enable them to protect people’s rights. Documentation did not always follow the principles of the MCA. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved. Conditions with DoLS authorisations had not been met. We made a recommendation about this.

People’s weights had not always been monitored. We made a recommendation about this.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. The staff ensured people received effective, timely and responsive medical treatment when their health needs changed.

Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities. People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect.

People’s information was treated confidentially and personal records were stored securely. Daily records were kept in an unlocked cupboard in a communal area; we made a recommendation about this.

People’s view and experiences were sought during meetings and through quality assurance surveys. Relatives were also encouraged to feedback through surveys, although relatives had not been sent surveys since 2014.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented, they were detailed and thorough.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The atmosphere in the home was calm and relaxed. All the interactions we saw between staff and people who lived in the home were positive. We saw that people felt free to express their needs to staff.

We observed that staff treated people with dignity and respect. Staff were polite and interacted well with people. Staff understood the needs of the people who lived in the home and supported them in line with the guidance in their care plans.

Peoples needs were met with regard to their nutritional and hydration needs and were provided with a range of suitable choices at meal times.

There were adequate staff on duty to meet the needs of the people who lived in the home.

People lived in an environment that met their needs.

There was an effective system to regularly assess and monitor the quality of service that people received.

There were three people living at the service and a small group of staff caring for them. We saw that staff respected people and involved them as much as possible in the daily routines of the service.

We found that staff interacted with people well and understood people's diverse and complex needs. We saw evidence that people's health, emotional and social care needs were considered and met. We saw that a number of professionals were involved in people's care, in order to meet their needs.

Staff received the support they required to meet the needs of the people living at the service.

There was evidence that learning from incidents took place and there were systems in place to monitor the quality of the service provided.