Archived: Signature at Banstead

Signature at Banstead is a residential care home providing personal care to up to 96 people. The service provides support to people over 65, some of whom are living with dementia. At the time of our inspection there were 68 people using the service. The care home accommodates people in one adapted building comprised of a residential setting and a wing on the ground floor for people living with dementia.

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

People were included in the running of the home. There was a person-centred, positive, inclusive culture at the home that was promoted by staff and the registered manager. Relatives had been included and provided the opportunity to join as volunteers to be involved with other areas of the home and spend quality time with their loved ones. Audits were thorough and improvement was driven by the whole staffing team and the registered manager. Staff felt involved in the running of the home and were confident to put forward ideas to drive improvement.

People had access to a wide range of activities that had been designed to match people’s likes, dislikes and different preferences. People received personalised care from staff that knew them well.

People were supported by kind and caring staff that treated them with dignity and respect. People’s privacy was respected and people were encouraged to make decisions about their care. People had access to food and drinks when they needed them and staff were aware of people’s individual nutritional needs.

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.

People’s risks were assessed and managed appropriately. People received support with their medicines by trained staff. There were enough staff to meet people’s needs and safe recruitment practises had been followed. People were safe from the risk of infection due to the standard of cleanliness and hygiene in the home and staff knowledge in this area. Staff were working well with other professionals to effectively support people in a timely way.

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

Rating at last inspection

This service was registered with us on 01 December 2021 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 23 August 2018.

Why we inspected

We inspected based on our information and scheduling in line with the period of time passed with a new provider registration.

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.

Follow up

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

Sunrise of Banstead is a care home for up to 97 people living with dementia, physical disability or sensory impairment. There were 54 people living at the home at the time of our inspection.

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

People were supported by kind and caring staff with whom they had established positive relationships.

Staff treated people with respect and maintained their dignity when providing their care. Equality and diversity was valued and celebrated.

Staff knew and respected people’s preferences about their care. They encouraged people to remain as independent as possible.

The registered manager and senior staff team had implemented effective quality monitoring systems. Staff communicated important information effectively, which helped ensure people received consistent care.

Staff were well supported by the registered manager and senior staff team. Staff achievements were recognised and valued.

People had opportunities to give feedback about the home and the care they received. They said staff listened to and acted upon what they had to say.

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.

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 22 August 2018).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9 May 2018. We rated the Caring key question requires improvement.

We undertook this focused inspection to check they had made the required improvements. This report only covers our findings in relation to the key questions Caring and Well-led which contain those requirements.

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 changed remained good. This is based on the findings at this inspection.

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.

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.

We found the following examples of good practice.

Staff had received support throughout the pandemic to check on their wellbeing and ensure staff’s mental health was prioritised with appropriate support. The provider ran a pilot project within the home looking at bereavement support and counselling. The registered manager told us they had received positive comments about how this had helped staff to explore their feelings and thoughts and how it had helped to flip some negative thinking around to promote wellbeing.

The registered manager had reviewed lessons learnt from other services who had dealt with an outbreak of COVID-19. The registered manager stated this had helped to take on board additional learning and information of what signs and symptoms to look out for which may not have been known previously.

The provider was able to implement an effective zoning strategy within the home. The contingency plan in place gave detail around planning for an emergency or an outbreak of COVID-19. During an outbreak of COVID-19 the registered manager was able minimise the spread of infection by ensuring the home was zoned off appropriately.

There was an infection prevention and control (IPC) champion in place within the home who was able to support the registered manager with additional changes during the pandemic. This included changes to cleaning schedules to include high touch point areas and daily infection control monitoring.

The provider had in place a robust system to ensure visiting could take place for people living at the home. There was an internal visiting pod with separate entrances for people and relatives which supported the nominated visitor process. Outside visits and window visits were also taking place which enabled more family members to visit. All visits were risk assessed prior to taking place.

The provider had ensured a high level of personal protective equipment (PPE) stock had been maintained throughout the pandemic. Staff were observed to be following the guidance for use of PPE.

The provider had supported people to receive their first vaccine dose. This included supporting people to understand why the vaccine was being offered and responding to any concerns from people or their families. The second dose of the vaccine had been booked for the start of April 2021.

Sunrise of Banstead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home can accommodate a maximum of 97 people in two 'neighbourhoods.' The reminiscence neighbourhood provides care to people living with dementia and the assisted living neighbourhood supports older people who may have mobility and health needs. There were 83 people living at the home at the time of our inspection.

There was a registered manager in post. 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.

Although staff were caring, one person was subject to restrictions which affected their experience of care and their life at the home. Although it affected only one person, this restriction was significant and breached the person’s human rights.

Overall people were safe although we identified an area for improvement in the use of equipment. We made a recommendation about this.

Overall people’s medicines were managed safely although we identified an area for improvement in the use of medicines prescribed ‘As required’ (PRN). We made a recommendation about this.

People felt safe and secure at the home. There were enough staff on each shift to meet people’s needs. Staff understood safeguarding procedures and were aware of their responsibilities should they suspect abuse was taking place. People were protected by the provider’s recruitment procedures.

There were plans in place to ensure people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly to keep the premises safe for use. The home was clean and hygienic and staff maintained appropriate standards of infection control.

People’s needs were assessed before they moved into the home and kept under review. People’s care was provided in line with the Mental Capacity Act 2005 (MCA). When assessing people’s capacity to make decisions, staff had followed an appropriate process to ensure their rights under the MCA were protected. Staff understood that any restrictions should only be imposed upon people where authorised to keep them safe.

Staff had access to the induction, training and support they needed to do their jobs. Staff attended all elements of mandatory training during their induction and refresher training at regular intervals. Staff had access to further training relevant to the needs of the people they cared for. All staff attended regular one-to-one supervision, which gave them the opportunity to discuss any further training they needed, and an annual appraisal.

People enjoyed the food provided and were involved in developing the menu. People’s feedback about meals and mealtimes was encouraged and their suggestions were implemented. People’s nutritional needs had been assessed and were known by care and catering staff. Staff supported people to maintain adequate nutrition and hydration.

People’s healthcare needs were monitored effectively and people were supported to obtain treatment if they needed it. Referrals were made to healthcare professionals if staff identified concerns about people’s health or well-being. Any guidance about people’s care issued by healthcare professionals was implemented and recorded in people’s care plans.

People were supported by caring staff. People told us they had developed positive relationships with staff and enjoyed their company. They said the atmosphere in the home was friendly and welcoming. Staff supported people to maintain relationships with their friends and families. People said staff treated them with respect and maintained their dignity. Staff encouraged people to remain as independent as possible. People’s care plans were personalised and reflected how they preferred their care to be provided.

People had opportunities to take part in activities and to attend events and outings. People were protected from the risk of social isolation.

People and their relatives were given information about how to complain and felt able to raise concerns if they were dissatisfied. Complaints were investigated and responded to appropriately and used as opportunities to improve the care people received.

The home was well managed. People told us they saw the registered manager and senior staff regularly. They said they were encouraged to give their views about the home and how it could be improved. There was an open culture in which staff felt able to express their views and raise any concerns they had. Staff felt well supported by their managers and the senior management team. They said they were valued for the work they did. The provider recognised staff who strove to provide excellent care.

Staff communicated important information effectively. Staff at all levels met regularly to share information about people’s needs and any changes to their care. The provider had effective systems of quality monitoring and improvement. Key areas of the service were audited regularly and discussed at clinical governance meetings. Where opportunities to improve the service were identified, these were incorporated into the home’s development plan.

We identified a breach of the Health and Social Care Act 2008. You can see what action we told the provider to take in the full version of this report.