This inspection took place on 11 January 2016 and was unannounced.
During our previous inspection on 24 June 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to; the management of medicines, care records and governance systems and processes. During this inspection we checked improvements had been made in these areas and re-rated the quality of the service provided.
Sunningdale EMI Care Home provides residential care for up to 41 people. The home was full on the day of our inspection. The home specialises in providing care and support to people who live with dementia. The building is a large Victorian house which has been extended to provide additional single en-suite bedrooms. Accommodation is on two floors with passenger lift access. Some of the larger rooms in the older part of the house are shared between two people.
The home has a registered manager who has been in post for over six years. 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.
We saw some improvements had been made to the systems and processes for managing medicines. However, further improvements were needed to ensure accurate and complete records were maintained.
We found poor standards of hygiene throughout the home. We found communal areas, people’s bedrooms and bathrooms had not been thoroughly cleaned and some beds were made with stained bedding.
Risks to people’s health and safety had not been appropriately assessed, monitored and mitigated. Many risks were managed through a collective approach, rather than adopting an individualised and person centred approach to risk management.
Staff told us they had completed safeguarding training and could identify the different types of abuse. A new safeguarding policy had been introduced however we found this needed to be reviewed to ensure it was fit for purpose.
People told us they felt safe living at the home. However, our observations and other evidence showed there were not enough staff to ensure people were kept safe and that they received responsive care.
The provider operated recruitment procedures to ensure the staff they employed were suitable for the role and safe to work with vulnerable people. We found some improvements were needed to ensure their recruitment procedures were consistently followed.
Staff told us and records showed that staff received supervisions and regular training updates. However, our observations showed that staff did not always apply their training to ensure their caring practices were appropriate and person centred.
The environment and care practices adopted in the home were not always appropriate to the specific needs of people who lived with dementia. We found many care practices were based on routine and a common approach about how staff thought they should care for people living with dementia. Such approaches to care delivery meant that people were not being supported in a person centred manner.
People were not always offered and explained choices in an appropriate way. This meant people were not empowered to make decisions about their care and treatment. We saw examples where staff did not take appropriate action to ensure people’s dignity was maintained. People who lived with dementia did not always have a voice and where they did express their views these were not always heard and acted upon.
Regular checks of the building and equipment took place to ensure it was safe.
People told us the food was good. However, where people were at risk of malnutrition or dehydration we identified concerns that staff were not always ensuring that their needs met. There was also a lack of monitoring of people’s daily food or fluid intake to establish if they had received sufficient food and fluids. We found meals lacked attention to detail and a person centred approach.
Assessments and applications had been made to ensure the rights of people with limited mental capacity were protected in line with the legal framework of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. However, we found an absence of appropriate documentation and staff knowledge to ensure that people were protected from the risk of being unlawfully deprived of their liberty.
Staff supported people to access other health professionals to help maintain their health and wellbeing. Health professionals told us that staff listened to their advice and knew people well.
People who used the service told us they felt safe and that staff were kind. The feedback provided by people and staff about the registered manager was also positive.
There was a lack of stimulating and meaningful activities for people to engage with. People told us they were often bored and relatives told us they had raised this with the provider but nothing had been done to address this.
Feedback about the registered manager was positive. However they were also managing another home which we saw impacted upon the quality and frequency of the management checks they completed.
The governance systems and processes in place were not effective and did not consistently improve the quality of the service provided. Robust improvements had not been made to address issues previously identified by the Commission with regards to care records and quality assurance systems. Where people provided feedback this was not always appropriately acted upon to improve the quality of the service.
We identified seven 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 the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.