Archived: Sunnyfields

Updated 31 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 08 August 2017 and was unannounced. The inspection was carried out by one inspector.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed previous inspection reports and the provider's action plan. We also reviewed information of concern.

During our inspection we observed care in communal areas. We examined records including staff rotas; management records, care records for two people, medicines records for all four people and two staff files. We looked around the premises and spoke with two people and four staff including a support worker, senior support worker, the home manager and the registered manager. We also spoke with one person’s relatives.

We contacted health and social care professionals to obtain feedback about their experience of the service. These professionals included local authority care managers and local authority contract monitoring teams.

We looked at two people’s personal records, care plans and medicines charts, risk assessments, staff rotas, staff schedules, two staff recruitment records, meeting minutes, policies and procedures.

We asked the home manager to send us additional information after the inspection. We asked for a policy and proof that a shower chair had been ordered. These were received in a timely manner.

Updated 31 October 2017

We carried out this inspection on 08 August 2017. The inspection was unannounced.

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.