Signature at Banstead

Updated 23 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was 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.

The inspection was brought forward due to the notification of an incident in which a person using the service sustained a serious injury. The information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

This inspection took place on 9 May 2018 and was unannounced. The inspection was carried out by three inspectors, an inspection manager, a specialist occupational therapy advisor and two experts by experience. An expert by experience is someone who has experience of using or caring for someone who uses this type of service. .

Before the inspection we reviewed the evidence we had about the service. This included any notifications of significant events, such as serious injuries or safeguarding referrals. Notifications are information about important events which the provider is required to send us by law. We did not ask the provider to return a provider information return (PIR) as this inspection was brought forward from its originally scheduled date. 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.

During the inspection we spoke with 12 people who lived at the home and two relatives. We spoke with the registered manager and nine staff, including the deputy manager, care, activities, housekeeping and catering staff. We observed the care people received, their mealtime experience and the interactions they had with staff.

We checked the care records of five people, including their assessments, care plans and risk assessments. We looked at how falls were managed and assessed whether any equipment used in people’s care was appropriate for their needs. We checked the management of medicines. We looked at five staff recruitment files and records related to staff support and training. We checked meeting minutes, the complaints file and reviewed the provider’s policies and procedures.

After the inspection the registered manager sent us further information, including quality monitoring reports, minutes of clinical governance meetings and the home’s emergency recovery plan.

Updated 23 August 2018

This inspection took place on 9 May 2018 and was unannounced.

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.