Archived: Signature at Esher

Sunrise of Esher provides care and accommodation for people some of whom have a diagnosis of dementia. The home is registered for 88 residents and is a purpose built home. The building consists of three floors. The ground and first floor of the building are called the Assisted Living Neighbourhood. The care provided in the Assisted Living Neighbourhood includes minimal support for peoples care. The second floor of the building is called the Reminiscence Neighbourhood. The Reminiscence Neighbourhood provides care and support to people who live with dementia as their primary care needs.

At our inspection of 15 December 2016 we found the service was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The assessments and care plans were not personalised. During this inspection we found the provider had met this Regulation.

There was not a registered manager in place. However the current manager was going through the process of applying to be the registered manager with the Care Quality Commission. The manager supported the inspection team throughout the day. 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.

The inspection looked into how risks to people were managed following an incident where a person using the service sustained a serious injury. Following this the local safeguarding adults board decided to look into the circumstances of the incident by undertaking a Safeguarding Adults Review (SAR). The purpose of the SAR is to identify learning and good practice for all agencies involved in people’s care and to promote areas where improvements can be made. At the time of the inspection the SAR, and any learning from this, had not been completed.

People and their relatives told us they felt the home was safe. They told us they had no concerns about being safe. All staff had received training about safeguarding and they were knowledgeable about the processes to be followed when reporting suspected or actual abuse. Medicines were managed in a safe way and recording of medicines were completed to show people had received the medicines they required. Risks to people had been identified and documentation had been written to help people maintain their independence whilst any known hazards were minimised to prevent harm. People were protected against the spread of infection within the service. The environment was clean, tidy and free from malodours. Infection control processes were followed by staff to minimise the risk of cross infection. The management of the home and staff had learned lessons from when things had gone wrong and put systems in place to help prevent a repeat of these.

There were sufficient numbers of staff on duty at all times to ensure that people’s assessed needs could be met and these were reviewed on a daily basis. The provider had carried out appropriate recruitment checks so as to ensure that only suitable staff worked with people at the home. Staff had a good understanding about people’s life histories, their preferences and how to attend to their needs.

Where there were restrictions in place, staff had followed the legal requirements to make sure that this was done in the person’s best interest. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that decisions were made in the least restrictive way. People were supported to ensure they had enough to eat and drink to keep them healthy. Healthcare professionals were involved with people’s care that ensured their healthcare needs were met. The environment was suitable for people living with dementia.

People’s visitors were welcomed at the home and there were no restrictions on the times of visits. People’s privacy, dignity and independence were promoted by staff who showed kindness and understanding of people’s needs. People were able to make choices about how they received their care, support and treatment.

A variety of activities were available for people to take part in both internally and externally on trips to places that interested them. Documentation that enabled staff to support people and to record the care they had received was up to date and reviewed on a regular basis. People received person centred care and they or their representatives had signed their care records that signified their involvement in their care, treatment and support. People’s likes, dislikes and preferences were recorded and known by staff. Staff were knowledgeable about people’s needs and had received training that helped to attend to the assessed needs of people. People’s end of life care was attended to in a sensitive and caring way that encompassed their preferences and needs.

Complaints were taken seriously by the provider and staff and addressed within the stated timescales to the satisfaction of complainants. A complaints procedure was available to people, relatives and visitors.

The provider and staff undertook quality assurance audits to monitor the standard of service provided to people. An action plan had been produced and followed for any issues identified. People, their relatives and other associated professionals had been asked for their views about the service through surveys and resident meetings.

The interruption to people’s care in the case of an emergency would be minimised. The provider had a Business Continuity Plan that provided details of how staff would manage the home in the event of adverse incidents such as fire, flood or loss of gas or electricity.

The provider was aware of their responsibilities with regard to reporting significant events to the Care Quality Commission Accidents and incidents were recorded and monitored to by staff to help minimise the risk of repeated accidents.

The home is a large, bright and airy building split into two units, based on the needs of the people that lived there. There was a reminiscence unit for people that lived with dementia, and an assisted living unit for people that did not require much support from staff. Communal areas, for the use of people from both units, include a large dining area, large lounge, gardens.

There was a not 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 2008 and associated Regulations about how the service is run. The new manager had just started at the home, and had begun the process of registering with us.

The inspection took place on 15 December 2016 and was unannounced. At our last inspection in September 2013 we had not identified any breaches in the regulations. There was positive feedback about the home and caring nature of staff from people who live here.

People told us they were happy living here. Comments such as, “It’s a lovely place. I couldn’t be looked after better,” “very nice people,” and, “I’m comfortable and satisfied.” Were made to us during the inspection. Staff were happy and confident in their work and proud of the job they do.

Care records were not always person centred, and people did not always receive the support they needed to meet identified needs. We have identified one breach in the regulations. You can see what action we have asked the provider to take at the back of the full version of this report.

People were safe at Sunrise Esher because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks.

Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Staff received comprehensive training, to ensure they could meet and understand the care needs of the people they supported.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health was seen to improve due to the care and support staff gave. People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met. Where people had commented on the preparation of the food, the provider had investigated to try and see if they could put things right.

The staff were kind and caring and treated people with dignity and respect. People had access to a wide range of activities that met their needs. Activities were based on individual interests and people were supported to continue with hobbies.

Feedback was sought from people, and complaints and compliments were reviewed to improve the service. When complaints were received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.

The service was well led. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. The provider had effective systems in place to monitor the quality of care and support that people received.

We were assisted by an expert by experience who spent time talking with people over the lunch period. People told us 'We have wonderful carers, they are very polite to me and always speak in a caring manner'. Another person told us 'I am offered choices and therefore I am able to give consent because I understand.'

We spoke to staff who confirmed they had procedures in place to gain consent from people.

We found arrangements were in place to ensure people had their nutritional needs met.

We saw that the home had systems in place to protect people from abuse and staff had received training.

We saw that the manager had carried out appropriate checks when employing new staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

We were told complaints were taken seriously and would be responded to within the provider's timescales.

People that we spoke with told us they could get involved with the home by attending a meeting every month. We were told that one of the meetings was about food and the chef attended. People told us that they thought they had completed surveys about the service provision but could not remember when this was.

We could not seek the views of people living on the reminiscence unit so we spent time observing people who used the service and interactions between them and the staff.

We asked people who used the service if staff were kind and helpful and they told us that most staff were very good. People told us they thought the staff must receive training as they seemed to know what they were doing.

Activities are available everyday but some people told us they would love to go out on more trips in the mini bus. We looked at activity provision and found regular trips were available. We were told it was not possible to take everybody that wanted to go each time. Some people would miss one trip but could go the next time.

When asked if people knew how to raise a concern all told us they did and would have no hesitation in talking with the manager.