Sunhill Court Nursing Home

Sunhill Court Nursing Home is a residential care home providing personal and nursing care for up to 40 people, the majority of whom are living with dementia and/or mental health conditions. At the time of our inspection, 32 people were using the service.

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

We had significant concerns about a person living at the home and made a safeguarding referral as a result. Some parts of the home were not cleaned or maintained to a good standard. The administration of medicines to people required improvement because eye drops were left on top of the trolley. Hand hygiene by the staff member was not undertaken between each person receiving their medicines. One person receiving their medicine in their dessert was not supervised to ensure they took all their medicine.

At lunchtime, several people had to wait a while before they received their meal; this caused anxiety for some. People’s preferences with regard to menu planning were acknowledged and included. People were encouraged in a healthy lifestyle with their dietary needs, and healthcare professionals were involved in their care. The layout of the home was accessible and conducive to people living with dementia. People were supported by staff who knew them well.

Audits were not sufficiently robust to monitor the care delivered and the service overall. Environmental audits had not identified issues found at this inspection. Risk assessments were not always documented accurately with information and guidance for staff to follow. Notifications of abuse or alleged abuse had not always been sent to CQC in line with regulatory requirements.

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 were happy living at the home. One person said, “They look after me very well. I don’t get too lonely as staff pop in, check on me and have a chat. There are enough staff. Sometimes they are a bit short, but generally, yes, there’s enough, and some are very good.” There were sufficient staff on duty to meet people’s care and support needs promptly. Staff were recruited safely.

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

Rating at last inspection

The last rating for this service was good (published 7 April 2020).

Why we inspected

This inspection was prompted in part due to concerns received about safeguarding. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led section of this report. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sunhill Court Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the administration of medicines, risk management, monitoring of the service and auditing systems, protecting people from abuse or harm, and statutory notifications.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

The provider facilitated safe visiting arrangements by enabling people’s families and friends to book a visit online or by telephone.

The provider had a detailed contingency plan setting out how to handle any future COVID-19 outbreaks and how to minimise the risk of spread of the infection. The plan was updated with relevant resources and reporting details and accessible to the management team and staff.

The provider had actively recognised the commitment and contribution of staff during the COVID-19 pandemic and ensured the team benefitted from various recognition schemes.

Sunhill Court Nursing Home was providing residential and nursing care to 36 older people at the time of the inspection. The majority of people living at the home have a diagnosis of dementia. The service can support up to 40 people. Accommodation is provided over three floors, accessible by a lift and stairs.

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

People were safe living at the home. However, we observed an incident at lunchtime when one person was given the wrong meal by care staff. The consistency and texture of the food was not in line with their assessed needs and caused the person to have a coughing episode and a near-choking incident. Staff need to be vigilant to ensure this person receives the correct meal as per their dietary needs.

Risks to people were identified and assessed with clear guidance for staff which was followed. Staffing levels were sufficient and had been assessed based on people’s needs; new staff were recruited safely. People confirmed there were enough staff on duty. Medicines were well managed. The home was clean and smelled fresh.

Before people came to live at the home, their needs were assessed, to ensure the home could provide the level of care and support they required. People’s care and support needs were continually reviewed and assessed. People received care from suitably trained staff and were encouraged to be involved in all aspects of their care. 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 had a choice of menu and were supported to eat a healthy diet. One person commented, “The food is lovely, we have a choice of two meals at lunch. I had a birthday celebration with cake and I enjoyed that”. People had access to a range of healthcare professionals and services.

Staff were warm, kind and caring with people and had time to sit and chat. People’s diverse needs were identified and catered for, so that care was delivered in a personalised way that met people’s preferences.

Care plans were detailed and provided clear information and guidance for staff. Activities were planned according to people’s preferences and what they were interested in. People’s communication needs had been identified, so that staff communicated with them in a way that suited them. Complaints were managed in line with the provider’s policy. If it was their wish, and their needs could be met, people could live out their lives at the home.

People were happy living at the home and spoke positively about their experiences, the caring nature of staff and the registered manager. Feedback was obtained through surveys and friends and relatives’ meetings were organised. A robust system of audits monitored and measured the care provided and the service overall. The service worked in partnership with others to benefit people’s care.

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

Rating at the last inspection (and update)

The last rating for this service was requires improvement (published 4 April 2019).

At this inspection we found improvements had been made. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Sunhill Court Nursing Home is a ‘care home.' Sunhill Court Nursing Home accommodates 40 people in one adapted building. At the time of this inspection 37 people lived at the home. People were supported who lived with different long-term conditions. Most people at the home lived with dementia. The home also supported people with diabetes and Parkinson's disease.

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

People’s experience of using this service:

People were not always kept safe from avoidable harm. Diabetes management and the management of medicines were not always safe.

Other risks to people were assessed, although lacked personalised detail for each person living at the home.

People enjoyed meals that appeared appetising, varied and of their choosing. The mealtime experience was not rushed and there were enough staff to support people’s individual needs.

People had access to healthcare support outside of the home. Although the timeliness of this was being addressed by the home and procedures were being implemented to ensure that these services were followed up by the home promptly.

Staff were seen to be very caring and compassionate towards people. People received appropriate emotional support from staff who knew them well. Agency staff were sometimes used to cover shifts at the home. The electronic records for people did not always provide sufficient person-centred details about their needs. This was being explored and improved by the home’s registered manager.

People were not always fully supported to have maximum choice and control of their lives. Staff aimed to support people in the least restrictive way possible; the policies and systems in the service supported this practice. However, people’s ability to make choices in their best interests was not always reviewed appropriately when their ability to do this changed. Staff ensured that they asked people for their consent before they supported them with any activities of daily living.

Staff had some basic understanding of the Mental Capacity Act [2005] and Deprivation of Liberty Safeguards [DoLS], but records for people were not always updated to reflect when their needs had changed regarding their ability to make decisions for themselves.

Safeguarding reporting procedures were understood by staff on a basic level. Staff had access on their hand-held devices that enabled them to find out information about how to report safeguarding concerns should this be required.

However, staff did not always receive sufficient training to enable them to fully understand the individual and specific needs of people they supported at the home. Such as diabetes care.

People were supported with individual, stimulating and engaging activities which were led by a highly motivated and dedicated activities coordinator. The home had linked up with a local children’s nursery and had participated in ‘intergenerational’ activities which involved four people visiting the nursery to enjoy activities with the children. This was very beneficial to all involved.

People had access to the complaints procedure. A board containing ‘you said, we did’ information was displayed in the communal lounge area. This showed actions the provider had taken to respond to people’s feedback. The provider understood the duty of candour process.

People were supported at the end of their lives to receive dignified, pain free care. The registered manager had completed detailed training with a local hospice which enabled them to identify and meet people’s needs at the end of their lives. Relatives felt supported and involved when their loved ones passed away.

The home was not always well managed. Systems and processes were not always effective and had not always identified some areas of concern regarding medicines management and diabetes care.

Rating at last inspection:

The service was rated as ‘Good’ at our last inspection (report published 18 May 2017). The overall rating has changed to ‘Requires Improvement’.

Why we inspected:

We conducted a responsive, comprehensive inspection to this service. This means that we brought our planned inspection forward due to concerns that we received of alleged risks to people.

Enforcement:

We found breaches of Regulations at this inspection. Please refer to the end of the full report for further details.

Follow up:

We will continue to monitor the service and inspect within 12 months of the report being published. This is in line with our methodology for services rated as ‘Requires improvement.’

Sunhill Court Nursing Home provides nursing care for up to 40 older people with dementia care needs and/or mental health needs. At the time of our inspection, there were 32 people living at the home. Sunhill Court Nursing Home is a large Edwardian building on the outskirts of Worthing and overlooks the South Downs. There are several communal areas – a large lounge, dining area and conservatory on the ground floor and a smaller lounge on the first floor. A passenger lift provides access between the floors. On the ground floor is a private room which is used when the hairdresser visits on a weekly basis. We also observed other seating areas along the hallways where people could rest and where dementia friendly activities were placed for people to engage in. People have their own rooms and have access to a large garden at the rear of the property.

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 2008 and associated Regulations about how the service is run. The registered manager was not available on the day of the inspection. The operations director made themselves available to assist with the inspection.

The last inspection took place on 24 and 26 February 2016. As a result of this inspection, we found systems and processes had not been established to prevent abuse of service users. This was a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had rated the service as Requires Improvement overall, because although significant improvements had been made to address previous shortfalls raised at the inspection in June 2015, where the service was rated as Inadequate, these improvements were yet to be embedded and sustained. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider had met all the legal requirements.

People were cared of by staff who understood the importance of making sure they were safe and protected from harm. People were protected against the risk of abuse; staff had a good understanding of how to recognise abuse and what action they should take if they suspected it had taken place. Staff demonstrated they were clear about how to report any concerns. The service had systems in place to notify the relevant authorities when concerns were identified. Staff were confident that any allegations made would be fully investigated to ensure people were protected. People and their relatives said they would speak with staff if they had any concerns and seemed happy to go over to staff and indicate if they needed any assistance. We observed staff to be vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia.

Systems were in place to identify risks and protect people from harm. Care records contained guidance and information to staff on how to support people safely and mitigate risks. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. Accidents and incidents were accurately recorded and were assessed to identify patterns and trends. Records were detailed and referred to actions taken following accidents and incidents.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

There were sufficient staff in place to meet people's needs, the registered manager used a dependency tool employed by the provider to assess staffing levels were based on people's needs, were up to date and reviewed monthly. Robust recruitment practices ensured that new staff were vetted appropriately and checks were undertaken to confirm they were safe to work in a caring profession.

Staff received an induction into the service and senior staff checked competencies in a range of areas. Staff had received a range of training and many had achieved or were working towards a National Vocational Qualification (NVQ) or more recently Health and Social Care Diplomas (HSCD). Staff received formal supervision and annual appraisals from their managers. At the last inspection, we found some staff, who did not have English as a first language, were unable to communicate effectively and people living with dementia may have found it difficult to understand them. At this inspection, we found this had improved and we observed all staff being able to effectively communicate with people.

People looked comfortable and happy moving around the home, some people stopping for rests or a nap, other people enjoyed having a late breakfast, doing a crossword or reading the newspaper. Staff were always visible to interact or sit with people. Staff said it was important they were also involved in ensuring people had something to do or someone to talk with. The operations director showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. For example, providing opportunities for staff team building and on-going training in a variety of courses to make the training more interesting. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. Staff were very positive about working at the home. All staff had a good understanding of the implications and requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards

People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice and where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional assessments were in place and special dietary needs were catered for. Where needed, advice and guidance was sought from healthcare professionals.

The home had been decorated and arranged in a way that supported people living with dementia.

People were well cared for and treated in a respectful way. People were involved in planning and reviewing their care as much as they could, for example in deciding smaller choices such as what drink they would like or what clothes to wear. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people's stories.

Staff had good knowledge of people, including their needs and preferences. Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively.

People's privacy was respected. Staff ensured people kept in touch with family and friends. Two relatives told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

At the last inspection, an activities co-ordinator was employed for three mornings a week and a programme of activities had been organised for people. Since the last inspection, this had increased to being a full time role, Monday to Friday 8am to 4pm. People were engaged in these activities in a meaningful way and appeared to enjoy what was on offer.

Complaints were listened to and managed in line with the provider's policy. Relatives told us that they felt welcomed at the service and people and relatives said that they would be confident to make a complaint or raise any concerns if they needed to.

People and their relatives were involved in developing the service through meetings. People, relatives, healthcare professionals connected to the service and staff were asked for their feedback in annual surveys. All responses were positive from the recent quality assurance questionnaire. People's views were acted upon where possible and practical. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them. Staff felt the registered manager was very supportive and said there was an open door policy. Relatives spoke positively about the care their family members received.

There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider audits. An area manager and operations director who visited the home on a weekly basis supported the registered manager. We met with the operations director during the inspection and people knew who they were and enjoyed spending time with them.

Sunhill Court Nursing Home provides nursing care for up to 40 older people with dementia care needs and/or mental health needs. At the time of our inspection, there were 34 people living at the home. Sunhill Court Nursing Home is a large Edwardian building on the outskirts of Worthing and overlooks the South Downs. There are several communal areas – a large lounge, dining area and conservatory on the ground floor and a smaller lounge on the first floor. People have their own rooms and have access to a large garden at the rear of the property.

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 2008 and associated Regulations about how the service is run.

The last inspection took place on 30 June 2015. As a result of this inspection, we issued five Warning Notices in August 2015. We asked the provider to take action to address areas of concern relating to safe care and treatment, nutritional and hydration needs, good governance, dignity and respect and staffing. The provider was required to take appropriate action to meet these Warning Notices by 18 September 2015. In addition, we found the provider in breach of a number of regulations and asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken, the majority of which would be completed by the end of September 2015. At this inspection we found that the provider and registered manager had taken appropriate action to meet the Warning Notices and were now meeting required standards. However, we identified that further time and action was necessary to ensure the improvements continued and were embedded consistently into staff practice.

Some staff did not have a good understanding of safeguarding and how to protect people from the risk of abuse. Other staff were able to explain the different types of abuse and what action they would need to take. The provider had failed to alert the local safeguarding authority to a series of incidents that had occurred and had failed to notify the Commission.

Risks to people were identified and assessed appropriately. Care records contained guidance and information to staff on how to support people safely and mitigate risks. Medicines were managed appropriately, although the refrigerator did not work effectively and the packaging of some medicines was damp.

There were sufficient staff in place to meet people’s needs, although a dependency tool employed by the provider to assess staffing levels based on people’s needs, was out of date. There had been a high turnover of staff in recent months and there was a heavy reliance on agency staff, especially registered nurses, to ensure staffing levels were safe. Robust recruitment practices ensured that new staff were vetted appropriately and checks were undertaken to confirm they were safe to work in a caring profession.

Improvements had been made to staff training and opportunities were available to staff. However, not all staff had completed the mandatory training and attendance by staff at training sessions was not consistently high, so some staff were not up to date with their training in specific areas. Staff received formal supervision and annual appraisals from their managers. Some staff, who did not have English as a first language, were unable to communicate effectively and people living with dementia may have found it difficult to understand them. All staff had a good understanding of the implications and requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards.

People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. However, some staff did not understand how to approach people in line with their needs to enable them to enjoy the lunchtime experience. Other staff were empathic in their approach. Special diets were catered for and people’s nutritional needs were assessed appropriately. Where needed, advice and guidance was sought from healthcare professionals. The environment was not always arranged in an effective way that was conducive to meeting the needs of people living with dementia.

The majority of staff had developed positive, caring relationships with people. However, there were occasions when staff did not communicate appropriately to meet the needs of people living with dementia. This may have been due to a lack of understanding by some staff and cultural differences. People’s spiritual needs were catered for and they were treated with dignity and respect. As much as they were able, people were involved in making decisions about their care.

An activities co-ordinator was employed for three mornings a week and a programme of activities had been organised for people. People were engaged in these activities in a meaningful way and appeared to enjoy what was on offer. The provider hoped to be able to have more staff on duty to enable people to access the community and planned outings. However, some people cared for in bed lacked similar opportunities for mental stimulation.

Comprehensive, detailed care plans provided staff with information about people, their personal histories and how they needed to be supported and cared for. Staff did not understand the concept of person-centred care, although the provider had arranged for training on this topic.

The provider had a complaints policy in place, although no formal complaints had been received since the last inspection.

People were asked for their views about the service and regular residents and families’ meetings were held. Staff were also asked for their feedback and felt that the registered manager was supportive. A range of audits was in place to monitor and measure the quality of care delivered.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

The majority of people we spoke with were happy with the care they received and found staff to be kind and accommodating. Not everyone was able to comment on their level of consent but some people indicated that they were given choices and that staff listened to them. We found that people's care was planned and delivered in line with their needs.

We found that people's medicines were stored and administered safely. The service had systems in place for ordering medication and destroying unused drugs. People's medicines were administered as prescribed by trained members of staff.

We found that staff received appropriate training and support. Nursing staff maintained their professional registration and all staff received mandatory training updates. Staff also had supervision meetings, appraisals and spot checks to help ensure their work was of a good standard.

The service had systems in place to monitor their own quality. If issues or complaints were raised, the service took clear action to improve the service and learn from incidents.

We found that two members of care staff had been recruited since our visit in October 2012. We viewed the recruitment and vetting documents from these two staff members. We found that the provider had taken appropriate measures to assess and recruit new members of staff.

A relative told us the staff treated their family member "as an individual" and remarked that the family "could see the difference, she was relaxed." Another relative said, "We think it's wonderful. We are lucky, very lucky." A further relative commented that their relative was "much safer now than she was in the community." They added that their relative "Still has choices and quality of life."

We found that people were treated with respect and dignity. People and relatives were involved in discussions about people's care. People living in the home were protected from the risk of abuse or neglect. We found there was enough qualified and skilled staff who had received training and support. There were procedures to capture complaints, concerns, or comments and people felt confident to raise any issues with the staff. We found that the home had not followed vetting procedures which meant that some members of staff had incomplete checks prior to starting employment.