Archived: Sunrise of Southbourne

We found the following examples of good practice.

Comprehensive steps had been taken to try to prevent infections being brought into the home by visitors. Staff had been specifically trained to support visitors through a process of handwashing, putting on personal protective equipment (PPE) and completing a questionnaire about their health and recent places they had visited. Their temperature was taken, and a rapid Covid-19 test was carried out. No visits were allowed if a test was positive or the person had a raised temperature.

There were notices to explain these procedures and the manager confirmed that letters had also been sent to all residents and their visitors to explain the process.

An area of the home had been adapted to enable safe visiting. There was external access for visitors and a full screen was in place to protect people from potential transmission of the virus. There was an intercom system to ensure people could hear one another. Visits were planned to allow for deep cleaning of the areas in between.

Where visiting in person was not possible, staff had access to computers and tablets and were able to support people to make video calls. Following learning from other services, a 60" screen had been purchased to enable the calls to take place on the larger screen so that people were better able to see and hear their loved ones.

Furniture in communal areas had been rearranged to support social distancing: space between dining tables and armchairs had been increased and some seats (such as on sofas) had been blocked off to ensure suitable gaps between people were created.

Staff were wearing PPE correctly and it was being used in accordance with government guidelines. Specific areas for putting on and removing PPE safely had been created within the home.

Staff were required to change into clean uniforms and footwear in the home at the start of their shift and back into home clothes at the end of the shift. Staff uniforms were laundered in the home to ensure they were washed at the correct temperature.

Staff were given face masks and hand gels to wear and use on public transport, when car sharing or when out in community settings to help reduce the possibility of staff bringing the virus into the home.

The service had registered for regular testing of residents and staff. The frequencies of testing were in accordance with current government guidelines. Additional training in relation to IPC and Covid-19 had been provided for staff.

The home was clean and hygienic. Detailed cleaning schedules were in place. Cleaning products met the requirements that were specified in government guidance. Where it was safe to do so, wipes and alcohol-based hand gels had been left out to encourage people and staff to use these. Some people did not understand the need for frequent had washing or use of alcohol-based gels. In these situations, staff had learnt that offering a hand massage with the gel was effective.

Daily spot checks were completed to ensure measures to prevent and control infection were implemented as required. Plans were in place to support the service appropriately should there be any increased risks or outbreaks. This included plans for staffing and additional PPE.

Sunrise at Southbourne is a residential care home providing personal care to 79 older adults at the time of our inspection. The service can support up to 103 people. Accommodation is provided over three floors one of which specialises in providing care to people living with dementia.

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

People and their families described the care as safe. Staff had been trained to recognise signs of abuse and understood their role in reporting concerns. Risks to people had been assessed and actions had been taken to minimise the risk of avoidable harm whilst respecting people’s freedoms and choices. People had been protected from preventable infections.

Staff had been recruited safely including checks that they were suitable to work with vulnerable adults. People were supported by enough staff to meet their care needs effectively. Staff had completed an induction and had on-going training and support that enabled them to carry out their roles effectively.

People had person centred care plans that reflected both their care needs and lifestyle choices. When people had been involved in end of life planning their spiritual and cultural wishes were understood and respected. Staff knew people well and understood their communication needs enabling them to be involved in decisions about their day to day lives. 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 their eating and drinking needs met and were provided with meal choice and well-balanced meals.

Medicines were administered safely by trained staff who had their competencies checked regularly. People were supported to live healthy lives and had access to healthcare services for both planned and emergency events.

People and their families consistently spoke positively about the care they received and felt their privacy, dignity and independence was respected by the staff team. People felt able to express their views about their care and the service. People were aware of how to make a complaint and felt they would be listened to and any actions needed taken.

The culture was positive, open and honest and lessons had been learnt and improvements made when things went wrong. Staff felt appreciated in their roles and spoke positively about their own roles and teamwork. Quality monitoring processes were effective at capturing the voice of people, their families and staff and driving improvements when needed.

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

Rating at last inspection and update

The last rating for this service was ‘Requires Improvement’ (published 11 September 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. Prior to the inspection we received a notification of a specific incident following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of choking. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the ‘Safe’ and ‘Effective’ sections of this full report.

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.

Sunrise of Southbourne is registered for 104 people. There were 97 older people living in the home at the start of our inspection. People had a variety of care and support needs related to their physical and mental health. The home was divided into two main areas with people living with dementia accommodated on a separate floor called Reminiscence.

This unannounced inspection took place on 26 June 2018 with further visits to the home on 2 July, 4 July and 10 July 2018. We continued to receive evidence from the service until 19 July 2018. This was our first inspection of the service since the provider had changed.

There was a registered manager for the service; however, they had not been overseeing the home since the end of May 2018. They resigned their post during the time that we were inspecting. 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 previous registered manager, who knew the service well, had been appointed and had submitted their application to register with the CQC.

At this inspection we identified breaches of regulation with respect to: safe care and treatment, safeguarding adults, the deployment of staff, dignity and respect and the governance of the service including notifications. You can see what action we told the provider to take at the back of the full version of the report.

Staff understood most of risks people faced. However, these risks were not always recorded and shared consistently and as a result care staff did not always act to reduce these risks.

People did not always receive their medicines as they were prescribed.

Staff encouraged people to make decisions about their day to day lives. However, care plans had not always been reviewed to reflect changes in behaviour. This meant that that staff did not always have guidance to follow to meet emerging needs.

People described the food as good.

Care plans also did not always reflect that care was being delivered within the framework of the Mental Capacity Act 2005. This meant people were at risk of receiving care that was not in their best interests or was overly restrictive. The failure to apply the MCA appropriately had led to Deprivation of Liberty Safeguards not being applied for a person we were told would be brought back if they left the home.

People were largely positive about the care they received from the home and told us the staff were kind. We observed that most care was delivered respectfully and with kindness but we also saw that some care practices did not promote dignity and that people were sometimes treated disrespectfully.

People told us they felt safe. Staff knew how to identify physical abuse and told us they would whistle blow if it was necessary. One person had not been protected appropriately because the safeguarding process had not been implemented effectively.

Quality assurance systems had not been effective in identifying the issues identified during our inspection and notifications that the provider was required to make to the CQC had not been made.

Care staff were consistent in their knowledge of people’s on-going care needs and spoke confidently about the support people needed to meet most of these needs.

Staff told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received refresher training as deemed necessary by the provider and enhanced training in dementia was being delivered to staff working with people who lived in the Reminiscence part of the home.

People had support and care from staff who had been safely recruited. Staff had not always been deployed effectively to meet people’s needs. This had included not deploying night staff who were trained to give medicines. We were assured that this would be addressed immediately.

People were engaged with activities including individual and group activities. There was work being done to develop the opportunities available to people living with dementia. Most people and relatives felt that they were listened to and their views were considered and acted upon.

The environment was clean and maintained efficiently. An unlocked door to an area where soiled laundry was kept was addressed immediately.