Sunbury Nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Sunbury Nursing Home is registered to provide accommodation with nursing care for up to 57 people. At the time of our visit, there were 52 older people living at the home. Some of the people who live at the home are living with dementia, whilst others have complex needs from living with Parkinson’s disease, stroke or epilepsy. The home also provided end of life care.

The inspection took place on 29 June 2018 and was unannounced.

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.

At our previous inspection on 27 July, 2 and 3 August 2017, we found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to risk assessments for people, care plans and assessing and monitoring the service. The provider sent us an action plan on 20 March 2018 and provided timescales by which time the regulations would be met.

At this inspection we found improvements had been made. However, we noted inconsistencies about the information recorded in people’s care records. The impact to people was lessened due to the knowledge and experience of the consistent staff team. We have made a recommendation to the registered provider in relation to this.

People were safe at Sunbury Nursing Home. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm. There were sufficient numbers of suitably trained staff to support people’s needs safely. Recruitment practices were safe and relevant checks had been completed before staff started work.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the person’s GP and medicines administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The home had a business contingency plan which identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Although we found some concerns around infection control such as dirty commodes and mattresses these were quickly remedied during the inspection. We reviewed the systems in place to prevent and control infection. After the inspection, the provider sent us an amended infection control auditing system to help ensure safe standards of cleanliness were maintained.

Staff worked within best practice guidelines to ensure people’s care and support promoted well-being and independence. We found the staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

The registered manager ensured staff had the skills and experience which were necessary to carry out their role. The registered manager ensured that clinical staff abided by the requirements set out by the Nursing and Midwifery Council (NMC). The NMC is the nursing and midwifery regulator.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. Staff worked effectively with healthcare professionals and were pro-active in referrin

This inspection took place on 27 July, 2 and 3 August 2017 and was unannounced. We last inspected the home in May 2016 and found one breach of the Health and Social Care Act 2008 Regulated Activities Regulations 2014. This was in relation to failure to gain appropriate consent in accordance with the requirements of the Mental Capacity Act 2005 (MCA 2005). Following the inspection we issued a warning notice for this breach. During this inspection we found that the breach of the regulations identified in the warning notice had been met.

Sunbury Nursing Homes is registered to provide accommodation with nursing care for up to 57 people. At the time of our visit, there were 53 older people living at the home. Some of the people who live at the home had dementia, whilst others had complex medical and healthcare needs.

The service had a registered manager. 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.

Whilst we saw there were systems in place for quality assurance, this had not been applied consistently in all areas important in the delivery of care. The service did not carry out audits on people’s care records. As a result, the shortfalls we found during this inspection had not been identified and actioned.

People receiving care told us they felt safe living at the home. We received similar feedback from their relatives and some healthcare professionals. However, we noted the service did not have effective systems for the management of risk. Despite the fact that staff were knowledgeable about how to protect people from risks, in some examples, we saw that the care plans and risk assessments had not been developed to ensure this was carried out consistently.

A safe recruitment and selection process was in place. This ensured staff had the right skills and experience to support people. However, we received mixed opinions from people about staffing levels . The majority of people told us there were sufficient staff available to meet their needs. However, others shared a different view. We observed that staff were being constantly moved between areas of the home during shifts to cover workload. Staff told this caused disruption and affected continuity of care. We have given a recommendation about this in the report.

Some care plans lacked personal information about how people needed and wanted to be supported. In some examples, we observed care records contained brief details about people's health and care needs and lacked personalised information to ensure they received care in line with their preferences.

Staff received training on safeguarding adults from abuse. They could describe different types of abuse and were aware of the action they would take to protect people from harm.

Medicines were managed safely. People received their medicines as prescribed. All prescribed medicines were available at the home and were stored securely. Controlled drugs were appropriately stored in accordance with legal requirements, with daily audits of quantities completed by two members of staff. People were able to obtain their ‘when required’ (PRN) medicines at a time that was suitable for them.

Staff sought and obtained people's consent before they helped them. People's mental capacity was assessed for particular decisions. Relevant people were invited to make decisions in people's best interest, as required under the MCA 2005.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options had been considered.

Each person had a personal emergency evacuation plan (PEEP) which provided

This was an unannounced inspection that took place on 16 March 2016.

Sunbury Nursing Home is registered to provide accommodation with nursing care for up to 81 people. At the time of our visit, there were 56 older people living at the home. Some of the people who live at the home are living with dementia, whilst others had complex needs as a result from living with Parkinson’s disease, stroke and epilepsy. We noted that an application to change their registration to a maximum of 57 instead of 81 people being accommodated had been approved on 28 April 2016.

The service offers 6 “step-down” beds, which is an interim accommodation arrangement with the local hospital and social services to provide care between the discharge from hospital and people moving back to their own home or elsewhere. We noted that the “step-down” bed contract ended on 30th April 2016 and all places are now occupied by long term residents. The service also provided end of life care. The accommodation is provided over three floors that were accessible by stairs and a lift.

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.

Staff knew what to do to support people to make decisions. The registered manager and staff understood their role and responsibilities with regards to the Mental Capacity Act and Deprivation of Liberty Safeguard. However not everyone who lacked capacity was fully assessed and if necessary DoLS application completed and submitted to the local authority in accordance with current legislation.

Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There was sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff started work. Staff worked within best practice guidelines to ensure people’s care and support promoted well-being and independence.

Medicines were administered, managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. The staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People received comfortable and dignified end of life care. The service obtained guidance and best practice techniques from professional bodies to assist them in providing good q

We visited Sunbury Nursing Home and looked at the care and welfare of people who used the service. During the inspection we spoke with the registered manager, the owners, seven members of staff, five people who used the service and three relatives.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. People told us they felt safe with the staff that provided care. We saw information displayed throughout the home from Surrey Protection committee regarding reporting any form of abuse.

We saw the nursing home was clean and that cleaning was carried out on a daily basis. We saw staff wearing disposable aprons and gloves. All of the staff were seen to be ‘bare below the elbows’. This meant that staff were able to wash their hands more effectively. Residents and relatives confirmed that staff wore aprons and gloves when providing personal care. We observed disposable aprons available in holders in corridors and bathrooms. This demonstrated that there were arrangements in place to prevent and control infections.

Systems were in place to make sure that staff learnt from events such as accidents, incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

Recruitment and selection processes were in place and the provider carried out relevant checks when they employed staff. Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

Care plans demonstrated that people’s healthcare needs were addressed. Staff carried out regular checks to ensure that people were cared for in a safe environment and risk assessments had been carried out to identify and manage any risks to people.

Is the service effective?

People told us that they could make choices about how they spent their time and that they had opportunities to take part in activities they enjoyed.

Guidelines were provided for staff in the way people preferred their care and support to be delivered. Staff communicated information about people’s needs effectively and provided care and support in a consistent way. People were supported to access their local community, and to maintain relationships with their friends and families.

Records, including care records, were organised, up to date and reflected the needs of the person. There were clear operating procedures in place, which were known and understood by staff.

Is the service caring?

People were supported by kind, caring and attentive staff. A person who used the service told us “I am more settled that I thought I would be.” They went on to say “I am well looked after.” Another person told us “The staff look after me extremely well.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Staff had worked with the people who used the service for some time and knew their needs well. This meant that people received consistent care from staff they knew and understood their needs.

The provider obtained feedback about the quality of the care and support provided as they were in regular contact with relatives and social care professionals.

Is the service responsive?

People’s needs had been assessed before they began to use the service to ensure that the service was suitable for them. People received a personalised service based on their individual needs and preferences. People’s needs were reviewed regularly and the provider responded appropriately if their needs changed.

People told us they knew how to make a complaint if they were unhappy. There had been no complaints this year. We saw that a complaints procedure was in place.

Is the service well-led?

The registered manager had been in post for a number of years. The service worked well with other agencies and services to make sure people received their care in a person centred way.

The service had a quality assurance system, we saw systems in place that identified shortfalls and documented action taken. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and of the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We visited Sunbury Nursing Home on 8 October 2013 and raised minor concerns which related to cleanliness and infection control.

During our follow up visit on 8 January 2014, we saw that the provider had not made all the improvements that were required to be compliant with the regulations. This meant that people were not protected from the risk of infection because appropriate guidance had not been followed.

We visited Sunbury Nursing Home and looked at the care and welfare of people who used the service. During the inspection we spoke with five members of staff, two people who used the service, five relatives and a health care professional.

We saw people were respected and involved in their care, treatment and support. A relative told us “My family member is very well taken care of; I have recommended the home to others.” A second relative told us “My family member’s needs have changed over the years, I constantly review their plan, and we work as part of a team with the home.”

People received care and welfare that met their needs. A relative told us they were “100% happy with the care.” A second relative told us “Staff are well tuned in. They can just look at my family member and know if they are feeling alright or needed help with something.”

We saw the nursing home was clean and that cleaning was carried out on a daily basis. We raised concerns about the condition of three commodes which were stained and dirty.

The provider had systems in place for recording training. One staff member told us “Yes I feel supported, there is lots of recognition, and nothing gets missed.” Another said “The management are very kind and caring.”

The majority of the people we spoke with were very happy with the service. We saw that the provider had a complaints policy and that information about how to complain was available to people in a format that met their needs.

During the visit, we spoke with one person who was using the service and two visitors. They told us the staff kept them involved in the review of the care plans and always asked for permission before they delivered care. One visitor told us “I have the power of attorney for my relative and am kept involved with any decisions that need to be made.”

The people we spoke with told us they were happy with the care they received. They told us the staff discussed their care needs with them on a regular basis.

They told us the staff were very friendly, caring and responsive. One person said “The staff treat people with great kindness and respect.”

They also told us that they had no concerns about the care they received and would speak to the senior staff or the registered manager if they had any concerns. Everyone we spoke with told us they felt that the people living at the home were safe.