Sunningdale Lodge is a purpose built home which is situated in a residential area in Yeovil. The home provides accommodation with personal care for up to 40 older people. Bedrooms are for single occupancy and are arranged over three floors. A shaft lift and stairs provide access to the floors above ground level. There are pleasant gardens and parking is available. The home is staffed 24 hours a day.

At the time of the inspection there were 39 people living at the home. This included three people who were receiving treatment in hospital.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. When asked, one person said “I do feel safe here; yes.” Another person said “This is my home now. The staff take good care of me.” People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of pressure damage to their skin.

People continued to receive effective care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. One person said “I can do as I please. Nothing is forced here.” Another person who was in their bedroom told us “I prefer to stay in my room. It’s my choice. I like to sit here and read. I do go down to lunch though.”

People told us their healthcare needs were met. One person said “If you feel unwell they [the staff] would be there in a flash and would certainly get the doctor for you.” Another person told us “The physiotherapist is coming to see me soon to see if I can get moving again.” A visiting healthcare professional told us that staff always listened and acted on any recommendations they made.

The home continued to provide a caring service to people. One person said “I am very happy here and I don’t want for anything. All the staff are very kind.” Another person described the home as “perfection itself.” They said “I mean that. I couldn’t be happier and the staff are marvellous.” People could see their visitors whenever they wanted and the visitors we met with told us they were always made to feel welcome. Staff treated people with respect and respected their right to privacy.

The home continued to provide a responsive service. The management team made sure people’s needs and aspirations could be met before a person moved to the home. Care plans contained information for staff about people’s needs and preferences and how these should be met. The management team acknowledged that care plans relating to people’s mental health needs could be improved and they agreed to address this.

People could take part in a range of social activities and designated activity staff were employed to support people. Care had been taken to ensure people experienced a pleasant and sociable mealtime experience. Any complaints about the service were taken seriously and responded to. The people we met with told us they felt comfortable in raising any concerns. One person told us “I have no complaints at all. I’ve never had to complain but I would certainly tell the staff if something was bothering me.”

The service continued to be well led. The registered manager was supported by a deputy manager and the skill mix of staff meant experienced staff were available to support less experienced staff. The management team were described as open and approachable. People’s views were valued and responded to. The provider operated an initiative called ‘You said. We did.’ Where people who lived at the home, their representatives and staff could make suggestions

This inspection took place on 11 August 2015 and was an unannounced inspection.

At the last inspection carried out on 8 September 2014 the service was found to be in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Care plans did not always reflect the care people received. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. At this inspection we found that action had been taken to improve the service and meet the compliance action set at the previous inspection.

Sunningdale Lodge is a purpose built home which is situated in a residential area in Yeovil. The home can accommodate up to 40 people and it provides accommodation and support with person care needs to older people. Bedrooms are for single occupancy and are arranged over two floors. A shaft lift and stairs provide access to the first floor. There are pleasant gardens and parking is available. The home is staffed 24 hours a day.

There is a registered manager who is responsible for the home. 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.

The registered manager had a very good knowledge about the needs and preferences of the people who lived at the home. They had a clear vision for the home and they made sure this was understood and followed by the staff team. They were committed to ensuring people received the best possible care.

People were cared for by a staff team who were appropriately trained and well supported. There were enough staff to help keep people safe and the staffing structure meant that senior staff were always available to support less experienced staff.

People and their visitors told us staff treated them with kindness and respect. One person told us “All the staff are so lovely. I am very happy here.” Another said “It’s a very friendly place here. The staff are very kind to me.”

People received their medicines when they needed them. Staff followed safe procedures for the management and administration of people’s medicines.

People received effective care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required.

People were provided with opportunities for social stimulation and trips out. Designated activity staff were employed and activities were tailored to meet the needs and preferences of the people who lived at the home.

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences.

There were effective quality assurance systems in place to monitor care and plan on going improvements. There were audits and checks in place to monitor safety and quality of care.

This inspection was carried out by a single inspector to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People's care was planned and delivered in line with their care plan and personal choices, however, some records about how people’s needs were being met were not maintained or were incomplete. For example, on one chart we found an entry of two sips of tea taken at 4pm but no entries of any drinks offered or taken either before or after this time for the entire day. This showed that gaps found in daily fluid charts meant it was unclear whether drinks had not been offered or had been offered and given but not recorded. Following the inspection the manager told us that people’s fluid was recorded both in their care plan and on separate charts in their rooms. However, the charts in people’s rooms were not accurately updated. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff showed they knew people well and followed their individual care plans when providing support. For example, one person told us that staff had applied sun lotion to their skin and a hat to prevent sunburn. People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were aware of the risk of abuse to vulnerable adults through training and development.

Senior staff had met with the Deprivation of Liberty Safeguards (DoLS) Officer from the appropriate authorities and discussed plans about the application process for people likely to need a DoLS assessment.

Is the service effective?

There were effective arrangements in place to deal with foreseeable emergencies. A list of relevant telephone numbers of staff and emergency services for staff to call was available in the office. Staff responded effectively and promptly to people's needs. One person said, "When I call for help, they always respond quickly."

Staff received effective training and development to carry out their roles. One worker described their moving and handling training which included the use of hoists and slings. They told us this had improved their understanding of hazards and safety issues.

Is the service caring?

In one care plan we read that the person required support and assistance from staff to reduce the risk of falls. We observed staff provide care and assistance compassionately to the person as they moved about the home. For example, we heard a worker say, "Take it slowly." This meant staff demonstrated how to reduce risks while carrying out care. Comments from people included, "A good team," "very attentive," and "I want to be independent; carers let me do that; nothing is too much trouble."

Is the service responsive?

People's health needs were met because staff responded to people's needs and liaised with relevant professionals about people's well-being. For example, one person was taking antibiotics for an infection and someone else saw the podiatrist for diabetic foot care. One person could not remember how their care plan was arranged. However, they felt they received the right care. When asked who had arranged care, another person said, "I don’t know; it must have been my daughter." Both people felt they could discuss their care with staff who would listen.

Is the service well-led?

The provider had systems in place to monitor the quality and safety of the service, however, the provider may find it useful to note that some external checks and audits were not always followed up. For example, in a medicines check one entry had no date, signature or identifying information about the staff member or the person it was about and the action plan had not been signed by senior staff for this and other outstanding actions. Following the inspection we were told by the acting manager that the care plan audit file we were given was a copy folder and not the original and that original audits had been previously signed by the registered manager. The provider sent us information relating to some of this.

People, their representatives and staff were asked for their views about their care and treatment and they were acted on. In May 2014, the provider sought people's ideas and suggestions which included inviting the music entertainer back to the home, film choices and a special afternoon tea with buffet foods, popcorn and ice cream, which several people enjoyed.

Following our inspection on 5 September 2013 we found that people were not always experiencing care that met their needs. We served a warning notice on 25 September 2013 which required compliance with the regulation by 9 October 2013. We followed up this requirement during this inspection.

We spoke with the operations manager, the deputy home manager, five staff and two people living in the home. We found that improvements had been made and that care was now being planned and delivered in a way that was intended to ensure people's safety and welfare.

We inspected Sunningdale Lodge following concerning information about the delivery of care. The people living at Sunningdale lodge were older people some of whom had dementia and mobility needs. During our inspection we looked at six care plans, spoke with six people who lived in the home and three relatives. We also spoke with four members of staff, the deputy manager and the registered manager.

People were supported by staff who were caring, friendly and respectful, but risks were not assessed effectively and care was not always delivered in line with individual care plans.

Staff knew how to identify abuse but management plans put in place following a safeguarding concern in the home were not effective in keeping people safe.

There were enough staff to meet people’s needs.

Staff were not being supported to deliver care and treatment safely and to an appropriate standard.

The home regularly involved staff, and people living in the home, in monitoring quality. However, there were gaps in these systems that led to them being ineffective in both monitoring the quality of the service, and assessing and managing risks to people living in the home.

Care records were not completed or accurate.

You can see our judgements on the front page of this report.

The home is situated just off Yeovil town centre and built on 2 floors with stairs and lifts to all floors. On the day of our visit it was well staffed with carers and support staff.

Relatives and loved ones were actively encouraged to take part in all aspects of the home's daily activities. The home made all reasonable efforts to keep people engaged with the local community and the information board in the entrance indicated a range of things it was planning.The 'You say, we do' suggestions board showed a range of ideas that had been put forward and acted on by the home.

People were involved in all aspects of their own care and wellfare. The home tries to involve people as much as possible. People told us "we've been involved in reviews, and we know who we can talk to if we've any problems".

One person using the service told us "it's my home" and that the staff "are lovely". We saw that people were encouraged to decorate and have their rooms as they liked. People were seen to be actively going about things as they wished and staff encouraged independance.

The home had visitors calling allday and has a relaxed feel about it. Relatives of people who use the service told us "I'm never worried when I leave" and "the staff are always friendly". Relatives were seen to be involved in activities and interacting with staff in a friendly way.

People using the service told us that they were supported to make choices and decisions about their lives. They said “You are never rushed or told what to do; you can do pretty much what you like”.

People said “I have a key worker who makes sure I have everything I need”, “The staff are so kind and always ask if I am alright”, “There is no pressure to do anything”

During our visit we observed staff offering choices to people.

People living at the home commented on the kindness of the staff team. They told us “All the carers are so kind”, “The staff know exactly what I like and they look after me so well”, “The staff always make sure that I am alright and ask me if there is anything that I want”.

When asked, people confirmed that they felt “very safe and well cared for” at the home.

We observed staff interactions with people throughout our visit and it was apparent that staff were very aware of peoples’ needs and preferences.

The home ensures that people have access to appropriate health care professionals. People living at the home told us “they will always get the doctor to visit whenever you need it”; “I feel well looked after and know that I can see a doctor whenever I need to”.

People using the service can be confident that their medicines are appropriately managed and administered by staff who have been appropriately trained.

People living at the home told us that the food was “very good”. They also said, “You always have a choice”, “there is so much to eat”.

We observed the lunch time experience to be relaxed and sociable. People were served with their preferred choice of meals and staff were observed assisting those who required it, in a dignified and unhurried manner.

People are protected by the home's procedures for safeguarding people from the risk of abuse.

People live in a home which is clean and the home have procedures in place to reduce the risk of the spread of infection.

People live in a homely environment which is well maintained and comfortably furnished.

We observed people moving freely around the home and utilising all communal areas.

People are able to access their bedrooms throughout the day as they choose.

We observed staff knocking on bedroom doors before entering.

People told us; “I like my bedroom very much”, “It is very comfortable here”.

People can be confident that the home provides the specialised equipment they need to assist with their mobility needs.

People living at the home can be confident that staff are appropriately recruited and that they are protected from the risk of harm or abuse by the home’s staff recruitment procedures.

We noted a good staff presence throughout our visit. People told us “there is always someone about to help you”.

The atmosphere in the home was noted to be relaxed and we observed staff spending quality time with people.

Staff were heard communicating with people in a kind and respectful manner. People living at the home told us that “all the staff are so kind and helpful”.

People told us that they felt “very well looked after”. Staff confirmed that staffing levels were “safe” and that they did not experience any concerns in meeting the needs of people living at the home.

People benefit from a staff team who are appropriately supported, supervised and trained.

People told us that they felt “very well cared for by all the staff”. Staff spoken with told us that training opportunities were “very good”. They told us that they were never asked to do anything that they did not feel trained or competent to do.

People living at the home told us “they keep us very well informed and we have meetings”. They also said “they are always asking for our ideas”.

We spoke with people using the service and they told us that they felt “confident” in raising concerns. They told us that “all the staff are very approachable”. When asked people told us “The staff listen and I know that they would deal with any concerns”.

People can feel confident that their records are up to date and appropriately stored.