This inspection took place on 13 December 2016 and was unannounced. This was the service’s first inspection ratings inspection under the new management arrangements of Staffordshire Care Limited.

We carried out a focused inspection on 23 May 2016 as we had received concerns from the local authority about how people received their support and care. We found improvements were needed as the provider had not identified that some people may not be receiving their care in a safe and effective way; We also identified there were no staff available in communal areas due to the deployment of staff and managing staff breaks. This meant at those times, some people were not able to summon prompt assistance from staff. During this inspection we found some improvements had been made.

Sunningdale provides accommodation for up to 42 people who require nursing or personal care. At the time of our inspection 34 people were using the service.

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.

People were asked for their consent before care was delivered although where people lacked capacity to make some decisions; it was not clear how this had been assessed. Where restrictions had been identified, application to ensure these were lawful had been made.

Where people needed to have their food and drink monitored, systems were not in place to ensure health support was sought promptly to ensure people were well. Where specific health care tasks were needed, we found this had not always been done promptly to ensure people’s care and dignity. Action was taken by the registered manager and provider following our inspection to make these necessary improvements.

How people received their medicines had been reviewed and people were now receiving their medicines at the time they needed these. People’s medicines were managed, stored and administered safely.

Staff understood their responsibilities to protect people from harm and knew how to raise any concerns. There were enough staff on duty to meet people’s needs and checks were carried out to ensure staff’s suitability to work in social care. Staff received training and support and when they were new to the service they were able to work alongside experienced staff and spend time with them so they knew how to provide the care they wanted.

People were cared for by kind and compassionate staff who understood them. Staff knew about people’s individual preferences for care and their likes and dislikes. People and their relatives were involved in planning and agreeing how they were cared for and supported. Care was planned and reviewed to meet people’s individual needs, abilities and preferences. People were able to engage in activities that interested them in the home and could go out if they wanted to.

The premises and equipment were checked to ensure they were suitable and maintained to ensure risks to people’s safety were minimised. Quality checks of people’s care and health, medicines management, meals and suitability and management of the premises were completed. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

We inspected this service on 23 May 2016 and this was the first inspection visit under the new provider. We previously inspected this service in January 2016 and rated the service as Requires Improvement as people were not consulted about changes in the service and had limited opportunities to engage in activities according to their interests. We carried out this focused inspection as we had received concerns from the local authority about how people received their support and care. A full inspection will be carried out to ensure improvements are made in all areas.

Sunningdale provides support and nursing care for up to 41 people. There were 31 people living in the home on the day of our inspection.

The service had a manager who had applied to become the registered manager for this service. 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.

Systems were in place to assess and monitor the quality of the service. However, the provider had not identified that some people may not be receiving their care and in a safe and effective way; these concerns had been identified by the local authority. The care records did not always show how risks associated with catheter care and skin damage were managed to ensure people received the most appropriate care.

There were sufficient staff on duty who provided respectful care to people. On occasions, there were no staff available in communal areas due to the deployment of staff and managing staff breaks. This meant at those times, some people were not able to summon prompt assistance from staff.

Staff now understood the importance of safeguarding people and their responsibilities to report this. Staff knew how to recognise the signs of potential abuse and knew what to do when safeguarding concerns were raised.

Following concerns identified by the local authority the medication system had been reviewed. The provider had made arrangements for a different pharmacy to dispense all the medicines and provide support to ensure people received their medicines as prescribed.

There was a homely and relaxed atmosphere and people were generally treated with care and compassion. People told us the staff were kind and treated them respect. People liked the staff who supported them and had developed good relationships with them.

When new staff started working in the service, recruitment checks were carried out to ensure that they were suitable to work with people.

The new provider had spoken with people who used the service and staff to ensure they had all the information about how improvements were being made.

This inspection took place on 20 January 2016 and was unannounced. This was the service’s first inspection under the new management arrangements of Avery Care.

Sunningdale provides accommodation for up to 42 people who require nursing or personal care. At the time of our inspection 33 people were using the service.

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.

During our previous inspection, we identified concerns with how people were provided with dignified care and able to make choices. During this inspection, we saw improvements had been made. Staff were respectful and people chose how they wanted to be supported. People received individual support to eat and drink and staff spoke with people and included them in conversations during the meal time. People had a choice of what to eat and drink and specialist diets were catered for.

Improvements were needed to ensure people were provided with activities to meet their interests. There were limited opportunities for people to engage in activities and as the lift was not in operation, people were spending long periods of time in their room unoccupied and with limited opportunities for socialising with others.

Communication was not effective from the provider, and people, their relatives and staff were unsure of what was happening in the home and in the future. Meetings were held with people and staff but there was not an effective system in place to ensure people had up to date information about any changes or developments.

People’s risks were assessed and there were sufficient numbers of staff to promote people’s safety. However, some care records still needed to be updated to ensure they reflected current information about how people wanted to be supported.

People were confident that staff supported them in a manner which protected their welfare and they told us they felt safe. Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

The staff had received training that enabled them to meet people’s needs. Care was provided with kindness and compassion and people’s independence and dignity were promoted. People’s health and wellbeing were monitored and they received their medicines as prescribed. The staff worked with other professionals to ensure people received medical, health and social care support when required.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them. Where restrictions were placed upon people these had been assessed and applications made to appropriate authorities to ensure any restriction was lawful.

You can see what action we told the provider to take at the back of the full version of the report.

We inspected Sunningdale on 10 February 2015 as an unannounced inspection. At our last inspection in October 2013 the service was meeting all of the legal requirements we looked at. The service provides residential and nursing care for up to 42 people. There were 37 people living in the home on the day of our inspection.

There was no registered manager in place as required for the service’s registration with us. The manager had been working at the home for a year but had not completed the registration process. 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.

People we spoke with during the inspection told us they felt safe. Staff understood their responsibilities to protect people from harm and knew how to raise concerns if necessary. There were processes in place to ensure medicines were administered correctly.

People’s human rights were protected as staff understood the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were asked for their consent to the care they received.

Some people required specialist equipment to receive their nutrition. We saw this was not stored as required to keep the equipment clean. Some people were rushed to consider their food choices and staff did not always guide them when required.

Staff received training which was linked to people’s needs. Staff told us they received supervision and they felt supported to fulfil their roles.

Some staff did not respond in a timely manner to meet people’s personal needs. There was limited communication between staff and the people who used the service.

There were arrangements in place to involve people in hobbies and pastimes which interested them but some people told us they would like a more variety.

People and their relatives told us they would feel comfortable raising complaints or concerns with staff or the registered manager and felt they would be listened to.

There were arrangements in place to monitor the quality of the service provided to people.

We inspected Sunningdale on a planned unannounced inspection which meant that the service did not know we were coming. We were supported throughout the inspection by the manager and operations manager.

We spoke with people who used the service, their relatives and staff.

We found that people’s care and welfare needs were being met. One person told us; “They (staff) are good, they look after me well”.

We saw that the service was clean and had systems in place to prevent the spread of infection.

We found that equipment was well maintained and suitable for its intended use.

The service followed the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure which was readily available for people who used the service or their representatives to raise any concerns they might have had.

Sunningdale was compliant in the five outcome areas we looked at.

When we visited Sunningdale in June 2011, we had minor concerns that people sometimes had to wait for the attention they needed. Following that inspection we received information about improvements made at Sunningdale, which included changes in the management and in staffing levels. When we inspected Sunningdale in October 2012, we observed that people did not have to wait to have their needs met.

We saw that staff treated people with consideration and respect. We found care plans provided a thorough assessment of people's needs and were updated as people's needs changed. Care workers and nurses referred to the care plans and risk assessments to ensure the care met people's individual needs. When we spoke with some of the people who lived at Sunningdale they told us positive things about their care, "I do like it here"; "the staff are very good"; "lovely food". A relative of one person said, "I am confident that Mum is well looked after".

The staff we spoke with had completed safeguarding training and they were clear about their responsibilities to protect people from any risk of abuse. They told us they had confidence in their managers and the home's owners to take appropriate action to keep people safe. When we visited, we observed that there were enough staff to meet people's needs. They worked well as a team and they had received regular training.

We saw that the provider company Restful Homes Ltd had robust systems to monitor the quality of the service.

A large scale investigation was initiated with regard to Sunningdale Nursing Home in April 2011. This means the local authority, the primary care trust (PCT), police, the provider for Sunningdale Nursing Home and CQC, have been working in partnership to improve outcomes for the people who live there. The investigation is still ongoing.

Due to the needs of some of the people living at the home not everyone was able to share their experiences of what it was like to live at Sunningdale Nursing Home. We spent time observing people being supported by the staff on duty during our visit.

We spoke with eight people who used the service their comments included:

“They look after you here the staff are very nice. “ They are brilliant they look after us wonderfully.” “I am happy here, I feel safe.” “They are good to us.”

Some people were not as positive because they had to wait to be assisted to the bathroom. One person said; “You can’t always go straight away when you ask.” Another commented, “I don’t have a bell I just yell, can I have a wheelchair please?” “They do their best; they only have one pair of hands.”

We spoke with visitors to the home their comments included; “Friendly open staff.” “I am very happy with the staff I cannot speak highly enough of them.” “The staff are respectful.” “It’s okay, I am happy enough.”

All seven staff that we spoke with told us things were better and improving.

When we asked them to explain this they said; “This experience has helped us all as a team, it has got the ball rolling.” “Communication has improved things now run smoothly.” “We have come together; the quality and compliance manager for the company has really improved things. She is on the floor looking at all aspects of our job and the home.” “Things get done now.”

We spoke with a visiting professional who had undertaken a review. They confirmed that the person using the service and their representative were happy with the care received.

Due to the needs of the people living at the home not everyone was able to share their experiences of what it was like living at Sunningdale Nursing Home. We spent time observing individuals being supported by the staff on duty during our visit.

People we spoke with told us they were well cared for and that the staff respected their privacy and dignity. “I have nothing to complain about. “ “Yes, the team of girls are good.” They told us the staff work hard and care for them but at times were stretched. Some individuals told us they had observed people having to wait for support from the staff. One person said, “I wonder whether they are coming or not, sometimes they are so busy.” During our visit we heard a person using the service being asked to wait. People described the staff as “good" and “helpful” but sometimes “too busy.” More than one person told us during our visit they thought the staff could or should be quicker at referring individuals if they had concerns about their health.

The staff told us that they enjoyed working at the home and considered they worked well as a team. They said the manager was “available and approachable.”