This inspection took place on 20 August 2018 and was unannounced. At the last inspection the service was rated 'Requires Improvement' overall. We issued one requirement notice for a breach of Regulation 17, good governance. This was because shortfalls were found relating to incomplete and missing records. Care plans were not always current and up to date relating to Parkinson’s and changes to fluid intake. Where people were at risk of their skin breaking down the care provided was not always being recorded. You can read the report from our last inspection, by selecting the ‘All reports’ link for Sunnymede, on our website at www.cqc.org.uk.

Sunnymede is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sunnymede accommodates up to 34 people. At the time of the inspection there were 25 people using the service.

There was a registered manager in place. 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's medicines were not always managed safely. Medicine administration records were not consistently signed.

Systems to monitor food storage were not always effective

The systems in place to monitor people's care delivery were not consistently effective.

Records of care delivered were not always completed as required as stated in people's care plans.

People had their needs assessed but further improvements were needed to how this informed people's care plans.

People were not always receiving support to be stimulated with activities and to follow their individual interests.

There was not enough information for people to be supported in a way that met their wishes and effectively at the end of their life .

People had their rights protected and the principles of the Mental Capacity Act 2005 were always followed.

People were supported by suitably trained and experienced staff.

Staff provided dignified care. Staff training was up to date and competency was checked.

The building was not always designed to meet people's needs; in particular people with dementia.

People's care plans were up to date but did not have much personalised information.

People were supported by knowledgeable staff.

People were safeguarded from potential abuse.

People received support from staff that were caring and people were involved in decisions and had their choices respected by staff.

People understood how to make a complaint.

Notifications were submitted as required and the provider understood their responsibilities for notifying us of specific incidents which had occurred at the service.

We found people, their relatives and staff felt supported by the registered manager.

We identified two breaches of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Sunnymede is a care home which provides accommodation, nursing and personal care for up to 34 older people. At the time of our inspection 27 people were living at the home.

This inspection took place on 12 and 13 June 2017 and was unannounced.

At the last inspection, the service was rated good.

At this inspection we found the service rated as requires improvement. This was because shortfalls were found relating to incomplete and missing records. Care plans were not always current and up to date relating to parkinson’s and changes to fluid intake. Where people were at risk of their skin breaking down the care provided was not always being recorded.

Medicines were stored and administered safely although records relating to medicines administered and topical creams were incomplete and missing.

People had mixed views about their meals and choices. Snacks were not always provided in line with people's specific dietary requirements. People did not always have access to adequate tables to eat their meals from.

Systems and audits in place did not always identify shortfalls found during this inspection.

Staffing levels were safe to meet people’s needs although we received mixed views from people.

People’s care plans confirmed if people were unable to make decisions relating to their care and treatment. The principles of the Mental Capacity Act were being followed. Where people had restrictions on their liberty authorisations were in place.

People’s care plans were personalised and included important information relating to their wishes and personal preferences. Feedback was sought from people and relatives.

The staff team were trained and received support from the management. Staff were knowledgeable about how to safeguard people from abuse.

People had access to an outside patio and garden area. This had various plants and flowers that people could enjoy. Some areas of the home had been updated including the tables and chairs in the dining area.

The service had a complaints policy in place. People and relatives felt able to raise any concerns with the registered manager.

People’s health needs were met and people benefited from support from staff relating to all medical and well-being appointments.

Staff were kind and caring. Positive feedback was received about the registered manager from people, relatives and staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Sunnymede is a care home which provides accommodation, nursing and personal care for up to 34 older people. At the time of our inspection 28 people were resident at Sunnymede.

This inspection took place on 26 March 2015 and was unannounced. We returned on 30 March 2015 to complete the inspection.

At the last inspection on 26 February 2014 we identified that the service was not meeting Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because of the way staff recorded the medicines people were supported to take. The provider sent us an action plan and said they were taking action to address the issues. During this inspection we found that medicines were managed safely.

There was no registered manager in post at the 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 and associated Regulations about how the service is run. The manager reported that she would be submitting an application for registration in the month following the inspection.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “You get the help you need” and “Staff are very good, they’re all interested in you”. People told us they felt safe when receiving care and were involved in developing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were supporting. People told us that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. One person told us, “If we had any complaints they would listen to us”. A relative said, “I have not had any serious complaints, but have had discussions with the manager when things were not quite right. They have always been very open and have resolved any problems straight away”.

The management team assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

We visited Sunnymede to follow up compliance actions made following our visit in October 2013. At our last inspection we had found there were shortfalls to care planning which put people at risk of receiving unsafe care. We also found that the provider did not have appropriate arrangement in place for the recording, safe keeping and safe administration of medicines.

We informed the provider they were not compliant with these essential standards and asked them to submit an action plan. This action plan was submitted on 18 December 2013 and set out the actions which would be taken to achieve compliance. On this visit we reviewed these actions.

We spoke with six people who used the service and two relatives. People who lived at Sunnymede had varying levels of dementia, so not everyone was able to tell us about their care and support. One person “they are very nice and helpful”. Both relatives told us they were happy with the care and support provided.

We saw registered nurses had sought advice and guidance from health care professionals when people had or were at risk of losing weight. People were provided with calorie dense meals, snacks and food supplements as required. This meant that staff understood how to support and care for people with dementia with their nutritional needs. During this inspection we found improvements had been made to the handling of medicines. However some further action was need to ensure that people were better protected from these risks.

The purpose of the inspection was to review areas of concern which had been raised with the Commission in relation to the care and welfare of the people who lived at Sunnymede Nursing Home. Other areas of expressed concern included how people’s consent was obtained before care was given and medicine administration.

We spoke with eight people who used the service. All the people we spoke with told us staff were approachable and treated them with respect and maintained their dignity. One person told us “even though they know me they don’t take it for granted. They are very good”. People told us they could make choices about their day to day lives such as what time they wanted to get up or go to bed or if they wanted to take part in the activities in the home.

People we spoke with were happy with the care provided. One person who lived at the home told us "I'm very happy, the staff have been very good, and they do things the way I want things to be done ".

We observed care staff were attentive, polite and sought consent before providing care and support.

Although most people told us they were satisfied with the care they were getting in the home, we found there were minor issues which could impact on people. For example, provider did not have appropriate arrangements in place for the recording, safe keeping and safe administration of medicines.

We spent some time talking with people and observed interactions between people and staff during the inspection. We saw staff reassuring people, listening to what they were asking or saying and acting on it. We saw staff kept people engaged in different activities throughout the home.

We saw people were responsive to the company of staff and smiled as they walked through the home at different times. We observed people drinking tea and coffee and chatting with staff and each other. People were not rushed and were supported to do things in their own time. One person told us “they work so hard and they have more time to talk to us, they don't rush around anymore”. People said they felt safe using the service.

We saw the provider had a policy on safeguarding people from abuse. Staff had attended training to help ensure that people who lived in the home were protected from the risk of abuse.

We saw there were sufficient numbers of suitably qualified and experienced staff at all times in the home to support the people who used the service.

People said they were aware of the complaints procedure and would let the manager know if they were unhappy. One person said “I am ok I have no complaints”.

We saw the environment was suitably designed and adequately maintained. To provide care for people who used the service.

We saw the provider had effective systems in place to regularly monitor the quality of service that people received.

People we spoke with told us that they were happy with the care and support provided by the home. People told us that they were assess before they came to live at Sunnymede. They said they were involved with developing their care and support plan and that staff treated them kindly and politely. For example one person said “I feel safe here there is nothing to worry about. I have no complaints. Another person said if I am not happy I will let staff know but I am ok”.

We saw that the provider had a policy on safeguarding people from abuse and that staff had attended training to ensure that people who live in the home were protected from the risk of abuse.

We saw that the provider had an effective system in place to regularly monitor the quality of service that people received.

We found from speaking to the people living in the home, staff and looking at the staff rota that that there were insufficient numbers of suitably qualified, skilled and experienced staff at all times to meet the needs of the people who used services.

People looked relaxed and comfortable in the company of the staff. People were being supported by the staff team with their range of needs. The staff were polite and respectful when helping people with their care. We found that there were not consistently enough staff on duty to support people so that all of their needs were met. One person who uses the service told us, “you feel like you are in a queue, there are not enough staff these days”.

The newly introduced care plan format was comprehensive in the areas of a person’s life that it looked at. We saw that the care plan format included people’s physical, psychological and spiritual needs, as areas staff should consider when planning what care they required.

People were cared for by staff who knew what to do to protect them from abuse. There was guidance information for staff to follow if an allegation of abuse was made.

The environment was mostly adequately maintained. There was a strong offensive odour in the main lounge. There was a window that was marked as dangerous in an occupied bedroom. The window was loose in the frame and could have been a risk to people. We contacted the providers during our inspection .They have taken action to make the window safe.

We saw a system that the providers were in process of using for monitoring and checking the overall care and services for people at the home. People would benefit if the quality monitoring process included an action plan, with realistic timescales to show how the service will be improved and developed at Sunnymede.