The inspection took place on 7 March 2018 and 13 March 2018 and the first day was unannounced. The last inspection took place on 3 May 2016 when the service was rated Good.

Sunnyside 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.

Sunnyside accommodates up to 27 older people in one adapted building. The home is situated about two miles away from Bolton town centre.

There was a registered manager in place at 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 2008 and associated Regulations about how the service is run.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance.

Over the previous year the service had experienced some difficulties following changes within the structure of the ownership personnel. This had resulted in the registered manager finding some of the paperwork incomplete or difficult to access and having to take on extra administrative duties. Some of the quality assurance systems, which had previously been maintained at a provider level, had not been maintained. The systems which were in place were poor and did not include issues identified and actions to address them. Staff files were incomplete and did not include all the information required. We discussed this with the registered manager who agreed to implement new systems where previous systems could not be located or were lacking in detail.

People told us they felt safe and we observed a staff team that was very caring and proactive in providing support throughout the day. Some health and safety certificates could not be produced on the day of the inspection, but we saw evidence of new checks being undertaken following the inspection.

Safeguarding policies and procedures were available but needed updating. Staff were aware of how to recognise and report any abuse or poor practice. Individual risk assessments were in place within people’s care files. Staffing levels were flexible and were sufficient to meet the needs of the people who used the service.

Medicines policies required updating, there was a lack of staff guidance and systems were not robust or clear. Accidents and incidents were recorded and reported appropriately. However, there was no overview to enable monitoring on a general scale.

Care files included a good range of health and personal information and were reviewed and updated regularly. We saw evidence of a thorough induction programme. There was a range of training offered on a regular basis and mandatory training was updated when necessary.

The home had recently gained a 4 Star rating from the national food hygiene standard rating scheme. There were plentiful supplies of fresh and frozen food. There was some signage around the premises to help people living with dementia to orientate them around the home.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us they were well looked after and the staff were kind and caring. During the inspection we observed warm and friendly interactions between staff and people who used the service.

People who were able were involved in their own care planning and reviews. Relatives were encouraged to be involved where appropriate.

The service produced a service user leaflet and there was also an up to date statement of purpose. The service was committed to the principles of equality and diversity. People were encouraged to be as independent as poss

The unannounced inspection took place on 03 May 2016. The last inspection was carried out on 30 March 2015 when the service was found to require improvement.

Sunnyside provides residential care for up to 27 older people and is situated about two miles away from Bolton town centre. On the day of the inspection there were 24 people using the service as two were currently in hospital and one had passed away recently.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

People said they felt safe at the home. The premises were safe and secure, but the internal fire escape staircase was in need of some improvement. Health and safety measures were in place.

There were sufficient staff to meet the needs of the people who used the service. The recruitment procedure was robust.

There had been no recent safeguarding concerns but staff demonstrated knowledge of the procedures and were confident to report any concerns.

Systems relating to medicines were robust and medicines were administered safely.

The home had been audited by infection control three times in the last year. Actions had been put in place following the first audit and the second audit had shown significant improvements. A third audit was undertaken by a specialist nurse on the day of the CQC inspection and the home had continued to improve in this area, achieving a score of 85%.

There were robust induction procedures and staff training was thorough and on-going.

Care plans included appropriate health and personal information and referrals were made appropriately to other agencies.

People’s nutritional and hydration needs were addressed and people were given a choice of food and drinks. Monitoring was carried out where there were nutritional risks to ensure these were addressed in a timely way. People’s specific dietary needs were catered for.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated an understanding of both MCA and DoLS.

Without exception people who used the service, relatives and friends and health and social care professionals we spoke with were positive about the care and treatment at the home.

We observed care interventions and interactions between people who used the service and staff throughout the day. The atmosphere was friendly and relaxed and staff were kind, caring and polite.

People’s privacy and dignity was respected.

People were given choices around their daily routines, such as when they wanted to get up and go to bed and what they wanted to wear, do and eat.

There were a number of activities on offer and people were frequently taken out of the home if they wanted this.

The care was person-centred and each file included information on the individual’s personality, moods, background, interests and preferences.

There was a complaints policy, but no complaints had been received recently. The home had received a number of thank you cards.

Notifications were sent in to CQC appropriately.

The registered manager had an open door policy and people who used the service, relatives and staff all felt comfortable to speak to her at any time.

Staff supervisions were undertaken regularly. A member of the management team was on call at all times, when not on shift, to ensure support and assistance was given as required.

A number of quality audits and checks were carried out to help ensure continual improvement in service delivery.

We carried out this inspection on 30 March 2015. The inspection was unannounced. The last inspection was carried out on 8 April 2014 and the service was found to be meeting all regulatory requirements inspected.

Sunnyside provides residential care for up to 27 older people and is situated about two miles away from Bolton town centre. At the time of the inspection the home was full with 27 people currently using the service.

There was a registered manager at 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 2008 and associated Regulations about how the service is run.

The building was secure and the communal areas clutter free. This enabled people with restricted mobility to move around safely.

We saw that some people were able to leave the home alone, to pursue their own interests. This was risk assessed on an individual basis, to help ensure people were able to do this safely.

People who used the service had personal emergency evacuation plans (PEEPs) to ensure staff were aware of their level of need in case of an emergency evacuation. These documents were reviewed and updated on a monthly basis.

The service recruited staff in a robust manner, ensuring they had application forms, references and Disclosure and Barring Service (DBS) checks in place. This helped ensure people were suitable to work with vulnerable people. We saw that there were sufficient numbers of staff to attend to the needs of the people who used the service.

Safeguarding procedures were in place and staff we spoke with demonstrated an awareness of safeguarding issues. They knew how to follow the procedures and who to report to should the need arise.

Systems were in place for the safe ordering, administering, storing and disposal of medicines.

We observed a mealtime at the home and saw that the food at the home was good and nutritious and people were given choices. However, the meal time experience could have been improved with more attention to detail. There were no condiments placed on the tables, some people were seated in poor positions and staff missed some opportunities to provide assistance when required.

Initial training was given to staff on induction and further training was on-going to help keep their skills and knowledge up to date.

We saw that care plans included a range of personal and health information. There were risk assessments and monitoring charts for issues such as turning, nutrition and weight. All those we looked at were complete and up to date.

Consent was recorded within care plans where required and verbal consent was gained by staff for all interventions and assistance offered.

The service worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA sets out the legal requirements and guidance around how to ascertain people’s capacity to make particular decisions at certain times. There is also direction on how to assist someone in the decision making process. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.

There was no one at the home who was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation, but the manager was aware of how to refer for authorisation should the need arise.

People told us they were looked after with kindness. We observed staff throughout the day offering care in a friendly and caring way, using verbal communication, touch and body language to ensure they communicated effectively with people.

We saw that people were encouraged, as far as they were able, to be involved in the planning and delivery of their care and support. Relatives were also included in this process, subject to the agreement of the person who used the service.

Staff were able to give examples of how they respected people’s privacy and dignity. We saw evidence of this throughout the day.

We saw that the service sought informal feedback regularly via chats with people who used the service and their families. Formal feedback was obtained via an annual survey.

People told us they were given choices about their daily lives, such as what time they wanted to rise and retire and whether they wanted a bath or shower.

We looked at five care plans and saw they were person centred and reflected people’s individual preferences and wishes.

A range of activities were on offer at the home. These included a monthly communion service, exercises, music for health, parties, bingo and pampering sessions.

There was an up to date complaints policy and log. We saw that no recent complaints had been received by the service, but people reported they were confident any concerns would be followed up appropriately. We saw some compliments, in the form of cards, received by the service.

We found that the provider had been failing to send in statutory notifications as required by the Care Quality Commission (CQC). Following this being discussed with the registered manager the notifications were forwarded and systems were put in place to ensure that notifications would be forwarded appropriately in future. Due to the prompt action by the service we will be following this up outside the inspection process.

People who used the service and their relatives told us the registered manager and all the staff were approachable.

Staff felt the registered manager was supportive and they were able to call the registered manager or deputy manager at any time, for support and advice.

The service had a stable staff group, most of who had been employed at the home for a significant length of time.

A number of audits and checks were carried out at the home to help ensure continual improvement to service delivery.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at respect and dignity, care, nutrition, equipment and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking with visiting professionals and looking at records:

Is the service caring?

We saw people being cared for by staff who showed kindness and compassion in their interactions. One person said, “All the girls are really caring”. A visitor told us, “The girls are all wonderful, every one, there is not a bad one amongst them. They take their time to get to know the person and their particular needs. They are kind and gentle with everyone”.

We saw evidence within the care records of people’s individual choices being noted and followed.

Is the service responsive?

People received an assessment prior to being admitted to the home. The care records included a large amount of information about the person’s needs, wishes and preferences. We spoke with two professional visitors to the home who told us the home had considerable success in providing individual care for people who were difficult to place in other residential homes, due to particular issues or difficulties.

People’s mental capacity was taken into consideration with regard to decision making and meetings were held to ensure decisions were made in the person’s best interests. Professionals were consulted for advice and appropriate referrals were made to others services.

Is the service safe?

Risk assessments were in place in the care records, along with clear guidance for staff to follow. These risk assessments were reviewed and updated regularly to ensure people’s needs were met safely.

There was evidence that equipment used to transfer people was used correctly and appropriately. Equipment was in good working order and was regularly serviced.

Staff wore the correct personal protective equipment, such as white aprons and gloves, to administer personal care and blue to serve food.

The kitchen staff were aware of hygiene and safety procedures and produced food in line with these practices..

Is the service effective?

We observed staff interacting well with people who used the service. We spoke with four care staff who demonstrated a good

understanding of people’s individual needs. People were well presented and looked well cared for.

There were a number of activities on offer within the home and people were encouraged to join in at a level which was within their own capabilities and skills.

Is the service well-led?

There was evidence that communication between management and staff was good and effective. Handovers were clear and staff had knowledge of their roles and responsibilities.

There were quality assurance systems in place to ensure any issues were identified and addressed in a timely and appropriate manner.

On our visit to Sunnyside we found the home warm and clean, with no malodour. People who used the service were appropriately dressed and well presented and we saw staff delivering care in a polite, friendly manner.

We looked at three care files and saw that they included relevant information about people’s health, care needs, background, likes and dislikes. Appropriate risk assessments and monitoring charts were held within the files and were reviewed and updated on a monthly basis.

We spoke with two people who used the service. One person said “The food is good, they cut it up for you. If you ring the buzzer they come quickly.” They went on to say “I know what good care is – I used to be a carer.” Another person told us “There’s always something going on if you want to join in. It is a happy place, the staff are all lovely.”

We also spoke with three professional visitors to the home. They all felt the home communicated well, made appropriate referrals and administered excellent care to people who used the service.

We looked at three staff files and saw that robust recruitment and induction procedures were used. Staff were appropriately qualified and training and development were ongoing.

We saw that the home had some systems in place to assess the quality of their service and were working towards further ways to monitor service delivery and try to continually improve the service. There was a complaints policy and complaints were followed up appropriately.

One person living at the home told us that it was a difficult decision to move into the home but now they had accepted the situation they were glad that it was at Sunnyside because they “fitted in”.

A relative told us that they “Could not have found a better place. They love her to bit’s and I am more than welcome to visit at any time.” Another relative told us that they came to visit their relative everyday and stayed and had a meal with them. They said that they were made to feel very welcome. They told us that they had known some of the staff team when they were children and this gave them reassurance that their relative was being well cared for.”

A relative told us that the home had a “nice atmosphere” and that the “carer’s are marvellous. I would recommend Sunnyside to anyone, they keep me informed I ring every night and it is not a problem.”

People we spoke with told us that they felt safe at the home. People said that if they had any worries or concerns they would speak to the provider or the manager and they were confident that the matter would be sorted out. A person told us that they felt safe because the security arrangements at the home meant that no-one could access the home without using the bell at the front door and staff could see who the person was before allowing them to enter. A relative said, “I have peace of mind because I know my husband is safe and being looked after when I go home.”

People told us that they got on well with the staff. A relative said that they were “marvellous” and “I admire the staff and the way they help strangers, I could not do it.”

Everyone one we spoke with told us that either the provider or the manager were always available either at the home or on call. They said that they were both approachable and supportive.