CQC report explained · a residential care home
What the CQC found at Sundial Cottage Rest Home Ltd
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unsafe or poorly recorded medicines, inconsistent risk management, incomplete recruitment records and weaknesses in infection control. Staffing levels were planned to meet people's needs, and people said they felt safe.
- Effective?
- Requires improvement
- Consent processes did not always follow the law. Care plans were personalised, staff were trained and the home sought advice from health professionals.
- Caring?
- Good
- People and relatives described staff as kind, caring and friendly. Staff respected privacy, dignity and personal choices.
- Responsive?
- Good
- Staff knew people well and provided personalised care. There was a varied programme of activities, and complaints were responded to.
- Well-led?
- Requires improvement
- The provider's checks had identified some problems but had not led to enough progress. Records, risk assessments and quality monitoring were not consistently reliable.
What inspectors found, October 2022
Rated Requires Improvement; inspectors found kind, personalised care but serious weaknesses in medicines, risk management, consent and oversight.
This was an unannounced inspection on 24 August 2022. Inspectors spoke with six people, managers, staff, relatives and health professionals. They checked the care, the building, records, staffing and infection control.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were also Requires Improvement. Caring and Responsive were rated Good.
Inspectors found problems with medicines, risk assessments, recruitment records, infection control and the management of accidents and incidents. They also found that consent was not always handled lawfully. These issues led to breaches of regulations about safe care, consent, staff recruitment and good governance.
People generally felt safe and said staff were kind and caring. Care plans were personalised, activities were regular and staff worked with health professionals. The home had an interim management team because the registered manager had resigned, and a new manager was due to start in September 2022.
Kind and respectful care
People and relatives said staff were kind and caring. Inspectors observed positive interactions and saw staff protecting privacy and dignity.
“People told us staff were kind, caring and friendly and we observed a number of positive interactions where staff clearly conveyed their regard for people.” from the report
Personalised support
Care plans reflected people's needs, communication preferences and choices. Staff knew people's histories, interests and preferences.
“People had care and support plans that were personalised and reflected their needs including any communication or cultural needs they might have.” from the report
Activities and relationships
People had access to regular activities such as cooking, puzzles, singing, exercises and boat trips. Relatives were positive about the activities.
“A weekly programme of activities was planned and included cooking and puzzle clubs, singing groups and armchair exercises.” from the report
Working with health professionals
Staff sought advice from several health professionals and held weekly discussions about emerging health risks.
“Staff sought the specialist advice of a range of health care professionals such as the palliative care team, tissue viability nurses, speech and language therapists and the community mental health team.” from the report
Medicines were not always managed safely
seriousRecords contained unexplained gaps and some medicines were given, or not given, contrary to prescriptions. One person's covert medicines were mixed with food in a way that did not follow professional advice.
“Improvements were needed to ensure the safe and proper use of medicines.” from the report
Risks were not managed consistently
seriousInspectors found concerns about choking, pressure damage, falls and stair access. Records did not always show that required checks had been completed.
“Systems to manage risk were not sufficiently robust. This placed people at risk of harm.” from the report
Consent processes were unlawful
seriousBest-interest consultations were not consistently recorded, and people without legal authority signed consent forms for others.
“Consent was not always being obtained in line with law and guidance.” from the report
Quality checks did not drive enough improvement
seriousThe provider had identified some problems but had not acted on them quickly or effectively enough. Records and risk assessments did not always show who had completed them or when.
“The systems in place were not being effective at ensuring compliance with the fundamental standards.” from the report
Infection control needed improvement
needs fixingSome bathroom surfaces were worn, cloth hand towels were used in some toilets and protective equipment was stored near clinical waste. Some items also needed replacement.
“Whilst feedback from people and their relatives about the cleanliness of the home was positive, we found some areas needed to improve.” from the report
Recruitment records were incomplete
seriousSome staff files did not contain full employment histories. One staff member had started before their DBS check was returned without a recorded risk assessment.
“Some of the required records to support safe recruitment were not in place.” from the report
- 01What changes have you made to medicines records, PRN medicines, covert medicines and medicine errors since the inspection?
- 02How do you now check that people at risk of choking, falls or pressure damage receive the correct support and monitoring?
- 03How are mental capacity assessments, best-interest decisions and consent forms checked to make sure they follow the law?
- 04Has the new manager started, and who is currently responsible for checking safety and quality each day?
- 05What repairs and infection control improvements have been completed, including worn flooring, hand towels, PPE storage and the bed rail bumper?
This was the first inspection of the newly registered service under the current provider, covering all five key questions and infection prevention and control; the previous Requires Improvement rating was under the former provider. This explanation was written from the published report of 12 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Sundial Cottage Rest Home Ltd
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- October 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Sundial Cottage Rest Home Ltd →
- August 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- November 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2021
Registered with the Care Quality Commission on 28 July 2021.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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26 live-in carers within about an hour of Hampshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 23 can care for a couple. 14 years' experience on average.
“I cannot recommend Prisca highly enough, she is one in a million.”
“He stayed with her throughout the pandemic, refusing to visit his own family, who lived nearby, to reduce the risk of infection.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.