Sundial Care Home

Sundial Care Home 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.

Sundial care home can accommodate up to 37 people in a detached period property in the village of Tipton St. John, East Devon, near the seaside town of Sidmouth. The home consists of two floors with a passenger lift providing level access to each floor. There are two large communal areas, both providing kitchenettes, dining areas and comfortable seating where people could spend their time as they chose. To the rear of the house was a large secure landscaped garden with country views which people could access independently.

At the time of this inspection there were 23 people using the service. One of these was staying at the service for a period of respite (respite is planned or emergency temporary care provided to people who require short term support). One house of 11 bedrooms was closed for refurbishment which was due to be completed later this year.

There was a registered manager. A registered manager is a person who has registered with CQC to manage the service. Like registered persons, 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 registered manager was supported by a deputy manager and the provider's management team. They covered seven days a week and worked closely with people, relatives and the staff team.

People received outstanding care and were supported to have the best quality of life possible. People and visitors said they felt the care at the home was exceptionally good. Comments included, "It's a good quality place to be. Very comfortable. I am looked after extremely well. They are very kind here."

The provider had recruited a specialist team to design their model of care to cater specifically for people they support. They had completed research examining care models in Australia and America and best practice in care homes in the United Kingdom. They had written 'The Evolve Household Model of Care'. This model ensured that barriers between people and staff do not exist. Staff were trained to be with people, talking and listening, enabling them to maintain maximum independence and constantly evolving to improve the quality of people's lives. For example enabling people to do everyday tasks like making a cup of tea, sweeping the floor and making and buttering their own toast. It was clear people were at home at

Sundial.

The provider recognised the importance of recruiting the right staff with the right skills. They involved people in the recruitment process. The registered manager said, "Skills can be taught however the drive to have a career in care is heartfelt and driven by a person's (staff member's) beliefs and values." Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

Staff demonstrated a passion to provide individualised care for people. They were highly motivated and offered care and support that was exceptionally compassionate and kind. There was a strong person- centred culture at the home, with people being at the centre and focus of everything. Staff had a real empathy for the people they cared for and treated people like family members. They interacted positively with people and had a good knowledge of the people they cared for. Care plans contained detailed information, including life history, to help staff support people in a personalised way. Relatives were made to feel welcome and were involved in the care planning process. Staff provided care in a way that protected people's privacy and dignity and promoted independence. People and relatives were very happy with the care the staff provided. People and visitors said the care at the home was exceptionally good. Comments included, "It's a good quality place to be. Very comfortable. I am looked after extremely well."

People received care that was tailored to their individual needs. They were very well supported by sufficient numbers of staff on duty to care for them safely and spend time with them. The provider monitored people's needs and took prompt action to increase staff levels as people's needs changed.

The staff demonstrated a real passion to ensure people were supported at the end of their life with dignity and respect. There was a strong sense of people being an important part of a family at Sundial Care. An area in the garden referred to as a remembrance garden remembered people who had stayed at the home. There were numerous thankyou messages from relatives regarding the good quality care people had received at the end of their lives at the service.

Staff were highly skilled and had the knowledge to meet people's individual physical, psychological and social needs. They had received the provider's very comprehensive induction and bespoke training which was based on the provider's model of care and CQC's key line of enquiries. There were designated staff champions for providing knowledge and expertise for other staff. Equality and diversity was part of the provider's mandatory training requirements and people were cared for without discrimination and in a way that respected their differences.

People's medicines were managed safely and overseen by a medicines champion. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines.

People were protected from harm as staff were able to demonstrate a good understanding of what constituted abuse and how to report if concerns were raised. Staff had safeguarding of vulnerable adults training and had the knowledge on how to report any concerns internally and externally and what action they would take to protect people. Robust systems were in place to manage risks to people, which were monitored by the provider's senior management team. Risks had been identified and managed appropriately with full involvement of people and relatives in a meaningful way. People had individual personal emergency evacuation plans in place. Accident and incident records showed staff had taken appropriate action at the time to protect people. The management team had analysed these to look for patterns or trends. The provider had completed a near miss project which gave staff clear examples of environmental near misses and how to report and prevent them.

People were assessed in line with the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguarding (DoLS). People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected and staff worked with other professionals in their best interest. 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. Capacity assessments were being undertaken and best interest decisions were being recorded.

People were supported to maintain their health and wellbeing and had access to health professionals when needed. Staff had a strong emphasis on the importance of eating and drinking well at the home. They supported people to have sufficient to eat and drink and maintain a balanced diet and enjoy their food. The service provided good quality food with a variety of different options to choose from each day. People told us they enjoyed their meals, there was plenty of food and we observed people were not rushed. People who had previously used the service for respite stays remained involved in the life of the service, through the monthly lunch clubs and social events.

People were actively encouraged to use the two kitchenette areas to make food as they chose supported by staff. Snacks and drinks were always accessible if people required them. People's weights were monitored regularly and advice sought from GPs if there were any cause for concern.

The provider actively involved people, staff and local people in developing the service. Regular residents and relative meetings were held giving them the opportunity to voice and share their opinions and ideas about the future of Sundial. People and their relatives were happy with the way care was delivered and happy with the staff approach. The national care homes review website had six positive reviews from relatives of people using the service. They all rated the service as excellent and good. One relative recorded, "Supported very well by the friendly, helpful staff. She is so much happier than when she was living at home."

The management team continually strived to improve the service and their own practice finding new and creative ways to do that. The provider used a tailored quality monitoring system at the service. The staff team were fully involved in the provider's governance process. They were supported to identify issues, address them and find more creative ways to support people's health and wellbeing.

The provider recognised the importance of social activities and that all activities no matter how small formed an important part of people's lives. They used the phrase 'magic moment's' where staff recognised throughout the day they can support people to do tasks for themselves, what they want to do and feel a sense of purpose. There were no 'activity' staff because all staff were involved in engagement and stimulation depending on people's needs.

People knew how to make a complaint if necessary and were confident any concerns would be dealt with quickly. The registered manager had received one concern which had been managed in line with the provider's complaints policy, with the outcome satisfactory to the complainant.

There was a lovely homely environment, people were relaxed and appeared at home amongst friends. The staff team had ensured the premises and adaptations were arranged to promote people's wellbeing. The premises had undergone an extensive refurbishment and work was still being completed on the final wing. People were consulted regarding the extensive refurbishment and their individual preferences supported. The premises and equipment were managed to keep people safe. Regular maintenance checks and repairs were carried out and all areas of the service were clean and tidy.

The views of people using the service, relatives and staff were at the core of quality monitoring and

assurance arrangements. The provider learnt from concerns and incidents and used this information for continuous improvement. The provider recognised the importance of staff being supported in their role from the beginning of their employment. Staff had numerous supervisions and opportunities to discuss concerns and express their views. The provider used feedback to continuously develop the induction program to ensure it reflected the home. Staff said they felt well supported by the management team and felt involved with the development of the service. Staff spoke highly about the registered manager and management team and said they were able to discuss any issues.

The service had close links with healthcare professionals who gave positive feedback regarding the knowledge and cooperation of management and staff.

The five questions we ask about services and what we found