Archived: Sand Banks Care Centre

This inspection took place on 5 September 2018 and our inspection was unannounced. This meant the service did not know we would be visiting,

At our last inspection in November 2017 we rated the service as Requires Improvement and found breaches of regulations 18 and 17. The breaches concerned the staffing levels, records and staff recruitment.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and effective to at least good. During this inspection we found improvements and no further breaches of the regulation. However, there were still areas of improvement to be achieved and sustained.

Sand Banks Care Centre 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.

The home accommodates up to 77 people in one adapted building across three floors. At the time of inspection, there were 54 people using the service. There was no one receiving nursing care at the time of our inspection.

The service did not have a registered manager. A registered manager is a person who has registered with the CQC 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 manager at the home had applied to become the registered manager and was waiting for an interview with the CQC. The manager had extensive experience of working in the social care sector

Medicines were administered safely and were managed however we found that some records systems were not in place for topical medicines and ‘as and when required’ medicines.

Some records relating to medicines were not in place however, these were addressed during our inspection.

Best interest decisions records were not always kept effectively to show the process that had taken place and who was involved when best interest decisions were made for people

Care plans were person centred regarding people’s preferences and were personalised. However, some still needed improving.

People’s personal risks had been identified and more detailed risk assessments had been written to give staff the necessary guidance on how to keep people safe.

Staff were trained in safeguarding, first aid, the Mental Capacity Act and infection control. Additional training was in place or planned in areas specific to people’s individual needs. Feedback from staff regarding their training was positive.

People were supported by sufficient numbers of staff to meet their needs. This had improved since the last inspection. Additional staff were added to each area of the home and new staff had also been recruited safely.

People’s nutrition and hydration needs were met and they were supported to maintain a healthy diet, Where needed records to support this were detailed.

People were supported by kind and caring staff. We observed positive, dignified interactions between people and staff. The feedback from people and their relatives was positive about the staff.

People were complimentary about the food. The food served appeared appetising.

Communication systems were in place for staff. Staff used handover notes to pass on important information between shifts.

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.

Improvements were made to systems that ensured staff were employed safely and pre-employment checks were carried out on staff before they began working in the service.

Staff were supported through an induction period. They received training and supervision from the manager together with an annual appraisal.

The manager introduced a monitoring system to highlight people’s dependency needs to monitor the staffing levels on duty. Rotas’ showed there were consistent numbers of staff on duty each day to meet people’s needs.

People were supported to maintain their independence by staff that understood and valued the importance of this.

People were supported to take part in a wide range of activities at home and in the wider community as active citizens and to suit their individual preferences.

The home was exceptionally clean, tidy, well presented and infection control was carried out to a high standard.

People were supported to access information in a variety of formats to suit their needs and adaptations could be made to suit individual needs.

Arrangements were in place for people to receive appropriate end of life care. We received positive feedback from relatives regarding this area of care. Surveys had been used to monitor the quality of the services. The largely positive results had been presented and were on display in the home.

Staff, people who used the service, relatives and other professionals agreed that the manager led the service well and was approachable and accountable. We found they had a sound knowledge of the needs of people who used the service and clear expectations of staff. They had plans in place to make further improvements to the service.

A programme of audits was carried out by the manager which were effective at improving the service and we saw that improvements were ongoing.

Partnership working was in place with other professionals, including; health care professionals, and dietitians or specialist consultants were Involved in people’s care as and when this was needed and staff supported people with any appointments.

Notifications of significant events were submitted to us in a timely manner by the manager.

However the information shared with CQC about the incident indicated potential concerns about the management of the risk of falls from moving and handling equipment. This inspection examined those risks.

Sand Banks Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sand Banks Care Centre accommodates up to 77 people in one purpose built building across three floors. The ground floor (Stead) and the second floor (Mowlam) accommodation is for people with residential care needs. The first floor (Bell) provides residential care where some people were living with a dementia type illness. On the day of our inspection there were 63 people using the service.

Facilities included en-suite bedrooms, several lounges and dining rooms, communal bathrooms, shower rooms and toilets, hairdressing room, a large well maintained communal garden and a spacious reception area. Entry to the premises was via a locked, key pad controlled door and all visitors were required to sign in.

The home had a registered manager in place. A registered manager is a person who has registered with CQC 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.

Sand Banks Care Centre was last inspected by CQC on 23 March 2016 and 7 April 2016 and was rated Good.

The provider did not have an effective recruitment and selection procedure in place and did not always carry out relevant checks when they employed staff.

There were not always sufficient numbers of staff on duty in order to meet the needs of people who used the service. For example, to support people to eat and drink at meal times or answering people's call bells, when required.

Care records were not person-centred and in some instances not reflective of people’s needs. ‘Person-centred ‘is about ensuring the person is at the centre of everything and their individual wishes, needs and choices are taken into account.

Staff were not always properly supported to provide care to people who used the service as some staff training was not up to date and supervision records were repetitive and not always focussed on the individual.

Accidents and incidents were recorded. People had risk assessments in place however they were insufficiently detailed and we could not be assured that staff were able to identify and minimise the risks to keep people safe.

The registered manager understood their responsibilities with regard to safeguarding. Staff we spoke with knew the different types of abuse and how to report concerns.

People’s medicines were safely administered. However medicine audits were not up to date and identified actions had passed their completion dates.

The service was clean, spacious and suitable for the people who used the service. The provider had procedures in place for managing the maintenance of the premises and appropriate health and safety checks had been carried out.

People had access to food and drink throughout the day. People’s weight and nutrition was monitored although records were not always completed consistently.

People who used the service had access to healthcare services and received ongoing support from external healthcare specialists.

People who used the service and their relatives had conflicting views about the standard of care at Sand Banks Care Centre.

The staff knew the care and support needs of people well. We found most staff were caring and responsive to people’s needs however we observed some care delivery to be task focussed. Staff understood how to provide care in a dignified manner and respected people’s right to privacy.

The provider had appointed two new activities co-ordinators to develop and arrange activities for people who used the service based on their likes and interests to meet their social needs in the service and within the local community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The provider had a complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

The provider had audits in place to measure the quality of the service however some of the audits had failed to successfully identify the deficits we found in the service.

Some staff told us they did not always feel supported in their role and felt unable to approach the registered manager to report concerns.

People who used the service, their relatives and staff were regularly consulted about the quality of the service via meetings and the provider planned to send out surveys in January 2018.

The provider had policies and procedures in place that took into account guidance and best practice from expert and professional bodies and provided staff with clear instructions.

At this inspection we found 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 the report.

Sand Banks Care Centre is a residential care home that can accommodate up to 77 people. The service can provide nursing care but at present is not delivering this form of care. At the time of our inspection there were 22 people living at the home.

There had been no registered manager in post since October 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered provider had appointed managers following the departure of the last registered manager but they had not stayed in post. The operations manager was attempting to recruit to this post and in the interim they were completing the process to become the registered manager. They were at the final stage of this process.

People were happy and felt safe. We found that a range of stimulating and engaging activities were provided at the home. People told us staff worked with them and supported them to continue to lead fulfilling lifestyles. People were supported to recognise the impact any memory loss had on their ability to go out independently and they told us that they needed staff support. People felt they would receive support from staff when needed.

People’s care plans were tailored for them as individuals and created with their family and social worker’s involvement. People were cared for by staff who knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful and we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

Staff were very well supported and had the benefit of a programme of training that enabled them to provide the care and support people needed. Staff were all clear that they worked as a team and for the benefit of the people living at Sand Banks Care Centre. Their comments and feedback are used towards the continuous improvement of the service.

The management team investigated even the smallest concern. We saw that they thoroughly looked at the concern and took prompt action to resolve them. They freely admitted where they had made mistakes and were very open and honest with people who raised issues.

The staff had a clear understanding of safeguarding and ensured that action was taken if concerns arose about the way people were supported. The registered provider had found that on initially opening there had been problems setting up an effective nursing service so following a full review made the decision to cease providing this service until the home was more established. We found that over recent months the operational manager and management team had made sure the home improved and visiting professionals now found that the care delivery was effective and appropriate.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The management team closely considered people’s needs and for the 22 people using the service there was two senior carers and four care staff on duty during the day and two senior carer and three care staff on duty overnight.

Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

We reviewed the systems for the management of medicines and found that people received their medicines safely. Medicines were closely managed and this ensured people received their medication exactly as prescribed.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. A generous catering budget was provided. The cook also provided a range of fortified meals for people who needed extra calories to ensure they maintained their weight.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

The service had a strong leadership presence with management team who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible. The operational manager actively sought review from external agencies.