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Inspection carried out on 25 July 2017

During a routine inspection

This inspection took place on 25 July 2017 and was unannounced.

Sandbanks Care Home is registered to provide personal care and accommodation for up to 25 older people; some who live with dementia. There were 23 people using the service during our inspection; some of whom were living with conditions such as diabetes or impaired mobility.

Sandbanks Care Home is a very large detached property situated in the coastal village of Littlestone-on-sea. The service has a communal lounge, dining area and a conservatory decorated with a seaside theme. There is a large garden; where extensive decking was being laid during our inspection to provide a raised outdoor seating area.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in February 2017. This was a focussed inspection looking at whether the service was safe; to follow up on a breach of regulation found at the previous inspection. There had been some improvement when we inspected in February 2017 but the service remained rated as ‘Requires Improvement’ for safety.

At this inspection, the service was found to be safe for people living there. Assessments had been made about a range of risks to people and actions were taken in practice to reduce them to acceptable levels. Medicines were safely managed and the environment was free from hazards, with regular safety-checks being made on the premises and equipment.

There were enough staff to meet people’s needs, and a robust recruitment process ensured only suitable staff were employed. Staff knew how to keep people safe and how to raise concerns if they were ever worried about people. Accidents and incidents were properly documented and follow up actions evidenced.

Weight losses had not always been referred for professional advice in a timely way. The registered manager took appropriate action about this during the inspection. People enjoyed their meals and were given a choice of food in line with their own preferences.

Staff worked within the principles of the Mental Capacity Act 2005 (MCA) to ensure people’s rights were protected and the registered manager had applied for Deprivation of Liberty Safeguards (DoLS) when necessary. People’s consent was routinely sought for day to day tasks.

Training and supervision of staff had taken place regularly to make sure that staff knowledge and understanding was up-to-date and any development needs were addressed. People’s health was monitored and reviewed by GPs, opticians, chiropodists and the district nurse.

Staff were caring and supportive, treating people with dignity and respect and observing their confidentiality. People were encouraged to be independent where possible and provided with equipment and support to facilitate this.

People told us they felt there were enough activities on offer. Some people preferred to stay in their rooms but said they were happy with this arrangement. Staff sat with people and read to them or shared jokes throughout the inspection.

Care plans were written in a person-centred way and people received individualised care in ways that they preferred. Rooms were homely with people’s own possessions and pictures around them.

There had been no complaints since the last inspection but people and relatives felt confident that the registered manager would deal with any concerns promptly and effectively.

The service was well-led by a registered manager who was respected by the staff team. Improved auditing had been introduced to provide better oversight of quality and safety and feedback had been sought from a number of sources to further enhance people’s experiences.

There was an open culture where staff felt valued and able to speak out with any con

Inspection carried out on 1 February 2017

During an inspection looking at part of the service

This inspection took place on 1 February 2017 and was unannounced.

Sandbanks Care Home is registered to provide accommodation and personal care for up to 25 older people .There were 24 people using the service during our inspection; who were living with a range of health and support needs. Most people were living with dementia and one person was receiving respite care.

This service is a very large detached house situated on the sea front at Littlestone-on-sea, Kent. There was a large communal lounge/dining room with armchairs and a TV for people and a separate bright conservatory where people could sit quietly if they chose to. There was a secure enclosed garden to the rear of the premises, with far-reaching views over the sea.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Sandbanks Care Home was last inspected in June 2015. At that inspection it was rated as good overall but with the safety of the service being rated as requiring improvement. Two breaches of Regulations were found at that time.

At this inspection we returned to check that the safety of the service had improved. We found that although the issues highlighted in our last report had been addressed, some others had arisen.

Following the last inspection, broken or unsuitable waste bins had been replaced and the service was generally clean and hygienic throughout. Cleaning staff had been deployed in such a way to ensure better cover over seven days and to facilitate weekly deep-cleans.

Medicines had not always been managed safely. There were gaps in the recording of some administrations, which could only be resolved by carrying out a physical check of medicines. We found people had received their medicines but recording had been poor. The storage and recording of creams required improvement to make sure risks were assessed and addressed and that people consistently received creams as they had been prescribed for them.

A range of individual risks had been assessed and, in the main, actions to reduce them had been carried out effectively. However, more could have been done to prevent known risks to people’s skin; through accurate setting of air mattress pumps and consistent repositioning.

There were enough staff to meet people’s needs and rotas evidenced that there had been no recent short-falls. The registered manager assessed people’s dependencies to determine how many staff to have on shift and we observed that staff were attentive and prompt in supporting people.

Recruitment processes were robust and helped to ensure that only suitable staff were employed to work with people. Staff had up-to-date training about keeping people safe from abuse or neglect and knew how to report any concerns. Accidents and incidents had been properly documented and reviewed by the registered manager. Preventative actions had been taken so that reoccurrences of accident and incidents were less likely.

The premises were well-maintained to reduce the chance of hazards emerging. Routine safety checks were made on a number of aspects of the service, including equipment, the passenger lift and gas and electrical supplies. Staff received fire safety training and fire alarm tests and drills were regularly conducted. Personalised evacuation plans were in place for individuals which took account of their physical and emotional needs in the event they had to leave the building in an emergency.

We recommend that risk assessments are made about the storage of prescribed creams in people’s bedrooms.

We recommend that daily checks include noting whether pump settings match people’s current weight and making any necessary adjustments.

Inspection carried out on 04 June 2015

During a routine inspection

The inspection visit was carried out on 04 June 2015 and was unannounced. The previous inspection was carried out in July 2013, and there were no concerns.

The home provides accommodation, and personal care for up to 25 older people living with dementia. There were 23 people receiving care and support on the day of the inspection. Accommodation is provided over two floors with a passenger lift between floors.

The service is run by a registered manager, who was present on the day of the inspection visit. 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 service was generally clean in all areas. Bedrooms were vacuumed daily and were dusted on alternate days. Communal areas and toilets were cleaned daily, and bathrooms and shower rooms between use. The service allocated one member of domestic staff to clean a large building every morning. This was not sufficient to keep up with the demands of deep cleaning for carpets needed for bedrooms and communal rooms on a regular basis, or to carry out extra cleaning tasks such as moving beds out and cleaning underneath them, and cleaning skirting boards.

The registered manager was familiar with the ‘Code of Practice for health and adult social care on the prevention and control of infections and related guidance’ which sets out the requirements for regulated services to meet the regulation for cleanliness and infection control. This was applied as far as possible, but cleaning was inadequate with insufficient staff to carry it out. Three waste bins were unsatisfactory. One was for disposal of paper towels in the staff toilet, but the pedal was broken and so staff had to touch the lid for disposing of paper towels. Waste bins outside the kitchen and in the ground floor sluice room were visibly old and had damaged paintwork on the metal, meaning that they could not be cleaned thoroughly.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The deputy manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was fully informed about how and when to make applications for DoLS authorisations, and had applied for some previously. There was currently no one in the service who had a DoLS authorisation.

Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.

The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. There were comprehensive risk assessments in place for each area of the premises. These showed how to minimise the assessed risks. The risk assessments were reviewed by the registered manager as part of regular monitoring programmes. There were individual risk assessments for each person living at the service. These included assessments for the risk of falls, developing pressure sores, using stairs, and risks associated with poor mobility. The risk assessments were written in relation to each person’s needs. Actions were identified and put in place to lessen the risks. Each person had a personal emergency evacuation plan (‘PEEP’) kept in a folder with other information in case an emergency evacuation should be needed.

The registered manager and staff were visible throughout the service during the day. There were sufficient care staff to attend to people’s needs and requests without rushing them. People and their relatives spoke highly of the staff with comments such as “All the staff do an excellent job”. The service had robust recruitment procedures in place to check that staff were suitable for their job roles.

The company provided new staff with a detailed induction which included all essential training. The registered manager and deputy discussed aspects of their training with staff to ensure they fully understood and knew how to apply it. Staff were kept up to date with refresher courses for essential training, with subjects such as fire safety, food hygiene, health and safety and moving and handling. Staff were encouraged to carry out formal training qualifications in health and social care, and all the care staff had completed this training to levels 2 or 3 or were studying for these. Other training was provided which was relevant to staff’s job roles. All staff were trained in dementia care, and some had carried out advanced training. Their understanding of this training was evident in how staff supported people with their care. Staff had individual supervision every two months, and said that they could speak to the registered manager at any time if they required additional support or advice. Staff meetings were carried out nearly every month, and staff said they could ask anything at these meetings.

Medicines management was overseen by the registered manager and deputy manager, who carried out arrangements for repeat prescriptions and receipt of medicines into the home. Only senior staff who had completed training and been assessed for their competency were permitted to administer medicines.

Staff were informed about people’s medical and mental health needs and noticed if they were behaving in ways that were unusual for them which might indicate that they felt unwell. Referrals were made to other health professionals as needed. This included GPs, dentists, opticians and the mental health team. District nurses visited to carry out any wound care needed.

The premises were suitable for their purpose and provided people with large communal areas and a secure garden. Relatives had commented on survey forms that the ‘Décor is looking a bit tired’ , and ‘The décor needs a bit of updating’, and this corroborated our own findings. There were areas of scuffed and damaged wood work on stairs, doors and skirting boards which detracted from the overall impression of the service. The provider had a business plan which included carrying out improvements to the décor.

Staff enabled people to make choices about their lives where they were able to do so. This included getting up and going to bed when they wished; and choosing their clothes, their meals and their activities. People were given different choices at meal times and could have snacks at any time. The menu was changed at intervals to take account of people’s preferences and changing seasons.

Staff had caring and kind attitudes and provided a calm and friendly atmosphere. People and their relatives were given clear information about the service at the time of admission, and discussions were carried out with them about their care planning and any changes needed. Some people lacked mental capacity to make decisions or had fluctuating capacity, and were supported with decision-making. This followed agreed protocols to involve their next of kin or representative, and health and social care professionals, to make decisions on their behalf and in their best interests.

Staff were fully informed about the importance of applying the Mental Capacity Act 2005, and to enable people to make decisions within their capacity. People’s care plans were person-centred, and were discussed with people and their relatives as appropriate. Separate care plans were written for each aspect of care, and monthly reviews were carried out. People’s family members were invited to take part in reviews if they wished to do this.

People were supported in carrying out activities of their choice, and staff were mindful of people’s individual needs and wishes. There was a range of individual and group activities available and carried out by all the care staff in accordance with what people wanted. An activity planner was in place for group activities, but this was flexible depending on what people wanted to do.

People were informed about the service’s complaints procedure and this was clearly displayed. There were systems in place to monitor and follow through minor concerns as well as complaints. The records showed that people’s views were taken into account, were listened to, and changes were made in response where needed.

The staff team was led by a registered manager who demonstrated detailed knowledge of the people and their support needs. The registered manager and the deputy manager spent as much time as possible working alongside the staff team, giving them a clear lead. Staff showed thoughtfulness and respect for each other as well as for the people living in the service, and worked well together as a team. Staff were encouraged to raise ideas and felt valued and supported.

The registered manager and the providers carried out monthly audits to monitor the progress of the service, and took action in response to their findings. People’s relatives and visitors were asked to complete surveys for their views of the service and these had provided positive responses during 2015. Records were well maintained and were kept up to date.

We found 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.

Inspection carried out on 23 July 2013

During a routine inspection

At the time of our inspection, there were 24 people living at the home. We used a number of different methods to help us understand the experiences of people who used the service, because the majority of people had complex needs, which meant they were not all able to tell us their experiences. We spoke to three people who used the service and four relatives who were visiting at the time of our inspection. We made observations of people and the staff who supported them.

People we spoke with told us that they were happy with the care and support they received. One person told us "I'm happy here, I�m well looked after". A visiting relative told us �I would recommend this home to anybody�.

We found that care plans were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible to people who used the service.

All the people we spoke with who used the service told us that they felt safe and visiting relatives told us that they would know what to do if they had any worries or concerns. One relative told us �I would go to the manager� and that they were confident it would be sorted out �100%�.

People told us there were enough staff on duty and that staff had a good understanding of people's needs. A relative told us that the staff were �very well trained�.

The home had a range of checks and audits in place to monitor the quality and safety of the service provided.

Inspection carried out on 21 March 2013

During a routine inspection

People who used the service were experiencing dementia. We used a number of different methods to help us understand the experiences of people using the service. We spoke with four people who were using the service, a visitor, three relatives, four members of staff and the manager.

People told us they could make decisions about their day to day care and support. They said their privacy and dignity was respected. People were very happy with the care they received at Sandbanks. Two people told us, �You get looked after here and we have no responsibilities, we are ladies of leisure�. A relative said, �We think it is lovely, the best place for Mum�. Some people said staff had discussed their care and support needs with them. However we found that some care plans did not reflect people�s current care and support needs and some care needs were not met.

People said they received their medicines when they needed them and we found that generally medicines were handled safely.

People said they felt staff had the right skills and experience to meet their needs and staff they were �Alright�.

People said they had no complaints, but told us they would �Talk to the one in charge� if they did. People were confident any issues would be resolved. The provider undertook health and safety checks on the service. We found that one of these checks highlighted unsafe hot water and the provider had not taken any action to make sure hot water outlets were safe for people to use.

Inspection carried out on 14 February 2012

During a routine inspection

People who lived in this home were experiencing dementia. The majority of people who lived in the home were not able to engage directly with the inspection process. We spoke with three people who lived in the home. One person told us staff were careful to protect their privacy and dignity. They said staff knocked on their bedroom doors before entering. Two people who we spoke with told us they were happy with the care they received at Sandbanks. They said all the staff were kind and helpful. People said the food was usually good although those we spoke with were not aware there was a choice of food. One person said �They make me drinks when I want one�. One person told us they enjoyed being taken out for a walk along the sea front. They told us they felt safe in the home.

Reports under our old system of regulation (including those from before CQC was created)