10,11 & 19 December 2014
During a routine inspection
This was an unannounced comprehensive inspection carried out on 10, 11 and 19 December 2014.
Sandringham House is registered to provide accommodation for people who require nursing or personal care. The provider has chosen to specialise in caring for people living with dementia. The home is registered to accommodate a maximum of 16 people. There were nine people living in the home.
There was a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
At this inspection we found there were shortfalls in a number of areas. Improvements were needed to ensure the service kept people safe and their rights were protected.
Policies about keeping people safe and reporting allegations of abuse were in place. However, these were generic and did not reflect local guidance. We found one instance where the safeguarding policy had not been followed. Staff training records indicated that most staff received training in how to protect people from abuse and report it should they suspect abuse had occurred.
Systems to assess and manage any risks to people’s safety and well-being were not consistently used, acted upon and reviewed. For example, one person tried to climb over bedrails on their bed. There had been no risk assessment prior to their use and no review when this event occurred to try to prevent further incidents. Other people had been identified as at risk of malnutrition but no action had been taken.
Staff were not always recruited safely to make sure they were suitable to work with vulnerable people and staffing levels in the home did not always ensure that there were staff on duty with suitable qualifications, skills and experience.
People’s medicines were not managed safely. Medicines were not stored, administered and recorded safely. Staff did not have clear instructions about the administration of some medicines such as pain relief. This put people at risk of harm.
Systems for ensuring the cleanliness of the home and prevention and control of infection were poor. Areas of the home such as kitchen, lounge, bathrooms and bedrooms had not been cleaned thoroughly. We found that items of furniture such as tables, armchairs and bedside cabinets were dusty or soiled. Equipment including hoists and commodes were not clean. Many areas required maintenance to ensure that surfaces were non porous and could be properly cleaned. The laundry area did not have separate areas for clean and dirty items.
Staff were caring and treated people kindly, with dignity and respect. We mostly saw good interactions between staff and people living in the home. However, we also heard inappropriate conversations in front of people and observed that when staff interacted with people it was mostly whilst specific task based activities were taking place.
Staff did not have the right skills and knowledge to provide personalised care for people living with dementia. This was because they did not have up to date, comprehensive training or regular support and development sessions with their manager. There were no systems to review staff competency and identify training needs. For example, some people were no longer able to communicate verbally. There was no evidence that staff had been shown other ways to enable communication or how to provide personalised care for people who had specialist needs such as epilepsy and diabetes.
There was little organised activity in the home. People’s need for meaningful activity, occupation and stimulation had not been met.
It was evident that, despite undertaking training, staff did not fully understand the Mental Capacity Act 2005, how to assess people’s capacity to make specific decisions or about those people who were being restricted under Deprivation of Liberty Safeguards. This meant that some people may not have been given the opportunity to make decisions about themselves and others may have been unlawfully deprived of their liberty.
People’s care and monitoring records were not reviewed and maintained and were lacking in detail. This meant that they did not accurately reflect the care and support that they needed and put people at risk of not receiving appropriate care.
The design and layout of the home had not been adapted to reflect best practice guidance about how to meet the needs of people living with dementia. For example, the use of special signs had not been introduced and doors had not been painted in different colours to help people orientate themselves around the building.
The systems and culture of the home did not ensure that the service was well-led. This was because people were not encouraged to be involved in the home and they were not regularly consulted. The quality assurance systems in the home did not ensure that people received a good service and did not identify any of the shortfalls found at this inspection.
Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.