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Archived: Sandringham House Inadequate


Inspection carried out on 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.

Inspection carried out on 5 November 2013

During a routine inspection

During our visit we spoke with two members of staff, the Registered manager, the provider and two visiting relatives. The majority of people who lived in Sandringham House had communication difficulties as a result of being diagnosed with dementia. Therefore they were unable to tell us their experiences of the home.

Staff took into account people's individual needs and ensured that these were met.

People were appropriately assisted with mobility needs.

Staff had received safeguarding training and were able to say what action they would take if concerns were raised or observed.

Staff told us that they felt the staffing levels were sufficient to the needs of the home and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

Relatives said that they had no complaints about the service and that if they did they would speak to the manager or the provider.

We saw that the service was audited by the provider ensuring that people who used the service benefit from a service that monitors the quality of care that people received.

Inspection carried out on 27 December 2012

During an inspection looking at part of the service

We carried out an unannounced inspection at Sandringham House. This was to review the compliance actions issued for care and welfare of people, medicines management and assessing and monitoring the quality of services and records.

On the day of our inspection there were 9 people living at the home. All of the people living at the home had dementia.

We used a number of different methods to help us understand the experiences of people using the service. This was because they had complex needs which meant they were unable to tell us about them. We spoke with the manager, the provider and two staff.

During observations we saw that care workers knew individual�s well and understood their needs. They knew what interested people and what kept them occupied. People were relaxed and occupied by listening to music, holding dolls and communicating with each other.

We observed that staff were caring and provided care and support in a sensitive way. They gently and discreetly spoke with people when they needed any personal care.

There were suitable medication management systems in place and there were systems in place to monitor and assess the quality and safety of the service.

Inspection carried out on 3 September 2012

During an inspection in response to concerns

We carried out an inspection visit on 3 September 2012 to Sandringham House following concerns that were raised about the care and welfare of people at the home, infection control, medicines management and the safety and suitability of equipment.

On the day of our inspection there were nine people living at the home. The manager was not present during the inspection; the provider came into the home shortly after our arrival.

We used a number of different methods to help us understand the experiences of some people using the service. This was because they had complex needs which meant they were unable to tell us about them.

We used the Short Observational Framework for Inspection (SOFI). It is a specific way of observing care to help us understand the experiences of people who could not talk with us.

This involved observing four people for forty five minutes, recording their experiences at five minute intervals. We observed their mood, how they engaged in tasks and activities, and interacted with staff members, other people and the environment. We observed people in the ground floor dining room at lunchtime.

We saw that staff and people living in the home were relaxed with each other, chatting and enjoying each others company. Staff knew each person�s likes and dislikes and had good relationships with the people they cared for.

We spoke with one person, one relative, three staff, the provider and a visiting infection control nurse.

A visitor told us that the care of their relative was �excellent� and that all of their needs were met. They said they knew all of the staff and that they were actively involved in and consulted about the care of their relative. They described the home as �comfortable and homely�.

We found that there were shortfalls in the completion of assessments and care planning, medicines management, and the assessment and monitoring of the service provided.

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