Sands Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to need for consent and dignity and respect, this was because informed consent was not always gathered and principles of the Mental Capacity Act 2005 (MCA) were not always followed.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We found that when people’s needs were identified the provider supported people effectively, for example the provider had identified a need for breast screening in the service. The registered manager arranged an outreach nurse who specialised in breast cancer to be a guest speaker for a meeting with female members of staff and people who use the service. This proved beneficial in increasing awareness of the disease and staff and people who used the service were reassured and supported to undertake screening.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We found that the provider did not always follow guidance and best practice. For example, the provider was not following the Right support, right care, right culture guidance to provide people with a learning disability and autistic people good care and outcomes. We found that the model of care provided at Sands lodge did not always maximise people’s choice and control. We also found that care did not always promote people’s dignity and privacy. Several people did not have easy access to private spaces; people also did not always have their preferences respected or accommodated.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff knew people well and were seen to be contacting professionals and requesting the support of external health professionals when required. They spoke positively about communication between themselves and external professionals.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

We saw good evidence that people had regular activities and engagement within the service and in the community. We saw that people who had designated 1-1 hours had these met and engaged in activities such as walks along the pier or going fishing. There was good community engagement also with local groups such as a church group socialising with the provider and people who used the service.

People were supported to gain education and pursue employment and volunteering opportunities, and this was actively encouraged.

The provider monitored people’s care and treatment to improve it. We found that people were supported to gain independence and discover new skills. For example, one person was being actively supported to manage their own medicines. The provider ensured that the person was supported, consented, had the appropriate risk assessments and knowledge in order to do this safely. The provider also ensured they conducted relevant checks to ensure safety. This was monitored well and appeared to be empowering for the person involved.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment in all areas.

The provider did not always follow the principles of Mental Capacity Act 2005 (MCA, 2005). We found significant concerns around decisions made for those that may lack capacity or be able to give informed consent.

For example, we found that the home operated a shared room service model, we found that the provider did not always follow their own safeguards in placements and admissions to these rooms. There were no robust systems in place to conduct adequate mental capacity assessments and best interest decisions were not suitably evidenced.

We found that best interest decision-making was not always completed in line with best practice guidance. Records showed that, in some instances, relevant individuals involved in supporting people, such as Independent Mental Capacity Advocates (IMCAs), were not included in discussions relating to care and support decisions.

People told us they felt safe; however, documentation did not support this.

We found significant gaps in consent at the service for example one person’s consent forms were out of date for over a year and had not been reviewed with the person or significant others.

We found that relevant agreements for shared rooms were also not reviewed at regular intervals or when significant changes had occurred for example different people moving in and out of the service.

However, in day-to-day interactions between staff and people we saw consent being actively sought when engaging in everyday tasks.