Archived: Sancroft Hall

At our previous inspection of Sancroft Hall in August 2016 we found that the service was not meeting the requirements of the law in relation to the planning and recording of care for people who lived at the home. During this inspection we found that the provider had made improvements in order to meet the requirements identified at the previous inspection.

Sancroft Hall is a care home situated in Harrow. The home is registered to provide care to up to 50 older people. Care is provided in five 'houses' of 10 people each. Two of the houses are specifically for elderly Asian people, and some of the people residing at the home are living with dementia. At the time of our inspection there were 46 people living at Sancroft Hall.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

People who lived at Sancroft Hall told us that they felt safe. We found that people were protected from the risk of abuse or other harm. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they

were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

The medicines for people who lived at the home were well managed. Staff members administering medicines to people had received training to support them in this.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet their physical and other needs and people told us that they did not have to wait for support when required. People who remained in their rooms for part of the day were regularly checked on.

The staff who worked at the home received regular training and they were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions about their care and support was contained within their care files. Applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. DoLS authorisations are required for people living in care homes where they do not have capacity to look after their person safety and are supervised to ensure that they are safe within the home and outside. Staff members had received training in MCA and DoLS. Where necessary they had involved other professions and family members in making decisions about people's best interests.

People's nutritional needs were well met. Meals were nutritionally balanced and met individual health and cultural requirements as outlined in people's care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day.

Risk assessments for people were up to date and included guidance for staff on how they should manage any identified risk. People also had detailed care plans which outlined the care that people required. These included information for staff about how people preferred their care and support to be provided. Staff members recorded the care and support that was provided to people on a daily basis.

The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively to participate in activities. People's cultural and religious needs were supported, both within the home and through regular visits to places of worship.

People who lived at Sancroft Hall knew how to complain. The records of complaints that we saw showed that these were dealt with quickly and to people’s satisfaction.

People’s care documents showed that their health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

The home had systems in place to monitor the quality of people’s care and support. Where concerns had been identified we saw that actions had been taken to address these.

The home had a range of policies and procedures which reflected legal requirements and current best practice in care of older people. Staff members were required to sign to show that they had read and understood these.

People who used the service and staff members spoke positively about the management of the home. They spoke highly of the registered manager and the senior staff team.

At our previous inspection of Sancroft Hall in September 2014 we found that the home was meeting the requirements of the outcomes that we assessed. These were: Respecting and involving people who use services; care and welfare of people who use services; caring for people safely and protecting them from harm, staffing, quality and suitability of management.

Sancroft Hall is a care home situated in Harrow. The home is registered to provide care to up to 50 older people. Care is provided in five 'houses' of 10 people each. Two of the houses are specifically for elderly Asian people, and some of the people residing at the home are living with dementia. At the time of our inspection there were 48 people living at Sancroft Hall.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

People who lived at Sancroft Hall told us that they felt safe. This was confirmed by a family member whom we spoke with.

We found that people were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

The medicines for people who lived at the home were given to them correctly, and were generally well stored and recorded. Recent training had been provided for staff administering medicines. We had concerns about guidance available for staff administering PRN (as required) medicines to people. Guidance was limited and did not provide information about how and when staff members should be giving PRN medicines to people. The registered manager told us that they would immediately address this concern.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms for part of the day were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. Staff members had received training training in MCA and DoLS. The home had undertaken capacity assessments of people’s ability to make decisions about their care. Where necessary they had involved other professions and family members in making decisions about people’s best interests.

People’s nutritional needs were well met. Meals were nutritionally balanced and met individual health and cultural requirements as outlined in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. The home had involved other professionals such as dietitians where they had concerns.

Risk assessments for people were up to date. However, we found that some care plans did not always include guidance for staff members about how they should meet people’s needs and had not always been updated to reflect changes in need. The daily records of care for one person did not reflect anxieties and concerns that they had demonstrated during our inspection. We noted that actions had been put in place to improve the quality of care records. Although these were still in progress we could see that some improvements had already been made.

The home provided a range of individual and group activities for people to participate in throughout the week. This was confirmed by people whom we spoke with, and we saw photographic and other evidence of activities both within the home and in the wider community. Staff members engaged people supportively in participation in activities. People’s cultural and religious needs were supported.

People who lived at Sancroft Hall knew how to complain. We were given examples of complaints that people told us had been dealt with quickly.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. Issues around the quality of people’s care plans had been identified and plans were in place to ensure that staff members were enabled to develop the skills and knowledge they required to make improvements in this area. Policies and procedures were up to date and staff members were required to sign that they had read and understood any new or amended ones.

The registered manager was new to the home and was working to improve the quality of care and support that people received. While some of these improvements had not yet been achieved, they had taken action to ensure that there was an on-going process of continuous improvement. In addition to improvements in relation to staff support, medicines administration and care records, we saw that they had, for example, requested works to take place to create a more dementia friendly physical environment and to create a more suitable medicines storage area.

People who used the service, their relatives and staff members spoke positively about the management of the home. We were able to see evidence that the registered manager was working to improve the quality of care and support.

We found one breach 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.

We spoke with nine members of staff, including the manager and an assistant manager. We spoke with five people who used the service and one visiting relative. We observed how staff interacted with people whose communication was limited. We looked at care records for four people who used the service.

The care records we saw contained brief assessments of each person's needs and appropriate risk assessments were also in place. Each support plan contained with a one page 'at a glance' summary of the support each person needed with daily tasks. This showed that information on how to support each person was easily accessible for staff. Risk assessments and detailed support plans gave further details for all these needs, and how staff should support the person.

Staff told us that they felt that staffing was sufficient to enable them to meet people's needs. They said that they could call for additional help from the managers if needed, and this was always available. However the provider may find it useful to note that one person we spoke with said that staff were always changing, and they didn't know who they were. They said, 'Some are managers, some are carers, but they don't introduce themselves.'

The relative of a person living with dementia said, 'I am very happy with their care. The carers are always the same, so they all know my relative and my relative recognises them.'

We found that people were involved in decisions about their care and support, and information was presented in ways people could understand so they could make informed choices. The care we observed was compassionate and kind, however some people's care plans were incomplete and reviews of people's care occurred sporadically.

People were supported to see health and other professionals when they needed to, and we found that the premises were suitable for people's needs. Staff were vetted before starting work, and we found that complaints were managed appropriately.

Most of the people we spoke with said they felt well cared for. They said they felt safe and happy with the service provided. The relative we spoke with said the service was "as safe as it can be." Most of the people we spoke with said staff were caring and that their requests were met by staff. One person said staff were able to take them out and the relative we spoke with said staff dealt with a request for additional equipment promptly when they made it. When we observed staff interacting with people who use the service, staff were supportive, allowing people to take their time with the activity they were undertaking. Staff also spoke with different people in different ways depending on their needs. For example one person needed to be treated with more patience than others and this was done.

When we viewed the records for people who use the service, they had the information necessary to enable staff to meet people's needs. However there were not always sufficient assessments to mitigate situations where people could be at risk.