We carried out an unannounced comprehensive inspection of this service on 4 and 7 December 2015. During this visit a breach of legal requirements was found. We found the provider was failing to ensure the management of medication was safe and failing to ensure people’s legal consent in relation to their care was always obtained. We issued the provider with requirement actions at this inspection.
Requirement actions require the provider to make the necessary improvements to ensure legal requirements are met within a timescale they agree is achievable with The Commission. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach and agreed appropriate timescales for completion.
We undertook this inspection on the 5 and 6 January 2017. This inspection was also an unannounced comprehensive inspection. During this visit we ensured we followed up the breaches identified at inspection in December 2015. We found that the manager had taken appropriate action to meet all of their legal requirements in relation to the service.
Sandstones is registered to provide personal care and accommodation for up to 35 people. The home is situated in Wallasey, Wirral and is a purpose built facility. There is a small car park and garden available within the grounds. The home is close to Liscard town centre. A passenger lift enables access to bedrooms located on the first floor for people with mobility issues. Bedrooms are single occupancy and each bedroom has its own en-suite toilet facilities. Communal bathrooms with specialised bathing facilities are available on each floor. On the ground floor, there is a communal lounge and dining room for people to use. The home is decorated to a good standard throughout.
On the day of our visit, 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.
During our visit, we observed a medication round and saw that the administration of medication to people who lived at the home was now safe. People’s care files contained clear information about people’s medications and any medications the person was allergic too. This was good practice as it alerted staff to the fact that these medications should not be prescribed.
We found however that there was a discrepancy in relation to the quantity of medication in stock in respect of some people’s medications. A set of eye drops had also not been dated when opened so it was impossible to know if they were still safe to use. This aspect of medication management required improvement.
We reviewed the care files of four people. We found them to be well organised and easy to follow. Staff were given relevant information in relation to people’s needs and risks and clear guidance on how to support them. We saw that people’s risks were appropriately managed and professional advice sought appropriately as and when required or when people’s needs changed. For example, we saw evidence of the involvement of district nurses, tissue viability teams, falls prevention teams and mental health services in relation to people’s care.
We checked whether people’s legal consent to the care they were provided with had been sought in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation and we found that it had. People’s capacity had been assessed for specific decisions about their care and best interest meetings held to ensure any decisions made were in the person’s best interests.
People were offered a varied menu to choose from at mealtimes and offered snacks and drinks regularly throughout the day to promote their dietary intake. People told us the food was good and they had lots of choice. Relatives we spoke with confirmed this and told us they were able to enjoy at meal at the home with the person in the dining room if they so wished.
People’s emotional and social needs were met by a range of diverse activities. There were organised sing-alongs, knit and natter sessions, music for health, memory matters, iPad sessions and chair based activities using pompoms. During our visit, we saw people enjoying a sing- a-long with staff, a knit and natter session and on the second day of our inspection, people had enjoyed a visit from two Shetland ponies called Jaffa cake and Cupcake. This showed that people’s emotional well-being was considered an important part of their care.
People’s care was regularly reviewed to ensure it continued to meet their needs and we found the care planned and delivered to be person centred and holistic. People who lived at the home said they were well looked after and felt safe with the staff team.
During our visit we observed many positive interactions between staff, the people they cared for and their relatives. Staff were patient, kind and responded to people’s needs promptly. They made an effort to ensure people’s relatives and visitors were made to feel welcome and we found the atmosphere at the home to be warm, homely and positive. It was clear that staff knew people well and everyone we spoke with thought highly of the staff team.
Records showed that accident and incidents at the home and any complaints received were responded to appropriately by the manager and the staff team. We found however that the contact details of the external agencies people could contact in the event of a complaint needed to be added to the complaints procedure so people knew who to direct any complaints to. No one we spoke with during our inspection had any complaints or concerns about the service.
People who lived at the home, relatives and staff told us that the home was well led. We found the management of the home to be open and inclusive and both the manager and the care manager were positive role models for staff in the day to day running of the service.
There were a range of audits in place to assess and monitor the quality and safety of the service provided. For example, accident and incident audits, medication audits, infection control audit and premises checks. People’s views and opinions on the service provided were regularly sought. For example, there were monthly resident meetings, an annual satisfaction survey and a ‘You said, We did’ board. These showed that people were happy with the service and that when people had offered suggestions for improvement, they had been acted upon where possible.
We found the service to be well led.