Sandiway Manor Residential Home

Sandiway Manor is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 29 people and accommodation is provided in one adapted building.

People’s experience of using this service and what we found

Improvements in the quality of care had been made since our last inspection. People were fully protected from harm and the risks they faced from malnutrition had been reduced following better monitoring of weights and more attentive care practice. The governance of the service had improved with a range of effective audits being used to identify shortcomings in a timely manner and actioned them as soon as possible. Improvements had also been made in providing a range of suitable activities to minimise the risk of social isolation.

These improvements were reflected in comments made by people who used the service. They told us “I do feel safe living here, they really do look after me” and “[staff] always make sure I am safe”. They told us “food is really good” and “we always get a choice and we are well fed”. People were clear that there was “always plenty to do” during the day and “there is always some activity we can join in”.

Relatives echoed these views and were positive about the management of the service. They told us “things have really improved here and the service is very well managed now” and “we are so pleased with the service [name] is happy here and we have no concerns”.

People received safe care. Equipment within the environment was regularly checked to ensure it was safe and the premises were clean, hygienic and well maintained. Medication was robustly managed with people telling us “I always get my medication” and “they never miss me out”.

Sufficient staff were available to meet people’s needs and our observations noted that there was always a member of staff to attend to people when they were needed.

Lessons had been learned from the shortcomings at the last inspection with all breaches being identified and issues such as recruitment being more robust.

Staff now received more consistent training. This was echoed by relatives who considered staff to be “knowledgeable” as well as by staff comments and training records.

Assessments captured the main needs of people and the registered manager had sought to offer people the opportunity to stay within the home during the day so that their views could be gained.

People and their relatives consistently stated that staff were “kind and attentive” and “respectful” and this was reflected in our observations of interactions between staff and people. Care was taken to ensure that people could express their views, maintain their independence and ensure sensitive information remained confidential.

Care plans were regularly evaluated and up to date. They were person-centred outlining the main preferences of people and in some instances included handwritten entries from people about how they wished to live their lives. Information was provided to people in an appropriate format.

Complaints were thoroughly investigated with outcomes always being relayed back to people raising concerns.

Governance of the service had improved. Staff, people and relatives spoke about how the management of the service had improved of late and how the registered manager had been a key part in creating a person-centred and positive environment. There was an improved oversight of all aspects of the quality of care within the service and prompt action taken when needed.

The registered manager was keen to develop the service further through increased community links and was fully aware of their responsibilities as a registered person.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was requires improvement (published 18th January 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sandiway Manor on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This is the fifth consecutive time the service has been rated Requires Improvement. This has been reflected in the rating of inadequate awarded in the well led domain.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the overall rating to good. At this inspection we identified that improvements had not been made.

Sandiway Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate up to 29 people. People each have their own bedrooms and have access to well- maintained gardens. There is a lift to provide access between the first and ground floor, and level access throughout for people who require the use of a wheelchair.

At the time of the inspection there was a manager in post who was in the process of registering with the CQC. 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.

At this inspection we identified ongoing breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified an additional breach of Regulation 13.

You can see what action we told the provider to take at the back of the full version of the report.

We identified issues with the leadership provided by the registered provider. Sufficient action had not been taken to ensure stable leadership within the service after the previous registered manager had left in May 2018. The registered provider had poor quality monitoring processes in place and was not fully aware of their role and responsibilities in relation to meeting the standards required by the Regulations. This had been identified as an issue at the last inspection, however action had not been taken to address this. At this inspection the new manager and new Chief Executive had started to implement new processes.

Issues had been identified by the local authority safeguarding team with the completion of investigation into safeguarding concerns. In this instance significant harm had not occurred, however action needs to be taken in a timely manner to ensure appropriate protective measures can be implemented where required. Poor processes place people at potential risk from ongoing harm.

Recruitment processes were not robust enough to ensure staff were of suitable character. Action was taken immediately by the manager when we raised this as an issue and assurances were given which showed risks had been mitigated. We have made a recommendation regarding this.

Ongoing issues with the completion of nutritional risk assessments were identified which placed people at potential risk of harm. Immediate action was taken when we raised these issues and it was identified that no one had come to harm. A review of other people’s care plans were undertaken to ensure this risk was addressed with other people.

The quality of information contained in people’s care records was mixed. Some care records contained a good level of detail, whilst some were incomplete and not up-to-date. Following the inspection, the manager confirmed that these were all in the process of being reviewed and updated.

Staff training was not being kept up-to-date. This meant there was a risk that staff knowledge and skills would not be kept in line with best practice. However, during the inspection we observed staff practice to be good.

People commented that there were limited activities available to them and told us they were “bored”. During the inspection we did not observe any activities taking place with people. One person told us that people spent a lot of time sleeping in the lounge area. This put people at risk of social isolation. We raised this with the manager so that action could be taken.

People had received their medicines as prescribed. Staff had signed Medication Administration Records (MARs) to show that these had been administered as required.

Infection control procedures were being followed as required by staff. We observed staff using personal protective equipment (PPE) where required which helped prevent the risk and spread of infection.

People told us they enjoyed the food that was available. This was freshly prepared on a daily basis. Alternative options were available to meet people’s preferences or special dietary requirements. This helped ensure people’s nutritional needs were met.

Positive relationships had been developed between staff and people using the service. We observed people and staff chatting together in a friendly manner and we also observed staff being kind and respectful towards people.

People were treated with dignity and respect. Staff spoke kindly and respectfully towards people and we observed examples where they took action to prevent people from becoming distressed or upset.

People's communication needs were being met. We observed people wearing their glasses and/or hearing aids as required which helped ensure they were able to communicate to the best of their ability.

Sandiway Manor is located five miles from Northwich in Cheshire and is run by a charitable organisation. It provides accommodation and personal care to older people and can accommodate up to 28 people. At the time of the inspection there were 19 people living at the service.

There was a registered manager in post within the service. 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 this inspection we identified that medication was not always dispensed safely, or as prescribed. We found issues relating to monitoring the quantity of medication being stored, which impacted upon the efficacy of audit systems.

Audit systems were not always effective. For example they had failed to identify and address issues relating to medication systems. Health and safety audits had not identified where radiators had been exposed in communal areas, and care plan audits had failed to address known issues. For example, whilst it had been identified that staff were not completing malnutrition risk assessments, this had continued to be an issue.

The registered provider’s quality monitoring of the service was not robust enough to identify required areas of improvement within the service. Where issues were identified, action was not taken in a timely manner to address these. Quality monitoring audits did not give consideration to the requirements of the Health and Social Care Act 2008, and therefore were not able to identify areas that needed improvement.

The registered provider had not given due consideration to the Data Protection Act 1998 in determining how long to store people’s personal information for. We found boxes of records being stored which the registered manager told us were being kept for 50 years before being destroyed.

You can see what action we told the provider to take at the back of the full version of the report.

The service supported some people living with dementia, however the registered provider had not made any suitable adaptations to the environment to support and promote wellbeing. The registered manager told us that a lighting specialist was due to be consulted to look at ways of improving people’s visual perception. However other options such as the use of colour schemes, or placing objects of interest about the service had not been considered. We have made a recommendation to the registered provider around this.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However the policies and systems in the service did not always support practice that was in line with the requirements of the Mental Capacity Act 2005. Mental capacity assessments and best interest decisions were not always being made where required. We have made a recommendation to the registered provider around this.

There were sufficient numbers of staff in post to meet people’s needs. There was a staffing tool in place which enabled the registered manager to determine the number of staff required depending upon occupancy levels and people’s dependency.

Recruitment processes were robust and ensured that staff were of suitable character to work with vulnerable people. New staff had been subject to a check by the disclosure and barring service, and had been required to provide references from their most recent previous employer.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and were aware of how to report their concerns to the local authority.

Where people had been identified at being at risk of deteriorating physical or mental health, or a pattern had emerged from monitoring of accidents and incidents, they had been supported to access health care professionals. This helped to ensure people’s wellbeing was maintained.

People commented positively on the food that was available. During meal times they received the required support to ensure they had enough to eat and drink. Kitchen staff were aware of those people who required a special diet which helped ensure people received meals that were appropriate for their needs. This helped protect people from the risk of malnutrition.

Staff were kind and caring towards people. They offered support where it was needed, and were patient when providing support. They worked to ensure people’s privacy and dignity was maintained by knocking on doors prior to entering, and ensuring doors were closed whilst supporting with personal care tasks.

Positive relationships had been developed between people and staff which was evidenced by the flow of conversation, and the laughter that was heard within the service. People’s family members commented that they were made to feel welcome when they visited the service, which enabled them to spend time with their relatives.

People each had a personalised care record which included information about their support needs, and what staff needed to do to support them. These were reviewed to ensure they were kept up-to-date; however we identified some issues around monitoring of people’s risk of malnutrition. Information about people’s life histories was also included, which provided staff with valuable information around getting to know the people they supported.

There was a complaints process in place which was on display in the reception area of the service. Whilst no recent complaints had been made the registered manager was aware of the process that should be followed.

The registered provider had completed a survey of people’s experience of the service. This showed that a majority of people were ‘very satisfied’ or ‘satisfied’ with the service that was being provided to them. This process enabled the registered provider to ascertain any issues people may have, so they could act upon their concerns.

Sandiway Manor is located five miles from Northwich in Cheshire and is run by a charitable organisation. It provides accommodation and personal care to older people and can accommodate up to 28 people. At the time of the inspection there were 24 people living at the service.

At the last inspection on 19 January 2016 we found that a number of improvements were needed. People were not always protected from the risk of unsafe care and treatment and there were issues relating to poor management of infection control. Staff did not always have a good understanding of their roles and responsibilities in relation to the Mental Capacity Act 2005, and DoLS were not always in place for those people who needed them. Action was not always taken to ensure people received the care and support they needed in response to changes in their care needs, and quality monitoring systems were not always effective in identifying where improvements were required. The registered provider had also failed to notify us of specific incidents as required by law.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 4 March 2016. This inspection found that the registered provider had met their own action plan and had demonstrated full compliance with the Health and Social care Act 2008 (regulated activities) 2014.

There was a registered manager at the service however they retired on the first day of the inspection. The registered provider had recruited a replacement manager who was in the process of registering with the CQC. 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 were supported to take their medication as prescribed. Medicines were stored safely, and records indicated that staff administered these appropriately. There were examples where some medicines had been over stocked which we drew to the attention of the manager. We have made a recommendation about the management of medicines.

Improvements had been made to the safety and security of the premises. Doors were secure and alarms were in place to alert staff to anyone attempting to exit the building without the necessary support. Whilst improvements had been made, some aspects of the environment would benefit from further consideration by the registered provider. For example there was nothing to prevent people from accessing the busy road outside the premises, which placed people living with dementia at risk of injury. We have made a recommendation about supporting people living with dementia.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable people and were able to describe how they would report any concerns they had and to who.

Recruitment processes were robust and ensured that people were protected from harm. Checks were completed to ensure staff were of suitable character, and new staff members went through an interview process during which their suitability for their role was assessed.

People told us that there were sufficient numbers of staff in place to meet their needs, and rotas indicated that staffing levels were consistent. Staff told us that they felt they had time to spend with people and did not feel rushed.

People’s rights and liberties were protected. Deprivation of liberty safeguards (DoLS) were in place for those people who needed them and staff had completed training in the Mental Capacity Act 2005 (MCA). Staff were aware of their roles and responsibilities in relation to the MCA and people confirmed that they were given choice over their care and support.

People told us that they enjoyed the food that was available, and we observed them complimenting the chef during lunch time. People were given the option of having a second helping of food if they still felt hungry. Staff offered appropriate support where people required assistance with eating.

People were treated with dignity and respect. People commented that they felt relaxed with staff during personal care interventions, and that staff were respectful in their approach. Relatives commented that they were made to feel welcome when they visited, and there was a calm, relaxed atmosphere throughout the service.

People told us that they would feel confident in making a complaint, and felt their concerns would be addressed. The registered provider had not received any recent complaints, however there were examples where people had written ‘thankyou’ cards in response to the quality of the service received.

There were a number of systems in place to monitor the quality of the service being provided. Audits were completed around safeguarding, the environment and accidents and incidents. There were examples where appropriate action had been taken to address safeguarding concerns and accidents and incidents. The registered provider had also sought feedback from people using the service, and action had been taken in response to any issues raised.

Sandiway Manor Residential Care Home is owned by a charitable organisation. Accommodation for up to 28 people is provided over two floors. People have access to a large enclosed garden, which have walkways and seating areas.

The service had 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.

Our last inspection of the service was carried out on the 29 and 30 December 2014 and we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan which included a timescale by which improvements would be made. Not all of these actions had been completed within the given timescale.

Improvements have been made to people’s safety since our last inspection. Covers have been fitted to radiators and recruitment of staff was more robust.

During the last inspection we had concerns because the registered provider had failed to apply for deprivation of liberty safeguards (DoLS), for people living within the service. At this inspection we found that whilst some applications had been made, we found an example where this had not been done. This meant that people’s rights were not being upheld in line with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report

At this inspection, most staff had not completed training on the Mental Capacity Act 2005. Staff did not have a good understanding of the basic principles of the act, or the associated DoLS. This meant that people were at risk of having their rights infringed.

People’s safety was not always maintained as we found that one person had managed to leave the service unaccompanied on a number of occasions, despite having a DoLS authorisation in place which stated that they were not safe to do so. During the inspection a back door to the service was unlocked and the door alarm was turned off. This meant that staff would not have been alerted to people who were at risk, of leaving the building.

Information within care records was not always up-to-date or reflective of people’s needs. This meant that people were at risk of not having their needs met because there was a lack of accurate and up-to-date information about their needs and how to meet them.

Audit systems did not always identify where improvements were needed. For example, care plan audits had not picked up on information being out-of-date and safeguarding audits had not identified incidents as safeguarding concerns. This impacted upon the registered provider’s ability to generate improvement and to protect people within its care.

Systems were not in place to notify the CQC of serious incidents, which meant that the registered provider was not operating in accordance with the law.

The registered provider had not been completing checks on the water system to ensure that it was free from harmful bacteria. This placed people at risk of infection.

There were enough staff in place to meet people’s needs. Staff had a good understanding of the different types of abuse and they told us how they would go about reporting any concerns. This meant that people were protected from the risk of harm.

People told us that staff were caring and that they were supported in a respectful and dignified manner. People also told us that they enjoyed the activities that were available, and that the food was nice. People with special dietary requirements told us that kitchen staff were supportive in trying to make food options more varied.

People told us that they knew who the registered manager was, and that they would not hesitate to raise any concerns with her.

All the people we spoke with said that their needs were met and they were happy with the care provided. Comments included: "I'm happy here"; "I've no complaints"; "I like the personal attention and that I'm treated as an individual".

Recruitment procedures ensured that suitable staff were employed. People said the staff treated them with respect, maintained their privacy and dignity and only assisted them to do things they were unable to do themselves. Comments included: "They're very good, really"; "The staff are lovely and very caring"; "They're very helpful and respectful".

People received their medicines as prescribed by their GP.

We spoke with a visiting GP who said that they had no concerns about the care provided to their patient.

The people we spoke with said they knew how to raise any concerns and a satisfactory complaints procedure was included in the 'service user guide' in every room.

All the people we spoke with said that their needs were met and they were happy with the care provided. They said they felt safe in Sandiway Manor and knew how to raise any concerns. People said that call bells were answered promptly and staff were very caring. Comments included; "the staff are very good", "they are very obliging", "they come promptly when I call them".

People said they were able to pursue their own hobbies such as reading, doing crosswords and sewing. Two people told us they enjoyed walking round the garden when the weather was fine.

The people we spoke with were generally positive about the meals provided. When asked to describe the food two people said it was "good" and two said it was "reasonable". Two people said "we get plenty to eat" and one person said "I have a healthy appetite and would like bigger portions".

There had been one complaint in the last year that had been resolved to the satisfaction of the complainant.