Sandybrook

Sandybrook is a residential care home providing accommodation to people who require personal care to up to 25 people. The service provides support to younger and older people who are living with mental health, physical disabilities, sensory impairments or dementia. At the time of our inspection there were 24 people using the service.

People’s experience of the service and what we found:

Risks were not always safely managed, and recruitment practices were not robust. Sufficient staffing was not in place and although this had been raised both internally and externally this issue had not been resolved. Medicines were not safely managed. Although the home appeared clean, we found multiple infection control practices that were not safe. People were supported to have visitors and there was some evidence of the home learning lessons in relation to previous accidents and incidents. People told us they felt safe living at the home and we were able to see that appropriate safeguarding referrals had been made when needed.

Environmentally the home needed improvements made, to ensure it is safe and suitable for the people living there. Staff did not receive regular supervisions in line with policy, and staff training compliance rates needed to be improved. People’s needs were usually assessed before admission. Although people were supported to eat a healthy balanced diet, we were not assured that people who required thickened fluids were receiving them. The service worked with a variety of health and social care professionals.

People were not always supported to have maximum choice and control of their lives though staff tried to support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Though we did find examples where people needed restrictive practices put in place and this had not been considered.

Although we observed staff were kind and caring, some of the concerns identified at this inspection did not mirror this. People were involved in making decisions about their care.

People were not supported to regularly take part in activities. We were not assured that people received person centred care and records did not reflect a person-centred approach. People’s communication needs were being met, however, the newly appointed manager needed to improve their knowledge on how to make information accessible. We made a recommendation about this. A complaints policy and log were in place and complaints had been resolved in line with policy. No one was in receipt of end-of-life care during our inspection, though end of life policies were in place.

We identified poor governance and oversight during our inspection. Audits were not robust and failed to identify or resolve issues identified during our inspection. Surveys and staff meetings were being conducted. However, when staff shared issues, these were not always acted upon. Staff feedback around culture and management was mixed and we found that due to the issues identified throughout the report people were at risk of receiving poor outcomes. The newly appointed manager was not able to successfully explain about the duty of candour to our inspector during the inspection.

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 16 September 2020) and there were breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last targeted inspection on 05 January 2021 we made recommendations about the providers recruitment processes and risk around assessing and recording people’s dietary requirements. At this inspection we still had concerns about these issues.

Why we inspected

The inspection was prompted in part due to concerns received about various aspects of care, poor record keeping and a lack of staff training. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk, infection control, recruitment, staffing, premises, training, staff support, activities, records and governance. We have also made a recommendation around ensuring the new manager is fully aware of the requirement to make sure information is accessible. Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sandybrook is a residential care home providing accommodation for up to 25 adults, who require assistance with personal care needs. The home accommodates people across two floors. A large number of people living in the home are living with dementia. The service was supporting 15 people at the time of the inspection.

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

During the inspection, we had concerns about the recruitment processes for some of the staff members working with people. Additional checks were made during the inspection and the provider wrote to CQC to outline what further measures were to be implemented to ensure all staff members were safe to work with vulnerable people. We have made a recommendation about this that can be seen in the 'Safe' section of this report.

There were enough suitably trained and supported staff to care and support people. We saw staff engaged with people and treating them with kindness, respect and compassion. We saw some good interactions with those who lived at the home and people were assisted in an appropriate manner.

The premises were clean and well maintained throughout. A safe and hygienic environment was provided for those who lived at the home. People were protected from the risks of transmitting Covid-19 and other infectious diseases because staff complied with the use of personal protective clothing and equipment. Processes to manage infection control were robust.

Some care plans and a dietary check list did not reflect the proper position around some people's dietary requirements. We have made a recommendation about this that can be seen in the 'Safe' section of this report.

Rating at last inspection

The last rating for this service was Requires Improvement (published 16 September 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing, infection prevention control measures and people's dietary requirements . A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

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.

Sandybrook is a residential care home providing accommodation, care and support for up to 25 people aged 65 and over, most of who were living with dementia. At the time of the inspection, there were 20 people living in the home. Bedrooms comprised of 25 single bedrooms, all of which had en-suite facilities.

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

Systems and processes safeguarded people from the risk of abuse. Staff were confident the management team would act quickly to keep people safe. Systems were in place to ensure lessons were learnt from any incidents and the management team understood their responsibility to be open and honest when something went wrong.

Risks to people's health, safety and wellbeing were managed well. Equipment was safe to use and regularly serviced and maintained. Environmental risks and shortfalls, found at the last inspection, were being addressed with an ongoing improvement plan in place. Staffing levels had improved and safe recruitment systems ensured staff were suitable to work with vulnerable people. The cleanliness of the home had improved, and staff followed safe infection control practices. Additional systems and guidance were in place to reduce the risk of infection during the pandemic. Medicines were managed safely.

The management team and staff had worked hard to address the shortfalls found at the last inspection. The registered manager was aware of the regulations and their responsibilities to meet these. There were effective systems to check the quality of the service and to monitor staff practice with clear evidence improvements had taken place. People's views were sought about the service and acted on. Where possible, people were involved in decisions about their care and support. Care was planned in a person-centred way which helped ensure good outcomes for people. Records were accurate and organised. The service engaged well with external professionals to ensure people received prompt and coordinated care.

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 Inadequate (published 7 January 2020). There were multiple breaches of regulation including continued breaches of the regulations, new breaches and failure to act on previous recommendations. The service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

During this inspection, we found improvements had been made and the provider demonstrated that improvements have been made in Safe and Well-Led. The service is no longer rated as inadequate overall, or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

At our unannounced comprehensive inspection of this service on 12, 13, 14 November 2019, we found breaches of legal requirements in safe, effective, caring, responsive and well-led. Warning notices were served in relation to Regulation 15 – Premises and Equipment, Regulation 17 - Good Governance and Regulation 19 – Fit and Proper Persons Employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed in special measures.

We undertook this focused inspection to follow up on whether the warning notices we previously served, had been met. We also checked they had followed their action plan and to confirm they now met legal requirements in Safe and Well-Led. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. 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 Sandybrook on our website at www.cqc.org.uk.

Follow up

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

Sandybrook is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 25 people. Bedrooms comprised of 25 single bedrooms, all of which had en-suite facilities, spread over two floors.

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

The service was not safe. We found continued breaches of the regulations, new breaches and failure to act on previous recommendations.

Recruitment systems and processes were not sufficiently robust. Relatives and staff told us there were insufficient staff and audits suggested more incidents and accidents occurred when staffing levels were reduced. People were at risk as the environment was dirty and unhygienic. Risks within the environment had not been considered and we had to insist a significant hazard was addressed during the inspection. Medicines were not managed safely.

The service was not well led. The registered manager worked full time within the staffing levels and evidence showed they had insufficient time to undertake their role. There was not a positive culture within the service. Staff spoke about low morale and changes not being sustained. None of the staff had received supervision to support them in their roles. The registered manager did not always respond effectively to risks and inappropriate practices. The registered manager lacked knowledge of the regulations and their responsibilities to meet these. Quality audits were not sufficiently robust to highlight the concerns we found or to drive timely action when issues were identified.

A number of communal rooms and bedrooms required re-decoration and some furniture was damaged and in need of repair/replacement. The design and decoration of the service did not always meet the needs of people living with dementia. People were not always treated with dignity and respect. People did not have access to activities and stimulation on a regular basis. Relatives had raised concerns about activities in meetings and told us about this during the inspection. The registered manager had not ensured people always had access to information in a way they could understand.

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. Staff had access to various training courses and they completed an induction when commencing employment. People received a balanced and nutritious diet. Relatives were complimentary about the food.

Relatives gave us positive feedback about the care staff being kind and caring. People and their relatives were involved in decisions about their care and the care planning process. Consideration had been made to people’s end of life wishes. The service engaged well with external professionals.

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 23 January 2019) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, premises and equipment, good governance, staffing and fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

• The service had deteriorated in some domains since our last inspection.

• The service met the characteristics of requires improvement in four out of the five key questions.

• We found three breaches of the regulations in relation to recruitment, consent and good governance.

• Staff were not always recruited safely.

• The registered manager was not following the principles of the Mental Capacity Act 2005.

• People were not always assisted to have maximum choice and control of their lives.

• Risks to people’s health and safety were not always managed safely.

• Care records were not always up to date to reflect people’s current health care needs.

• We have made three recommendations in relation to the management of risks to people’s health and well-being, infection control and the storage of some medicines.

• There were also good practices within the service.

• People liked living in the service. We observed a homely and friendly atmosphere.

• People were protected against abuse, neglect and discrimination through good safeguarding processes.

• Staff we spoke with were positive about their roles and wanting to do their best for people.

• Staff we spoke with knew people well. They had developed good relationships with people. People who used the service clearly enjoyed the presence and attention from staff.

• More information is in the full report.

Rating at last inspection: At our last inspection the service was rated good overall. Our last report was published on 10 May 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

The service were last inspected in May 2014 when the service met all the regulations we inspected.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, including the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

We found the administration of medicines was safe, the system was audited to look for errors and staff had their competency checked regularly.

People who used the service said food was good. People were given a nutritious diet and had choices in the food they were offered. We saw meals were unhurried and staff interacted well with people to make it an enjoyable experience.

Some staff had been trained in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there was a good interaction between staff and people who used the service. Family members told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record of people's end of life wishes to ensure their needs could be met at this time.

There was a record kept of any complaints (none since the last inspection) and we saw the manager took action to investigate and reach satisfactory outcomes for the concerns, incidents or accidents to reach satisfactory outcomes.

Staff, people who used the service and family members all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The environment was maintained at a good level and homely in character. We could see that where some areas of the home needed upgrading work had commenced to improve the décor.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and all people who used the service had their mental capacity assessed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw that applications had been made, when appropriate, to the local authority safeguarding team. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. There were policies and procedures for the control of infection. Two family members told us, "The home is always clean and tidy". A district nurse said," The home is very clean".

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. Family members said, "They keep us informed of any incidents or if she is ill. We go through the care plan. The care she gets is what she needs. She is well looked after".

Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

We saw that medication policies and procedures were adhered to in order to ensure people who used the service had the correct medication administered at prescribed times.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Family members told us, "We come every day to see her. We can come when we like. The staff are all very good and she is being well looked after". A district nurse said, "The staff are helpful and very obliging. They seem to know what they are doing and the manager makes herself available".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service or a family member were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

Was the service responsive?

People completed a range of activities in and outside the service regularly. We were told by the registered manager that people particularly enjoyed singing together with staff. Entertainers visited the home once a month. Other activities included arts and crafts, baking and special event days such as the Mexican day that was being held on the day of the inspection.

The registered manager held regular meetings with staff, family members and people who used the service. The registered manager also held a weekly 'surgery' in the evening for anyone to come in to the home and talk about the service.

We saw that quality assurance questionnaires had been used to collect people's views of the service. We looked at the quality assurance summary and found answers to be very positive. Cleanliness was either excellent or good, as was meals although three people did not know, activities in general was good, quality of service was good or excellent, staff attitude was excellent or good although one person thought fair. The homes decor was thought to be good or excellent as was staff courtesy.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

The service had good quality assurance systems. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Plans of care contained up to date information for staff to deliver effective care.

Two staff member we spoke with said, "I like working here. We have a very good team. You get satisfaction knowing that you have done something good by looking after vulnerable people" and "I like working here. You get peace of mind knowing you are keeping people safe and you have looked after them to the best of their ability. They are very well looked after". Staff were motivated and supported to meet the needs of people who used the service.