Sandiway Lodge Nursing Home

We found the following examples of good practice.

Systems were in place to screen any visitors for symptoms of Covid-19.

Staff were provided with the personal protective equipment (PPE) they needed. We observed that this was used in accordance with current national guidance.

People were able to see family members through window visits. Indoor visits had been in place but paused with the recent increase in infection rates. The registered manager was ensuring that people at 'end of life' were still able to see their family. An outdoor visiting pod had been purchased to enable additional visits in the forthcoming weeks.

The provider had ensured family were kept informed of infection outbreaks, the health of their loved ones and changes to visiting arrangements through daily phone calls, email updates and newsletters.

The risks to people living at the service and staff had been assessed in regard to COVID-19 and management plans were in place to manage these risks.

The guidance around 'isolation' was being followed for people who had been newly admitted to the home or those returning from hospital. Staff were carrying out activities on a one-to-one basis to keep people occupied whilst staying in their bedrooms.

The premises were visibly clean. Cleaning and housekeeping tasks had been reviewed and enhanced to reduce the risks of cross infection. However, records needed to better reflect what had taken place.

The provider had tried to allocate staff to designated parts of the home to minimise the spread of infection. However, due to the level of infection outbreak this was not always possible. A review was to take place of the space used by staff in their break time to ensure the risks of cross infection were minimised.

Further information is in the detailed findings below.

The home itself was built towards the end of the 19th century as a large country house and has been adapted over the years for its current use as a care home. Sandiway Lodge is situated off Chester Road in Sandiway, approximately three miles from the town of Northwich and is set in an acre of gardens. There is a local shop conveniently situated across the road, and other community facilities within the village of Cuddington

This inspection took place on the 9 January 2019 and was unannounced.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service good overall. We previously rated the ' Well Led' domain as requires improvement but at this inspection we found the evidence supported the rating of good. There was and no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection

Staff had the skills and knowledge to keep people safe. Care plans contained risk assessments and when risks were identified plans provided clear guidance for staff on how to reduce the risk of harm. Incidents and accidents were reported and analysed to identify trends. There was evidence that lessons were learned when incidents happened.

Safe recruitment procedures were in place and there was enough staff on duty to meet people’s needs.

Medicines were managed safely. The environment was exceptionally clean.

Staff were trained to undertake their roles. Staff had regular supervisions with a supervisor. People’s nutritional needs were met and people were complimentary about the meals they were served.

Staff remained knowledgeable about the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed many positive interactions between people and staff. People spoke highly of the staff and staff spoke positively about their roles. Regular feedback was sought from people.

Care plans were person centred and contained details of people’s choices and preferences for how they wanted to be supported.

There was a complaints procedure in place which allowed both complaints and concerns to be recorded and investigated appropriately.

There were robust quality assurance processes in place which identified shortfalls. Action plans were then put into place to highlight the concern, who was to resolve the matter and by when.

People and staff unanimously, spoke highly of the registered manager who they described as a strong leader with high standards. Staff told us morale at the service was good and that they felt valued.

Sandiway Lodge is a privately owned care home situated off Chester Road in Sandiway which is approximately three miles from the towns of Northwich and Winsford. The service provides personal care for up to a maximum of 36 people. At the time of the inspection there were 17 people using the service.

The service does not have 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager had been appointed to manage the service and they have submitted an application to CQC to become the registered manager.

We carried out an unannounced comprehensive inspection of this service on 11 May 2015 and 18 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches of Regulations 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sandiway Lodge on our website at www.cqc.org.uk.

At the last inspection in May 2015, we asked the provider to take action to make improvements around the safe care and treatment of people by improving staff knowledge around safeguarding and the process of reporting their concerns. We also asked that they improve the cleanliness of the environment, and rectify areas of the environment that were not safe. At this inspection we found that this had been done.

Staff did not have a good understanding of the Mental Capacity Act 2005, and the associated Deprivation of Liberty Safeguards (DoLS). Notifications around DoLS and serious incidents were not being sent to the CQC as required by the regulations. We also asked them to make improvements around monitoring people’s wellbeing and keeping records up-to-date to reflect people’s needs. We issued the registered provider with a warning notice with regards to these issues.

Accidents and incident reporting needed to be more detailed and measures implemented to prevent issues occurring again in the future. We saw that information gathered from audits needed to be acted upon to ensure people’s safety was maintained.

At this inspection we found that action had been taken to address the issues raised during the previous inspection.

People who used the service told us that they felt safe. Staff were able to identify safeguarding concerns, and knew how to report their concerns. We saw examples where safeguarding concerns had been identified and appropriately followed up.

There were sufficient numbers of staff in place to meet people’s needs and the manager used a dependency tool to determine how many staff were needed. Recruitment processes were robust enough to ensure people’s safety was maintained.

Care records contained detailed and up-to-date information, which enabled staff to provide appropriate support. These were reviewed on a monthly basis, and updates were made to reflect any changes, which ensured that information remained accurate.

People were supported to take their medicines as prescribed, and there were sufficient processes in place to ensure that the handling and administration of medication remained safe.

People told us that they enjoyed the food and that they were offered a choice of food and drink. People with special dietary requirements received appropriate support to ensure that they had adequate nutrition.

New staff completed an induction when they first started work at the service and ongoing training was provided for staff which enabled them to carry out their role effectively.

Staff were caring and treated people with dignity and respect. Relatives told us that they received a warm welcome when visiting the service, and that they found staff approachable.

People were aware of how to make a complaint, and information about how to complain was clearly displayed on entering the building. People told us that they would be comfortable raising any concerns with the manager.

There were quality monitoring systems in place, which included audits by both the manager and the registered provider. This information was shared with staff to ensure that they knew what improvements needed to be made and how.

"The staff get us everything we need"

"They do their best, I have no worries and I am happy"

"I feel safer here than I did before"

"They are good to me"

"They are very good and listen to me"

"I would not be here if I had did not like it here"

"Staff are very good, they keep me informed"

"Staff are approachable and they are extremely good"

"I have no complaints about them"

"Level of care was excellent; the staff had empathy and were exemplary carers. The manager was extremely understanding and caring when my relative died"

Our visit found that the care and welfare of people was promoted through the practice of the service as.well as through the safe management of medication. We found that people were protected from harm through the training and procedures adopted by the provider. Staffing levels had improved with the recruitment of more staff. People knew who to make a complaint to and were confident that their comments would be listened to and acted upon.

Our observation of care practice noted that staff acted on the needs of individuals and related to them in a friendly, encouraging and reassuring manner.

The people using the service who were able to tell us said that they were happy living in the home. Comments included, 'This is one big happy family and there are lots of things going on. We are asked what we are interested in, lovely place'; 'I am very picky but this is a good place' and 'The staff are very good.'

We asked people about the staff working in the home, one of them told us; 'Always treated with respect, we have fun, couldn't be better.'

The staff members we spoke to were also very positive about the home. One of them said; 'This is like a second home, I love it here and I am proud of our home.'

We observed good communication and understanding between the members of staff and the people who were receiving care and support from them. We also observed people being supported with their daily life activities in a dignified and respectful way.