Sandwood Care Home

Updated 3 November 2020

The Inspection

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 Good governance. of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

The inspection was completed by one inspector and one assistant inspector.

Service and service type

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

Notice of inspection

The inspection was announced. We gave the provider 10 minutes notice because we needed to check the current Covid-19 status for people and staff in the service.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke to four people who used the service about their experience of the care provided. We also observed staff interacting with people. We spoke with the registered manager, a senior care worker and a care worker. We also spoke with a visiting community nurse. We reviewed a range of records. This included in part, two people's care records. We also reviewed a variety of records relating to the management of the service, including audits and checks on health and safety.

Updated 3 November 2020

About the service

The Firs Nursing Home can accommodate 31 older people and people living with dementia and nursing needs in one adapted building. Accommodation is provided on three floors; a passenger lift is available. At the time of our inspection 26 people were living at the service.

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

People did not receive consistent safe care. People’s dependency needs had not been consistently reviewed, to ensure staffing levels were sufficient in meeting people’s individual care needs and safety. Risks associated with people’s care needs and health conditions had been assessed. However, documentation to confirm care needs had been provided at the frequency required showed gaps. Pressure relieving mattresses to assist in the prevention of pressure ulcers developing, were not set correctly. Best practice guidance in the administration and management of medicines were not followed. Equipment was not consistently clean.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Safe staff recruitment checks were completed before staff commenced. Health and safety checks were completed on the environment. The provider had a process that analysed accidents and incidents, but this information was not available during the inspection.

People did not receive consistent effective care. Where people had been identified at risk of malnutrition and required additional snacks, this was not seen to be provided. People’s pre-admission assessment showed gaps in important information such as a person’s religion, social history, interests and hobbies. The environment required some refurbishment work, it was not clear of the plans in place to complete this. Best interest decisions completed for people who lacked mental capacity to consent to their care, did not consistently show who had been involved in the decision-making process.

Staff received an induction, ongoing training and opportunities to discuss their work. Staff worked with external health care professionals in supporting people’s health care needs. 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.

People did not receive care that consistently respected their dignity. Staff used good communication skills and understood people’s needs and involved them as fully as possible in their care. Advocacy information was available for people should they have required this support.

People did not receive care that was consistently responsive to their individual care needs. Staff were not always responsive to requests for assistance, resulting in a delay of care and support. Social activities and opportunities for people to pursue interests and hobbies were very limited. Complaints had not always been responded to in a timely manner.

People received good end of life care.

The leadership of the service had been poor, and this had resulted in staff not being sufficiently supported and guided. Staff were task focused and there was a lack of direction. Whilst audits and checks monitored quality and safety these had not been fully effective in driving forward improvements.

People received opportunities to feedback their experience of the service. The provider had met their registration regulatory requirements.

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 December 2018). The service remains rated Requires Improvement. This is the provider's third consecutive rating of Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

During this inspection, we identified three breaches of the Health and Social Care (Regulated Activities) 2014. This was in relation to people's nutrition and hydration needs being met, care not being consistently respectful or dignified, and the governance of the service.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least Good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.