Archived: Sandmartins

Sandmartins is a residential care home providing accommodation and personal care to up to 40 people with a range of health care needs, including dementia, in one adapted building. At the time of our inspection there were 20 people using the service.

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

Following the last inspection, improvements had been made in a number of areas, such as the way people’s support needs were recorded in their care plans. Further actions were needed to ensure people received a consistent standard of care.

People told us they felt safe living at Sandmartins. Their risks had been identified and assessed; staff knew people well and how to support them. Staffing levels were sufficient to ensure people’s needs were met promptly and appropriately. Medicines were managed safely.

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.

A range of audits had been implemented to measure and monitor the service. The provider had drawn up an action plan to show what improvements had been made and what areas still required attention. People told us about their experiences of the home and were happy living there; they felt cared for by staff.

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 4 November 2022) and there were breaches of regulation. At this inspection we found improvements had been made in the recruitment of staff, and in the management of medicines. Further work was required to sustain and embed the improvements made. At this inspection we found the provider remained in breach of one regulation.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this focused inspection and remains requires improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

This report only covers our findings in relation to the Key Questions Safe and Well Led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. 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 Sandmartins on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to records of staff competency to administer medicines, the auditing of medicines and the management of care plans at this inspection. We have made a recommendation about the management of some medicines.

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.

Sandmartins is a residential care home providing accommodation and personal care to up to 40 people, with a range of health care needs, including dementia, in one adapted building. At the time of our inspection there were 24 people using the service.

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

Auditing systems had failed to identify issues of concern we found at this inspection. Audits were not effective in driving improvements to ensure people received a good standard of care and support.

Thorough recruitment checks had not always been completed to ensure people received care from new staff who were of good character. Some people’s medicines were being used beyond their recommended expiry dates. Information within people’s care plans was inconsistent. Auditing systems in relation to medicines and staff competency to administer medicines, were not effective. Systems were not sufficiently robust to prevent and control the risk of infection. Some people felt there was a lack of organised activities to keep them occupied.

People felt safe living at Sandmartins, and any risks had been identified and assessed appropriately. There were enough staff on duty to look after people. People could receive visits from relatives and friends by appointment.

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.

People had a choice of what they would like to eat at mealtimes and enjoyed the food on offer. They had access to a range of healthcare professionals and services.

People were encouraged to be involved in developing the service and their feedback was obtained through occasional residents’ meetings.

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 6 March 2020).

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 the provider remained in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We also looked at the actions taken by the provider since the last inspection to see whether improvements had been made. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

We carried out an unannounced comprehensive inspection of this service on 20 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Sandmartins 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 monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, staff recruitment, infection prevention and control and governance systems. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Sandmartins is a residential care home providing personal care to 40 older people with various support needs, including people living with dementia. At the time of our inspection, 25 people were in residence. The care home is located close to the seafront. It consists of one adapted building with a garden. There are a range of communal areas for people to enjoy.

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

At the last inspection in July 2018 the overall rating for this service was requires improvement with five breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because the registered person had not ensured the care and treatment of service users was appropriate, met their needs and reflected their preferences and they had not ensured staff had received appropriate training, necessary to enable them to carry out the duties they were employed to perform. There were also issues relating to the governance and oversight of the home. This is the third consecutive time that the home has been rated as requires improvement.

At this inspection, we found continued issues relating to staff training and some remaining concerns over governance and records which resulted in continued breaches of regulation. There were, however, significant improvements in care planning and involving people in their care. An activity manager had been recruited and there was good provision of group and individual activities which people told us they enjoyed.

The registered manager did not have clear oversight of staff training needs and not all staff had received refresher training, in line with the provider's policy, to ensure their knowledge and skills were up to date. The home was registered to provide support to people living with dementia. At the time of our visit there were eight people with dementia support needs, yet staff had not received training in this area. We have made a recommendation about monitoring behaviour that is out of character for an individual.

The governance system at the home had improved and audits had delivered positive changes in the service. Further improvement was needed, however, to ensure all areas of improvement were identified and that actions were reliably delivered.

People were looked after by kind and caring staff who knew them well. In an online review, one relative wrote, ‘The staff are so kind and helpful, cannot fault any of them at all. Care is also excellent’. Since our last visit the use of agency staff had reduced and people enjoyed continuity within the staff team. Relatives spoke highly of the care. One relative said, “He just stayed in his room, now he is out every single day. Dad is getting what he needs and he is very happy”. People were encouraged to be involved in decisions relating to their care and were treated with dignity and respect.

People felt safe and told us they enjoyed living at the service. There was a calm and happy atmosphere when we visited. Risks to people had been assessed and staff followed guidance to keep people safe. Staffing levels were enough to meet people's needs. Medicines were managed safely. The home was clean and staff had been trained in infection prevention and control. Lessons were learned if things went wrong.

People enjoyed the food and were seen chatting with the chef over the meal choices for the day. Snacks and drinks were readily available. People had access to a range of healthcare professionals and support. Premises were suitable, comfortable and met people's needs.

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.

The registered manager provided a visible presence at the home and was well-regarded. People were encouraged to be involved in developing the home and their feedback was welcomed.

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 22 January 2019) and there were five 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, although improvement had been made, some areas required further improvement and the provider was still in breach of two regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

There was a registered manager at the home. 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.

This was a comprehensive inspection which took place on 9 and 10 July 2018 and was unannounced on the first day. Since the last inspection the home had changed its name. The home was formerly called ‘Homeleigh’. Homeleigh was a nursing home with a registered nurse manager. The location is now named Sandmartins and provides a residential care service. People, staff and the registered manager moved from a former home, owned by the provider, to this home. The home no longer provides nursing care.

At the last inspection in May 2016 the overall rating for this service was Requires Improvement with two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014, this was because the registered person had not ensured the care and treatment of service users was appropriate, met their needs and reflected their preferences and they had not ensured staff had received appropriate training, necessary to enable them to carry out the duties they were employed to perform. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of effective and responsive to at least good.

At this inspection, we found continued issues relating to staff training and person-centred care which had resulted in continued breaches of regulation. We also identified issues relating to the governance and management oversight of the home. This is the second consecutive time that the home has been rated as Requires Improvement.

People told us they felt safe at the home but did not feel they were able to take risks and risks were not consistently assessed for people. We have made a recommendation regarding assessing risks. People and staff gave mixed feedback about staffing levels, there were enough staff to meet people’s care needs at the inspection, however people’s social and wellbeing needs were not always met.

The registered manager did not have clear oversight of staff training needs, not all staff had received refresher training, in line with the provider’s policy, to ensure their knowledge and skills were up to date. People’s needs were known by staff but these were not always documented and assessments were not consistently accessible for staff. There were a number of agency staff working at the home who did not know people’s needs as well as permanent staff, this posed an increased risk of people’s needs not being met in line with their preferences.

People were not consistently involved in the development of their care plan. One person told us “There’s a care plan, but I haven’t seen it” and a relative told us, when asked if they were involved in the reviewing their loved one’s care plan said, “They haven’t done that here.”

There was inconsistent access to meaningful activity at the home and people gave variable feedback about their access to activities. One person said, “We sit here for hours and hours on end every day.” Some people had access to meaningful activities such as being involved in the gardening and household tasks which were things they enjoyed doing before moving to the home.

People said they felt their needs were met by staff. Staff had developed positive relationships with people. However, people’s care plans did not consistently reflect their social, care or wellbeing needs. Care plans and other associated records were not always complete or accurate. The registered manager told us they were currently transferring care plans from paper documents onto a computerised care planning system. However, there were gaps in paper documentation and inaccuracies in people’s care plans that had been recently updated on the new computer system.

Quality assurance systems and process did not consistently identify areas for improvement and issues identified were not always acted on. The registered manager and provider did not show they fully understood their responsibilities in relation to their registration with the Care Quality Commission (CQC) and had failed to notify us of an authorised deprivation of liberty safeguard (DoLS). The registered manager also failed to display their previous inspection rating conspicuously within the home, as required.

People were protected from abuse. One person told us “The staff are very caring and make you feel secure.” The provider ensured staff were suitable to work at the home before they started. There were safe systems in place to manage, administer, store and dispose of medicines.

People were given choices and were supported to make day-to-day make decisions. People’s needs in relation to food and fluid were assessed and staff had a good understanding of people’s preferences. One person told us “The food’s very good. You have two choices a day”

People and their relatives told us staff were kind and caring. One person said of the staff “They are very attentive, very caring.” People’s privacy was respected. Staff knocked and waited for consent before entering people’s rooms. People’s independence was promoted. One person told us “Yes. I go out quite a lot on my own. The staff will go with you if needed. The manager is happy for the staff to go with us, if you’re a bit nervous.”

People were offered the opportunity to plan for the end of their lives. Discussions had taken place with people and their families about their end of life care wishes.

People and staff spoke positively of the management. One person said the home was “very well managed”. Staff worked well together and in partnership with other organisations to meet people’s needs. We observed positive interactions between staff and visitors.

We found five breaches of regulation at the inspection. These breaches related to staff continuing to not receive appropriate training relating to their role, people continued to not have consistent access to meaningful activity, the registered manager did not notify CQC of authorised DoLS, the quality of the service was no consistently assess or monitored to drive improvements and the registered manager failed to display their rating conspicuously in the home. You can see what action we told the provider to take at the back of the full version of the 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.

Homeleigh provides accommodation, support and nursing care for up to 38 older people. At the time of this inspection, there were 25 people living at the home, nine of whom were living with different stages of dementia.

A registered manager was in post when we visited. 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.

The current registered manager was appointed in December 2015 following the retirement of the previous manager. One senior member staff had also chosen to retire, and two staff have been absent due to sickness for an extended period of time. This meant that a large number of staff have had to be employed on a temporary basis via employment agencies to ensure appropriate staffing levels have been maintained. Whilst the provider and registered manager have demonstrated they have been taking steps to recruit new staff the evidence gathered during this inspection has indicated that the number of current staff vacancies has had an impact on the provision of care.

Not all staff had received up to date training to ensure they had the necessary skills and knowledge to provide care effectively to meet the needs of people accommodated.

We observed mixed experiences of people being treated with dignity and respect. Some staff on duty were seen to be kind and caring towards people accommodated. However, we also observed examples where staff practice did not always respect people’s right to privacy and dignity. For example, we saw staff entering people’s rooms to clean even though they were in bed and asleep.

People living with dementia and people who were cared for in bed were not provided with sufficient activities to ensure they were not a risk of social isolation.

People had not always received person centred care. For example, the needs of one person with a sensory impairment had not been met. The support provided to some people required was not sufficient to ensure they had enough to eat and drink.

Medicine Administration Record (MAR) sheets had not been kept up to date to confirm medicines had been administered as prescribed. Medicines had been stored safely.

People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything.

Care plans had been drawn with the involvement of people and their families.

The registered manager understood the principles of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and how they affected their work. These safeguards protect the rights of people by ensuring if there were any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm.

Newly appointed staff told us they felt well supported by the registered manager. They had been provided support and assistance during induction to help them understand their role. The registered manager had set up a programme of supervision for all staff to ensure they received the support they needed.

The registered manager had arranged meetings with people and their relatives meetings to enable people to express their views and to be involved in making decisions about the service.

A written complaints procedure was in place that showed that, where concerns or complaints had been raised, the registered manager would respond to them on an individual basis in writing.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The home was neat and clean throughout and was free from offensive odours.

We spoke with a visiting community physiotherapist who told us the staff at the home were good at following any instructions given to aid people's rehabilitation.

People told us they were very happy in the home. One person told us "The staff are very jolly, helpful and cooperative". Another told us "They come quickly when the call bell is rung". All people spoken with told us they were very happy with the staff, the food and life in the home.

The two relatives spoken with told us that they were very happy with the home and the standard of care on offer. One told us that their family member had been in another home previously and that in comparison this one was "excellent". Both said that communication was very good.

We saw that people were treated with respect and that their privacy was protected. One person, when asked about privacy being protected replied "Absolutely".

We saw that care needs were assessed, recorded and met. Medicines were handled appropriately in the home.

Staff told us they felt supported in the home, however, staff supervision was not up to date as per the provider's policy.

Complaints were handled appropriately in the home.

People told us they felt safe but if they had any concerns or wished to raise a complaint they would tell the manager.

Visitors we spoke with made us aware they were happy with the care their relatives received. One visitor told us: 'This is a very caring home, I have no complaints, the staff treat all the people living here with dignity and respect'.

We saw that people's privacy and independence were respected. People experienced care based on detailed care plans and risk assessments that documented people's preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

Staff records evidenced that the provider had robust recruitment procedure in place.

The Provider had effective systems in place to monitor quality assurance and compliance.