Archived: Sandridge House

Updated 8 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a focussed inspection due to concerning information. The inspection took place on 6 January 2016 and was unannounced.

The inspection team consisted of two inspectors. Both inspectors work in inspecting adult social care locations. One inspector is a registered nurse.

This inspection took place after the 2 December and 3 December 2015 comprehensive inspection. This inspection looked at only two key questions; “Is the service safe?” and “Is the service effective?”

Before the inspection, we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was not required for this type of inspection.

We reviewed the information we held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law. We reviewed weekly action plans sent to us by the provider, and information received from local authorities.

During the inspection some people who used the service did not have the capacity to express their views. However, we were able to speak with two people. We also looked at the premises and observed care practices by staff on the day of our visit.

We spoke with the nominated individual, the operations manager, home manager, five care staff, the nurse in charge, two activities coordinators, the maintenance person and a cleaner. We looked at seven records relating to the care of individuals, staff duty rosters and other records relating to the running of the service.

After the inspection, we asked the provider to send us further information and evidence.

Updated 8 July 2016

Sandridge House is a care home with nursing that is based in a busy area of Ascot, Berkshire. The care home is set back from the street, close to the High Street of Ascot and nearby Heatherwood Hospital. The location is registered to provide care and support for up to 38 people. At the time of the inspection there were 33 people accommodated. Sandridge House is located in an older style premises with two floors and a number of outbuildings. There is an expansive garden around the care home.

At the time of the inspection, there was no 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. The last registered manager left their position in April 2015. A home manager commenced in post in April 2015 and had applied to CQC to become the registered manager. The person was awaiting an interview with our registration inspectors on 22 January 2016.

The previous inspection of Sandridge House occurred on 2 December and 3 December 2015. At that inspection, there were eight breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The location was rated “inadequate” overall and placed into ‘special measures’.

We were concerned during the inspection on 2 December and 3 December 2015 that people’s care was seriously unsafe and ineffective. The provider agreed to take immediate steps to safeguard people. This included sending an urgent action plan to us by 7 December 2015. Due to the concerns about safe night-time care for people, effective from 4 December 2015 the provider agreed to deploy a fourth staff member and provided evidence to the us to show this had occurred.

We also contacted local authorities on 4 December 2015 regarding people’s welfare and they decided to commence conducting unannounced checks at the location to ensure that people received safe and effective care, particularly on weekends. These visits commenced on 5 December 2015 and continued.

We received the provider’s action plan on 7 December 2015. However, the action plan was not robust, did not sufficiently demonstrate how people were being protected and contained some timeframes for completion of actions that were too long. We asked how the provider was protecting people and what actions they had taken to make improvements to care that assessed, prevented and mitigated risks. The provider submitted a revised and detailed action plan to us on December 2015. Once we had assessed the revised action plan, and determined it had satisfactorily documented the provider’s actions to ensure people’s safety, the provider agreed to submit the updated action plan to us each Monday. This was so that we could regularly monitor the safety and welfare of people who lived at Sandridge House. The provider sent their action plan to us four times between the last inspection and this inspection; sometimes with documents attached that supported the action plan's contents.

We received information of concern from other organisations following the December 2015 inspection. This information indicated that people at Sandridge House were still at risk of harm due to failure to make necessary improvements or that the care people received continued to remain unsafe. The inspection by us on 6 January 2016 was necessary to again assess the safety and effectiveness of people’s care.

People did not receive safe care. Hazards that were highlighted in the December 2015 inspection feedback were not addressed quickly enough to prevent the risk still existing for people who used the service. This included the risk and continued occurrence of falls, the deployment of staff to ensure people’s continuous safety, the maintenance of a safe environment and care planning. People continued to have injuries resulting from falls. We observed this occurred due to failure to assess, mitigate and review risks for people at high risk of falling. Care plans were being reviewed, but these were not specific enough for individual risks and person centred care provision. Although numbers of staff present on shifts were maintained, this was not linked to the dependency of people and some staff worked high numbers of hours in given weeks. The environment had some modifications to address risks, but risks from fire safety and Legionella prevention and control continued.

People did not consistently receive effective care. There was mixed evidence that people’s food and fluid provision was sufficient for their needs. There was improved recording of people’s fluid using the intake charts. Our observation showed that more offers of fluids were made to people, although there were some periods where people failed to pay attention and focussed on tasks instead. People with challenging behaviours, especially those with dementia diagnoses, posed the highest risk of malnutrition and dehydration. This was due to the increased difficulty in convincing them to consume food or fluids, their behaviour when they were provided with nutrition or hydration, and staff ability to use suitable or alternate ways of assisting the person.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.