Sandiacre Court Care Centre

Sandiacre Court Care Centre is a care home providing accommodation for people requiring personal care to up to a maximum 81 people. The service provides support to younger and older adults, people with dementia, people with sensory impairment and people with a physical disability. At the time of our inspection there were 43 people using the service. The accommodation is a purpose built three storey building with communal living, dining and activity areas and private en-suite bedrooms on each floor. At the time of inspection, the top floor was not in use.

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

Improvements had been made in response to the previous inspection and the provider responded immediately to opportunities for improvement identified at this inspection. Following the inspection, the provider gave us assurances the issues identified had been addressed.

People, or their relatives, and staff identified positive changes had taken place recently in the service.

The electronic care record system in use was kept up to date, this ensured staff had current guidance to follow to meet peoples’ needs.

Systems were in place to manage environmental hazards to mitigate the risk of harm to people.

People received their medicines as prescribed. Cleaning schedules were implemented to ensure a good standard of hygiene in the home.

There were sufficient numbers of suitable staff available to meet people's needs.

Incidents and accidents were analysed by the provider and lessons were learnt to improve outcomes for people.

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.

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 25 April 2022) and there were 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 we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider take action to ensure equipment was maintained; review risks to people; improve safeguarding processes and provide relevant training for staff. At this inspection we found the provider had developed and implemented an action plan to meet the regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Sandiacre Court Care Centre is a nursing and residential care home providing personal and nursing care to 53 people aged 65 and over at the time of the inspection. The service can support up to 81 people. Accommodation was provided in a purpose-built home across three floors, with communal areas on each floor. However, at the time of our inspection the top floor was not in use.

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

The provider had not ensured good oversight of the home in maintaining peoples care and safety. The new manager had only been in post for three weeks and was dealing with a COVID-19 outbreak. Audits had not been completed to consider how to mitigate risk or to drive improvement.

Staff and people’s views were not always listened to, especially in relation to staffing and deployment.

Risk to people were not always assessed and actions taken to mitigate the impact. There were not always enough staff to support people’s needs. The provider used the domestic staff to support when there was a shortage of care staff, however this then impacted on the domestic support of the home.

Training was not in place for all areas to support the staff in their role. Safeguarding was not always reported and consideration of how to protect people from harm.

Medication was managed safely. Where people had behaviours which challenged, there were no consistent care plans or guidance for staff to know how to effectively support difficult situations.

Relatives commented positively about the care their relative received. They commented on kind and caring 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 good (published 28 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and the safety of some people. A decision was made for us to inspect and examine those risks.

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 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 is 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 Sandiacre Court Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 risk of harm, people’s safety and governance of the service 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

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.

We found the following examples of good practice.

¿ The service introduced drive through visits when lockdown restrictions began to ease. This progressed to garden visits using large perspex screens on wheels along with personal protective equipment (PPE) as additional safety measures. Visits were carefully planned and risk assessed.

¿ Activities were undertaken in smaller groups and on a one to one basis with people living in the service. This meant more people became involved as they did not need to join a big group or move to another room to participate. Competitions, for example in artwork or doing quizzes, between the floors in the service were successful.

¿ New admissions to the service were regarded as high risk in all areas, for example, skin integrity, mobility and emotional health, and so received enhanced care and observations during their 14 day isolation period. The service liaised with relatives to understand how to best support people during this period.

¿ The whole staff team practiced putting on and taking off full PPE in small groups. This also included practicing PPE routines if someone tested positive for Covid 19. A video of the registered manager putting on and taking off PPE was put on the staff WhatsApp group so they could refer to this when needed.

¿ Any staff member at higher risk if they contracted the virus received weekly supervision sessions with the registered manager to support them. All staff and people living in the service had an individual risk assessment in place which meant measures could be put in place to keep them safe.

¿ A room on each floor was designated as a staff area to change into and out of their uniforms each shift, which including changing their shoes. Staff remained on separate floors as far as possible to reduce the risk of cross infection.

¿ There was a robust plan in place in the event of an outbreak. Some rooms on one floor, separated from others by a fire door, would be used as an isolation area. A number of bedrooms were kept empty so staff could move into those and remain on site in the event of an outbreak.

¿ Enhanced cleaning in all areas was supplemented by an additional four hourly cleaning schedule for regularly touched areas such as door handles, light switches and electronic equipment. This reduced the risk of infection.

¿ Comprehensive audit processes, including infection prevention and control, were tailored to the specific needs of the service and were not completed using a standard template. This meant features and risks unique to Sandiacre Court were identified and addressed.

At our last inspection we rated the service ‘Good’, with the responsive domain rated as requires improvement, at this inspection we saw improvements had been made. The evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing 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.

The service had improved to provide responsive care. Peoples care plans reflected preferences and choices which were followed. Areas of interest and stimulation were on offer. People’s views had been included and new initiatives developed. There was a complaints policy which was followed and concerns responded to. When people required end of life care it was provided with care and compassion and in line with peoples wishes.

The service continued to provide safe care. People felt supported by staff who knew how to ensure they remained safe from harm. Any risks had been reviewed and measures taken to reduce the risks. There were sufficient staff to support people’s needs. Medicines were managed safely by staff who had received training and guidance. Measures were in place to protect people from the risk of infection. When events had occurred improvements were made to reflect learning.

The service continued to provide effective care. Staff received training to support their role and had the opportunity to develop their learning. People had a choice of meals and their dietary needs had been catered for. When people required support from other health care professionals this was obtained. Shared learning from these professionals was used to develop good practice and follow current guidance or standards. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The people told us they continued to receive good care. People had been supported to remain independent and their choices respected. People had established positive relationships and their dignity was respected. Individual needs had been considered, which included supporting peoples spiritual needs.

The service continued to be welled. There was a registered manager who understood their registration. People’s views had been obtained and any areas addressed. The provider continued to make improvements to the home and audits were completed to continually address all areas of the home and care being provided. Partnerships had been developed and these helped to advance learning in areas of care.

Further information is in the detailed findings below

There was a registered manager in post. 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 care records did not always reflect the care people were receiving this meant there was a risk that some people would not receive the correct care as their needs changed.. Stimulation was offered on an organised basis and people and relatives told us they would like to see an increase in daily meaningful interactions. The provider had responded to verbal complaints it had received however there was no system in place to record these to look at themes and trends to drive improvement..

People told us they felt safe and staff had received training to ensure they knew how to recognise and report any concerns. Staff told us they had received training on their induction and on going regular training to maintain their knowledgeable and skills about their roles and responsibilities. People had risk assessments to reflect their individual needs in maintaining their independence and safety in the environment. There were sufficient staff to support the needs of the people. The manager ensured an on going review of staffing to reflect the changing needs of the people who used the service. People received their medicines safely and there were checks to ensure appropriate recording and storage. Staff received checks to ensure they were safe to work at the service.

We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider ensured that people had been involved in their care planning and where they lacked capacity other people were involved to ensure decisions were made in people’s best interests. People felt they received a good choice of food and their individual preferences were considered in the menu planning. Referrals to health care professionals were completed in a timely manner to ensure people’s health care was maintained.

Staff had developed positive relationships with people and they knew about their life and daily choices. People who used the service told us they felt their privacy and dignity was respected.

The manager had a range of auditing systems which reflected in developing the quality of the care being provided. The provider used a range of methods to continue to drive improvement. Staff felt well supported by the manager in their everyday role and in their career development.