Sandhurst Residential Home

We found the following examples of good practice.

Staff were aware of the correct personal protective equipment (PPE) they needed to wear to keep people and themselves safe. There were several doffing and donning stations with Public Health England posters about correct order to put and take off the PPE. Staff were able to describe the right order and said there were always plentiful supplies.

All visitors were only allowed into the home once they had declared their health status, provided their contact details, completed a rapid COVID-19 test and had their temperature checked.

People were being supported to have visits from one designated family or friend into the service. This was done with testing of all individuals on each visit.

Staff supported people to maintain contact using video calls and phone calls. One person told us “Staff help me call my family when I ask.”

The service had regular testing and had a good take up of staff and people receiving their first corona virus vaccine.

The home was clean and there were cleaning schedules to show that high touch points were being cleaned on a regular basis to help keep people safe. The registered manager said they were employing another cleaner to ensure that there was good cover across the seven days.

Staff had training and support to understand the fundamentals of infection control and COVID-19. There was a contingency plan for if the service had an outbreak

Staff were observed wearing PPE throughout the building and throughout the inspection. However, we did observe one or two staff members not wearing masks appropriately and another eat food with their mask around their neck and then return their mask without changing it. We fed this back to the registered manager who assured us they would ensure further PPE training would be put in place.

We advised on infection control within the laundry and following the inspection, the registered manager sent us evidence of lidded boxes being purchased for clean laundry.

People’s experience of using this service:

People were positive about their experience of living at the home. For example, they said about their relationship with staff as being “more like friends.”

People said they felt safe; there was a stable caring staff group. People continued to be supported by staff who respected their privacy and dignity. Staff relationships with the people they supported continued to be caring and supportive. People's nutritional needs were met; people praised the quality of the food. Care plans for each person held information about their dietary needs and their likes/ dislikes.

Risk assessments identified when people could be at risk and covered people's physical and mental health needs and the environment they lived in. The registered manager recruited staff who suited the caring values of the service and recognised the importance of team work to provide consistent and safe care. People were protected from abuse because staff understood their safeguarding responsibilities.

People were supported by staff who completed appropriate training and understood their needs. Staff spoke confidently about the care they delivered and affectionately about the people they supported. They understood how they contributed to both people’s physical health and mental wellbeing.

Referrals were appropriately made to health care services when people’s needs changed. People were supported to maintain good health and had access to appropriate services, which ensured they received on-going healthcare support. Medicine administration, recording and auditing had improved and was safe.

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. Information was in place to ensure people’s legal rights were protected.

Improvements to how the quality and safety of the service was monitored meant the service was well led. There were clearer lines of responsibility and with records of actions taken to address identified issues, such as maintenance actions.

The management team, through regular reviews, unannounced spot check visits and observations of staff practice ensured people received a good quality service. Feedback from people using the service and quality assurance records showed this had been achieved.

Rating at last inspection (and update):

The last rating for this service was requires improvement (published June 2018). 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.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

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

This unannounced comprehensive inspection took place on 18 and 20 April 2018. It was carried out in response to the home being placed in Special Measures following an ‘inadequate’ rating at its last Care Quality Commission (CQC) inspection on 29 September, 4 October, 10 and 16 October 2017. There were seven breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the last inspection, we were in further contact with the registered manager and the provider. They assured us they wished to improve the service. We received a service improvement plan which logged the timescales that improvements would be made by. This was reviewed by the registered manager on an on-going basis and updates made.

We imposed a condition which required the provider to send us a monthly report of how they were addressing breaches of regulation and improving the quality of the service. These have been sent and been reviewed by CQC as part of our risk assessment for the service.

After the last inspection, Devon County Council took the decision not to admit any further people to the service and they reviewed the people living there. The provider agreed to voluntarily restrict admissions and to liaise with the local authority and CQC before they considered a new person moving to the home.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures. Following this most recent inspection, we judged this service had demonstrated improvement and had not been rated as inadequate in any of the five key questions.

On this inspection, some areas of management and auditing of medicines still required improvement. This meant there was a continued breach of regulation. However, the other six breaches identified at the last inspection had been met.

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. In March 2016, this service was registered with CQC under a new legal identity; this is the second comprehensive inspection in connection of that registration. The registered manager and the provider have not changed.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.

At the time of the inspection, there had been a number of improvements. There was a more consistent approach to making applications to the local authority in relation to some people who lived at the service. People were now routinely involved in their assessments, care plans or reviews so their consent was gained. Documentation linked to lasting power of attorney for health and welfare was now requested. These practices meant people’s legal rights were now better protected. Staff recognised further training would help them fully understand the MCA and make them more confident in their recording, such as in the case of best interest decisions.

Risks to people’s health were better managed, for example monitoring people’s fluid intake and weights. Lessons had now been learnt from an incident relating to previous poor skin care.

Improved recruitment practice ensured all the necessary information was now in place before staff started working at the home. Staff training routinely included practical training. This was in recognition that staff benefited from hands on training for some areas of care. Training had been extended to covered dementia care and end of life care in more depth. Staff practice supported people’s dignity and privacy.

People were supported to see, when needed, health care professionals. Care staff recognised changes to people’s physical well-being and visitors said they were kept well informed by staff regarding their relative’s health and well-being.

Safety checks were carried out and the systems in place were more thorough although some action was needed during the inspection to address an unrestricted window and two unprotected radiators. Staff practice showed a better of understanding of infection control.

Staff had good relationships with people who used the service and spoke about them in a caring and compassionate manner. Visitors to the service praised the staff group and the registered manager. They were happy with the standard of care and the welcoming and friendly atmosphere. However, improvements were needed providing consistent meaningful activities and social events. A system had not yet been introduced to ensure activities happened regularly and met people’s individual interests. However, an activities champion had been appointed who was keen to develop new ideas with the people living at the home.

The provider had extended their visits to the home and completed more detailed reports to show how they judged people were receiving good care and living in a safe environment. This was on-going work to ensure there was sustained improvement.

We found two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a recommendation in relation to the environment and the Mental Capacity Act. We will meet with provider. You can see what action we have told the provider to take at the back of the full version of this report.

This unannounced comprehensive inspection took place on 29 September, 4 October, 10 October and 16 October 2017. It was carried out in response to reports from community nurses relating to how people’s pressure care was managed. We found improvements were needed to reduce the risk of pressure damage for people living at the home.

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. In March 2016, this service was registered with CQC under a new legal identity; this is the first comprehensive inspection in connection with the new legal identity. However, the registered manager and the provider have stayed the same.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, there was not a consistent approach to making applications to the local authority in relation to some people who lived at the service. People were not routinely involved in their assessments, care plans or reviews so their consent was not gained. Best interest decisions were not recorded and documentation linked to lasting power of attorney was not requested. These practices meant people’s legal rights were not protected.

Some risks to people’s health were not well managed, for example monitoring people’s weight. Lessons had not been learnt from an incident relating to poor pressure care. Staff had to be prompted to check the setting of a person’s pressure mattress. It was incorrectly set on two separate occasions and put the person at increased risk of pressure damage. They had also been at risk of entrapment in their bedrails, which staff had not noticed. We ensured action was taken during the inspection to reduce these risks to the person’s health and safety.

Recruitment practice did not ensure all the necessary information was in place before staff started working at the home. Staff training did not routinely include practical training, although the registered manager began to book this type of training during the inspection. This was in recognition that staff benefited from hands on training for some areas of care, such as using moving and handling equipment. We saw examples of kind care, with staff showing affection and compassion towards people. However, there were also practices which undermined people’s dignity and privacy.

People were supported to see, when needed, health care professionals. Care staff recognised changes to people’s physical well-being and visitors said they were kept well informed by staff regarding their relative’s health and well-being. The management and storage of medicines required improvement. People were supported with their meals, where needed, but people’s weight and fluid intake was not monitored in a robust way.

Safety checks were carried out but the systems in place were not thorough and potentially left people at risk of harm. Some areas of the home were potentially unsafe to people living with dementia. Staff practice showed a lack of understanding of infection control. Some items of furniture were damaged or stained. There were areas of the home which were poorly maintained.

Staff had good relationships with people who used the service and spoke about them in a caring and compassionate manner. Visitors to the service praised the staff group and the registered manager. They were happy with the standard of care and the welcoming and friendly atmosphere. However, improvements were needed in staff skills and knowledge in supporting people living with dementia and people with complex health and emotional needs. People were not always provided with meaningful interactions which meant they were at risk of social isolation. There was no system to ensure activities happened regularly and met people’s individual interests.

The service was not well led. During our inspection, we found a number of areas that needed to improve to maintain the safety and well-being of people that had not been identified by the registered manager or the providers. We found seven 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 this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection, we shared our concerns with the local authority safeguarding team, commissioners, deprivation of liberties team, fire service, community nursing team and the clinical commissioning group so they were aware of the potential risks to people’s safety and well-being at the home. We made an individual safeguarding alert for one person who has since moved from the home. The local authority safeguarding team are organising a strategy meeting to discuss the whole service.

Since the inspection, we have been in further contact with the registered manager and the provider. They have assured us they wish to improve the service and have begun organising new training for staff. The registered manager has sent us a list of the action they have taken so far. For example, fire equipment being serviced, new furniture and improved practice in medicine management. They have stated they will work alongside the local authority quality assurance and improvement team to make further improvements.

CQC have taken enforcement action by imposing a condition on the provider's registration. This requires the provider to provide CQC with a monthly report outlining actions and progress in making the required improvements. We will inspect this service again within the next 12 months.