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Sandhurst Residential Home Good

The provider of this service changed - see old profile

Reports


Inspection carried out on 20 June 2019

During a routine inspection

Sandhurst Residential Home is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. On the first day of inspection, 19 people were living at the home. On the second day there were 17 people as one person had been admitted to hospital and another had returned to their own home.

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

Inspection carried out on 18 April 2018

During a routine inspection

Sandhurst Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They provide accommodation with personal care to a maximum of 23 people. The home provides care for older people, some of whom are living with dementia.

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

Inspection carried out on 29 September 2017

During a routine inspection

Sandhurst Residential Care Home provides accommodation with personal care to a maximum of 23 people. The home provides care for older people, some of whom are living with dementia. When we visited 22 people lived at the home, some of whom were staying temporarily. The bedrooms are on all three floors, which can be accessed by stair lifts.

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 damag