Sandy Banks Care Home

Sandy Banks is a care home providing personal and nursing care for up to 39 people. At the time of this inspection there were 31 people living in the home most of whom were living with dementia. The home had a variety of communal spaces available which included, lounges, dining rooms and quiet areas.

The service had a registered manager in post at the time of our inspection. 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.

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

People received safe care from staff who had received the necessary training and information about people's needs and preferences.

Relatives we spoke with were confident their relations were safe. Comments included, "[Name] is very safe there, they were brilliant with [name] and are very good and caring.", "They look after [name] really well, they are very safe there." and "The quality of care is excellent, [name] health and wellbeing has improved considerably."

Staff had been recruited safely and received induction training and other training relevant to their roles. Staff told us they felt confident they understood people's needs and how to care for them.

Risk assessment and management plans helped people to maintain their safety and wellbeing whilst promoting their independence and control.

People were protected, as far as possible, from the risks associated with the Covid 19 pandemic by robust policies and procedures.

The home was well managed and both staff and relatives said the home was friendly and caring. One relative said, "I think the openness in the home comes from the (registered) manager. If we ask a question we always feel they are telling us the truth."

People's relatives felt they had been communicated with on a regular basis during the recent pandemic lockdown. Comments included, "I get at least one phone call a week." and "They have a lady who rings me regularly. I know I could always speak to the manager if I had any problems at all."

Rating at the last inspection

The last rating for this service was good (published April 2018).

Why we inspected

This was a focused inspection prompted in part by some concerns which had been raised with CQC. The information suggested people may not be receiving consistent safe care in relation to personal care, skin care and health care. We looked at the key questions of safe and well-led. We did not find evidence to support the concerns and were assured people received safe care.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We also made recommendations about the management of mealtimes, the recording of local applications of creams, the recording of drug fridge temperatures and a more structured auditing system.

Following the last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, caring and well led to at least good. During this inspection, we found the service was meeting the requirements of the current legislation.

Sandy Banks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sandy Banks accommodates up to 39 people in one adapted building. It provides accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for people living with a dementia, people with mental health needs, older people, and people detained under the mental health act and younger adults. There were 29 people in receipt of care at the service at the time of our inspection.

The service had a registered manager in post at the time of our inspection. 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 was run.

Staff demonstrated understanding of actions they needed to take if they suspected abuse. Training records confirmed staff had undertaken safeguarding training.

Improvements had been made to the management of medicines. We observed staff administering medicines safely. The management team told us improvements in the competency checks for staff were being implemented.

Individual and environmental risk assessments had been completed. Evidence confirmed regular servicing and audits of the environment were undertaken.

A safe recruitment procedure was in place that ensured only staff who were suitable to work with vulnerable people were employed. Duty rotas confirmed staff allocations for each shift. Where agency staff were utilised to cover shifts we saw regular consistent staff were accessed. Staff were provided with a variety of training that ensured they had the knowledge and skills to deliver effective care to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Best interest decisions and capacity assessments had been completed for people who used the service. Where required, Deprivation of Liberty Safeguard applications had been submitted to the relevant assessing authority.

People were supported to eat their meals in a timely manner. Meals looked appetising and people were offered choices of what they wanted to eat.

We received positive feedback about the care people received in the home. People were treated with dignity and respect. Staff were seen talking with people nicely and it was clear people who used the service were comfortable in the presence of staff.

Family members told us the home involved them in decisions and kept up to date about their relatives care. However, one person said they would like more updates about the care their relative received. Care files for people who used the service had detailed care planning and risk assessments in place, which provided up to date information about how to support their individual needs, choices and likes.

People had access to activities in the home. There was dedicated staff in the home to provide a varied activities programme. Assistive technology was utilised in a variety of ways in the home to monitor the quality of the service and support people’s needs and choices.

Complaints were dealt with appropriately. People had access to policies and guidance about how to raise a concern or complaint. We received very positive feedback about the registered manager and the improvements she had made in the home.

A variety of audits and monitoring was taking place. These demonstrated the home was safe for people to live in. Feedback and questionnaires had been completed and we saw evidence that staff and relative meetings were taking place.

Accommodation is provided at ground floor level. There are some amenities and public transport links close by. The city of Preston, the market town of Chorley and Bamber Bridge village centre are within easy reach. A small car park is available at the home. However, on road parking is also permitted.

This was the first inspection of Sandy Banks Nursing Home by the Care Quality Commission [CQC], since the current management team took over the management of Sandy Banks Care Home under the new provider's registration in May 2016. Although some improvements are still needed at Sandy Banks, we did note that significant improvements had been made since our last inspection under the previous provider and it is important that improvements continue to be made in order to maintain sustainability.

This inspection was conducted over three days, 30th August 2016, 8th and 9th September 2016. The first day was unannounced, which meant that people did not know we were going. Although the registered manager was off duty on the first day of our inspection he did attend shortly after our arrival, so that he could be fully involved with the inspection process. The home was given short notice of the second and third days of our inspection. The manager was on duty on both these days.

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 of the Health and Social Care Act and associated regulations about how the service is run.

There were sufficient numbers of staff on duty to keep people safe. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at Sandy Banks. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.

Medicines were, in general being well managed. However the application of local creams was not always being recorded on the appropriate charts. We have made a recommendation about this.

During the course of our inspection we toured the premises and found that the environment was well maintained and in general the home was clean and hygienic throughout.

Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. We saw evidence that a wide range of environmental risk assessments had been conducted. However, some of these were not up to date. We have made a recommendation about this.

Staff we spoke with were able to discuss the needs of people well and were confident in reporting any concerns they may have had about the welfare of those who lived at Sandy Banks.

Certificates of training showed that a broad range of learning modules were provided for the staff team and those we spoke with provided us with some good examples of learning they had completed. However, the training matrix was not up to date, in order to reflect the current level of training provided. We have made a recommendation about this.

Evidence was available to demonstrate that supervision sessions were conducted for staff, as well as annual appraisals, which enabled them to discuss their work performance and training needs with their line managers.

Although staff were seen to be kind and caring interaction with those who lived at the home could have been better, particularly during meal times. We discussed this with the managers of the home at the time of our inspection and we were confident that they would address our observations. We have made a recommendation about this.

Legal consent had been obtained for some areas of care and treatment. However, this had not been consistent for some restrictive practices, such as the use of bed rails and reclining chairs. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw that in some cases relatives had given consent on behalf of those who lived at the home, but there was not always documented evidence available to demonstrate they had the legal authority to do so. We have made a recommendation about this.

Mental capacity assessments had been conducted prior to applications being made to deprive someone of their liberty.

The planning of people’s care was based on an assessment of their needs, which was conducted before a placement at the home was arranged, with the exception of emergency admissions, in which case people’s needs were assessed shortly after arriving at the home.

We found the plans of care to be, in the main, person centred, providing staff with clear guidance about people’s needs and how these were to be best met. However, on occasions some conflicting information was provided in the records we saw. We have made a recommendation about this.

Complaints were being well managed and systems had been implemented to allow the quality of service provided to be assessed and monitored on a regular basis, by obtaining feedback from those who lived at the home, their relatives and staff members, by holding regular meetings and conducting audits. However, the audits we saw were not always clear and up to date. We have made a recommendation about this.

Records showed that since the current management team took over the management of Sandy Banks in May 2016 eleven safeguarding referrals had been made by the home to the local authority. The provider had not always notified the Care Quality Commission about such incidents. However, they had been reported under the correct procedures, in order to safeguard those who lived at the home. We discussed this with the management team at the time of our inspection, who assured us that notifications of such incidents would be reported to us in the future.

Staff spoken with told us they felt well supported by the registered manager of the home. They described him as being, ‘approachable’ and ’easy to talk to’.

We found a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the need for consent.

You can see what action we told the provider to take at the back of the full version of this report.