Sandgate Manor

About the service

Sandgate Manor is a care home providing accommodation and personal care to 18 people at the time of the inspection. The service can support up to 22 people. Support was provided to people who lived in one adapted building and there were 3 single person lodges in the grounds. Some people had learning disabilities and or autism, other people received support for physical disabilities.

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

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. There were no plans in place to support people to maintain or increase their independence. However, the service was in the process of making improvements to increase accessibility for people and some improvements had already been made.

Staff did not always support people to achieve their aspirations and goals. Processes to do this effectively required review, as goals and aspirations had not been formally assessed. People’s sensory needs had not been assessed.

People received their medicines as prescribed. Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

People were supported to engage in activities. Improvement was still needed; however, staff were working towards this.

Right Care:

People’s support plans did not always reflect their range of needs as care plans were not up to date and did not include some important information.

Equality and diversity needs had not been assessed to provide people the opportunity to share their views and enable staff to provide support. However, improvements had been made to protect one person’s human rights.

There had been improvements in how staff spoke to people and there were positive interactions between staff and people. Staff understood how to protect people from poor care and abuse and the service worked with other agencies to do so. Staff had training on how to recognise and report abuse and knew how to apply it.

Staff understood how people communicated. Where complaints had been received these had been investigated and acted upon. Staff had undertaken training in end of life care. However, end of life care planning needed to be reviewed.

Right Culture:

The management of incidents and accidents needed to be improved. Some incidents were acted upon. Further review was needed to ensure people were receiving the right support.

The new management team was putting improvements in place to address concerns. The office had moved into the main building which improved communication between managers and staff and gave the manager better oversight of the service.

Staff training had improved, and the new management team was making further improvements arranging for staff to attend further learning.

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 rated inadequate (published 24 August 2022)

Following the last inspection, we issued Warning Notices for regulation 10, 12, 16 and 17. The provider also completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made. However, the provider remained in breach of regulations.

This service has been in Special Measures since 04 August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of the report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the “all reports” link for Sandgate manor on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, promoting independence and good governance 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.

About the service

Sandgate Manor is a residential care home providing accommodation and personal care to 21 people at the time of the inspection. The service can support up to 25 people. Most people lived in one two story building. There were also three individual lodges on site each of which accommodated one person. The service provided support to people with a learning disability and autism and people with physical disabilities.

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

Right Support

The service had not supported people to have the maximum possible choice, control and independence. People did not have control over their own lives. Staff did not respect people’s rights. They had not made reasonable adjustments to enable people to do things for themselves. Staff did not focus on people’s strengths and did not promote what they could do for themselves. People did not always have a fulfilling and meaningful everyday life.

Staff did not support people with their medicines in a way that promoted their independence. The support people needed with their medicines was not assessed. Some staff did not have training in emergency medicines, and this restricted how often, when and where some people could go out.

Most people were not supported by staff to pursue their interests or to achieve their aspirations and goals. People were not always enabled to access specialist health and social care support where appropriate. Staff did not always support people to lead their own health and make healthy choices.

Right Care

People did not always receive kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity. Some staff spoke to people in a disrespectful way at times.

Staff did not promote equality and diversity in their support for people. They had not assessed people’s cultural needs to ensure they provided culturally appropriate care.

Staff had failed to recognise and act on concerns which needed to be investigated to ensure they were not the result of abuse. The service did not have enough appropriately skilled staff to meet people’s needs.

What activities people wanted to take part in had not been discussed with people. People’s care, treatment and support plans did not reflect their range of needs and promote their wellbeing and enjoyment of life.

Right culture

People were not supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

Staff had not placed people’s wishes, needs and rights at the heart of everything they did. There was a lack of information about preferences to support people with these. People were not always involved in planning their care. People were not leading inclusive and empowered lives. However, there was a new manager in place who had started to address issues at the service.

Rating at last inspection

The last rating for this service was Good (published 31 July 2019).

Why we inspected

We received concerns in relation to the management of the service, staffing levels and people’s support with risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led. We also identified concerns with how staff promoted people’s independence, managed complaints and supported people with their health, so we widened the scope of the inspection to include all five key questions.

The overall rating for the service has changed from good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to treating people with dignity and respect, staffing levels, providing safe care, person-centred care, the management of the service, safe staff recruitment, and reporting significant events to CQC at this inspection.

Please see the action we have told the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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.

Sandgate Manor is a residential home for adults with learning disabilities who may also have physical disabilities. It provides accommodation for up to 25 people. There were 22 people living there at the time of our inspection. The service is made up of a large main house and three individual lodges. The service is run by the MNP Complete Care Ltd.

Sandgate Manor has been developed and designed in line with the values that underpin Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

Relatives told us their family member was safe. Staff had received safeguarding training and knew when and how to raise concerns.

People were protected from risks. There were various risk assessments in place for each person giving guidance to staff to reduce the risks identified. Risk assessments were reviewed regularly or when people’s needs changed.

There were sufficient numbers of staff on duty. Staff who knew people well and had been recruited safely with all the appropriate checks in place.

Medicines were administered, stored and managed safely. Audits identified no errors in the months before the inspection.

The service was clean, tidy and homely and suited to the needs of people living there. People had individualised rooms with their personal items and favourite colours and chose their decoration.

People’s needs were thoroughly assessed by a multi-disciplinary team of specialist professionals within the learning disabilities service. People had access to health care and hospital treatment when needed.

Staff were trained in all of the providers mandatory areas and had the ability to access on line, face to face or group training. New staff had a robust and induction period and were well supported. Staff received regular supervision and yearly appraisals.

Staff were very caring and knew people, their preferences likes and dislikes well. Staff took pride in the standard of care they provided. We received good feedback from relatives and visiting professionals about the quality of care and the quality time staff spent with people.

Care plans were person centred and were regularly reviewed and updated. They were all being actively reviewed at the time of the inspection ready for transfer to an efficient electronic version.

When people’s needs changed the appropriate referrals were made to re-assess and devise new strategies to support them effectively. The staff had regular meetings and discussions with health and social care professionals to ensure the right care was being provided.

There was a clear and supportive management structure in place. Quality assurance, audits and monitoring were undertaken by several layers of management. This meant that areas identified for improvement were acted upon in a timely manner.

Rating at last inspection:

This service was registered with us on 14 May 2018 and this is the first inspection.

The last rating for this service was Requires Improvement (Published 28 November 2017). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected:

Scheduled inspection based on timescale for unrated services.

Follow up: We will continue to monitor the service.