Sandhurst Lodge

At our last inspection we rated the service Good overall with Effective rated requires improvement as staff had not received an annual appraisal. At this inspection we found this issue had been rectified and the evidence continued to support the rating of Good. 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.

At this inspection we found the service remained Good.

The service had 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

People were safe living at Sandhurst Lodge. Risks associated with people’s care had been appropriately assessed. Medicines were managed and administered in a safe manner. There were sufficient staff available to ensure people received person centred care. Staff were safely recruited. Systems and processes were in place to ensure people were protected from abuse.

Staff had received regular training, supervision and an annual appraisal to support them to provide effective care. 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. People had choice around what they ate and were supported to maintain good health.

We observed kind and caring interaction between people and staff. People living in the home and their relatives praised the caring nature of the care staff and registered manager. People were supported to increase their independence and maintain strong links with their families. People were involved in planning their care.

Care plans were person centred, detailed and updated as and when people’s care needs changed. People were supported to lead active and fulfilling lives and went on regular daytrips. Systems were in place to manage complaints.

People and relatives told us they were happy with the overall service at Sandhurst Lodge. Quality assurance processes were in place to monitor the quality of care delivered. The registered manager worked in partnership with external health and social care professionals to ensure people’s health and social care needs were met.

Further information is in the detailed findings below.

During our inspection on 13 May 2014, we were concerned that people were not always protected from the risks of unsafe or inappropriate care and treatment because appropriate records and information related to the care of people and the management of the regulated activity were not always comprehensive or well maintained.

During our inspection on 1 September 2014, we found that the service had taken appropriate action to ensure that the concerns raised at our inspection were addressed.

During the inspection the home had five people who used the service. All of them had a learning disability. Four of them who were present during the inspection expressed their views to us.

We observed the care provided and the interaction between staff and people who used the service. We spoke with two care staff and the registered manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The home was clean and well furnished. Health and Safety checks had been carried out on the premises to ensure that any risks to people were identified and minimised. The fire risk assessment was up to date and checks on electrical equipment had been carried out.

People told us that they were well treated. Safeguarding procedures were in place and staff had been provided with safeguarding training. They were aware of action to take in response to safeguarding incidents or allegations.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Staff had an understanding of the implications of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005. The manager told us that no applications for deprivation of liberty needed to be submitted and staff were able to gain the co-operation of people. However, we noted that with one exception people living in the home needed continuous supervision and control. Staff told us that due to risk to their safety people were not free to leave without staff or family members accompanying them. This may mean that deprivation of liberty authorisations were required. The registered manager agreed that she would contact the local authority with regards to this issue.

Is the service effective?

Feedback people who used the service and from letters received from relatives indicated that the service was effective and responsive to the needs of people. People's care needs had been assessed with the help of their relatives and representatives. Their likes and dislikes were documented and staff we spoke with were aware of these. This meant that staff could respond to people effectively. Care plans had been prepared and these were up to date and had been regularly reviewed. There was evidence that people's medical needs had been attended to by healthcare professionals such as their psychiatrists, community nurses and their GP. Staff were knowledgeable regarding how to care for people with behavioural needs and gain their co-operation. This meant that potential problems and risks could be minimised or defused. We noted that people interacted well with staff, they laughed and appeared happy.

Is the service caring?

We observed that people were dressed cleanly and appropriately. Staff were welcoming and pleasant towards people. We noted that people were able to approach staff freely and were at ease with staff. Staff were seen offering people food and drink although most of them went to the kitchen and helped themselves to breakfast. People informed us that they were provided with food they liked. Staff were aware that all people who used the service should be treated with respect and dignity. We noted that people who chose not to go out could remain in the home. Arrangements had also been made to ensure that people's religious and cultural needs were responded to. We saw letters from relatives which complimented staff for being caring towards people who used the service.

Is the service responsive?

Staff were attentive towards people and when people needed help or attention, we saw that staff responded immediately. One to one sessions had been organised where people could discuss their progress or concerns with staff. Weekly meetings had been held where people could express their views and provide suggestions. Staff gave us examples of what they did in response to suggestions made. These included organising a barbecue, an outing to Epping Forest and visiting relatives. We noted that the bedrooms of people had been personalised with pictures and ornaments they liked. When we needed information regarding the care of people, this was promptly provided.

Is the service well-led?

The registered manager was knowledgeable regarding her role and responsibilities. There were arrangements for monitoring the quality of care provided. A satisfaction survey had been carried out. The results indicated that people who used the service were satisfied with the care provided. Monthly monitoring visits had been done by the company director to check on the condition of the home and the care of people. Regular checks on medication arrangements, the cleanliness of the building, and Health and Safety audits had been carried out.

Staff meetings took place monthly. The minutes of meetings indicated that staff had been updated regarding the management of the home and the care of people. Staff we spoke with informed us that they had been provided with appropriate support to enable them to take good care of people. Staff had received essential training and were knowledgeable regarding their roles and responsibilities.

Some policies were not sufficiently comprehensive and needed to be updated. These included the safeguarding policy and medication policy. The home did not have a policy or guidance on the Mental Capacity Act 2005 (MCA). Care records of people contained details of assessments. However, these assessments were not sufficiently comprehensive as they did not contain all essential information such as assessments of people's mental capacity, moving and handling needs and people's skin condition. These are needed to provide essential information about people and ensure that their needs could be met. The registered manager informed us that improvements would be made in these areas.

All the people we spoke with felt involved with their care. They told us they were able to make choices regarding their care, and if a choice was not available the service made arrangements to provide the choice. The provider had appropriate measures in place to obtain and review people's consent to the care and the support that they received.

People who used the service told us that they were happy with the care and support that they received from the service. However the service did not have appropriate procedures in place to assess, plan and review people's care needs.

All the people we spoke with were happy with how their medicines were handled and administered. However the service did not have appropriate arrangements in place to store or record medicines safely.

Everyone we spoke with told us that staff were always available when they needed them and that they felt confident in the support that staff provided. However although the service had an induction process for staff, it did not follow professional guidance. A full training programme was not yet in place to provide staff with the skills that they needed to meet the needs of the people who used the service.

Although people who used the service felt confident to give their views about the quality of the service, there was not an effective operation of monitoring of the quality of the service.