The Care Quality Commission (CQC) has rated Sandgate Manor in Folkestone, Kent inadequate overall, following an inspection in June.
Sandgate Manor is a residential care home providing accommodation and personal care for up to 25 people who may be living with a learning disability or autistic people.
Following the inspection, the overall rating for the service has dropped from good to inadequate. The ratings for being safe, effective, caring responsive and well-led have also dropped from good to inadequate.
The service is now in special measures which means it will be kept under review, by CQC and re-inspected to check sufficient improvements have been made.
Hazel Robson, CQC head of inspection for adult social care, said:
“During our inspection of Sandgate Manor there were widespread and significant shortfalls in the leadership of the service. Staff weren’t clear about their roles and responsibilities in relation to the overall quality of care delivered.
“People’s rights weren’t being respected and there was no focus on their strengths to promote what they could do for themselves. Where people were struggling, staff hadn’t made reasonable adjustments so that people could do things for themselves. This meant that people didn’t always have a fulfilling and meaningful everyday life. For example, one person told us they didn’t like the coffee staff made for them. They said they'd rather make their own coffee. Staff then spoke over the person and told us the person wasn’t able to do this because of their health conditions. However, there had been no thought to find out whether the person could do this safely with adaptations or with support from staff
“We found people weren’t always receiving kind or compassionate care. Staff didn’t always protect and respect people's privacy and dignity and some were seen speaking to people in a disrespectful way at times or talking over people. One person was left for some time with food on their face before staff supported them to clean it off. They were eating in the entrance hall by the door so they would be on full view to anyone visiting the service.
“There were some cases where staff were treating people in a demeaning manner. Our inspectors saw one person being made to say please before being provided with assistance to eat and then being called a "good girl" when they did. This isn’t a respectful way to treat anyone.
“Some people living in the service had behaviours that increased their risk of poor dental health. But, there weren’t any dental or oral care assessments in place to assess people's risks. There were no records to show that some people with high risks had seen a dentist since before the pandemic. Staff hadn’t undertaken training in oral care.
“We have told the provider to make urgent improvements to ensure that people and staff are safe, and we will monitor the service closely to ensure these are made and fully embedded. If they are not, we will not hesitate to take appropriate enforcement action we feel is needed to drive the improvements needed.”
Inspectors found the following during this inspection:
- Action wasn’t always taken to reduce risks when incidents had occurred, Inspectors identified one person having a near miss choking on some meat. They had historical swallowing issues which had improved following medical intervention. Following the incident, no action had been taken to assess if the person's choking risks had increased to reduce the risk of the person choking again
- Some people had gastrostomy tubes in place but there was no information on the signs for symptoms of possible infection or blockage. A gastrostomy tube is a tube inserted through the tummy that enables people to take in fluid, nutrition or medication when they don’t do so orally
- People's care records didn’t always help them to get the support they needed. Staff and agency staff didn’t always have access to guidance on how to support people as risk assessments contained limited information that could be unclear. For example, there were no risk assessments to support people with epilepsy whilst bathing. There were also no risk assessments where people had asthma. This increased the risk that staff might not be supporting people correctly
- People weren’t always supported by staff who had received relevant and good quality training in evidence-based practice. Some people at the service lived with epilepsy and were prescribed emergency medicines to be used in case of a seizure. Not all staff were trained in administering these medicines. The manager and staff told us this restricted how often and when people could go out as they could only go out if trained staff were available
- People weren’t well supported to manage risks to their teeth and oral care. There were no oral care assessments in place to assess people's dental risks. Some people at the service had behaviours that increased their risk of poor dental health. There were no assessments about these risks. There were no records to show that some people with high risks had seen a dentist since before the pandemic. Staff hadn’t undertaken training in oral care
- People weren’t protected from the risk of abuse. Staff had training on how to identify and report abuse, but they seemed unable to recognise potential abuse when incidents occurred. For example, one person had raised a complaint to staff. The complaint was an allegation that staff had said something inappropriate to the person. Staff had not considered if the matter was also verbal abuse. Another person had an unexplained graze. This was reported as an incident but there was no investigation in to how it occurred, and it wasn’t reported to safeguarding
- One person was recorded as having hit another person. There was no information on what action was taken to reduce re-occurrence or any record that it was reported to safeguarding
- There weren’t enough staff to provide support to people. This also meant some people weren’t receiving the one-to-one they were assessed as needing
- Staff didn’t encourage people to eat a healthy and varied diet to help them to stay at a healthy weight. For example, one person's care plan stated they were overweight and at risk of serious health issues and staff should encourage the person to eat healthier low sugar, low carbohydrate foods. Inspectors saw staff encourage the person to eat sugary food.