Archived: Sandridge House

At the time of the inspection, there was no 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. The last registered manager left their position in April 2015. A home manager commenced in post in April 2015 and had applied to CQC to become the registered manager. The person was awaiting an interview with our registration inspectors on 22 January 2016.

The previous inspection of Sandridge House occurred on 2 December and 3 December 2015. At that inspection, there were eight breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The location was rated “inadequate” overall and placed into ‘special measures’.

We were concerned during the inspection on 2 December and 3 December 2015 that people’s care was seriously unsafe and ineffective. The provider agreed to take immediate steps to safeguard people. This included sending an urgent action plan to us by 7 December 2015. Due to the concerns about safe night-time care for people, effective from 4 December 2015 the provider agreed to deploy a fourth staff member and provided evidence to the us to show this had occurred.

We also contacted local authorities on 4 December 2015 regarding people’s welfare and they decided to commence conducting unannounced checks at the location to ensure that people received safe and effective care, particularly on weekends. These visits commenced on 5 December 2015 and continued.

We received the provider’s action plan on 7 December 2015. However, the action plan was not robust, did not sufficiently demonstrate how people were being protected and contained some timeframes for completion of actions that were too long. We asked how the provider was protecting people and what actions they had taken to make improvements to care that assessed, prevented and mitigated risks. The provider submitted a revised and detailed action plan to us on December 2015. Once we had assessed the revised action plan, and determined it had satisfactorily documented the provider’s actions to ensure people’s safety, the provider agreed to submit the updated action plan to us each Monday. This was so that we could regularly monitor the safety and welfare of people who lived at Sandridge House. The provider sent their action plan to us four times between the last inspection and this inspection; sometimes with documents attached that supported the action plan's contents.

We received information of concern from other organisations following the December 2015 inspection. This information indicated that people at Sandridge House were still at risk of harm due to failure to make necessary improvements or that the care people received continued to remain unsafe. The inspection by us on 6 January 2016 was necessary to again assess the safety and effectiveness of people’s care.

People did not receive safe care. Hazards that were highlighted in the December 2015 inspection feedback were not addressed quickly enough to prevent the risk still existing for people who used the service. This included the risk and continued occurrence of falls, the deployment of staff to ensure people’s continuous safety, the maintenance of a safe environment and care planning. People continued to have injuries resulting from falls. We observed this occurred due to failure to assess, mitigate and review risks for people at high risk of falling. Care plans were being reviewed, but these were not specific enough for individual risks and person centred care provision. Although numbers of staff present on shifts were maintained, this was not linked to the dependency of people and some staff worked high numbers of hours in given weeks. The environment had some modifications to address risks, but risks from fire safety and Legionella prevention and control continued.

People did not consistently receive effective care. There was mixed evidence that people’s food and fluid provision was sufficient for their needs. There was improved recording of people’s fluid using the intake charts. Our observation showed that more offers of fluids were made to people, although there were some periods where people failed to pay attention and focussed on tasks instead. People with challenging behaviours, especially those with dementia diagnoses, posed the highest risk of malnutrition and dehydration. This was due to the increased difficulty in convincing them to consume food or fluids, their behaviour when they were provided with nutrition or hydration, and staff ability to use suitable or alternate ways of assisting the person.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

At the time of the inspection, there was no registered manager. The last registered manager left their position in April 2015. 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. A home manager commenced in post in April 2015 and had applied to become the registered person.

Our inspection was brought forward from the scheduled date because of increasing concerns from a number of external agencies. We received information from other organisations telling us that people had been harmed or were at risk of harm. We had already been in liaison with police and local authorities to ensure protection of people who lived at Sandridge House.

The last inspection was conducted on 7 October 2014 under the 2010 Regulations. At the last inspection, we checked that the provider had completed actions to make improvements to obtaining people’s consent, cleanliness of the premises, reducing risks from the building and quality assurance. The provider demonstrated that they had achieved compliance with the regulations. The current inspection was unannounced and occurred over two days on 2 December and 3 December 2015.

People we spoke with told us they felt safe living at Sandridge House. People were not always safeguarded from abuse and neglect at Sandridge House though. When we questioned staff, they demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. However, not all staff had received regular safeguarding training to ensure their knowledge was current. When the provider had investigations carried out by the local authority following reported allegations of abuse or neglect, they did not take satisfactory steps to prevent recurrence or learn from the experience. The provider did not notify safeguarding events to the CQC as required by law.

A number of professionals who visited the care home or were involved because of people’s care arrangements expressed their concerns regarding the standard and quality of care at Sandridge House. They also told us they were concerned about the lack of leadership, the use of agency staff and the absence of a large number of quality monitoring processes. Other agencies had increased their monitoring of the service and required the service to keep in regular contact so that people’s safety was not further compromised.

Staff handling medications had not received satisfactory training or competency assessment to support them with this role. Appropriate protocols were not in place for the administration of ‘as required’ medicines. The location had ordered and overstocked too many medications, leading to wastage. Some documentation was not undertaken in line with standard practice.

Some staff had not received important training in topics like fire safety, chemical safety and health and safety. This meant people were at risk of receiving care from staff that did not have the required knowledge of how to provide assistance. Staff had also not participated in regular reviews of their performance with supervisors. Areas for staff improvement had not been discussed with individual team members.

People’s privacy was maintained and they were treated with dignity. There was evidence that some staff provided genuine compassion and kindness, especially the activities coordinators. On the whole however, people were not afforded the opportunity to regularly participate in the running of the service. Although there were ‘residents’ meetings held, people had little or no input into the management of the care home. They felt that when they did get to have a say, their opinion was not taken into account by the provider.

People’s care plans and risk assessments required significant improvement to provide the best care for them. We found examples where the construction of the care documentation was not followed through to ensure gaps had not developed in the planning. Some people and relatives told us they had been involved in the creation of their care plans, and other people said they did not know about them. The staff had commenced rewriting care plans and the content after revision was improved.

We found people’s care was task-focussed and not person centred. We observed people taken to communal lounge or dining room fell asleep without staff present. Some people’s care was ignored when they were not present in communal environments. For example, we saw people sitting by themselves and in their bedrooms where less attention by staff was paid. At meal times, people were taken to the dining room and had sufficient to eat and drink, but it was not a sociable environment.

Staff were concerned about the leadership and management of Sandridge House. They appreciated the home manager assisting with people’s care. However, staff told us they were not satisfied with the standard of leadership from the home manager. We found that there was not a strong system in place for monitoring, auditing and driving improvements in the quality of care. Some audits and action plans were completed, but the risks were not properly assessed, reviewed, recorded or acted upon by the provider.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

At the time of the inspection, there was no 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. The last registered manager left their position in April 2015. A home manager commenced in post in April 2015 and had applied to CQC to become the registered manager. At the inspection the staff member told us they had resigned from their post and would finish in their role as home manager in one month’s time.

The previous inspection of Sandridge House occurred on 2 December and 3 December 2015. At that inspection, there were eight breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The location was rated ’inadequate’ overall and placed into 'special measures'. We inspected the service again on 6 January 2016 following information of concern from other organisations following the December 2015 inspection.

This inspection was carried out in response to further information of concern that we had received which indicated that people at Sandridge House were still at risk of harm due to failure to make necessary improvements or that the care people received continued to remain unsafe. The inspection by us on 7 and 8 February 2016 was necessary to again assess the safety of people's care.

We found that some improvements had been made in relation to the documentation used to record the fluids and food people living at the home received. However, these were not consistent. During the inspection visit we saw fluid charts which weren’t tallied up and staff we spoke with were unsure of how much fluid people should be drinking. Therefore, they were unsure when to alert senior staff that someone was not drinking enough fluids.

We were concerned about the providers understanding of risk management in regards to recording people’s fluid intake. Staff told us they had been told to record what every person in the home ate and drank. Rather than recording this information for people who had been assessed to be at risk of dehydration or malnutrition. This had led to staff spending a lot of their time completing records for people that did not need them. Staff told us they resented having to spend their time completing records as opposed to providing care and support for people.

We also witnessed unsafe practice in regards to one person being fed by staff whilst they were in a position, which was not safe for eating or drinking. The person was at risk of choking due to the position they were in. We needed to ask the deputy manager to intervene to ensure this person received their food safely.

During the inspection we found that staffing numbers were adequate to meet the needs of the people living in the home However, we found that one member of staff had not received an adequate induction. We could not be assured that the care that they had been providing to people at the home had been safe care due to them not receiving adequate training.

At this inspection, we found that improvements had been made to the storage of chemicals used in the home. These were safely locked away. Improvements had also been made in the area of Infection prevention and control. At this inspection, we found the commencement of changes by the provider to ensure people’s safety from infections. We saw a new dirty utility room had been built on the first floor. However, further changes needed to be implemented to ensure people were fully protected from the risks of infection control.

During this inspection we found that although the provider was taking action to achieve safety for people who used the service, the progress was slower than needed to properly protect people.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

As part of this inspection we spoke with the provider, the registered manager, four nursing and care staff, the handyman and the laundry person. We inspected the premises and looked at records related to the building, maintenance and infection control. We also reviewed records related to the management of the home which included four care plans, consent records, audits, and managerial documents.

Below is a summary of what we found. The summary describes what we were told, what

we observed and the records we looked at.

Is the service responsive?

The service had a robust system to assess people's capacity to make decisions about their care and treatment. New documentation had been introduced which described when and in what circumstances individuals could make decisions and where other parties held a legal authority to make decisions on behalf of people living in the service.

The majority of staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards with the remainder of staff scheduled to attend training in the near future.

Is the service safe?

The provider had introduced a range of processes to ensure that the prevention of infection within the home was robust. There was now a documented deep cleaning rota which was signed when completed. The laundry area had been refurbished and the kitchen was due for complete renewal. The fire warning system had been upgraded and all recommendations from previous reports had been addressed.

Is the service well-led?

The provider had strengthened the system for auditing care plans to ensure that changes were recorded without undue delay. The management systems for ensuring the health and safety of staff and people using the service had been improved. However, there were still some areas such as risk assessments in relation to the operation of the home which required implementation and clarification to ensure that staff understood why they were undertaking testing and checks for health and safety matters.

Formal meetings for relatives and people using the service had been introduced and there was a more robust system of analysing and acting upon feedback. All accidents and incidents were regularly reviewed by the manager to ensure that any patterns were identified to prevent reoccurrence.

The provider undertook to ensure that the appointment of a competent person as required by the Management of Health and Safety at Work Regulations 1999 was undertaken without delay.

As part of this inspection we spoke with three people who use the service, two relatives, the registered manager, the provider's representative, the operations manager, five care staff and three registered nurses , the handyperson, one cleaner and two local authorities , including commissioners, care managers and safeguarding teams. We inspected the premises and looked at records related to the building, maintenance and infection control. We also reviewed records related to the management of the home which included four care plans, daily care records, audits, and managerial documents.

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.

Is the service safe?

People said they felt safe and were complimentary about the care they received, although we found they were at risk from issues related to the premises and infection prevention and control. Regular reviews of people's care had occurred and staff were knowledgeable about the care they provided to people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was not aware of a recent Supreme Court judgement relating to 'deprivation of liberty' but began immediate discussions with senior management regarding the implications, when notified of this during the inspection.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from speaking with staff that they understood people's care and support needs and that they knew them well. However, the provider did not ensure people's consent was correctly obtained for particular decisions. The provider did not comply with the provisions of the Mental Capacity Act 2005 (MCA) and failed to ensure that, where necessary, best interest decision making was in place for some people who use the service.

Is the service caring?

People told us that staff who helped them were caring. We saw people were supported by kind and attentive staff. We saw staff were ready to assist people when they needed and did not rush them with personal tasks like eating, drinking or mobilising.

Is the service responsive?

People's needs had been assessed before they received care. Risk assessments and care plans were completed but required some improvements identified by the registered manager's audits. We saw that when a person needed immediate assistance, it was offered to ensure their safety.

Is the service well-led?

Care workers were clear about their roles and responsibilities. Although the registered manager and operations manager had effective oversight of the quality of care and the safety of people, risks needed to be better identified, assessed and managed. People who use the service, relatives and staff were listened to but improvements were required to ensure people were not placed at risk of poor care outcomes.

People told us they were asked for their consent before they received care. We saw staff communicated clearly before delivering care to ensure people consented to the care they received. People with dementia who had difficulties retaining information were provided with visual choices at lunch to help them decide what meals they wanted. People who use the service and their relatives were complimentary about staff and the care they received. One person said "I was in hospital and it was agreed that I would require long term care, I agreed to come here and I am pleased that I made that decision."

The service did not follow the provider's policy on how to meet requirements of the Mental Capacity Act (2005). The service was not effectively assessing people's capacity to consent to decisions about their care and treatment.

The service planned people's care and treatment based on their individual needs. Care records were up to date and detailed. Other tools used to monitor and deliver people's care were used appropriately.

We saw the service had policies and procedures on safeguarding vulnerable adults. Staff were aware of where to access information on safeguarding and whistleblowing if they needed to raise a concern. Staff had received training in safeguarding adults and the Mental Capacity Act 2005.

We saw staff had received training relevant to the needs of people who use the service. Staff told us they felt supported by the service and were enabled to meet people's needs. Staff received annual appraisals and had supervision sessions.

There was an individual record of care for people who use the service. However some important information regarding people's care and treatment was not recorded.

A relative of someone who lives at this care home told us "Mum is looked after very well". A member of staff at the home said she would be "very happy for her mum to be here." One person who lives at the home told us "staff look after me very well." Another told us that staff were very busy but always came to help when he used his call bell.