Sandygate Residential Care Home

Sandygate is a residential care home providing personal care for up to 54 people. At the time of our inspection there were 45 people using the service. Some people were living with dementia.

People’s experience of the service and what we found:

People were safeguarded from the risk of abuse. Staff knew how to report and recognise concerns and felt confident the management team would take appropriate actions to keep people safe.

Risks associated with people's care were identified and actions taken to mitigate risks. Health and safety checks on the building were carried out in line with current expectations.

Accidents and incidents were analysed to ensure future incidents were mitigated. People received their medicines as prescribed.

We carried out a tour of the home with the deputy manager. We identified a couple of minor issues which were rectified during the inspection. The home was otherwise clean and well maintained.

The provider had a robust system in place to ensure staff were recruited safely and were suitable for the post they had applied for. There were sufficient staff available to meet people's needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Systems to monitor the service were in place and had identified any issues. Action plans had been devised to address any concerns and to improve the service.

People were involved in the service and an annual survey was sent out to relatives. The outcome of feedback was discussed in meetings and displayed as 'you said, we did.'

People received person centred care which met their needs. We observed staff interacting with people throughout the day and found they were kind, caring and offered choices.

The provider worked in partnership with other professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (28 September 2018).

Why we inspected

For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Sandygate on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had a process in place to enable relatives to visit their family members in a safe way by using a pod. Visitors were required to have their temperature taken outside of the home and fill out a form to ensure they are not showing any symptoms of illness. The home also facilitated window visits, phone calls, skype, email and video calls, to ensure people were able to communicate with their family and friends.

Social distancing was observed as far as it was practicable to do so. Staff wore appropriate PPE, regularly washed their hands and applied hand sanitiser. Staff had completed training in infection control, COVID-19 and donning and doffing PPE.

Staff and people using the service took part in the home’s testing programme. Appropriate actions were taken if anyone tested positive for COVID-19.

Staff had access to the provider’s well-being website, which can signpost staff to confidential advice and support including a counselling service and also a hardship fund. The chaplain service offered confidential support to both staff and people using the service.

The home was clean and there were no malodours. Staff had access to cleaning products and the cleaning of high touch areas such as door handles and hand rails, were cleaned regularly. Furniture throughout the service had been discreetly positioned to promote social distancing.

We were assured that this service met good infection prevention and control guidelines.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, caring, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

At this inspection we checked if improvements had been made. We found that the registered provider had addressed all the concerns raised at our last inspection and the rating of the service improved to Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Sandygate Residential Care Home’ on our website at www.cqc.org.uk.

Sandygate Residential Care Home 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.

Sandygate Residential Care Home is a purpose built care home located on the outskirts of Wath upon Dearne. The home provides accommodation for up to 54 people on two floors. The care provided is for people who have needs associated with those of older people, this includes a dedicated unit for people living with dementia. At the time of our inspection 49 people were using the service.

At the time of our inspection 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to safeguard people from abuse. Staff confirmed they had received training in this subject and knew what action to take if they suspected abuse.

Risks associated with people’s care were identified and managed effectively. Risk assessments were in place which detailed how risks could be minimised.

We observed staff interacting with people who used the service and we found there were enough staff to meet the needs of people in a timely way. However, during our inspection some people told us that there were occasions where there were not enough staff available to meet people’s needs.

We looked at systems in place to manage medicines and found they were stored and administered in a safe way.

The service was clean and well maintained. Some areas identified on inspection required attention and we discussed them with the registered manager. We were told that these issues were already in the process of being addressed.

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. The service was compliant with the Mental Capacity Act 2005.

Staff received training and support to carry out their role and they knew their responsibilities.

People were supported to maintain a balanced diet which met their needs and was in line with their preferences. Snacks and drinks were available throughout the day and were easy accessible.

People had access to healthcare professionals when required and their advice was taken seriously and documented within the care plans.

We observed staff interacting with people who used the service and found they were kind and caring in nature. People’s privacy and dignity were respected.

People received person centred care which was in line with their current needs and preferences.

The registered provider had a complaints procedure which was displayed in the home. People we spoke with felt able to raise concerns if they needed to.

The registered provider had a system in place to ensure the service was monitored and actions taken when concerns were identified. People had a voice and were involved in meetings about the home and were asked to complete an annual questionnaire. People we spoke with told us the management team were approachable and supportive.

Further information is in the detailed findings below.

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

Sandygate can accommodate up to 54 people. At the time of our inspection 49 people were using the service.

At the time of our inspection the service did not have 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of our inspection the home had a manager in post who had commenced their employment at the service in November 2017. The manager was not registered with Care Quality Commission, but had commenced the registration process.

We found risks had been identified and measures put in pace to manage the risk. However, we found the risks were not always managed so people were at risk of harm. We found risk assessments did not always contain enough detail to help prevent the risk occurring. This showed the registered provider was not doing all that was reasonably practicable to mitigate risks associated with people’s care and treatment.

The registered provider did not always ensure that safe arrangements were in place for managing medicines. We found people were prescribed medication to be taken as and when required known as PRN (as required) medicine. However, whilst protocols were in place to guide staff in how these should be administered, they lacked detail of what signs to be aware of prior to administering them. The temperature of the room upstairs, which was used to store medicines was not monitored or recorded to determine that they maintained the required temperatures. We also saw that eye creams and ointments were not always dated when opened. These medicines required disposal after four weeks of being opened.

We found some areas of the home were not kept clean and infection prevention and control policies were not adhered to. For example, store rooms were not always well organised. Some had items stored on the floor, which meant they were difficult to clean. One sluice area had shelves which were showing bare wood and therefore making them difficult to clean.

We observed staff interaction with people who used the service and found there was enough staff available to meet people’s needs in a timely manner. Staff we spoke with felt they worked well as a team and had enough staff working with them to support people appropriately.

Staff had received training to give them the knowledge and skills to carry out their roles and responsibilities. However, some staff had not received appropriate support, supervision and appraisal in line with the registered provider’s policy.

Staff were aware of how to report safeguarding concerns and use the whistle blowing policy if required.

Decisions made where people lacked capacity did not always follow best practice and did not evidence decisions were made in a person’s best interest. This did not meet the requirements of the Mental Capacity Act 2005.

People who used the service received appropriate support to eat and drink sufficient amounts to maintain a healthy and balanced diet. Meals we observed looked appetising and well presented. However, we observed lunch on the first day in both dining rooms and found the people living on the upstairs unit had a better experience than those on the downstairs unit. This was due to many people requiring assistance and staff not being able to provide this support to everyone at the same time.

People who used the service had access to health care professionals as required. However, advice given by health care professionals was not always followed appropriately.

Staff interacted well with people who used the service and were caring in nature. The home had a calm and relaxed atmosphere and staff and people had a good relationship. Staff respected people’s privacy and dignity.

We found people did not always receive care that was responsive to their needs. Care plans we looked at contradicted each other and were not always followed in line with peoples current needs.

All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with the manager or any of the staff.

We found that there had been a lack of consistent managers and a lack of provider oversight and governance which had contributed to the decline of the service. Audits in place to monitor the quality of service provision did not always take place in line with the registered provider’s policy. Where audits had taken place they were not effective and did not always identify the concerns we had raised as part of this inspection. Some concerns were highlighted as part of the audit process but there was no evidence that sufficient action had taken place to correct them.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; Person-centred care, Regulation 11; Need for consent, Regulation 12; Safe care and treatment, and Regulation 17; Good governance. You can

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Sandygate Residential Home’ on our website at www.cqc.org.uk’

Sandygate Residential Home is a purpose built care home located on the outskirts of Wath Upon Dearne. The home provides accommodation for up to 54 people on two floors, a lift is available to access the first floor and all rooms have en-suite facilities. The care provided is for people who have needs associated with those of older people, this includes a dedicated unit for people living with dementia.

The service did not have 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 and associated Regulations about how the service is run. However, a registered manager from one of the company’s other homes was overseeing the home and a new manager had been appointed the week before our visit.

We found people were cared for by a stable staff team who knew them well. We saw staff encouraged people to be as independent as they were able to be and spoke with them in a friendly and respectful way.

People who used the service, and the visitors we spoke with, told us that overall they were happy with how care and support was provided at the home. They spoke positively about how staff delivered their care, but the majority of the people we spoke with raised concerns regarding the number of staff on duty, especially on the upstairs unit. They told us they felt this sometimes affected the timeliness of the care provision. We saw action was being taken to address this.

Systems were in place to make sure people received their medications safely, which included key staff receiving medication training. However, new monitoring checks needed embedding to ensure medication was administered correctly.

People we spoke with felt the home was a safe place for people to live and work. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified any potential risks to people and plans were in place to ensure people’s safety.

The recruitment system helped the employer make safer recruitment decisions when employing new staff. Staff had received a structured induction into how the home operated, and their job role, at the beginning of their employment. Following this they had access to a varied training programme that met the needs of the people using the service.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The people we spoke with said they were happy with the meals provided, but we saw the overall dining experience could be better.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s needs had been assessed before they went to stay at the home and we found they, and their relatives, had been involved in planning their care. Care files checked reflected people’s needs and preferences so staff had clear guidance on how to care for them.

People had access to activities which provided regular in-house stimulation, as well as trips out into the community. People told us they enjoyed the activities they took part in.

There was a system in place to tell people how to make a complaint and how it would be managed. We saw the complaints policy was easily available to people using and visiting the service. When concerns had been raised they had been investigated and resolved in a timely manner.

There were systems in place to monitor and improve the quality of the service provided. However, there had been some delay in the provider highlighting shortfalls such as staff appraisals and support meetings, as well as people’s care reviews not being completed in line with the company policy. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People's needs were assessed and care and treatment had been planned and delivered as they preferred. A relative told us, 'They put my mind at ease straight away. If you ask for anything it is done straight away.'

People were provided with a choice of suitable and nutritious food and drink. They told us they enjoyed the meals they received and said they provided variety and choice.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to become knowledgeable about abuse and how concerns should be handled.

We saw there were effective systems in place to reduce the risk and spread of infection.

The premise was in a good state of repair. People said they were very happy with their rooms and the home's general facilities.

We found there was enough qualified, skilled and experienced staff to meet people's needs. People said they received the care and support they needed in a timely manner. One person told us, 'I am very happy here, the staff are excellent.'

We saw records were accurate and fit for purpose. They were kept securely and could be located promptly when needed.