Archived: Sanderstead Care Centre Limited Also known as Sanderstead Care Centre

Sanderstead Care Centre is a residential care home providing accommodation for persons who require nursing or personal care to 19 older people many of whom live with dementia. The service can support up to 44 people.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We found systems and processes used to ensure the service was safe and effective failed to meet the required standards. We observed a lack of leadership, direction and oversight. Governance arrangements and quality assurance auditing systems were in place but not used effectively. The service was not well-led.

While we did not identify any direct impact on people, however people were at risk of harm as risks were not adequately assessed and there was an absence of key care planning documentation.

Communal areas of the home were in need of redecoration, refurbishment and regular maintenance.

People were not supported to have maximum choice and control of their lives.

Incidents and accidents were reviewed and reported to ensure lessons were learnt to drive improvements. However, lessons were not cascaded to staff. This was confirmed by the provider and by staff.

We were assured people were protected from the risk and spread of infection.

Systems in place to safeguard people from abuse were effectively implemented.

People were supported by staff appropriately as far as it was possible during the COVID-19 pandemic restrictions.

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 requires improvement (published 20 April 2021).

Why we inspected

The inspection was prompted because we received information of concern from visiting professionals about the environment and the care and support people were receiving. A decision was made for us to inspect and examine those risks. As a result, we undertook a comprehensive inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. We have found evidence the provider needs to make improvements.

Following on from this inspection the provider submitted a formal application to the Care Quality Commission to close the location.

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.

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

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 monitor the service 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 safe care and treatment, premises, consent, staffing and good governance at this inspection.

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.

Special Measures

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 six 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 of 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.

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

Risk assessment processes were either not in place or not robust enough to demonstrate safety was effectively managed. This placed people at potential risk of harm. This was a continued breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks identified at our previous inspection regarding medicines management had been addressed and medicines were stored, managed and administered safely.

The provider had appropriate recruitment policy and procedures to ensure staff they recruited were safe to work with people. This included criminal record checks and references from previous employers.

People felt safe at the service. They told us they were well cared for by staff. Staff were aware of safeguarding adults’ procedures and had received regular training on this topic.

The manager had strengthened their quality assurance processes in response to our last inspection, including implementing a more detailed medicines management audit.

People and staff felt well informed and involved in service delivery. They said there was open communication between themselves and with the managers. They felt comfortable expressing their views and felt listened to. The manager was clear about their role, including their CQC registration requirements. Statutory notifications about key events that occurred had been submitted, their latest CQC rating was clearly displayed and the manager was aware of and adhering to the duty of candour.

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 requires improvement (published 22 July 2020). The service remains rated requires improvement.

Why we inspected

At our last inspection in February 2020 we found breaches of Regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulations 2014). The provider completed an action plan after the last inspection to show what they would do to improve and when they would do it. At this inspection we found improvements had been made in most areas. However we found that systems were either not in place or not robust enough to demonstrate safety was effectively managed. This placed people at potential risk of harm. This was a continued breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check they had followed their action plan and to confirm they met legal requirements. As well as to follow up on the other concerns identified through the intelligence we had received. This report only covers our findings in relation to the key questions Safe and Well-led.

The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion but were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Sanderstead Care Centre is a residential care home providing personal and nursing care to 21 people at the time of the inspection. The service can normally support up to 42 people over three floors in one adapted building, but at the time of the inspection part of the home was closed for refurbishment and its capacity was reduced.

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

People were not always safe from avoidable harm because risks were not always managed well. Staff did not always follow risk management plans and some equipment designed to reduce the risk of people developing pressure ulcers was not being used effectively. People did not always have call bells within their reach. Medicines were not always managed safely because there was not always enough information about medicines prescribed to be taken only when needed, records were incomplete and some stock records were inaccurate. The provider did not always adhere to safe recruitment practices and some staff were working without all of the necessary recruitment checks having been made.

The provider did not always comply with their legal duty to notify us of incidents where alleged or suspected abuse took place between people who used the service. Quality assurance checks were not always effective as they did not identify all the issues we found, for example with medicines management.

Staff generally treated people with respect, but occasionally omitted to explain to people what they were about to do while carrying out care tasks so there was a risk of people feeling disempowered. We also found care plans were not always as personalised as they could be, which could also contribute to this risk as people may not always be able to express their preferences to staff.

We have made two recommendations about researching person-centred care and how to improve the quality of interactions between staff and people.

The provider carried out checks to make sure the home environment was safe and staff knew how to protect people from the spread of infection. There were enough staff to care for people safely. The provider recorded and dealt with incidents appropriately. There were systems in place to protect people from the risk of abuse.

The provider was in the process of refurbishing the home and had made improvements to adapt the environment better to people’s needs. People’s needs were assessed in line with current guidance. Staff worked alongside healthcare providers to support people to keep healthy, maintain a healthy weight and eat and drink enough, although the variety of food was not always good for people who needed a pureed diet. Staff received appropriate training and support, and there were opportunities for them to develop their skills. The provider obtained people’s consent before carrying out care and treatment, or if people were unable to consent the provider followed the correct legal processes to make sure decisions made on their behalf were in their best interests. 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.

Staff developed good relationships with people and created a friendly atmosphere in the home. They supported people to express their views and make choices about their care. Staff respected and promoted people’s privacy, dignity and independence.

Care plans contained information about people’s care and support needs. The provider had improved these since our last inspection and had carried out work to ensure staff were well equipped to provide good quality care to people at the end of their lives. There was a variety of activities on offer and we received mixed feedback about these but the registered manager was in the process of taking steps to improve this. People received information in suitable formats and there was an appropriate process in place for responding to complaints.

The provider promoted a positive culture and staff worked well as a team and with other providers. There was visible leadership and the registered manager was supportive and approachable. The provider attempted to engage people and their relatives and involve them in the running of the service, and was looking at how they could do this better.

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 requires improvement (published 12 March 2019) and we found two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had not made sufficient improvements and was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, staff recruitment and notification of incidents. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the provider was in breach of the regulation in relation to safe care and treatment. This was because medicines were not always managed safely and some risk assessments were missing information. Stocks of medicines did not always correspond with what was recorded. We found some risk management plans did not contain important information about how to respond to people presenting aggressive or threatening behaviour.

The provider was also in breach of the regulation in relation to notifying the Care Quality Commission of any outcome of an application to deprive a person of their liberty and to notify us of any abuse or allegation of abuse. Since the inspection, the provider has submitted notifications to us. However, the provider remains in breach of this regulation because they need to demonstrate compliance with this regulation over a period of time.

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

People felt safe using the service and staff were aware of the service’s policy and procedures on safeguarding people from abuse. Risks to people’s safety were mostly managed appropriately, including risk of falling, developing pressure ulcers and risks relating to use of mobility equipment. The service had appropriate measures in place to deal with emergencies including fire and medical emergencies. Maintenance staff made sure the premises were safe by carrying out regular checks and minor repairs. The home was clean and there were systems to prevent the spread of infection.

The provider had systems to monitor accidents and incidents. We found evidence the registered manager took appropriate action in response to accidents and incidents.

Medicines were stored safely. There was appropriate guidance for staff about using medicines that did not require prescriptions. People who had medicines to take only when required had instructions for staff about when to give it, although these sometimes lacked details such as how to tell if a person was in pain.

The provider was in the process of refurbishing the home. Some areas looked fresh and pleasant but others still needed to be refurbished. The service was fully wheelchair accessible but did not have dementia-friendly features such as signage or contrasting colours. We recommend that the provider incorporates best practice guidance about providing a dementia-friendly environment into their ongoing plans for refurbishing the premises.

The registered manager made sure they kept up to date with current research and best practice and passed this on to staff. Some staff were qualified to train their colleagues and staff received a variety of training and supervision to ensure they had the support, skills and knowledge to carry out their roles effectively.

People had their needs assessed in line with current guidance and staff involved healthcare professionals in developing care plans to meet people’s healthcare needs. People were able to access healthcare services when they needed to. People’s nutritional needs were met and they had access to a variety of healthy, culturally appropriate foods. They received the support they needed to eat and drink although sometimes people had to wait a long time in the dining room before receiving their meals.

Staff obtained people’s consent before providing care and where this was not possible they acted in line with the Mental Capacity Act (2005) to provide care that was in people’s best interests. This included where people were deemed to have been deprived of their liberty.

People received care from staff who were kind and empathetic and took time to get to know them. Staff made sure people had the information they needed to make choices about their care and adjusted their style of communication to fit different people’s needs and abilities. Staff provided care in ways that promoted people’s dignity and independence and respected their privacy. Confidential information was kept securely at all times.

People had care plans that contained information about the support they needed. Some people had information missing about how staff could tell if they were becoming unwell. There was a risk that staff who did not know the people well would not know how to respond. However, there was person-centred information about how to support people according to their preferences. People were involved in planning their care.

Some people felt activities could be more varied or better tailored to their interests. However, we saw people enjoying several activity sessions. Staff took steps to protect people from the risk of social isolation and people’s religious and cultural needs were met.

The service had a robust complaints procedure and people felt confident raising any issues they had around their care and support. Staff listened to people and responded quickly to any minor concerns.

We received positive feedback about the registered manager, who was well liked by people and staff. The manager worked to promote a person-centred and inclusive culture within the home. People, relatives and staff had opportunities to feed back their opinions about the service. Their suggestions were incorporated into the provider’s plans for improving the service.

The provider used a number of audit tools to check the quality of the service. These were effective in identifying areas for improvement. Because these were only identified recently and because this was the service’s first inspection under the current provider we could not easily check if the provider’s systems were effective in terms of taking prompt action and driving improvement. We will check this at our next inspection.