The Sandford Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 1 breach of the legal regulations. Staff did not always work in accordance with the Mental Capacity Act (MCA) 2005 to ensure people’s rights were respected. People felt listened to however they were not always involved in planning or reviewing the care they received. Care plans were not always fully reflective of people’s needs and had not been regularly reviewed. People were supported to access healthcare services in accordance with their needs. People received food and drink which met their needs and preferences.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt listened to however they were unable to tell us how they were involved in planning or reviewing the care and support they received. People’s care plans did not demonstrate they had been involved in this process.

Staff knew people well and what level of support they required. However, they were unable to tell us how they involved people in planning and reviewing the care and support they received.

Each person had a care plan which was personal to them. However, some care plans had not been updated to reflect people’s needs and had not been regularly reviewed. The registered manager explained they were in the process of reviewing care plans and changing to an electronic system. However, not having up to date information about people’s needs could increase the risk of people not receiving the support they needed.

People told us they enjoyed the meals at the home and had plenty to eat and drink. One person said, “The meals are lovely and there are lots of choices. I’m sure I eat too much.” The mealtime experience was relaxed and sociable and people were offered a choice of meals. Condiments and a choice of drinks including wine were available. Modified diets such as soft or pureed meals had been attractively presented. Staff were available to support people who required assistance to eat and drink.

Staff knew people well and told us about people’s dietary needs and preferences. Staff told us any concerns about people’s food and fluid intake were recorded in their care plans and discussed with the nurses on duty.

People’s eating and drinking needs were assessed when they moved to the home. Where risks were identified, a plan of care was in place to manage and mitigate known risks. These included risks associated with choking and weight loss. However, these were not always regularly reviewed. We looked at the care plans for people who required their fluid intake to be monitored. Although staff were recording the amount people had drunk, there was no information about the recommended daily intake so it was not clear how care staff would know when to alert the nurses. We discussed this with the registered manager who assured us records would be updated to include the recommended fluid intake for people. Records showed referrals had been made to healthcare professionals where concerns were identified regarding weight loss. In addition to risks associated with eating and drinking, recognised tools were used to assess risks relating to pressure damage to the skin, moving and handling and oral healthcare. The home followed the Care to Smile programme which is a locally developed NHS programme based on the National Institute for Health and Care Excellence (NICE) guidance which aims to improve the oral health of people who live in care homes.

People told us they felt well supported by the staff team and could access healthcare professionals when needed. One person said, “The doctor sees me regularly and the nurses will get the doctor straight away if I’m not well.”

Staff told us they did not experience any difficulties in accessing health care for the people they supported. A healthcare professional from the local GP surgery visited the home each week.

We received mixed feedback from professionals involved in the home. Some felt communications needed to improve to provide better outcomes for people. Others said communications were good and the service worked well with them.

Staff recorded the outcome of any visits from external professionals in people’s care records. However, care plans had not always been updated or put in place to reflect recommendations made. For example, one person had been seen by a healthcare professional regarding their mental health and there was no care plan in place to guide staff about how to support the person.

People were supported to see healthcare professionals when they needed.

Staff told us they did not experience any difficulties in accessing health care professionals to meet people’s needs.

Staff recorded the outcome of people’s contact with healthcare professionals in their individual care records. Records showed people accessed a range of services to meet their individual needs.

People were not always involved in reviewing the care and support they received. People’s care plans and risk assessments had not been reviewed for several months.

The registered manager told us they were currently in the process of moving from paper-based care plans to an electronic system and would ensure that care records were up to date and reflective of people’s needs and would involve people in the process.

Staff recorded information about people at the end of every shift however this information focused on the tasks performed rather than more detailed information about the persons health, mood, well-being. This level of information would enable staff and visiting professionals to more effectively review the effectiveness of the care delivered. Care plans had not always been reviewed on a regular basis. Health care professionals visited the home each week to monitor people’s healthcare needs.

Staff did not always follow the principles of the Mental Capacity Act 2005 to ensure people’s rights were respected. However, people told us there were no restrictions on them and staff respected their wishes. One person said, “I prefer to stay in my room and the staff respect that. They [staff] have never forced me to do anything.” Another person told us, “The staff are respectful, and I have no worries.”

Staff understood the importance of ensuring people’s rights were respected. They understood people’s rights under the Mental Capacity Act (MCA) 2005, however they did not always follow the principles of the MCA.

Deprivation of Liberty (DoLS) authorisations were in place for people who required this level of support to keep them safe and meet their needs. However, where these authorisations were not in place, assessments of people’s mental capacity to consent to their care and treatment and to make certain decisions had not always been completed and there was no evidence that discussions had taken place to ensure any decisions were made in the person’s best interests. This included decisions around the use of bedrails, sensor mats, remaining at the home and lifesaving treatment. Staff had been trained in the principles of the MCA and understood the importance of ensuring people's rights were respected however, they did not always follow the principles of the MCA.