Archived: Sandy Lane Hotel

Sandy Lane Hotel is a residential care home providing personal care for up to 31 people. At the time of the inspection, 23 people were using the service. The service has 3 floors which can be accessed by a lift.

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

The provider had failed to make the required improvements to the safety and quality of the service. Governance systems in place were ineffective at identifying shortfalls and failed to support sufficient improvements.

People did not always receive their medicines as prescribed and processes were not followed to ensure people’s medicines were in date and safe to administer. Risks to people’s safety and wellbeing were not effectively assessed and mitigated and there was a lack of oversight to ensure people’s care was delivered in line with their care plans. Some equipment and areas of the service could not be appropriately cleaned and were not clean during the inspection.

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 expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. Staff did not have relevant training to meet the needs of people with a learning disability or autistic people.

People received appropriate support to eat and drink and specialised diets were catered for. Though records did not show regular monitoring and oversight of the support people received with meals and drinks to manage risks of malnutrition and dehydration.

People and their relatives were positive about the staff and the care provided. Communication with people’s relatives and relevant healthcare professionals had improved whilst the new management team were in post. Feedback about the delivery of the service had started to be gathered and used to make some changes.

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 inadequate (published 12 August 2022). The service remains rated inadequate. This service has been rated inadequate for the last 3 consecutive inspections.

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 addressed the breach of regulation regarding staff recruitment, but they remained in breach of regulations 9 (Person-centred care), 12 (Safe care and treatment) and 17 (Good governance).

At our last inspection we recommended that the provider reviewed their training procedures to ensure staff had the appropriate training to support people. At this inspection we found the provider had not acted on the recommendation and was in breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We carried out an unannounced focused inspection of this service on 15 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, safe care and treatment and good governance.

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection regarding fit and proper persons employed, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed and remains inadequate. This is based on the findings at this inspection.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sandy Lane Hotel on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, risk management, infection prevention and control, mental capacity, staff training, person-centred care and governance at this inspection.

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.

Since the last inspection we recognised that the provider had failed to notify CQC of all notifiable incidents. This was a breach of regulation 18(2) of the Care Quality Commission (Registration) Regulations 2009.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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 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.

Sandy Lane Hotel is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 31 people. The building has three floors and a lift which operates between all levels.

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

People were not receiving a service that provided them with safe, effective, high-quality care. Although some improvements had been made since the last inspection in relation to fire safety and staffing, not enough improvements had been made in other areas and the provider remained in breach of regulations.

People were not safe. Risks to people's health and safety had not been mitigated in a timely manner. This included risks in relation to window safety. The provider offered assurances after the inspection that the work to ensure windows were safe had been completed.

No improvements had been made in relation to recruitment of staff. The provider had failed to address systems and processes to ensure safe recruitment practices were implemented. Although some improvements were noted in relation to infection control and medicines, systems and processes had not been firmly established and we identified continued concerns in these areas.

The provider had started to make improvements to staffing and had implemented a dependency tool since the last inspection; however, staff were not always deployed in line with this. We have made a recommendation about this.

People were happy with the quality of the food they received. However, work was required to improve the mealtime experience.

Governance systems were not robust. The oversight of the service was not always effective and had not identified the issues we found at this inspection. The provider had recently employed a consultant to make improvements to the service. We received mixed feedback about the management team, some staff felt the management team were not approachable.

Although we identified some improvements in relation to the provision of person-centred care. There continued to be a lack of activities to provide people with stimulation and ensure people received person centred care.

Improvements had been made to support staff, this including now receiving training, supervision and appraisal in line with the providers policy. However, some training courses were not included as part of the providers mandatory training. We have made a recommendation about this.

People and their relatives were positive about the kind and caring nature of staff.

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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 December 2021)

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 remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well- led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to risk management, recruitment, person centred care and governance.

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 from the provider and will meet with them 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.

The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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 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.

Sandy Lane Hotel is a residential care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 31 people. The building has three floors and a lift which operated between all levels.

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

People were not receiving a service that provided them with safe, effective, high-quality care. Care and support were not tailored to meet people's specific needs. Care plans were not always in place and where they were, they were not personalised or contain information to inform staff of people’s preferences’ .

Risks to people were not always identified and managed. Recruitment of staff, infection control and medicines practices were not safe or robust.

Staff did not always receive effective training to support their role.

People’s dietary needs were not always recorded and records to monitor food and fluid intake required improvement. We have made a recommendation about this.

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 have made a recommendation about this.

Governance systems were not robust. The oversight of the service was not always effective and had not identified the issues we found at this inspection. People and their relatives gave positive feedback about the service.

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

Rating at last inspection

The last rating for this service was good (published 26 June 2018).

Why we inspected

We received concerns in relation to the management of medicines, staffing training and people's care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well- led sections of this full report.

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 discharge our regulatory enforcement functions required 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 safety, staffing, record keeping and oversight at this inspection. The provider was issued a warning notice.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 6 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 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.

Sandy Lane Hotel is a 'care home'. People 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. The service accommodates up to 31 older people who may be living with dementia. There were 24 people living at the service on the day of the inspection.

There was a registered manager employed at the service. 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.

Medicines were managed safely and in line with the company policy. Staff had received training and we saw checks had been completed to ensure staff were competent.

People told us they felt safe at the service. The service followed local safeguarding authority procedures in order to protect people and staff were trained accordingly.

Risks to people's health, safety and well being had been assessed. There were some minor issues around infection control which the registered manager addressed immediately. Where needed people were referred to healthcare professionals for support.

Accidents and Incidents had been recorded and analysed. Actions plans were in place where it had been identified that improvements or changes were needed to prevent reoccurrence of incidents.

There was sufficient staff on duty to meet people's needs. The recruitment process was robust. Staff were trained in subjects that enabled them to meet people's needs. Staff were supported through supervision, attended meetings with the management team and told us they enjoyed working at the service.

The environment was suitable for the needs of the people living there and had some positive dementia friendly areas. Communal areas displayed items for reminiscence and people's bedrooms had been personalised.

The provider had developed policies and procedures around equality and diversity to ensure a fair and equal service for all service users.

We observed some positive interactions between staff and people who used the service. Staff treated people with dignity and respect.

People had person centred care plans which reflected individual needs. We saw an activities programme displayed but people told us they would like to do more. People's sensory needs had been identified although this area could be developed further in line with the Accessible Information Standard.

People were aware of who they should talk to if they had a complaint.

There was a quality monitoring system in place with audits and checks of the service completed. The service had notified us of important events in a timely way.

The service is required to and did have a registered manager. A registered manager is a person who has registered with the CQC 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 registered manager is responsible for the day to day management of the home and was available throughout this inspection.

This inspection was unannounced and was carried out on 23 February 2017. The inspection was to check that the registered provider was now meeting legal requirements we had identified at the last inspection.

At the last inspection on 21 December 2015 we found the registered provider was in breach of five of the regulations we assessed. These were in relation to safe care and treatment, premises and equipment, staffing, good governance and non-notification of incidents. The registered provider sent us an action plan that contained information on how they intended to meet those regulations and achieve compliance, which was checked during this inspection. We found improvements had been made and this action had been completed for three of these breaches.

We found that the service had not taken sufficient actions in relation to infection control practices, medicine practices and monitoring and improving the quality of the service and continued to be in breach of Regulations 12, safe care and treatment and 17, good governance.

We found that people's medicines were not always managed safely, we saw gaps in the recording of some people’s medicine records and one person’s controlled drug had not been booked into the service. In one bathroom cupboard we found used hairbrushes and razors, soap and topical creams.

Staff were aware of people's care needs but people's records did not always clearly reflect these. Some documentation was old and had not been reviewed or updated consistently, this included risk assessments, fluid charts, moving and handling assessments and personal emergency evacuation plans (PEEPs). Although there were some audits in place these had not picked up the shortfalls and the inconstancies of the recordings in the care plans, infection control and medicine practices, therefore they were ineffective at driving improvements.

There had been many improvements to the environment since the last inspection. All the accommodation on the ground floor had been damp proofed, communal rooms and some bedrooms had been re-decorated and new carpets had been laid. On the first floor some bedrooms had been re-decorated and new vinyl flooring and carpets had been laid. We noted that particular attention had been paid to people living with dementia and the flooring on the first floor was plain in line with dementia best practice.

Improvements had been made to staff training and we found staff received supervision and an on-going training programme was provided to assist staff to increase their knowledge and skills.

The registered manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC as required and we found this had improved since the last inspection.

Staff had been recruited safely and appropriate checks were completed prior to them starting work at Sandy Lane. Staff had a knowledge and understanding of the needs of the people who used the service.

We found there was sufficient staff on duty to support people with their assessed needs. People told us they felt safe, were well looked after, happy and would inform staff if they were concerned about their safety. The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report any concerns they had. They had received training in how to identify and report abuse.

Safety equipment, electrical appliances and gas safety were all checked regularly.

Some people who used the service had Deprivation of Liberty (DoLS) authorisations in place. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found these were being monitored by the registered manager of the service.

People were given choices at mealtimes and they told us they enjoyed the meals. There were special diets for some people as required. People who used the service received additional care and treatment from health professionals based in the community.

Activities were low key in the service, we were told by the registered manager it was difficult at present to organise activities as activity staff were currently absent, although they were due to return to work in the near future. We saw some activities were offered such as bingo, music, movies, arts and crafts and outings. Records and evaluation sheets were kept to show if people had enjoyed these.

There was a complaints procedure on display and people felt able to complain.

People were protected from harm and the risk of harm through staff training and risk assessments. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them.

During our visit we saw that the home looked clean and tidy and there were infection control procedures in place.

The quality of the service was regularly assessed and people who used the service and staff were asked for their views about care and treatment and their feedback was acted on. There was a complaints procedure in place at the home. The people we spoke with knew what to do if they had any concerns.

Staff had received appropriate professional development and training to ensure they could meet the needs of the people who used the service.

In response the provider had sent us an improvement plan telling us how they would ensure the above standard was met. We visited Sandy Lane Hotel and spoke with the registered manager and the owner about the improvements made. We reviewed their improvement plan and inspected the premises to check the improvements had been made. We also checked the overall safety, suitability and maintenance of the building and looked at other relevant documentation.

At this visit we saw the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

We saw that there were appropriate recruitment procedures in place and sufficient numbers of staff on duty. People were protected from harm and the risk of harm through staff training and risk assessments. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them.

The quality of the service was regularly assessed and people who used the service and staff were asked for their views about care and treatment and their feedback was acted on. We saw that records were kept appropriately and securely.

During our visit we noted a number of areas of concern regarding the maintenance of the premises that might harm staff and people that lived there. Following the inspection we referred these matters to the East Riding of Yorkshire's environmental health department and asked them to confirm the home met their specific requirements.