Sandmar

Sandmar is a residential care home providing personal care to 11 people at the time of the inspection, with support needs relating to their mental health. The service can support up to 13 people in one adapted building.

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

People felt safe living at Sandmar. The provider had taken action to keep people safe and manage the risks they faced. Staff had a good understanding of the support people needed.

People were supported to take any medicines safely and staff sought advice from health and social care services when necessary. Relatives were happy with the care people received and were confident that people were safe at Sandmar.

The provider had made changes in response to the COVID-19 pandemic and there were good infection prevention and control measures in place.

Staff had developed good relationships with health and social care professionals.

People had been supported to develop detailed support plans, which were person-centred and gave staff clear information on how to meet their needs.

The management team had established good systems to monitor the quality of service provided and make improvements where needed.

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 27 March 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9 January 2019. 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 safe care and treatment.

We undertook this focused inspection 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, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sandmar 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on the 9 and 14 January 2019 and was unannounced. At the time of the inspection there were 11 people accommodated.

A registered manager was in post. 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.

There were a range of quality audits undertaken by the owner /manager however they were not always effective. Care plans had been reviewed but there were no set standards for auditing the quality of care plans. For example, ensuring care plans were person centred and monitoring of daily reports. We have made a recommendation to develop audits that assess and monitor the quality of service delivery.

Medicine audits were carried out weekly. Audits for reviewing policies, assessing staff training and infection control the were completed every three months. Where there were shortfalls the action taken was listed.

The views of people and staff were gathered to enable the provider to make improvements. Surveys were used to gather the views of people regarding food, personal care, daily living and the management of the home. People and staff had assessed the home to be good to very good.

Risk management systems were used to assess people’s individual level of risk. However, some guidance was not detailed and for others the risk assessments were not reviewed where the level of risk had changed.

Medicine Administration Records (MAR) were completed appropriately. Medicines no longer required were disposed of appropriately.

However, where people had medicines prescribed to be taken “when required” protocols were not always sufficiently detailed.

People told us they made their day to day decisions and who helped them with more complex decisions. Staff were knowledgeable about the principles of the Mental Capacity Act (2005) and there was guidance on display for staff’s reference. Mental capacity assessments were in place where needed. There were some restrictions imposed for activities such as smoking and having alcohol. Where people had capacity, agreements were in place for these restrictions. However if the agreements were not upheld they were not reviewed.

Some people have community treatment orders (CTO) imposed. The care plans were not clear on the conditions, how staff were to support the person and the action to take when the conditions were breached.

Where people had capacity and restrictions were imposed, agreements were in place. For example, not smoking indoors and having alcohol and illegal substances in the building. People signed the agreements and told us about these restrictions. However, these agreements were not reviewed when they were not adhered to.

People were aware they had care plans in place and told us their keyworkers went through their care plans with them. However, some care plans lacked detail on how staff were to support people effectively. At the time of the inspection the care coordinator linked to Sandmar agreed to support the home with developing the care plans.

Although there was a framework for staff to have daily one to one time with people these discussions were not based on pursuing hobbies or supporting people to retain or regain their independence. People told us they mainly watched the TV and the records supported their comments.

People told us they felt safe living at the home and the staff gave them a sense of security. The staff we spoke with knew the types of abuse and to report their concerns. They said they had attended safeguarding adults training to help them recognise the signs of abuse and about reporting concerns.

People we spoke with and relatives praised the staff for their caring manner. We saw some good interactions between people and staff. We observed staff use a calm approach and offer activities when people became distressed. We saw adequate numbers of staff available to support people. People told us the staff responded to their request for support and assistance.

New staff received an induction when they started work at the home. Staff said the training was good and they attended mandatory training set by the provider. Staff had regular one to one meetings with a line manager where they discussed the responsibilities of their role.

People had access to healthcare services as required. Relatives told us they were kept informed about GP visits and about important events. The hospital passports were updated during the inspection to ensure up to date information was included.

The provider and home manager were introducing lessons learnt system which gave the staff opportunities to improve the care delivery to people. The provider and home manager were aware of the challenges and the actions needed to overcome them.

People told us senior managers were approachable and they knew the providers. Staff told us the team worked well together. Staff and professionals said there was a provider presence at the home. There were no complaints received since 2017. The staff received compliments from professionals and relatives.

We found a breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in post when we inspected 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. The registered manager was present and approachable throughout our inspection.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Documents relating to people’s finances had not always been stored safely. We saw these had been placed in some people’s care plans. This meant that staff had access to information of a personal and private nature. We raised this with the management team who said they would remove all financial paperwork from people’s care plans and keep them in a locked cabinet so access was restricted.

Staff raised concerns with us around some people smoking in their bedrooms. We saw that staff had previously raised this concern during their supervisions with their line manager. The home had taken measures to prevent this occurrence which included reminding and educating people about the no smoking policy in their bedrooms and about the dangers this could cause.

Staff were appropriately trained and skilled. All new staff received an induction when they started working for the service, which included shadowing a competent member of staff. They demonstrated a good understanding of their roles and responsibilities.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “I like living here, the staff are nice and friendly” and “I do like living here, it’s a happy place”.

People were supported to have a meal of their choice by organised and attentive staff. The menu was displayed outside of the dining room with a notice that said if anyone did not like the choices they could inform the kitchen who would prepare something else for them. We saw this happening throughout our inspection.

Scheduling activities for people had previously been difficult and the management explained this was in the process of being reviewed. The staff had spent time asking people on an individual basis what activities they would like to have available in the home and this was in the process of being matched with staff so they could action on a one to one basis.

The provider regularly assessed and monitored the quality of care provided at Sandmar. The service encouraged feedback from people which they used to make improvements.

We looked at the care files belonging to three people in the home. We saw these people's care needs had been assessed by senior care staff and their care was planned accordingly. This was contained in a document called a 'home care programme'.

During our visit we looked around the premises and we found all the communal areas were clean, tidy and well furnished. The kitchen, lounges and bathrooms were in good condition and provided a pleasant and safe environment for people to use. There was also a games room for people to use which had a pool table, TV, games console and a variety of board games.

The manager told us about their recruitment process. All successful applicants were offered a post subject to appropriate references and completion of a six month probationary period. During this period staff had monthly supervision to track their progress and development and we saw records to confirm this.

We saw the manager maintained a record of training attended by staff during the past year. We also saw from training records staff had a regular training programme to update their knowledge and skills in areas relevant to their role. This included such subjects as, the safeguarding of vulnerable adults, moving and handling and mental health. The majority of training materials were sourced from an external company and accessed via DVD's. First aid and medication awareness training was accessed via face to face sessions from another training provider.

We saw the home had a current procedure and policy for the investigation of complaints. We saw a copy was clearly on display in the entrance hallway and t each person had been supplied with a copy as part of the homes information pack. This had been reviewed by the provider in 2013. It included details of how someone could complain and the timescales for receiving a reply. It also gave information on how to appeal if they were not happy with the outcome, and other agencies to contact to provide support for the complainant.

We found that peoples health and welfare needs were being met and that support given was individualised and person centred.

Evidence informed us that systems were in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that staff were available in enough numbers and had experience to meet the needs of the people living in the home.

We found the quality of the service was being monitored and evidence indicated that concerns were promptly acted upon.