Sandhurst Residential Care Home provides accommodation with personal care to a maximum of 23 people. The home provides care for older people, some of whom are living with dementia. When we visited 22 people lived at the home, some of whom were staying temporarily. The bedrooms are on all three floors, which can be accessed by stair lifts.This unannounced comprehensive inspection took place on 29 September, 4 October, 10 October and 16 October 2017. It was carried out in response to reports from community nurses relating to how people’s pressure care was managed. We found improvements were needed to reduce the risk of pressure damage for people living at the home.
There was 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. In March 2016, this service was registered with CQC under a new legal identity; this is the first comprehensive inspection in connection with the new legal identity. However, the registered manager and the provider have stayed the same.
The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, there was not a consistent approach to making applications to the local authority in relation to some people who lived at the service. People were not routinely involved in their assessments, care plans or reviews so their consent was not gained. Best interest decisions were not recorded and documentation linked to lasting power of attorney was not requested. These practices meant people’s legal rights were not protected.
Some risks to people’s health were not well managed, for example monitoring people’s weight. Lessons had not been learnt from an incident relating to poor pressure care. Staff had to be prompted to check the setting of a person’s pressure mattress. It was incorrectly set on two separate occasions and put the person at increased risk of pressure damage. They had also been at risk of entrapment in their bedrails, which staff had not noticed. We ensured action was taken during the inspection to reduce these risks to the person’s health and safety.
Recruitment practice did not ensure all the necessary information was in place before staff started working at the home. Staff training did not routinely include practical training, although the registered manager began to book this type of training during the inspection. This was in recognition that staff benefited from hands on training for some areas of care, such as using moving and handling equipment. We saw examples of kind care, with staff showing affection and compassion towards people. However, there were also practices which undermined people’s dignity and privacy.
People were supported to see, when needed, health care professionals. Care staff recognised changes to people’s physical well-being and visitors said they were kept well informed by staff regarding their relative’s health and well-being. The management and storage of medicines required improvement. People were supported with their meals, where needed, but people’s weight and fluid intake was not monitored in a robust way.
Safety checks were carried out but the systems in place were not thorough and potentially left people at risk of harm. Some areas of the home were potentially unsafe to people living with dementia. Staff practice showed a lack of understanding of infection control. Some items of furniture were damaged or stained. There were areas of the home which were poorly maintained.
Staff had good relationships with people who used the service and spoke about them in a caring and compassionate manner. Visitors to the service praised the staff group and the registered manager. They were happy with the standard of care and the welcoming and friendly atmosphere. However, improvements were needed in staff skills and knowledge in supporting people living with dementia and people with complex health and emotional needs. People were not always provided with meaningful interactions which meant they were at risk of social isolation. There was no system to ensure activities happened regularly and met people’s individual interests.
The service was not well led. During our inspection, we found a number of areas that needed to improve to maintain the safety and well-being of people that had not been identified by the registered manager or the providers. We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.
This will lead to cancelling their registration or to varying the terms of their 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.
During the inspection, we shared our concerns with the local authority safeguarding team, commissioners, deprivation of liberties team, fire service, community nursing team and the clinical commissioning group so they were aware of the potential risks to people’s safety and well-being at the home. We made an individual safeguarding alert for one person who has since moved from the home. The local authority safeguarding team are organising a strategy meeting to discuss the whole service.
Since the inspection, we have been in further contact with the registered manager and the provider. They have assured us they wish to improve the service and have begun organising new training for staff. The registered manager has sent us a list of the action they have taken so far. For example, fire equipment being serviced, new furniture and improved practice in medicine management. They have stated they will work alongside the local authority quality assurance and improvement team to make further improvements.
CQC have taken enforcement action by imposing a condition on the provider's registration. This requires the provider to provide CQC with a monthly report outlining actions and progress in making the required improvements. We will inspect this service again within the next 12 months.