The Sands Care Home

The Sands Care Home in Morecambe provides accommodation and personal care, including nursing for up to 97 people. Accommodation is provided in single ensuite rooms over four floors. There are spacious communal areas on each floor. At the time of inspection there were 97 people living in the home.

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

People told us they felt safe living in the home and praised the kindness and quality of the staff team. There were enough staff to help keep people safe; and people told us their call bells were always answered promptly. The provider maintained safe staffing levels. Some people living in the home and some staff felt they would benefit from more staff at times but did not feel unsafe. Staff had received training and new staff had a robust induction programme which both helped to ensure staff had the skills necessary to keep people safe and well.

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.

People living in the home, their relatives and staff felt confident the home was well managed. The registered manager ensured the quality of care and care records had been maintained, which helped ensure people received high-quality, person-centred care. The provider had ensured the premises and equipment had been maintained to a good standard. The registered manager had good oversight of the service and maintained a daily presence in each of the units. Staff told us the registered manager was approachable and supportive.

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 December 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do, and by when to improve.

Why we inspected

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 and Well-led which contain those requirements. For those key questions not inspected, we reviewed the information we held about the service. No areas of concern were identified in the other key questions. Ratings from previous comprehensive inspections 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 The Sands Care Home on our website at www.cqc.org.uk.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Sands Care Home is a care home providing accommodation and personal and nursing care to 97 people. There were 97 people living in the home at the time we inspected. The home is arranged in four living units. One unit specialises in supporting people who are living with dementia. The home is arranged over four floors and has a passenger lift to help people access the accommodation on the upper floors.

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

Medicines were not managed safely, and people had not always received their medicines as their doctors had prescribed. There were not always enough staff, with the right skills, to support people. People felt safe. Risks to people’s safety had been identified and managed. The provider’s recruitment processes ensured new staff were suitable to work in the home. People were protected from the risk of infection. The provider had systems to ensure lessons were learnt and shared. After the inspection they used verbal feedback given to make improvements to the safety of the service.

The systems used to assess the quality of the service were not effective and had not identified some areas where improvements were required. People knew the registered manager. They said she took action if they raised concerns. People said the home was well-managed and they would recommend the service. The provider understood their responsibilities under the duty of candour. The staff worked in partnership with other services to meet people’s needs.

Staff employed by the service were trained to provide people’s care. The provider used agency staffing to supplement the staff team. Some people raised concerns about the competency of the agency staff. People were supported to eat a balanced diet and to access healthcare services as they required. 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 CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 30 November 2017).

Why we inspected

The inspection was prompted due to concerns received about areas of care and treatment including medicines. 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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe 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 The Sands Care Home on our website at www.cqc.org.uk.

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 Sands Care Home is registered to provide care and accommodation for up to 96 older people. The home cares for people who require nursing or personal care. Care is provided on a 24 hour basis by registered nurses and care staff, including waking watch care throughout the night. There is a lift to access all five floors of the building. The home is situated on the promenade overlooking Morecambe Bay. The home is organised into separate units over 4 floors. The Keswick unit provides the regulated activity personal care. Grasmere, Derwent, and Langdale provide nursing care to people. In addition, since the last inspection visit Derwent unit has been made into a unit specialising in supporting people who are living with dementia. At the time of inspection 96 people were residing at the home and the registered provider employed approximately 170 staff.

At the time of the inspection there was no registered manager in place. 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. A new manager has been identified and we noted from our internal communication system they were currently completing the registration process with the Commission.

The service was last inspected in December 2016. We identified a breach to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We found systems for managing medicines were not consistently safe and risks were not always identified and addressed. In addition, the registered provider had failed in their duties to report statutory notifications as required to the 2009 Care Quality Commission (CQC) Registration Regulations. We used this inspection visit to ensure improvements had been made.

At this inspection visit in October 2017, we found improvements had been made. We reviewed care plans and risk assessments and found risk was suitably addressed and mitigated. When people were at risk of harm there were a number of risk assessments in place to manage risk. These were regularly reviewed and updated when people’s needs changed.

Following our inspection visit in December 2016, the registered provider had developed links with a pharmacist and had commissioned them to audit medicines and review systems for administering medicines. The pharmacist visited the home on a weekly basis. In addition, the registered provider had reviewed systems for administering medicines and had implemented a new electronic system. This had highlighted some concerns and the home was currently in process of implementing another new system to meet the needs of the service and to reduce risk. In the interim period, additional checks had been put in place to reduce any risk.

After the December 2016 inspection visit, one member of staff had been delegated responsibility for ensuring all statutory notifications were sent to the Commission. During this inspection in October 2017, we reviewed all accidents and incidents that had occurred at the home. We noted all statutory notifications had been submitted without delay.

People told us they were included in developing their plan of care when they started receiving a service. Care plans were reviewed and updated at regular intervals and information was sought from appropriate professionals when required. Although care plans were updated in a timely manner, people who lived at the home told us they were not always involved in reviewing their plan of care. We found the quality of person centred information held within care plans was variable. We have made a recommendation about this.

Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Good practice guidelines were sometimes implemented to ensure all principles of the Mental Capacity Act (MCA) 2005, were lawfully respected. We have made a recommendation about this.

We reviewed staffing levels at the home. People told us that on the whole they did not have to wait for assistance when required. We reviewed call bell times and found these were answered in a timely manner. Staff on nursing units told us there sufficient staff available to meet the needs of people who lived at the home when there was no unplanned absence. Staff on the residential unit however; felt that staff were not always effectively deployed to meet the needs of people on the unit. Staff throughout the home said high sickness levels had previously impacted upon staff deployment which in turn impacted on the quality of care delivered. Staff told us and we saw evidence the new manager was proactively addressing this.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought in a timely manner from health professionals when appropriate. We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people who lived at the home. We received no information of concern from external healthcare professionals we spoke with during the inspection process.

People told us staff treated them as individuals and delivered person centred care. Care plans contained some person centred information and took the needs and considerations of people into account. The manager informed us they were working to improve the quality of the records maintained to ensure it was more person centred. We saw evidence of improvements taking place.

People spoke positively about the care delivered. We observed staff being patient and spending time with people who lived at the home. There was a light hearted atmosphere within all units at the home.

Staff treated people with kindness and compassion. We observed staff being patient with people and offering reassurance when required. People who lived at the home told us staff were kind and caring.

Arrangements were in place to protect people from risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. We saw evidence of information of concern being passed onto the appropriate parties when required. This was to promote the safety of vulnerable parties.

People told us they felt safe at the home. People were encouraged to personalise their rooms to make it feel homely. There was an emphasis on promoting dignity, respect and independence for people who lived at the home.

Recruitment procedures ensured the suitability of staff before they were employed. Staff told us they were unable to start their employment without all the necessary checks being in place.

People were happy with the variety, quality and choice of meals available to them. We saw evidence that people’s nutritional needs were addressed and monitored. The home had recently reviewed all menus. They had adapted them to increase the nutritional value of meals in order to reduce the need for food supplements.

People told us activities took place and said they had the option as to whether or not to join in. We saw bingo and dominoes taking place on the first day of our inspection visit. Staff told us there had been a notable improvement in the number of entertainers visiting the home since the new manager had arrived. The new manager told us they were hoping to improve on the variety and frequency of activities in the near future.

We walked around the home and found premises and equipment were appropriately maintained. The registered provider had reviewed living areas since the last inspection and had developed a unit specifically for people living with dementia. We found good practice guidelines had been considered and implemented on the unit to promote independence for people who lived at the home.

The manager and deputy manager had reviewed training and development for all staff and had introduced a new induction programme for new starters. In addition, they had developed systems to ensure all staff completed their mandatory training. Staff told us they were happy with the training offered. They told us there had been an increase in external training since the new manager started.

The manager had an auditing system at the home to ensure safe and effective care was provided. This included auditing medicines processes, falls at the home, complaints, accidents and incidents.

Staff praised the improvements made at the home since the appointment of the new manager. They described the manager as committed and determined to raising standards at the home.

People who lived at the home told us they considered the home to be suitably managed. However, only one person knew who the manager was. Following discussions with the manager they said they would look into having a photo on each unit of the senior management team. This would allow managers to be identified.

The service had a system for managing and addressing complaints. When complaints had been raised, they were investigated and recorded. Apologies were offered when the service had slipped below a standard which was expected.

The Sands Care Home is registered to provide care and accommodation for up to 96 older people. The home cares for people who require nursing or personal care. Care is provided on a 24 hour basis by registered nurses and care staff including waking watch care throughout the night. There is a lift to access all five floors of the building. The home is situated on the promenade overlooking Morecambe Bay. At the time of inspection 86 people were residing at the home and the registered provider employed approximately 150 staff.

There was not a registered manager in place. 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 previous registered manager cancelled their registration in December 2015. A new manager has been identified and we noted from our internal communication system they were currently completing the registration process with the Commission.

The service was last inspected over several days in February and March 2016. At this inspection we found the service was not meeting the required fundamental standards. We identified breaches to Regulation 17 (Good governance) of the Health and Social Care Act, (2008) Regulated Activities 2014, as suitable systems were not in place to monitor, assess and improve the quality of services provided and care records were not always complete and accurate. We also identified a breach to regulation18 (Staffing) of the Health and Social Care Act, (2008) Regulated Activities 2014, as staff were not appropriately deployed to meet people’s needs.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Sands Care Home on our website at www.cqc.org.uk

We used this inspection carried out in November and December 2016 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out the comprehensive inspection to review the rating of the service.

At this inspection visit, we found improvements had been made to staffing. Following the previous inspection visit the management team reviewed staffing levels and deployed additional staff at peak times. New roles were created within the service to support the staff team responsible for delivering care and support. People who lived at the home consistently told us their needs were met by the staff team and they did not have to wait when they required assistance. Staff told us staffing levels had improved and staffing levels now allowed them to spend quality time with people who lived at the home. During the inspection visit we saw this occurring.

We found improvements had been made to ensure paperwork was completed in a timely manner. The registered provider had invested in an electronic care planning system. At the time of this inspection visit in December 2016 we found the service was in the process of transferring care planning information from paper copy to an electronic format. Staff were being provided with on-going training to use the system. The new system alerted staff if a person’s care required assessing. Care plans were developed and maintained for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

We found some improvements had been made to ensure auditing systems were implemented within the home. Following the last inspection visit, members of the management team had received training to enable them to carry out audits. A staff member had been identified to carry out audits as part of their job role. We noted some audits had taken place but these were not consistently applied. The staff member acknowledged that the auditing system was in its infancy and still needed developing. Audits did not consistently identify concerns within the service. For example, the medicines auditing system had not been reviewed since April 2016; consequently concerns identified within this inspection visit had not been picked up. We have made a recommendation about this.

We looked at how medicines were managed by the service. We found good practice guidelines were not considered and medicines records were not consistently up to date. This placed people at risk of harm. This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act (2008) Regulated Activities 2014.

People who lived at the home consistently told us they felt safe. We looked at how the service managed risk to keep people safe. Whilst risk assessments were in place for people we found these did not consistently record all aspects of risk. For example, there were no bed rails risk assessments in place within care records for people using bed rails. For people at risk of choking there was not always a choking risk assessment in place. This placed people at harm as risk was not clearly documented for staff to be aware of and address in an appropriate manner. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014.

During the inspection visit we identified two incidents that should have been reported to the Care Quality Commission. We spoke to the manager about their responsibilities for notifying the commission of significant events. The manager agreed to submit the notifications for both incidents but both of these notifications were not received. This was a breach of regulation 18 of the Care Quality Commission Registration Regulations 2009.

People who lived at the home said the food provided at the home was good. They told us there was plenty of choice and their nutritional and health needs were met. Systems were in place for managing people’s dietary needs. We noted input from health specialists when people were at risk of malnutrition.

People spoke positively about the quality of service provided. People consistently told us they were happy with the service provided and said they had no complaints. They were aware of the complaints procedure and their rights to complain.

People spoke highly about the staff. Staff were consistently described as caring and kind. People told us there was plenty of activities on offer to keep them busy. We noted there was a focus on providing person centred care.

People were protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. During the inspection visit we noted one incident which had not been safeguarded by the manager. We discussed their reporting responsibilities as part of the inspection process.

Staff had a sound understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. Mental capacity was routinely assessed and good practice guidelines were referred to when a person lacked capacity. Systems were being followed when people who lacked capacity where being deprived of their liberty.

Following the last inspection visit, the registered provider had developed incentives to encourage staff to complete training. Staff praised the variety of training on offer and said they felt supported within their role. The senior management were working proactively to develop a trained workforce.

Suitable recruitment procedures were in place which meant staff were correctly checked before starting employment.

Systems were in place to seek feedback from all people who lived at the home as a means to develop and improve service delivery however these had not been consistently applied. When we brought this to the senior management team’s attention, action was taken straight away. We have made a recommendation about this.

People who lived at the home consistently praised the manager and their attitude. People and relatives said the management team was approachable and they were confident if they had any concerns action would be taken.

Staff were extremely positive about ways in which the service was managed and the support received from the management team. They described a positive working environment with a positive culture and high morale.

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

The Sands Care Home is registered to provide care and accommodation for up to 90 older people. The home cares for people who require nursing or personal care. Care is provided on a 24 hour basis by registered nurses and care staff. There is a lift to access all five floors of the building. The home is situated on the promenade overlooking Morecambe Bay. Eighty eight people were residing at the home on the day of inspection.

There was not a registered manager in place. The registered provider informed us they were in the process of applying for registration as the 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.

The service was last inspected 17 May 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in February 2016, feedback from people who lived at the home, relatives and visitors was mixed. People, relatives and health professionals said staff were caring. People were aware of their rights to complain.

However two people were unhappy as sometimes they had to wait to have their needs met. Relatives and staff said staffing levels were not always conducive to meet people’s needs. We observed staff rushing around and people having to wait to have their needs met. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Arrangements were in place to protect people from the risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. Recruitment procedures were in place to ensure staff were correctly vetted before being employed.

Staff retention was good and relatives said people benefited from having regular staff. Staff were provided with training and supervision to support them in their role.

The home employed an activities coordinator who was responsible for developing social activities for people who lived at the home. People told us activities took place. Care staff said they provided social activities when they had time to do so.

Arrangements were in place for managing and administering medicines. However the registered provider was not consistently working within good practice guidelines. The registered provider took immediate action to improve systems of medicines management. We have made a recommendation about this.

Feedback from health professionals was positive. People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed. The registered provider had built links with other health professionals. This allowed good practice to be shared and developed within the home.

The registered provider was working in liaison with the local hospice to promote end of life care and prided themselves on their achievements in this area of work. Health professionals commended the way in which they managed end of life care.

We found care plans covered support needs and personal wishes. However plans were not consistently reviewed and updated. Paperwork was incomplete and there were no audit systems in place to identify consistencies within paperwork. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Feedback on the quality of food provided was positive. People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available to people between meals.

Staff were positive about the way in which the home was managed. They confirmed they were supported by the registered provider. Staff described teamwork as “Good,” and described the home as a good place to work.

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

As part of the inspection visit we looked at how people were being cared for and supported. We looked at how they recruited staff to ensure they were safe and suitable to meet the needs of people living at The Sands Care Home. We also looked at quality assurance systems and what procedures were in place to enable people to raise comments and complaints about their care and support.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people living at home, staff supporting them, relatives and by looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at The Sands Care Home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. One staff member said, 'We have undertaken training and it is ongoing for staff.'

People were treated with respect and dignity by the staff. People told us they felt safe. One relative we spoke with said, 'I come here nearly every day, the staff are so polite and always make me feel welcome.' We spoke with several residents and received only positive comments about the care they received. They included, 'The staff are wonderful it is a peaceful home run by caring people. It makes me feel safe knowing I can call on them at any time.'

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

People's health and nursing care needs were assessed with them, and they were involved in developing their plans of care where possible. Relatives views were also sought to ensure people received the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required. There was also an ongoing review process to ensure people's needs were continuously monitored and changes made when needed.

Is the service caring?

We spent part of the day observing staff interaction with residents. Staff were talking and supporting people in a kind and attentive way. We saw staff showed patience and gave encouragement when supporting people to move around the home. One resident said, 'I cannot fault the care and attention we receive here they are all caring people, some better than others.'

Is the service responsive?

People completed a range of activities in the home regularly. We saw evidence of daily activities in place and delivered by various staff. They employed an activities person to support people to undertake chosen interests and activities. One member of staff said, 'She is off today but the residents love here she is very good.' A resident we spoke with said, 'There is always something going on around the home.' Another person who lived at the home said, 'I don't join in much but I have to say she is always trying to put things on for people.'

Is the service well-led?

We had responses from external agencies including social services .They told us they had a working relationship with the owner/manager and staff to make sure people received their care and support they required.

There were a range of audits and systems put in place in by the home to monitor the quality of the service being provided.

The service demonstrated good practice that ensured people were cared for in a supportive and dignified manner. One person told us, 'It's great here. I found it hard to leave my home, but came here because of its reputation. The home deserves its reputation and I'm glad I'm here now'. Another person said, 'I've lived here a long time and can tell you it's a wonderful home'.

Additionally, care records were of a good standard. Care plans and risk assessments were in-depth, signed and regularly reviewed. Daily records demonstrated where other providers had been involved in people's care. This showed good communication within the home.

People were recruited appropriately because the home had followed its procedures. One staff member told us, 'I'm happy here ' I think it's a really good home'. The Sands additionally had appropriate processes in place to monitor the quality of its service.

We looked at the care plans for four people who lived at the home to see how their needs should be met.

People living at the home who were able, told us that they were satisfied with the care provided by the home and if they were not satisfied with their care they would tell staff.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.