Sandford Road

Updated 15 February 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

On the 28 September 2021 an inspector and a medicines inspector visited the service. On the 29 September 2021 an expert by experience made phone calls to relatives. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. A second inspector reviewed records remotely on the 30 September 2021. On the 5th October 2021 one inspector returned to the service. Our review of evidence sent to us concluded on the 26 October 2021.

Service and service type

Sandford Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager who was registered with the Care Quality Commission (CQC). This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection including the action plan that the provider sent us. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We received feedback from the local authority who commission packages of care with the provider.

During the inspection

We met all the people living at Sandford Road, one person was able to share their feedback with us. We spoke with six members of staff including the registered manager, nominated individual, and care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with three relatives.

We reviewed a range of records. This included three peoples care records and four medication records. We looked at two staff files in relation to recruitment. We also reviewed records that related to the management and monitoring of the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records and policies and procedures.

Updated 15 February 2022

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 guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people

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

People’s medicines were given safely and reviewed and monitored. However, we found some improvement was needed in ensuring medicines incidents were learnt from and ensuring all medication guidance was up to date.

People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used. Further improvements were needed around looking at trends of incidents across the service.

Governance systems did not always ensure people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve the service.

The service could show how they met the principles of Right support, right care, right culture. People were empowered to have choice in all aspects of their care and were supported to focus on areas of importance to them. People were supported in the way they preferred which was supported by the ethos, values and behaviour of the management and staff team.

The needs and quality of life of people formed the basis of the culture at the home. Staff undertook their role in making sure that people were always put first. They provided care that was person-centred and directed by the person.

The leadership of the service had worked to ensure everyone was included. Staff felt valued and empowered through inclusion in the development of peoples care and to suggest improvements that would benefit the people living at the home. There was a transparent, open and honest culture between people, those important to them, staff and leaders. They all felt confident to raise concerns and were confident these would be responded to appropriately.

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’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.

¿ People were protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

¿ People were supported to be independent and had control over their own lives. Their human rights were upheld.

¿ People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.

¿ People’s risks were assessed regularly in a person-centred way, people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

¿ People made choices and took part in meaningful activities which were part of their planned care and support. Staff supported them to achieve their short- term aspirations and goals. Further work was needed to think about longer term aspirations for people.

¿ People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs. We found that some care plans had not consistently been kept up to date.

¿ People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice. Staff regularly evaluated the quality of support given, involving the person, their families and other professionals as appropriate.

¿ People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

¿ People and those important to them were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

¿ Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

¿ People were supported by staff who understood best practice in relation to learning disability and/or autism.

At our last inspection the provider had failed to ensure recording and monitoring of the use of restraint had been carried out. This was a breach of regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection found new systems had been put in place to monitor the use of restraint.

At our last inspection the provider had failed to ensure safe recruitment practices had been carried out. This was a breach of Regulation 19 (Fit and Proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection found staff were safely recruited and a new system had been put in place to ensure this was carried out consistently.

At our last inspection the provider had failed to ensure people’s support plans reflected their needs or had consideration of the impact COVID-19 restrictions had had on peoples’ access to activities they enjoyed. This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection found that new care plans had been developed which focussed on the persons needs and wishes.

At our last inspection the provider had failed to implement robust governance systems or maintain oversight of the service. This was a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection identified many improvements had been made in the governance systems. However further work was needed to refine these and the provider was still in breach of Regulation 17

This service has been in Special Measures since 17 September 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this inspection to provide assurance that the service is applying the principles of Right support, right care, right culture.

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.

Enforcement

Systems were not fully effective at monitoring the quality of the service. This was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

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.