Sandford Road

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.

Sandford Road is a residential care home providing personal care and accommodation to six people with a learning disability. At the time of the inspection six people lived at the home.

The service has been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support (RRS) in respect of the environment. The building design fitted into the residential area as it was domestic in style in keeping with other homes in the street. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

We found people were not always safeguarded by the systems in place in relation to the use of physical intervention and lessons were not always learned about how to better support people during periods when they present behaviours that challenge.

Staff were not always recruited safely as not all required checks had been undertaken prior to commencing work at the home.

Staff were not always following current government guidance in relation to COVID19 and the use of personal protective equipment.

People received their medicines when needed and staff where trained to administer people’s medicines safely.

Peoples support plans where not always updated to ensure they reflected people’s individual needs and had not considered the impact of COVID19 restrictions on people using the service.

A lack of oversight meant potential risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were not effective and had not identified the areas for improvement found at this inspection.

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 Good. (Published 06 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, use of restraint, care being provided, financial issues and the environment. Additional concerns were shared with us by the Clinical Commissioning team. A decision was made for us to inspect and examine those risks.

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.

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

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 Sandford Road Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 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 person centred care, safeguarding, recruitment practices and governance.

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 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.

Special Measures

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.

People’s experience of using this service:

People were not all able to fully verbalise their views therefore they were not able to tell us about their experience of living there. Due to people’s current needs we were only able to spend a short amount of time with people. However, we were able to observe some interactions between people and the staff supporting them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. There was a stable staff team who were knowledgeable about the people living at the service and had built trusting and meaningful relationships with them.

Staff were recruited safely and sufficient numbers where employed to ensure people’s care and social needs were met. Staff knew how to keep people safe from harm.

There was time for people to have social interaction and activity with staff. Staff actively encouraged people to maintain links with the local community, their friends and family.

People's care was individualised and focused on promoting their independence as well as their physical and mental well-being. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.

The environment had been adapted to meet people’s individual needs and keep them safe from harm. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. People were involved in shopping, meal planning and preparation. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

Where restrictions had been put in place to keep people safe this had been done in line with the requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were recorded and regularly reviewed to check they were still necessary and proportionate.

There was a clearly defined management structure and regular oversight and input from senior management. Staff were positive about the management of the service and told us the registered manager was very supportive and approachable. Any concerns or worries were listened, addressed and used as opportunities to make continuous improvements to the service.

Rating at last inspection: This was the first inspection since the registration change. Under the previous provider the service was rated Good overall. However, they had been rated Requires Improvement in Well Led as quality assurance systems were not robust. That report was published on 15 May 2017.

Why we inspected:

This inspection was a scheduled comprehensive inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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