Sandybrook

Updated 1 March 2024

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 Health and Social Care Act 2008.

Inspection team

The inspection team consisted of an inspector a regulatory coordinator and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Sandybrook is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Sandybrook is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. Though the service had recently recruited a new manager who told us they planned to register.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and we sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We spoke with 10 people who used the service, 6 relatives and 1 health care professionals about their experience of the care provided. We spoke with 8 members of staff including the regional manager, manager, the associate director for elderly services, a registered manager who was supporting from another service, 3 care workers and a chef. During the inspection, we visited both floors of the home and we reviewed a range of records. This included reviewing 3 people's care records in detail. During the inspection we also looked at multiple people's medicines records, storage of medicines and various medicines documentation. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 1 March 2024

About the service

Sandybrook is a residential care home providing accommodation to people who require personal care to up to 25 people. The service provides support to younger and older people who are living with mental health, physical disabilities, sensory impairments or dementia. At the time of our inspection there were 24 people using the service.

People’s experience of the service and what we found:

Risks were not always safely managed, and recruitment practices were not robust. Sufficient staffing was not in place and although this had been raised both internally and externally this issue had not been resolved. Medicines were not safely managed. Although the home appeared clean, we found multiple infection control practices that were not safe. People were supported to have visitors and there was some evidence of the home learning lessons in relation to previous accidents and incidents. People told us they felt safe living at the home and we were able to see that appropriate safeguarding referrals had been made when needed.

Environmentally the home needed improvements made, to ensure it is safe and suitable for the people living there. Staff did not receive regular supervisions in line with policy, and staff training compliance rates needed to be improved. People’s needs were usually assessed before admission. Although people were supported to eat a healthy balanced diet, we were not assured that people who required thickened fluids were receiving them. The service worked with a variety of health and social care professionals.

People were not always supported to have maximum choice and control of their lives though staff tried to support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Though we did find examples where people needed restrictive practices put in place and this had not been considered.

Although we observed staff were kind and caring, some of the concerns identified at this inspection did not mirror this. People were involved in making decisions about their care.

People were not supported to regularly take part in activities. We were not assured that people received person centred care and records did not reflect a person-centred approach. People’s communication needs were being met, however, the newly appointed manager needed to improve their knowledge on how to make information accessible. We made a recommendation about this. A complaints policy and log were in place and complaints had been resolved in line with policy. No one was in receipt of end-of-life care during our inspection, though end of life policies were in place.

We identified poor governance and oversight during our inspection. Audits were not robust and failed to identify or resolve issues identified during our inspection. Surveys and staff meetings were being conducted. However, when staff shared issues, these were not always acted upon. Staff feedback around culture and management was mixed and we found that due to the issues identified throughout the report people were at risk of receiving poor outcomes. The newly appointed manager was not able to successfully explain about the duty of candour to our inspector during the 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 Requires Improvement (Published 16 September 2020) and there were breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last targeted inspection on 05 January 2021 we made recommendations about the providers recruitment processes and risk around assessing and recording people’s dietary requirements. At this inspection we still had concerns about these issues.

Why we inspected

The inspection was prompted in part due to concerns received about various aspects of care, poor record keeping and a lack of staff training. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk, infection control, recruitment, staffing, premises, training, staff support, activities, records and governance. We have also made a recommendation around ensuring the new manager is fully aware of the requirement to make sure information is accessible. 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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.