Sandy Banks Nursing Home is located in a residential area of Leyland. The home provides nursing and personal care. It is registered for up to 39 adults, who require help with personal and nursing care needs, including those who are living with dementia and those who have mental health problems. Accommodation is provided at ground floor level. There are some amenities and public transport links close by. The city of Preston, the market town of Chorley and Bamber Bridge village centre are within easy reach. A small car park is available at the home. However, on road parking is also permitted.
This was the first inspection of Sandy Banks Nursing Home by the Care Quality Commission [CQC], since the current management team took over the management of Sandy Banks Care Home under the new provider's registration in May 2016. Although some improvements are still needed at Sandy Banks, we did note that significant improvements had been made since our last inspection under the previous provider and it is important that improvements continue to be made in order to maintain sustainability.
This inspection was conducted over three days, 30th August 2016, 8th and 9th September 2016. The first day was unannounced, which meant that people did not know we were going. Although the registered manager was off duty on the first day of our inspection he did attend shortly after our arrival, so that he could be fully involved with the inspection process. The home was given short notice of the second and third days of our inspection. The manager was on duty on both these days.
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 of the Health and Social Care Act and associated regulations about how the service is run.
There were sufficient numbers of staff on duty to keep people safe. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at Sandy Banks. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.
Medicines were, in general being well managed. However the application of local creams was not always being recorded on the appropriate charts. We have made a recommendation about this.
During the course of our inspection we toured the premises and found that the environment was well maintained and in general the home was clean and hygienic throughout.
Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. We saw evidence that a wide range of environmental risk assessments had been conducted. However, some of these were not up to date. We have made a recommendation about this.
Staff we spoke with were able to discuss the needs of people well and were confident in reporting any concerns they may have had about the welfare of those who lived at Sandy Banks.
Certificates of training showed that a broad range of learning modules were provided for the staff team and those we spoke with provided us with some good examples of learning they had completed. However, the training matrix was not up to date, in order to reflect the current level of training provided. We have made a recommendation about this.
Evidence was available to demonstrate that supervision sessions were conducted for staff, as well as annual appraisals, which enabled them to discuss their work performance and training needs with their line managers.
Although staff were seen to be kind and caring interaction with those who lived at the home could have been better, particularly during meal times. We discussed this with the managers of the home at the time of our inspection and we were confident that they would address our observations. We have made a recommendation about this.
Legal consent had been obtained for some areas of care and treatment. However, this had not been consistent for some restrictive practices, such as the use of bed rails and reclining chairs. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We saw that in some cases relatives had given consent on behalf of those who lived at the home, but there was not always documented evidence available to demonstrate they had the legal authority to do so. We have made a recommendation about this.
Mental capacity assessments had been conducted prior to applications being made to deprive someone of their liberty.
The planning of people’s care was based on an assessment of their needs, which was conducted before a placement at the home was arranged, with the exception of emergency admissions, in which case people’s needs were assessed shortly after arriving at the home.
We found the plans of care to be, in the main, person centred, providing staff with clear guidance about people’s needs and how these were to be best met. However, on occasions some conflicting information was provided in the records we saw. We have made a recommendation about this.
Complaints were being well managed and systems had been implemented to allow the quality of service provided to be assessed and monitored on a regular basis, by obtaining feedback from those who lived at the home, their relatives and staff members, by holding regular meetings and conducting audits. However, the audits we saw were not always clear and up to date. We have made a recommendation about this.
Records showed that since the current management team took over the management of Sandy Banks in May 2016 eleven safeguarding referrals had been made by the home to the local authority. The provider had not always notified the Care Quality Commission about such incidents. However, they had been reported under the correct procedures, in order to safeguard those who lived at the home. We discussed this with the management team at the time of our inspection, who assured us that notifications of such incidents would be reported to us in the future.
Staff spoken with told us they felt well supported by the registered manager of the home. They described him as being, ‘approachable’ and ’easy to talk to’.
We found a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the need for consent.
You can see what action we told the provider to take at the back of the full version of this report.