Archived: Guide at Sandon

This is the first inspection of Guide at Sandon since the service was registered under the new provider Guide Total Care Group Ltd in January 2017. Guide at Sandon was formerly known as Chelmsford Nursing Home and is registered to accommodate up to 64 people some of whom may be living with dementia. The building is split over two floors. Nursing care is carried out on the first floor and people living with dementia reside on the ground floor.

Chelmsford Nursing Home was previously owned and ran by Forest Pines Care Limited. The last inspection of this service under this provider was carried out on 22 March 2016. The final rating for Chelmsford Nursing Home following the inspection was ‘Requires Improvement’. Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified during this inspection. This was because there was no registered manager in post. Staff morale was low and staff felt they did not have the right amount of staff to care for people. The service relied heavily on the use of agency staff who were often deployed to manage people with highly complex needs. The service had not learnt from incidents of falls, challenging behaviour and safeguarding concerns and had not effectively managed risks to people who used the service.

Before this inspection we received information of concern about medicines errors that had been made, the attitude of staff, poor care and overuse of agency staff who did not know the needs of the people using the service. At this inspection we found a new manager is in post, but they are not yet registered. 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.

Although there has been significant improvement made by the new manager to identify and manage risks to people’s health, safety and welfare we identified occasions where these measures were not protecting people from harm, or potential for harm occurring. Following six occasions of aggression between people who live at the service there has been no review of their care or strategies implemented to stop repeat incidents. Where risks to people’s health have been identified due to incontinence, poor skin integrity and dehydration, charts are in place to monitor they are receiving adequate hydration and being repositioned regularly. However, these are not being completed properly by staff and it is unclear if people are receiving appropriate care over a 24 hour period. The management team’s failure to identify the inconsistencies means people remain at risk of becoming dehydrated, at risk of urinary tract infections or developing pressure wounds.

Systems are in place to manage people’s medicines safely. There are sufficient staff on duty to keep people safe, but response times to call bells, especially at night and weekends could be improved. Agency staff are still being used on a regular basis for consistency, whilst a recruitment drive for permanent staff is in progress. Relatives were complimentary about the attitude and capability of the staff. Staff are kind and caring and have developed good relationships with people using the service.

A thorough recruitment and selection process is in place, which ensures staff recruited have the right skills and experience, and are suitable to work with people who use the service. Staff know the care needs of the people they support well. This is because staff have received training that gives them the skills and knowledge to meet people’s specific needs, including how to respond when a person is choking. Where people have been identified as at risk of choking detailed risk assessments with guidance for staff on how to minimise the choking risk have been developed and are being followed by staff.

The registered manager and staff understand the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible, the policies and systems in the service support this practice. People and their relatives are involved in planning and making decisions about their care. Joint working with the GP and the hospice team has provided greater clarity and support for staff so that they know how to manage, respect and follow people’s wishes for end of life care.

People are provided with sufficient to eat to stay healthy and maintain a balanced diet. People have access to health care professionals, when they need them. The manager is using innovative ways to improve the service. They have introduced the use of the National Early Warning Scores (NEWS) to monitor people’s health. This is an initiative used by medical services and all hospital staff to quickly determine the status of a person’s health, for example by checking their blood pressure, pulse and temperature, enabling a more timely response in case their health deteriorates. They are also trialing a development opportunity for care staff in an associate practitioner role. The aim of this role is to assist nursing staff to monitor people at risk of developing pressure ulcers, help with managing wound care and ensure people’s personal care is delivered in accordance with their care plan.

The manager and staff spoke passionately about the people they support and knew their care needs well. Staff are aware of the importance of ensuring people’s dignity is respected at all times. Staff offer people choices on how they choose to spend their day and what they want to eat. These choices are respected.

People, their relatives and staff were positive about the change of provider and the appointment of the new manager. They felt the service is moving in the right direction, things have brightened and staff morale has improved. Staff felt supported by the manager and felt there was good leadership in the service. Staff were clear about the provider’s philosophy of care and how this links to the vision and values of the service in relation to providing compassionate care, with dignity and respect. Staff knew what was expected of them and we observed staff putting these values into practice during our inspection.

People, their relatives and staff are kept up to date at regular meetings about changes to the service, what has worked well and where improvements are needed. The minutes of meetings show there is an open and transparent approach to sharing information including the outcome of incidents, safeguarding concerns and complaints. Concerns or complaints are taken seriously, explored and responded to.

Spot checks and daily audits are being carried out on each unit to ensure people are receiving appropriate care and support and their medicines. However, these had not identified the inconsistencies we found in the recording on people’s health charts. The manager told us they were still in the process of developing a raft of audit tools to assess and monitor the quality of the service, but these tools have not yet been used and therefore we could not determine their effectiveness. However systems were in place for reviewing complaints, safeguarding concerns, incidents and accidents. Documentation showed there has been learning from such events and measures have been taken to ensure these events are less likely to happen again.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.