Sandbanks Resource Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 2 breaches of the legal regulation Risk assessments and risk management plans had not always been completed to provide staff with guidance on how to reduce possible risks. The provider had a process to identify if people could consent to their care, but this was not always followed to ensure support followed the principles of the Mental Capacity Act 2005. The records relating to the administration of medicines did not always include guidance on covert medicines administration, medicines prescribed to be taken as and when required and staff did not always complete records in a timely manner. People knew how to raise any concerns with the provider. The provider had a process for recording and investigating incidents and accidents and identifying possible actions. Staff completed infection prevention and control training and had access to personal protective equipment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who lived at the home and relatives told us they felt able to raise any concerns or make a complaint about the care being provided.

Staff told us they completed incident and accident forms when required. They stated that the senior staff in the home identify if there is a change in the person’s support needs such as a change in mobility after a fall and appropriate equipment and guidance was put in place.

The provider had procedures for the investigation, review and response to complaints and incidents and accidents. When a concern or an incident and accident was identified, the initial information was reviewed, statements from staff were obtained when required and the actions taken were recorded. If a person experienced a fall their risk assessment was updated to reflect this and any changes in support need.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the home and could get to assist them when required. A relative explained 2 specific staff knew their family member well and they felt they were safe. While the people we spoke to expressed that they felt safe when they received care, our assessment found elements of processes related to how care was provided did not meet the expected standards.

Staff confirmed they had completed training in relation to safeguarding adults and they demonstrated an understanding of the importance of safeguarding to ensure safe care and support was provided. Staff also confirmed that they completed training for mental capacity and consent with one staff member explaining they “work on the assumption of capacity” when providing support.

The provider had a process for the assessment of a person had the capacity to make decisions about their day-to-day care capacity, but this was not always followed. In one area of the home, people had sensor mats and door sensors which alerted care workers if they got out of bed or left their bedroom as there was no staff member allocated to the specific area at night. If the sensor alarm sounded a care worker would check. Mental capacity assessments had not always been carried out to ensure people in this area of the home could consent to the use of the sensor system and a best interest decision to access if this was the least restrictive option possible. The provider had a procedure for the investigation and reporting of safeguarding concerns. Applications were made for Deprivation of Liberty Safeguarding (DoLS) if a person was identified as being unable to consent to their care with any conditions being complied with. DoLS were monitored to ensure application were made in a timely manner.

People’s risks were identified and managed with people saying they felt staff provided care which was safe with 1 person commenting, “It is safe. They treat me very well. I can always find someone if I need them.”

Staff confirmed they reviewed each person’s care plan and risk assessments monthly or if there was a change in the person’s support needs. They also discussed any changes or newly identified risks at the daily handovers. The registered manager confirmed they would review the risk assessments to ensure they reflected all the possible risks identified.

The provider had developed a range of risk assessments related to a person’s health and wellbeing, but these did not always reflect all the risks identified. A risk assessment or management plan had not always been developed where a person had been identified as having a possible risk such as living with a medical condition or being prescribed a blood thinner. This meant staff may not have been provided with appropriate information on how to provide support in a way that reduced possible risks. Other risk assessments contained conflicting information about the nature of people’s needs.

People were supported to personalise their bedrooms, and all bedrooms had an ensuite bathroom. There were memory boxes outside people’s bedroom with items related to the person. There was an accessible garden with a pond and seating which people could use.

The registered manager explained they carried out a number of health and safety checks to ensure the home’s environment was safe which included checks on equipment such as wheelchairs, fire safety and water temperature.

The separate sections of the home where people lived at the home were not as dementia friendly as they could have been. On one section there were glass cabinet which contained Christmas decorations and lights which could be confusing. Also, incontinence products were stored in some bedrooms under tables or in the bathroom which did not promote privacy and dignity. This was discussed with the registered manager who confirmed they would review the guidance on dementia friendly environments and how it could be implemented at the home.

People made a range of comments about the levels of staff. Some people thought were not always enough staff with their comments including, “If I needed anyone I’d go and find them. Oh yes, I’d find someone eventually” and “There aren’t enough staff, they are always rushing around. Some of the staff are more skilled than others. It’s like that in any job, there are some people who are much better at what they do and others who are not so good.” Other people felt there were enough staff on duty.

Staff told us they felt there were enough staff on duty in each separate part of the home but there was a lot of agency staff usage. A staff member did comment that having 2 staff members on each part of the home could sometimes be an issue when providing support for people requiring either 1 to 1 care or the support of 2 staff members, but they said they could call on senior staff for support when required. Staff confirmed they had completed a range of training courses with a staff member telling us, “It’s beneficial to us and every year we have to do it and it refreshes your memory. I would say so (high quality training). Mixture of face to face and e-learning.” Staff also confirmed they had regular handovers and supervision meeting with senior staff with a staff member commenting, “Yeah, it gives time if your worried about something, you can talk to them and normally come up with a solution, things with clients, you can bring up and they get onto it if the need anything.”

There were 2 staff members allocated to each section of the home during the day and 1 staff member on 5 of the sections at night. The sixth section was not staffed at night but the provider had implemented sensor mats and door sensors to alert staff if a person gets out of bed or left their bedroom. A staff member also carried out regular checks in the specific section during the night. This was discussed with the registered manager who explained assessments of people’s dependency were regularly carried out to ensure staffing levels met people’s needs. The provider had a robust recruitment procedure which included checks on criminal records, obtaining references from previous employers and the applicants right to work in the United Kingdom. Staff completed an induction and a range of training courses which included health and safety, basic life support and falls prevention.

People confirmed that care workers always wore personal protective equipment (PPE) including gloves and aprons when providing care. The home was clean and tidy and there were no malodours. A person told us, “The room is cleaned regularly. My bed is always made-up. The staff always wear gloves and aprons when doing my personal care.”

Staff explained they had completed training on infection prevention and control, and they demonstrated a good understanding of the importance of using PPE and infection control when providing care. Staff told us they have access to PPE, and it is delivered to each part of the home to ensure there were enough supplies.

The provider had appropriate processes to manage and control the risks of infection. Care workers had access to PPE in each of the specific section of the home. The provider carried out regular checks in relation to the use of PPE by care workers.

People confirmed care workers supported them with their medicines and explained what the medicines were for when they were administered. People commented that if they told the care workers, they were in pain they received appropriate medicine for pain relief. While the people we spoke to expressed that they were generally happy with the administration of their medicines, our assessment found elements of administration of medicines process that did not meet the expected standards.

Staff told us they had completed training on the administration of medicines and there was an assessment of their competency in relation to supporting people with their medicines. However, records showed that staff were not supporting people with medicines in line with their training.

The provider had a process for the administration of medicines, but this was not always followed. The medicines administration records for one section of the home were reviewed and we identified that the records had not been completed at the time people received their prescribed medicines. The National Institute for Health and Care Excellence guidance for managing medicines in care home states that records about medicines were accurate and up to date. The staff explained they had not completed the medicine records when they administered the medicines as they were busy providing care for people. This was discussed with the registered manager who confirmed they were look into the concern. Where a person had been prescribed medicines to be administered covertly documents including mental capacity assessments, best interest decisions and guidance for staff on how to appropriately administer were not always completed. If a person had been prescribed a medicine which was to be administered as an when required did not always have protocols in place which provided staff with guidance as to how and when these medicines should be administered. The medicines records for one person indicated they had been prescribed a regular dose of a pain relief medicine, but staff had been recording it as being administered as and when required so it was not clear it had been administered as prescribed. Aside from the information identified above, people’s medicines were securely stored in each section of the home where people lived. The medicine administration records (MAR) were completed by staff which included information on the prescribed medicine and if the person had any allergies. The stock levels of medicines were recorded accurately and medicines requiring refrigeration were stored in medicines fridges with the temperatures regularly checked and recorded.