One adult social care inspector inspected Sanford House. At the time of the inspection there were 39 people using the service. 15 people were cared for in the dementia unit and 24 people in the nursing unit.We spoke with four people who used the service, three people's relatives and seven staff members. We pathway tracked and reviewed the records for six people who used the service. We also reviewed a selection of other records that included staffing rotas, the provider's policies and procedures, training records and audit results in relation to all aspects of the service.
We used the evidence we collected during our inspection to answer five questions.
Is the service safe?
The management team had been trained and understood their obligation to apply the principles of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS). People who used the service had received appropriate mental capacity assessments and a number of 'best interest' decisions were recorded. At the time of this inspection the registered manager told us that a number of people had a Deprivation of Liberty Safeguard (DoLS) in place. This was in the form of a standard authorisation or an urgent authorisation. We saw evidence that the registered manager had acted in accordance with the law in relation to the MCA and DoLS.
People who used the service and their relatives told us that they felt there were enough staff on duty to meet people's needs at all times. This included the needs of people who required one to one care and support.
There were effective systems in place to record and investigate accidents and incidents. Trends analysis was undertaken by the manager and action plans put in place to reduce the risk of repeat occurrences.
Risk assessments had been completed in relation to people's needs with documentation as to how risks could be minimised. Examples of this included the use of a hoist and walking aids for people with mobility problems. This helped to ensure that people's safety and welfare was maintained.
Staff were up to date with their mandatory adult safeguarding training and told us the procedures they would follow if they suspected actual or potential abuse. The provider's safeguarding policy and procedure was in date and referred to the local authority's safeguarding procedure.
The provider had effective arrangements in place to manage foreseeable emergencies. These included plans in relation to fire and evacuation, loss of utilities and the loss of the nurse call bell system.
Is the service effective?
People's needs were assessed, and care and support was planned and delivered in order to meet these needs. Nationally recognised tools were used in the assessment of people's needs. This included the 'Malnutrition Universal Screening Tool' (MUST) for people at risk of malnutrition or obesity.
During the review of six people's care plans we saw robust evidence that the provider worked closely with other health and social care professionals. This meant that people received care and treatment from a multidisciplinary team that helped to address all of their needs. .
We noted that new care booklets had been recently introduced to the service. We reviewed the booklets that related to nutrition and hydration, and wound care management. We saw evidence that the information contained within the booklet was evidence-based and included nationally recognised screening tools and guidelines.
Staff were competent and had undertaken their induction and mandatory training. Additional specialist training was undertaken after the person had completed their induction training. All of the staff we spoke with told us that they felt well supported and received regular appraisals and supervisions.
Is the service caring?
All of the people who used the service and their relatives who we spoke with were positive about the service. One person said, 'I am very happy here. I am well looked after. I have no complaints. I choose what I want to do each day and if I want, I join in with things. The staff are very good.' Another person said, 'I am happy living here and choose to stay in my room. I am able to open my patio door to go into the garden to have a cigarette if I want to.'
One of relatives we spoke said, 'I am very satisfied with this home. The care given to my (relative) is excellent. Staff attend to my (relative's) personal needs and all the care is wonderful. The home's design, premises and environment is great. I have no concerns about my (relative's) safety, I feel fully involved in their care planning and support because my (relative) does not have capacity.'
During our inspection we observed the interaction between the staff and the people they cared for. Staff were compassionate and respectful at all times, and people's privacy and dignity were maintained.
Is the service responsive?
People's care plans responded to and reflected their physical and mental health needs as well as their social and spiritual needs. Staff were able to support people with complex needs. This included the needs of people living with advanced dementia.
People's care plans included an easy read format for personal care. This helped the person understand how the staff could assist them in meeting their personal care needs.
The environment was conducive to people living with dementia. The premises were spacious and there were activities and objects available to help meet the needs of people. We have highlighted our concerns to the provider in relation to the seating arrangements in the lounges in both the nursing and dementia units as well as the lack of ventilation in the lounge in the dementia unit.
Although there were minimal complaints received by the service, we saw evidence that learning from complaints and concerns took place.
Is the service well-led?
Sanford House was well led. Governance, risk management and quality measurement was effectively addressed on a daily basis, and formally on a monthly basis. Both the registered manager and the regional manager undertook monthly audits that addressed all areas of the service.
All of the people we spoke with who used the service and their relatives told us that they felt the service was well led. One relative said, 'The manager is wonderful. We are invited to meetings and complete the satisfaction surveys left in the doorway. The manager has an open-door policy and if we have any problems then they just sort it out. We have no complaints.'
All of the staff we spoke with told us that they felt they were well supported and that the registered manager was approachable and would always listen to what they said.
The management team told us that they were supported to try new ways of working to improve the efficiency and effectiveness of the service. This included a new initiative for new members of staff to wear a different coloured uniform. They said that this would help prevent other staff requesting their assistance before the person had received their necessary training and been signed of as being competent.