Sandrock Nursing Home

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• 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 3 breaches of the legal regulations in relation to safe care and treatment, staffing and neglecting the environment placing people at risk of harm. People were not protected from risks associated with infection prevention and control. People were not always safeguarded from the risk of abuse. Medicines were not always managed safely.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they generally felt safe within the service and that they were asked for feedback on how the service could be improved. However, when concerns were raised nothing changed or improved. One relative told us there was a lack of stimulation, “Only thing that disappointed with there is nothing to stimulate them mentally particularly now there are so few of them and they sit and TV is on and that’s it. I have raised it a couple of time but nothing.” Records showed staff took appropriate action where people had experienced an accident or incident. This included contacting the GP or other health professional for an assessment or review.

Staff told us they knew how to report accidents and incidents. Staff understood their roles and responsibilities, however with no clear leadership from the provider it was not evident that lessons learned with staff were discussed through supervisions or staff meetings.

Accidents and incidents were recorded and monitored and where accident and incidents had occurred, records showed people’s relatives were informed. However, the provider lacked robust oversight of the service. The provider was not proactive in making positive changes. They failed to take responsibility for assessing, monitoring and improving the quality of the service and for mitigating risks to people in the home. Their was a clear lack of progress made to address system issues.

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 were at risk of experiencing avoidable harm with the concerns we have identified with the safety and condition of both the inside and outside of the premises. Although we saw that people and relatives had been asked for feedback about the service no improvements to the environment had been made. People did tell us they felt safe living at the service. One relative told us, “I feel he is safe as he is going to be anywhere" and another said "I think the staff are lovely with them I go all sorts of times on different days and they are always very kind I would say they're well looked after".

Staff had completed training in safeguarding and explained what action they would take should a person experience abuse or neglect. Staff had access to safeguarding policies and procedures. Staff told us they felt confident to raise concerns. During the assessment, the service received a visit from Healthwatch who identified concerns around the environment. In the Healthwatch report the provider admits that these concerns had been ongoing for some time.

We found continued concerns with the safety and condition of both the inside and outside of the premises as found at the previous inspections. Sandrock nursing home is registered to deliver regulated activities to 28 service users and during this assessment 7 rooms were occupied. The provider had failed to appropriately assess, monitor and manage risks to people's health and safety by neglecting the environment placing people at risk of harm.

People were not being safeguarded from abuse. We found serious concerns with the safety and condition of both the inside and outside of the premises. With no registered manager or clarity who was managing the service this led to uncertainty for people, relatives and staff. The provider had systems and processes in place for safeguarding but there was no oversight from the provider. Staff had received safeguarding training and knew what action to take if they had any concerns.

People and their relatives told us staff looked after people well. However, robust systems would need to be in place to ensure risks associated with people's safety was minimised to ensure they always received safe care. People’s relatives told us they were informed if their loved one had suffered a fall or had been involved in an incident. One relative told us, " They have the falls team in I think every now and then to check on everything and give them advice." We saw that people who had been identified as at high risk of falls had risk assessments in place and if enhanced monitoring was required this was put in place to reduce the risk of falls.

Staff understood where people required support to reduce the risk of avoidable harm. Staff knew the risks to people and told us they were kept up to date if there had been any changes to people's care and support needs.

We observed people's care needs being met. Where people required assistance with walking or being transferred using equipment, staff provided this in a person centred way. We observed people in the dining room, where people required assistance with their dietary requirements being encouraged to be independent and staff took time to speak in an attentive and caring way to the people.

People's records showed advice and guidance was documented, and staff followed the information provided to help improve and maintain their care. Where people required some aspects of their care and support to be monitored, such as risks associated with poor skin condition, charts were in place to evidence how these were monitored and managed.

People and relatives told us that the environment was tired and in need of decoration. One relative told us, “Starting to look a bit run down” and another said “There are areas that need re-decorating, and some furniture could do with replacing, but I think they’re safe I don’t feel they’re going to come to any harm.”

Staff we spoke with all agreed that the home was in need of environmental improvements and they had been told by the provider this would happen once the future of the service had been resolved. One staff member told us, "think there [is] a lot he can do." During the assessment we did not get the opportunity to speak to the provider or anyone who was managing the service.

We found serious concerns with the safety and condition of both the inside and outside of the premises. Occupied and unoccupied bedrooms were in very poor condition. There were stains, damp patches and odious stale smells in most of the unoccupied rooms of the premises. The garden area presented multiple health and safety hazards to both people and staff. On the first day of inspection, we saw that a signage to support the safe evacuation of the premises to be broken and laying on the floor. On day two this had not been resolved despite highlighting with the maintenance staff on day one. We saw that there was damage to the eves of the building and in the eaves of the building and directly outside an unoccupied bedroom several pigeons had made nests. Gutters above the unoccupied bedrooms were overflowing with plant materials and there was damage to down pipes and gutters to the rear side of the building. In the rear side of the garden that was partially cordoned off there was pieces of timber in the rear side garden with nails sticking out. Corridors that leading to occupied rooms and the medicines room had damp on the walls. This corridor had a strong odious smell of urine. The doorway between the conservatory and lounge/dining area had a water leak.

The provider had failed to appropriately assess, monitor and manage risks to people's health and safety by neglecting the environment placing people at risk of harm. The evidence cited above demonstrates that the provider exposed service users to the risk of harm because the provider failed to identify and mitigate risks associated with the environment. Bedrooms, communal areas and garden were unsafe and in a poor state of repair exposing service users and others to the risk of avoidable harm. When we requested an improvement plan for the building and environment the provider did not provide one and gave no indication that they intended to make the necessary improvements. During the assessment process we issued a section 64 notice that requires the provider to give the Commission specified information and documentation under Section 64 of the Health and Social Care Act 2008. One of the items requested was environmental/building action plans. The provider did not provide this information. This is an offence under the Act. CQC chose not to pursue this offence as the provider cancelled their registration.

There were enough staff to meet people's needs. Relatives told us that they knew the staff well as most of them had worked at the service for a long time. One relative told us, “ the staff are very consistent and clearly they like working here” and “ They try to be as good carers for their patients as they can be.”

Staff told us there was enough staff to meet people needs and that the provider worked regularly at night to cover shifts. Staff could not confirm who was managing the service on a day to day. When we asked the staff who was managing the service on a day to day basis the staff would not commit to telling us. The staff did however confirm that they would go to the nurse or the provider when available in charge for help and support. During the assessment we did not get the opportunity to speak to the provider or anyone who was managing the service.

We observed enough staff on duty, including nursing staff. People’s needs were met in a timely way. The environment was calm and relaxed. There were positive interactions between people and care and nursing staff and it was obvious that these staff knew people well and were familiar with the needs and preferences of the people they were caring for.

During the assessment we requested a copy of the staff structure as to try to ascertain who was managing the service. The structure showed that a staff member who we were told was the administrator was the matron with lead responsibilities in dignity and diabetic champion, IPC lead, Medicines lead and End of life champion. Although we could not confirm if this person was managing the service we have strong evidence to suggest this member of staff was taking a lead role in all aspects of the service. This staff member had received a striking off order by the NMC council. The provider had failed to employ suitably qualified staff at Sandrock Nursing Home putting service users at risk of avoidable harm. Staff responsible for the administration of medicines to residents did not have an annual review of their knowledge, skills and competency relating to managing and administering medicines safely to ensure that they gave medicines safely.

Most people and relatives agreed that the building including furniture required replacing and that the home had been neglected. One person said, “Its an old building, it’s a little neglected, don’t think it is having enough investment in it.” relatives told us that staff wore personal protective equipment (PPE) when delivering care and support.

All the staff we spoke to told us that the building was in desperate need of updating and that the furniture was old and they couldn't remember when it was last replaced. They told us that housekeeping staff tried to keep the environment clean and they all worked hard to keep people safe from risk of infections.

We observed enough staff on duty, including nursing staff. People’s needs were met in a timely way. The environment was calm and relaxed. There were positive interactions between people and care and nursing staff and it was obvious that these staff knew people well and were familiar with the needs and preferences of the people they were caring for.

Although the provider had an up to date IPC policy and procedure and staff followed IPC best practice it was clear that the provider did not have any intention of improving the environment of the home. This included replacing old furniture that was frayed and had been at the home for at least the previous four inspections. The odious smells throughout the building were at times overpowering and these had been highlighted to the provider in the previous inspections.

Relatives told us that they were involved in changes to their loved ones medicines and staff would always call them to give updates. One relative told us, “Always kept informed” and another said, “yes they would inform us, they know best.”

Staff delivering medicines told us they were supported by the provider and had their competencies checked regularly. You can see below that this was not the case and staff delivering medicines did not have a review of their knowledge, skills and competency. During the assessment we did not get the opportunity to speak to the provider or anyone who was managing the service.

Records to show topical preparations such as creams were being applied were not completed accurately so we could not be assured they were being applied safely, as prescribed. The provider failed to have effective systems in place to ensure that up to date information to support staff to safely administer ‘when required’ medicines was in place. There was a risk people might not get their medicines when they needed them. The provider failed to provide evidence that a medicines policy was in place and being followed by staff employed. They failed to provide evidence that medicines incidents were recorded, analysed and learnt from. Therefore, we were not assured that robust processes were in place for the safe management of medicines and we could not be assured that a good safety culture was in place. The provider failed to ensure that staff responsible for the administration of medicines to residents had an annual review of their knowledge, skills and competency relating to managing and administering medicines safely to ensure that they gave medicines safely. The provider failed to follow current guidelines for effective governance arrangements relating to medicines. This includes assurance and auditing systems and processes. We were not assured that accurate, complete and detailed records for people living at the service and records relating to staff administering medicines were maintained.