Revitalise Sandpipers is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides short breaks for people with a disability and their supporters / carers. The service offers short breaks in a relaxed, holiday style environment with a variety of trips, entertainment and activities. People who use the service are supported by a team of staff and volunteers. The service can accommodate up to 38 people. At the time of the inspection 32 people were accommodated.

This was an unannounced inspection and it took place on 16 and 17 April 2018.

At the last comprehensive inspection in October 2016 we found a breach of regulations with in respect to, maintaining appropriate records for the care and treatment delivered to people and to demonstrate that effective systems where in place to identify and assess risks to individuals. The service was rated as ‘Requires improvement’.

On this inspection we found improvements had been made and the breach of regulations had been met. It was clear the improvements had been in place over a sustained period and the service continued to develop. On this inspection we rated the service as ‘Good’.

A registered manager was in post. 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.

We found improvements had been made so that any potential risks to people using the service were better identified. More effective care plans had been agreed with people so that potential risks could be reduced. This was evident with medicines management where people were now fully assessed on admission and clear strategies where in place for each person to manage medicines safely.

Key documentation included attention to ensuring people’s consent to any care and treatment was recorded and operated in accordance with the principles of the Mental Capacity Act 2005 (MCA).

Revitalise Sandpipers had improved much of their key assessment and care planning documentation. The service had continued to develop quality monitoring processes and the registered manager had support from senior managers.

Policies and procedures provided guidance to staff regarding expectations and performance. These included policies regarding people’s diversity. Staff were clear about the need to support people’s rights and needs regarding equality and diversity.

People using the service and staff were involved in discussions about the service and were asked to share their views. This was achieved through daily contact by the managers and staff and regular surveys. These provided very positive responses regarding people’s stay.

The service maintained effective systems to safeguard people from abuse and the service had worked effectively with the local safeguarding team when needed.

Medicines were safely stored and administered in accordance with best- practice and people’s individual preferences. The records we saw indicated that medicines were administered correctly and were subject to regular audit.

We saw evidence that the service learned from incidents and issues identified during audits.

People’s needs were assessed and recorded by suitably qualified and experienced staff. Care and support were delivered in line with current legislation and best-practice.

The service ensured that staff were trained to a high standard in appropriate subjects. There was clear demarcation between regular staff and volunteers so that roles were clear.

We saw clear evidence of staff working effectively to deliver positive outcomes for people. People reviewed were receivin

This inspection took place on the 24 and 28 October 2016 and was unannounced.

Revitalise Sandpipers is registered to provide accommodation with nursing and personal care to people with a disability and their carers. The service offers short breaks in a relaxed, holiday style environment with a variety of trips, entertainment and activities. People who use the service are supported by a team of staff and volunteers. The service can accommodate up to 38 people. At the time of this inspection 23 people were using the service.

A registered manager was in post. 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.

During this inspection we identified 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 the report.

Records relating to people’s care planning and the assessment of risk were not always robust. This was because records failed to fully demonstrate how risks to people had been determined and how their care needed to be delivered. Records relating to people’s care contained wording such as prompting, encouraging and assistance but failed to demonstrate how a person needed to be prompted, encouraged or assisted. Failure to have detailed information about how a person needed to be supported may result in individuals’ not receiving the care and support they required.

Records relating to complaints made about the service required improvement. The details complaints was recorded, however there were no records to demonstrate the process and investigations that had taken plan into the complaints. This meant that there was not clear audit trail in relation the recording of people’s concerns.

People told us that they felt safe at the service. Procedures were in place to protect people from harm. Safeguarding procedures were available at the service. Staff demonstrated a good awareness of how to respond to any safeguarding concerns. People told us that they felt safe at the service.

Effective staff recruitment procedures were in place. The process involved carrying out a number of checks to help ensure that only staff suitable to work with vulnerable people were employed.

People told us that staff always asked for their consent prior to carrying out any care and support. People told us that they were always given a choice of what they wanted to do with their time and what they wanted to eat.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; however, the policies and systems in the service did not support this practice.

We have made a recommendation that the registered provider ensures at all times up to date information is sought in relation to people’s status under the Mental Capacity Act 2005. This is to ensure that people’s rights are maintained and protected under the Act at all times

People were happy with the choice of food available to them and felt that their nutritional needs and choices were met.

Staff received regular updated training for their role. They felt well support by the senior staff, received regular supervision and attended regular staff meetings to keep them up to date with their role.

People told us that staff were caring and respected their privacy. The environment was relaxed, calm and friendly. Lots of laughter was seen to take place between people and the staff supporting them.

People’s needs relating their cultural and spiritual choices were sought and people were supported to attend local religious services of their choice. This helped ensure that people were able to practice and maintain their faith pat

We carried out this responsive inspection as the Care Quality Commission (CQC) had received information to suggest there were insufficient staff to undertake the moving and handling of people who used the service in accordance with their care plans.

We considered all the evidence we gathered under the outcome we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found –

Is the service safe?

We enquired about the staffing levels and people who used the service told us there was sufficient staff on duty to meet their needs. The staffing levels described by staff were reflected in staff duty rotas we looked at.

Because the service supported different people each week, the needs of people varied and staff said it could be very busy some weeks. The registered manager was aware of this and planned in January 2015 to increase staff support at key times in the morning and evening.

We found that people who required the use of equipment to move were supported with hoisting in accordance with their plan of care.

Is the service effective?

This was a responsive inspection based on specific concerning information CQC received about the safety of the service. We did not look specifically at this area.

Is the service caring?

This was a responsive inspection based on specific concerning information CQC received about the safety of the service. We did not look specifically at this area.

Is the service responsive?

This was a responsive inspection based on specific concerning information CQC received about the safety of the service. We did not look specifically at this area.

Is the service well-led?

This was a responsive inspection based on specific concerning information CQC received about the safety of the service. We did not look specifically at this area.

People we spoke with were very happy with the care and support provided at the centre. Some comments made were:

"The staff are very helpful.”

“The staff are fantastic, there are plenty to help at all times.”

“We have had a great time this week staying here and we are looking forward to the party night tonight before we go home tomorrow.”

We found people were treated respectfully and was given information before their arrival at the centre and had a welcome greeting on their arrival. Individuals could choose how they spent their stay at the centre. This included participating in the daily trips, staying locally around Southport amenities or staying at the centre.

We reviewed four electronic care files and found them to be person centred in their approach with good quality data being recorded by staff as they delivered care. There was a process in place to manage a guest’s care and support during the stay at the centre.

The organisation had effective human resource policies and procedures in place to support all aspects of managing and recruiting staff.

The centre had effective infection prevention and control policies and procedures in place to ensure guests and staff employed were protected against identifiable risks. Systems were in place to prevent and control the spread of infections.

During our inspection we spent time with people who were guests at Sandpipers, we invited them to share with us their views and experience of the care they received. We also spoke with carers and family members who were accompanying relatives on their short break.

One guest who stayed at the centre told us “Staff treat me as a person and did not look at me as having a disability.”

We spoke to another guest at the centre, they told us “The food is excellent and so are the staff. I will be back later in the year for another break.”

Throughout our visit we observed staff being attentive to the needs of the people staying at the centre and their tone and manner was respectful and caring.

The centre had a guest relationship manager who told us the quality assurance feedback from the guests was very important to ensure the centre continued to meet the changing needs of the guests.

At the time of our inspection it was party night; the guests were served a three course silver service evening meal, with choices from a selected menu. Following the meal a live entertainer had been planned. We observed staff and volunteers supporting guests to eat their meals and socialising with them. There was good interaction and communication between the guests and staff. We observed a relaxed party atmosphere with laughter and chatter.

We spoke with four people who were on holiday at the centre about their medicines and the care they received. All were positive about their holiday and raised no direct concerns about how their medicines were managed.

People at the centre told us they were provided with written information regarding Vitalise and specifically around Sandpipers. They said the information was informative in respect of what the centre provided and this included the level of care and support they would experience. The documents also gave details about the staff and volunteer service. Vitalise has a volunteer force at its centres and they spend time with the guests on a ‘one to one’ basis or within a group. Their primary functions is to assist with social arrangements.

We spoke with a number of people and asked them specifically about their experiences of how the service involved them and kept them informed. We were also able to make general observations of people’s well being, as further evidence of inclusion. Everyone we spoke with said they were able to talk freely to the staff and that their views were listened to and respected. For example, when the staff asked people if they would like to go out on the organised trip from the centre people were able to decide whether they wished to participate. Some people decided to stay at the centre and others to go out locally. They told us they could choose how to spend their day, staff respected their decisions and that having this choice was an important part of their holiday. People were of the opinion that their views were taken into account by staff in the decision making for social arrangements and care and treatment they received at the centre. An individual told told us the staff had discussed at length a medication that needed prescribing and they thought this was a good part of their care. Likewise a another person said a good holiday should involve a relaxed routine and the staff were mindful of this when providing care and support and also arranging entertainment at a time to suit each person. People's comments about the centre included:

“The staff always ask me what I would like to do"

"They respect my decisions"

" The staff check the care I need"

"It is good that you can come with a relative, a carer or on your own"

“I like all the entertainment.”

We spoke with a number of people at the centre and they confirmed their views, wishes and care needs were recorded following discussion with the staff. They told us their consent was gained for their care and treatment and that this information was initially obtained when completing the booking form for the stay at the centre. They said this was then followed up with a telephone call and discussion at the centre on arrival. A relative told us that the staff always made sure any changes to their family member’s care were discussed with them. A person also informed us that they had been consulted regarding an appointment with the centre’s GP and were aware of how this referral had been arranged.

People informed us they were pleased with the way in which medical and social information was sought and that the staff ‘did a good job’ in making sure their care was given according to need.

On the day of the site visit we spent some time observing the care and talking to people staying at the centre. Peoples' dependencies can vary we asked a number of them about the care and support they received. Their comments included:

“The staff are very good”

“The nurses help me with my medicines”

“I ring the call bell and the staff come to me and help me”

“The staff help me to get washed and ready in the morning”

“Having the volunteers is great”

“The care is ten out of ten.”

“The volunteers are so chatty and it is nice to have them to talk to”

“The staff appear to gets lots of training, as they are very good at making sure we are well looked after”

We saw people being helped with different aspect of care and getting ready for the trips out. Although the centre was very busy in the morning the staff were attentive to everyone’s needs. The volunteers were on hand to assist with the social arrangements and to support people getting ready for the trip out.

People we spoke with at the centre said they felt safe. For example, they said the staff were competent in using equipment for helping them in and out of bed, or using the aids/equipment in the bathrooms. They also confirmed they were able to raise any concerns and that they had confidence in the staff’s ability to deal with their concerns.

We spoke with three people who were on holiday at the centre about their medicines. Two of these people said nursing staff gave them their medicines properly and they had no concerns about the way they were handled. One person that was looking after their own medicines said they were supported to do this by staff and they had no problems. A lockable cupboard had been provided to keep them in and they said nursing staff had discussed this with them to make sure they knew about storing them securely. Likewise, a guest reported that they were pleased they could retain their independence by looking after their own medicines.

One person said they had their medicines given to them properly and two of their medicines used for pain relief were always offered at every medicines round.

People told us they were given the opportunity to talk with the staff about the centre and also to complete satisfaction questionnaires following their stay. We asked people about the quality of their holiday and we received the following comments:

“Very good indeed”

“The food is fine”

“The party night is very good”

“I come hear each year and always enjoy my break”

“The staff are really good”

“I like getting a questionnaire, as I can make suggestions”

“I love coming here”

We looked at some of the recent satisfaction questionnaires, which had been given to people following their stay. Their comments included:

“I don’t believe you can improve it”

“The quality of the care was exceptional”

“The quality of the meals need to be vastly improved”

“We enjoyed the standard of the place and holiday”

“Keep serving fresh food”

“Better food options for vegetarians”

“Sandpipers is excellent. The staff are fab and I will be coming back”

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found:

Is the service safe?

People staying at the centre told us they received a good standard of care and support. Some people told us they had visited before and that they continued to come to Sandpipers as they really enjoyed their visits. A person told us they felt safe as there were staff around to help at all times.

Is the service effective?

People who were staying at the centre told us the staff had a professional attitude and that they were attentive to their needs. People’s comments included, “What the staff do is wonderful” and “Staff deal with guests [people staying at the centre] really well - ten out of ten." People told us the staff and volunteers worked well together and that collectively the staff team were really good. Staff and volunteers received training and support to help them carry out their role effectively and safely.

Is the service caring?

People said the staff and volunteers were caring and helpful in their approach and no one raised a concern about the attitude of the staff or a lack of dignity when receiving personal care. People’s comments included, “The staff are absolutely marvellous” and “Everyone really cares about making the week enjoyable." During our inspection we saw very positive interaction between the staff, volunteers and guests. There was a relaxed atmosphere and people were able to choose what they wanted to do and at a time that suited them.

Is the service responsive?

People told us when they needed assistance this was provide promptly by the staff. People told us when they rang their buzzer the staff came as quickly as they could. We did not look at care files on this occasion. People said however they had been contacted prior to their stay to discuss their care needs and requirements. They told us that on arrival the staff discussed with them the care and support they needed. People at the centre had access to a wide range of activities that were important to them. People said the trips out were very good.

Is the service well led?

The service had a quality assurance system which included audits [checks] by the centre manager and senior management. Staff and volunteers told us they were clear about their roles, responsibilities and ethos of the home. People told us they were able to provide verbal feedback about their stay at the centre and also given satisfaction questionnaires to complete. We saw that the service was monitored to ensure it operated safely and effectively.