About the service:

Sandbanks Resource Centre is a care home and is run by the London Borough of Hounslow. It provides 24 hour care for up to 62 people who are no longer able to live independently at home. The home is situated within a residential area of the London Borough of Hounslow. At the time of our visit there were 56 people using the service.

People’s experience of using this service:

• The provider had a procedure in place for the management of medicines and care workers had completed training to support them in administering medicines in an appropriate manner.

• People told us they felt safe living in Sandbanks Resource Centre. The provider had a procedure in place to investigate and respond to any concerns raised regarding the care provided.

• There were adequate numbers of care workers deployed around the home to ensure people’s support needs were met.

• We saw risk assessments and risk management plans had been completed where a possible risk to a person’s health and wellbeing had been identified

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• The provider had a robust recruitment process in place. Care workers completed training identified as mandatory by the provider with regular supervision and an annual appraisal.

• People were supported to access a range of healthcare professionals to support them with their care needs.

• People told us they were happy with the care they received and care workers respected their privacy, dignity and independence.

• Care plans identified people wishes as to how they wished their care to be provided. A range of activities were organised for people and they told us they enjoyed them.

• The provider responded to complaints in an appropriate manner.

• The provider had a range of processes in place to monitor the quality of the care provided.

• People and the care workers we spoke with felt the service was well-led.

Rating at last inspection: At the last inspection the service was rated Good (report published 06 September 2016).

Why we inspected: This was a planned inspection to check/confirm that this service remained Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if we receive any concerning information.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook an unannounced inspection of Sandbanks Resource Centre on 12, 13 and 14 July 2016.

Sandbanks Resource Centre is a care home and is run by the London Borough of Hounslow. Sandbanks Resource Centre provides 24 hour care and supervision for up to 60 men and women over the age of 55, who are no longer able to live independently at home. The home is situated within a residential area of the London Borough of Hounslow. At the time of our visit there were 54 people using the service.

At the time of the inspection the service did not have a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider. The head of regulated services explained that the previous registered manager and the assistant manager had left the service at the end of March 2016. The head of regulated services confirmed they were acting as interim manager at the home while they recruited a new registered manager.

We previously inspected Sandbanks on 10 and 11 November 2014 and the home was rated as Require Improvement. Issues were identified in relation to staffing levels, pressure ulcer management, staff training and support, food, activities and quality assurance. Improvements have been made in relation to the care provided.

The system used to identify how care workers were allocated to meet the support needs of people using the service had improved.

The provider carried out assessments when people were identified as being at increased risk of pressure ulcers. A range of risk assessments were in place in relation to the care being provided.

The provider had appropriate processes and training in place for the safe administration of medicines. Processes were in place for the recording and investigation of incidents and accidents.

The provider had an effective recruitment process in place. There was a policy and procedure in place for the administration of medicines.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also, care workers had regular supervision with their manager and received an annual appraisal.

Some improvements had been made in the support provided to people to eat their meals and to make choices from the menu. We have made a recommendation for the provider to review guidance on developing appropriate menus.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

The range of activities and how they were provided had been improved.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided.

People using the service and their relatives had a range of ways to provide feedback on the way care was provided and the quality of the service.

The provider had systems in place to monitor the quality of the care provided and these provided appropriate information to identify issues with the quality of the service.

Care workers told us they felt supported by their line manager.

We visited the service because we had received information that the service might not be complying with essential standards of quality and safety. In particular, concerns were raised about inadequate staffing levels and about moving and handling equipment such as hoists not working properly.

During our inspection we spoke with the manager, five other members of staff and two people who were using the service. We found that two hoists, one ceiling hoist and one free standing hoist were in need of repair. However, staff were still able to use the equipment safely and we saw evidence that the repairs had been reported to the company responsible for maintaining the equipment and were being addressed.

We discussed staffing levels with the manager of the home. The home was not full at the time of the inspection with 46 people using the service out of a possible 62. The manager told us that the number of referrals was increasing and as a result staffing levels were being increased accordingly as more people were admitted to the home.

We spoke with two people who were using the service, they told us that there was always enough staff to support them and meet their needs. One person pointed to the call bell and said, "if I need anything I push this and they come quickly".

We spoke with the manager, four other members of staff and four people who use the service. People told us that they were happy and felt safe at the home. One person said the staff were "very nice and happy and cheerful".

People and their relatives were involved in making decisions and were asked for their consent in relation to their care. We saw that people or their representatives had been involved in the development of their care plans as they had been consulted about the content and included in regular reviews that were taking place.

We observed positive interactions between staff and the people using the service. People told us that staff treated them well and one person said, "I have a carer who is very good, so kind, if you want something they get it as soon as they possibly can".

A varied range of nutritious meals were provided. Staff told us that daily food deliveries took place and that mostly fresh produce was used. Staff were able to demonstrate that there were systems in place to ensure that people's individual dietary needs were met.

Systems were in place to report any concerns about people's welfare and safety. People told us that they felt safe in the home and one person said, "the night staff check on us and make sure we are safe".

People told us that there were always enough staff to support them and the staff spoken with said that there were always enough staff on duty for them to meet people's needs.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practicing professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

People said they were happy living in the home, their privacy was maintained when they received help with care needs. Comments included “staff give me all the time in the world”. People said that there was a different menu each day and staff asked them the day before what they would like. They confirmed that they could also request an alternative meal on the day.

This inspection took place on the 10 and 11 November 2014 and was unannounced.

Sandbanks Resource Centre provides accommodation and care for a maximum of 62 older people who may also be living with dementia. At the time of our visit there were 53 people using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The provider met all of the regulations we inspected against at our last inspection on 13 February 2014.

The service had a clear process in place to record and investigate incidents and accidents that occurred at the home. People we spoke with told us they felt safe in the home and the provider had policies and procedures in place to respond to any concerns raised relating to the care provided.

There was a clear process and procedure in place for the safe administration of medicines that had been prescribed to people using the service. We saw the Medicines Administration Record (MAR) charts were up to date and the information was clearly recorded.

The service had an effective recruitment process in place and people using the service had emergency evacuation plans in place.

The manager understood that appropriate authorisation was required where a person might be deprived of their liberty and was in the process of making Deprivation of Liberty Safeguards (DoLS) applications to the local authority for people using the service.

The feedback provided by people using the service and their relatives was limited and processes were not in place to identify and record any actions required to improve the service. We have made a recommendation about identifying different ways of obtaining and recording any actions from feedback received from people using the service.

People’s care needs were assessed when they initially moved into the home and we saw their care plans and risk assessments were regularly reviewed. Information about the person’s life experiences, likes and dislikes was used in the development of their care plans.

People and relatives spoke positively about the staff and the care they provided.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to risk assessments, staffing levels, training and supervision, nutrition, activities and monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of this report.