Sandholme Fold is a residential care home for 44 older people and people with dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider had systems in place to safely manage medicines within the home. All risk assessments, except one in relation to hot drinks and another in relation to bedrails, were in place and kept up to date. The registered manager ensured the missing risk assessments were put in place. People had personal emergency evacuation plans (PEEPs). There were enough staff to meet people’s needs.

There was a robust recruitment process in place and staff received appropriate training.

People’s care and support was assessed and reviewed on a regular basis. We saw people had access to healthcare professionals.

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 used 'show plates' of food to help facilitate people's choices. However, the menus were in written format which may make it difficult for people to understand. We made a recommendation for the menus to include pictures.

People’s privacy, dignity and independence was respected and promoted.

The provider had systems in place to assess and monitor the quality of the service. There were audits in place for areas such as; the environment, medicines, infection control and training. We made a recommendation that during the provider’s auditing of care records they look at a larger sample of care records.

Further information is in the detailed findings below.

We inspected Sandholme Fold on 25 February 2016 and the visit was unannounced.

Our last inspection took place on 30 July 2014 and, at that time, we found the regulations we looked at were being met.

Sandholme Fold is a 44-bed home registered to provide accommodation for persons who require personal care. There is a large communal lounge and dining area on the ground floor and a smaller lounge/dining area with a kitchen area on the first floor. All of the bedrooms are single occupancy with en-suite toilet facilities. Outside there is a secure garden area which is accessible from the ground floor lounge.

The service has a registered manager 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.

People told us they felt safe at Sandholme Fold and staff told us they would report any concerns to the registered manager. The registered manager understood how to report any suspicions of abuse in order to make sure people were safe at the home.

We found the home was clean and odour free. Bedrooms had been personalised and communal areas were comfortably furnished. The home was well maintained and services and equipment had been serviced to make sure they were safe to use

Recruitment processes were robust and thorough checks were always completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff told us they felt supported by the registered manager and that training was on offer.

There were enough staff on duty to make sure people’s care needs were met, people told us they liked the staff and found them kind and caring. On the day of our visit we saw people looked well cared for. We saw staff speaking calmly and respectfully to people who used the service.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. Safe systems were in place to manage medicines so people received their medicines at the right times.

The meal time experience was a relaxed and social occasion. People told us meals at the home were good and offered both choice and variety.

There were a range of activities on offer to keep people occupied and trips out were organised to a variety of venues.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

Visitors said they were made to feel welcome and told us dogs were welcome to visit too.

There was a complaints procedure in place and we saw where concerns had been raised these had been dealt with appropriately.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address these shortfalls. People using the service were asked for their views and were able to influence the way the service was managed.

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support. People’s health and care needs were assessed with them, and they were involved in writing their plans of care.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “It’s great here, and staff take care of me so well.” Another said, “It’s a great place to be as staff take really good care of me”.

A relative said, “They visited regularly without notice and they were happy their relative was well cared for in the home”.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, these were addressed.

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

“Sandholme Fold was recommended to me. The staff are all very good and patient. There is allsorts going on but I don’t join in much.”

“I can do what I want and my room is very nice.”

“The staff are very helpful, you only have to ask and it is done.”

“The activities person is very good and organises all sorts of things. We have had all sorts of trips out.”

“I really enjoy working here; no two days are the same.”

We found that although staff had identified that some individuals were at risk from not having a good diet and developing pressure sores action had not been taken to reduce those risks.

When we looked around the home we found that improvements needed to be made regarding infection control.

The medication system was not being managed safely and not all medication could be accounted for.

There were enough staff on duty to meet people’s needs who had received the necessary training.

Care records were not detailed and not always up to date meaning that people could be at risk of receiving unsafe care.

We spoke with 11 people who live at the home, four relatives and four members of staff. These are some of the things they told us:

“The activities person is very good there are exercises, bingo, games, golf, scrabble, dominoes and quizzes to take part in if you want to.”

“The staff are good and I get the help I need.”

“You can please yourself what you do, you can stay in your flat or come to the lounge.”

“I am very well looked after.”

“The home is always clean and tidy.”

“The food is good and we always have a choice of meals.”

“I have been able to bring my cat with me and this has really helped me to settle in.”

”We have residents meetings and can talk about anything we want to.”

“We are always made to feel welcome when we visit and keep us informed about our relatives’ wellbeing.”

People who use the service all told us staff looked after them very well and overall they were very satisfied with the care they receive and they were comfortable living at the home.

When we inspected the service in September 2013 we asked the provider to make some improvements. We went back on these visits to see what improvements had been made and also to look at some additional outcomes following information we had received about the service.

During our SOFI observation we found that when staff engaged with people the interactions were positive. However, we noted that there were a lot of missed opportunities when staff didn’t involve people. For example, when serving food and drinks.

We spoke with 20 people who used the service, five relatives, two district nurses, a social worker, care home liaison nurse and 10 members of staff. These were some of the things they told us:

“I am very happy here, the food is good and the staff are lovely. If I did have any concerns I would go to the desk and tell whoever was on duty.”

“I can choose where I spend my time I like to stay in my room but go downstairs to join in with the activities.”

“I have lived her for four years and I haven’t got any complaints.”

“Everyone is very nice, helpful and doing everything they can to make me comfortable.”

“I am very happy here the staff look after me very well.”

“I am always made to feel welcome when I visit and the food is very good, especially the fresh cream scones!”

“I am very impressed with the home.”

“It’s the best quality of life my relative could have.”

“I have been involved in the care plan and talked to staff about what my relative needs.”

“It’s a nice place to work, we have a good team and the managers are very supportive and approachable.”

“We provide good care and work as a team. We have residents/relatives meeting and staff meetings to discuss issues.”

We found that generally staff treated people with respect, were patient and responded to people’s requests.

There was no documentation in place to assess people’s ability to make their own decisions or who should be involved if decisions about their care and support needed to be made in their ‘best interest.'

People’s care and support needs were being met and there were a range of activities on offer to help keep people stimulated.

Staff were aware of the different types of abuse that could happen. When incidents had occurred staff had made appropriate referrals to the safeguarding team.

We found the home was clean and tidy and staff were following infection prevention guidance.

We looked at the medication system and found that it was being managed safely and people were getting their medication at the right times.

We looked at the homes statement of purpose and found that it did not reflect the service that was being provided when we visited.

We found there was a complaints procedure in place but concerns and complaints were not always being documented. We also found that staff were not always going back to the complainant to see if they were happy with the outcome.

Care records were not detailed and not always up to date meaning that people could be at risk of receiving unsafe care.