Sandiway Lodge Nursing Home 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 home itself was built towards the end of the 19th century as a large country house and has been adapted over the years for its current use as a care home. Sandiway Lodge is situated off Chester Road in Sandiway, approximately three miles from the town of Northwich and is set in an acre of gardens. There is a local shop conveniently situated across the road, and other community facilities within the village of Cuddington

This inspection took place on the 9 January 2019 and was unannounced.

There was 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 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service good overall. We previously rated the ' Well Led' domain as requires improvement but at this inspection we found the evidence supported the rating of good. There was and 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

Staff had the skills and knowledge to keep people safe. Care plans contained risk assessments and when risks were identified plans provided clear guidance for staff on how to reduce the risk of harm. Incidents and accidents were reported and analysed to identify trends. There was evidence that lessons were learned when incidents happened.

Safe recruitment procedures were in place and there was enough staff on duty to meet people’s needs.

Medicines were managed safely. The environment was exceptionally clean.

Staff were trained to undertake their roles. Staff had regular supervisions with a supervisor. People’s nutritional needs were met and people were complimentary about the meals they were served.

Staff remained knowledgeable about the Mental Capacity Act 2005. 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.

We observed many positive interactions between people and staff. People spoke highly of the staff and staff spoke positively about their roles. Regular feedback was sought from people.

Care plans were person centred and contained details of people’s choices and preferences for how they wanted to be supported.

There was a complaints procedure in place which allowed both complaints and concerns to be recorded and investigated appropriately.

There were robust quality assurance processes in place which identified shortfalls. Action plans were then put into place to highlight the concern, who was to resolve the matter and by when.

People and staff unanimously, spoke highly of the registered manager who they described as a strong leader with high standards. Staff told us morale at the service was good and that they felt valued.

The inspection was unannounced and took place on the 23 December 2015.

Sandiway Lodge is a privately owned care home situated off Chester Road in Sandiway which is approximately three miles from the towns of Northwich and Winsford. The service provides personal care for up to a maximum of 36 people. At the time of the inspection there were 17 people using the service.

The service does not have 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 2008 and associated Regulations about how the service is run. A manager had been appointed to manage the service and they have submitted an application to CQC to become the registered manager.

We carried out an unannounced comprehensive inspection of this service on 11 May 2015 and 18 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches of Regulations 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sandiway Lodge on our website at www.cqc.org.uk.

At the last inspection in May 2015, we asked the provider to take action to make improvements around the safe care and treatment of people by improving staff knowledge around safeguarding and the process of reporting their concerns. We also asked that they improve the cleanliness of the environment, and rectify areas of the environment that were not safe. At this inspection we found that this had been done.

Staff did not have a good understanding of the Mental Capacity Act 2005, and the associated Deprivation of Liberty Safeguards (DoLS). Notifications around DoLS and serious incidents were not being sent to the CQC as required by the regulations. We also asked them to make improvements around monitoring people’s wellbeing and keeping records up-to-date to reflect people’s needs. We issued the registered provider with a warning notice with regards to these issues.

Accidents and incident reporting needed to be more detailed and measures implemented to prevent issues occurring again in the future. We saw that information gathered from audits needed to be acted upon to ensure people’s safety was maintained.

At this inspection we found that action had been taken to address the issues raised during the previous inspection.

People who used the service told us that they felt safe. Staff were able to identify safeguarding concerns, and knew how to report their concerns. We saw examples where safeguarding concerns had been identified and appropriately followed up.

There were sufficient numbers of staff in place to meet people’s needs and the manager used a dependency tool to determine how many staff were needed. Recruitment processes were robust enough to ensure people’s safety was maintained.

Care records contained detailed and up-to-date information, which enabled staff to provide appropriate support. These were reviewed on a monthly basis, and updates were made to reflect any changes, which ensured that information remained accurate.

People were supported to take their medicines as prescribed, and there were sufficient processes in place to ensure that the handling and administration of medication remained safe.

People told us that they enjoyed the food and that they were offered a choice of food and drink. People with special dietary requirements received appropriate support to ensure that they had adequate nutrition.

We spoke to three people who lived at Sandiway Lodge as well as one relative. We also received comments through our website from two relatives. Their comments included:

"The staff get us everything we need"

"They do their best, I have no worries and I am happy"

"I feel safer here than I did before"

"They are good to me"

"They are very good and listen to me"

"I would not be here if I had did not like it here"

"Staff are very good, they keep me informed"

"Staff are approachable and they are extremely good"

"I have no complaints about them"

"Level of care was excellent; the staff had empathy and were exemplary carers. The manager was extremely understanding and caring when my relative died"

Our visit found that the care and welfare of people was promoted through the practice of the service as.well as through the safe management of medication. We found that people were protected from harm through the training and procedures adopted by the provider. Staffing levels had improved with the recruitment of more staff. People knew who to make a complaint to and were confident that their comments would be listened to and acted upon.

Our observation of care practice noted that staff acted on the needs of individuals and related to them in a friendly, encouraging and reassuring manner.

The people we met with appeared relaxed, comfortable and at ease with the staff. It was also evident that the staff members had a good understanding of what was important to each person and how to care for them.

The people using the service who were able to tell us said that they were happy living in the home. Comments included, “This is one big happy family and there are lots of things going on. We are asked what we are interested in, lovely place”; “I am very picky but this is a good place” and “The staff are very good.”

We asked people about the staff working in the home, one of them told us; “Always treated with respect, we have fun, couldn’t be better.”

The staff members we spoke to were also very positive about the home. One of them said; “This is like a second home, I love it here and I am proud of our home.”

We observed good communication and understanding between the members of staff and the people who were receiving care and support from them. We also observed people being supported with their daily life activities in a dignified and respectful way.

We visited Sandiway Lodge and spoke with people who told us about what it was like to live there. They all said that it was a good place to live and that they were encouraged to choose how they spend their day. They said that the activities were good and that there was a choice of meals.

People said that they were supported by the staff in the way in which they preferred. One person said “ the staff are really good and can’t do enough for you”. Another said that “the people who work here are wonderful and always kind”. They also said that “all the staff are lovely” and that there are always enough staff on duty to answer call bells quickly and to take them to the toilet without waiting. One person said “ we have a lovely home with great staff”.

People spoken with also said that they felt safe and happy living at Sandiway Lodge. They said that they would know how to make a complaint and felt that they were listened to. They felt that the staff were supportive and that the manager was very approachable.

We visited this service on the 11th and 18th of May 2015. Both these visits were unannounced.

Our last inspection had taken place on the 11th of October 2013. The service was found to be compliant with the regulations assessed. .

Sandiway Lodge is situated off Chester Road in Sandiway which is approximately three miles from the towns of Northwich and Winsford. The home provides accommodation and personal care for up to a maximum of 36 people. We were given conflicting information in respect of how many people were living there. It was confirmed on the 18th May 2015 that there were 27 people living at Sandiway Lodge at the time of our visit.

A manager had been in post since July 2014. This person had replaced the previous registered manager who had moved to another service. The manager had started to apply to us to become the registered manager but this process had not yet been completed. 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.

Prior to this inspection we had received concerns in respect of the safety of people living at Sandiway. We used this information when we inspected this service.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice to the registered provider.

We found that staff did not always uphold the privacy and dignity of people using the service.

Staff had not received the appropriate training in order to understand the process for assessing the capacity of people to make decisions for themselves. This meant that people using the service did not have their best interests served by a staff team aware of the mental capacity act.

The premises was not always a safe place for people to live with specific hazards in the environment not made safe. Hazards included inadequate measures to ensure that people did not fall down a staircase and a cupboard containing exposed pipework and electrical equipment was left unlocked. The environment was not clean in places which led to the risk of infection spreading.

Although staff have been provided with training they did not have a clear understanding of how to identify, prevent and safeguard vulnerable people from harm. We found that staff had not used whistleblowing procedures in an effective way to raise concerns. This meant that people using the service were placed at risk of harm.

People’s nutrition had not always been promoted in an effective manner in some cases and that the process for people to make complaints was incomplete and did not meet the communication needs of people.

We found that the management of the service had not been effective. Staff did not receive supervision consistently and no annual appraisals had been undertaken. We found that audits of key accidents and incidents had not been undertaken. The quality assurance systems used by the registered provider had not identified the issues which adversely affected people living at Sandiway Lodge.

The registered provider had failed to notify us of significant incidents which are legal requirements.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

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