The inspection was unannounced and took place on the 21 and 22 November 2018. At the last inspection we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we identified that some improvements had been made with regards to Regulation 12, however there remained issues which meant the registered provider continued to be in breach. Improvements had not been made with regards to Regulation 17 which meant this breach remained.

This is the fifth consecutive time the service has been rated Requires Improvement. This has been reflected in the rating of inadequate awarded in the well led domain.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the overall rating to good. At this inspection we identified that improvements had not been made.

Sandiway Manor 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 is registered to accommodate up to 29 people. People each have their own bedrooms and have access to well- maintained gardens. There is a lift to provide access between the first and ground floor, and level access throughout for people who require the use of a wheelchair.

At the time of the inspection there was a manager in post who was in the process of registering with the CQC. 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 this inspection we identified ongoing breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified an additional breach of Regulation 13.

You can see what action we told the provider to take at the back of the full version of the report.

We identified issues with the leadership provided by the registered provider. Sufficient action had not been taken to ensure stable leadership within the service after the previous registered manager had left in May 2018. The registered provider had poor quality monitoring processes in place and was not fully aware of their role and responsibilities in relation to meeting the standards required by the Regulations. This had been identified as an issue at the last inspection, however action had not been taken to address this. At this inspection the new manager and new Chief Executive had started to implement new processes.

Issues had been identified by the local authority safeguarding team with the completion of investigation into safeguarding concerns. In this instance significant harm had not occurred, however action needs to be taken in a timely manner to ensure appropriate protective measures can be implemented where required. Poor processes place people at potential risk from ongoing harm.

Recruitment processes were not robust enough to ensure staff were of suitable character. Action was taken immediately by the manager when we raised this as an issue and assurances were given which showed risks had been mitigated. We have made a recommendation regarding this.

Ongoing issues with the completion of nutritional risk assessments were identified which placed people at potential risk of harm. Immediate action was taken when we raised these issues and it was identified that no one had come to harm. A review of other people’s care plans were undertaken to ensure this risk was addressed with other people.

The quality of information contained in people’s care records was mixed. Some care records contained a good level of detail, whilst s

The inspection took place on the 3 and 7 August 2017. The inspection was unannounced on the first day, and announced on the second. At the last inspection there were no breaches of Regulations identified.

Sandiway Manor is located five miles from Northwich in Cheshire and is run by a charitable organisation. It provides accommodation and personal care to older people and can accommodate up to 28 people. At the time of the inspection there were 19 people living at the service.

There was a registered manager in post within the service. 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 that medication was not always dispensed safely, or as prescribed. We found issues relating to monitoring the quantity of medication being stored, which impacted upon the efficacy of audit systems.

Audit systems were not always effective. For example they had failed to identify and address issues relating to medication systems. Health and safety audits had not identified where radiators had been exposed in communal areas, and care plan audits had failed to address known issues. For example, whilst it had been identified that staff were not completing malnutrition risk assessments, this had continued to be an issue.

The registered provider’s quality monitoring of the service was not robust enough to identify required areas of improvement within the service. Where issues were identified, action was not taken in a timely manner to address these. Quality monitoring audits did not give consideration to the requirements of the Health and Social Care Act 2008, and therefore were not able to identify areas that needed improvement.

The registered provider had not given due consideration to the Data Protection Act 1998 in determining how long to store people’s personal information for. We found boxes of records being stored which the registered manager told us were being kept for 50 years before being destroyed.

You can see what action we told the provider to take at the back of the full version of the report.

The service supported some people living with dementia, however the registered provider had not made any suitable adaptations to the environment to support and promote wellbeing. The registered manager told us that a lighting specialist was due to be consulted to look at ways of improving people’s visual perception. However other options such as the use of colour schemes, or placing objects of interest about the service had not been considered. We have made a recommendation to the registered provider around this.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However the policies and systems in the service did not always support practice that was in line with the requirements of the Mental Capacity Act 2005. Mental capacity assessments and best interest decisions were not always being made where required. We have made a recommendation to the registered provider around this.

There were sufficient numbers of staff in post to meet people’s needs. There was a staffing tool in place which enabled the registered manager to determine the number of staff required depending upon occupancy levels and people’s dependency.

Recruitment processes were robust and ensured that staff were of suitable character to work with vulnerable people. New staff had been subject to a check by the disclosure and barring service, and had been required to provide references from their most recent previous employer.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and were aware of how to report their concern

This inspection took place on the 24 and 26 of May 2016 and was unannounced.

Sandiway Manor is located five miles from Northwich in Cheshire and is run by a charitable organisation. It provides accommodation and personal care to older people and can accommodate up to 28 people. At the time of the inspection there were 24 people living at the service.

At the last inspection on 19 January 2016 we found that a number of improvements were needed. People were not always protected from the risk of unsafe care and treatment and there were issues relating to poor management of infection control. Staff did not always have a good understanding of their roles and responsibilities in relation to the Mental Capacity Act 2005, and DoLS were not always in place for those people who needed them. Action was not always taken to ensure people received the care and support they needed in response to changes in their care needs, and quality monitoring systems were not always effective in identifying where improvements were required. The registered provider had also failed to notify us of specific incidents as required by law.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 4 March 2016. This inspection found that the registered provider had met their own action plan and had demonstrated full compliance with the Health and Social care Act 2008 (regulated activities) 2014.

There was a registered manager at the service however they retired on the first day of the inspection. The registered provider had recruited a replacement manager who was in the process of registering with the CQC. 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 were supported to take their medication as prescribed. Medicines were stored safely, and records indicated that staff administered these appropriately. There were examples where some medicines had been over stocked which we drew to the attention of the manager. We have made a recommendation about the management of medicines.

Improvements had been made to the safety and security of the premises. Doors were secure and alarms were in place to alert staff to anyone attempting to exit the building without the necessary support. Whilst improvements had been made, some aspects of the environment would benefit from further consideration by the registered provider. For example there was nothing to prevent people from accessing the busy road outside the premises, which placed people living with dementia at risk of injury. We have made a recommendation about supporting people living with dementia.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable people and were able to describe how they would report any concerns they had and to who.

Recruitment processes were robust and ensured that people were protected from harm. Checks were completed to ensure staff were of suitable character, and new staff members went through an interview process during which their suitability for their role was assessed.

People told us that there were sufficient numbers of staff in place to meet their needs, and rotas indicated that staffing levels were consistent. Staff told us that they felt they had time to spend with people and did not feel rushed.

People’s rights and liberties were protected. Deprivation of liberty safeguards (DoLS) were in place for those people who needed them and staff had completed training in the Mental Capacity Act 2005 (MCA). Staff were aware of their roles and responsibilities in relation to the MCA and p

The inspection took place on the 19 January 2016 and was unannounced.

Sandiway Manor Residential Care Home is owned by a charitable organisation. Accommodation for up to 28 people is provided over two floors. People have access to a large enclosed garden, which have walkways and seating areas.

The service had 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.

Our last inspection of the service was carried out on the 29 and 30 December 2014 and we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan which included a timescale by which improvements would be made. Not all of these actions had been completed within the given timescale.

Improvements have been made to people’s safety since our last inspection. Covers have been fitted to radiators and recruitment of staff was more robust.

During the last inspection we had concerns because the registered provider had failed to apply for deprivation of liberty safeguards (DoLS), for people living within the service. At this inspection we found that whilst some applications had been made, we found an example where this had not been done. This meant that people’s rights were not being upheld in line with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report

At this inspection, most staff had not completed training on the Mental Capacity Act 2005. Staff did not have a good understanding of the basic principles of the act, or the associated DoLS. This meant that people were at risk of having their rights infringed.

People’s safety was not always maintained as we found that one person had managed to leave the service unaccompanied on a number of occasions, despite having a DoLS authorisation in place which stated that they were not safe to do so. During the inspection a back door to the service was unlocked and the door alarm was turned off. This meant that staff would not have been alerted to people who were at risk, of leaving the building.

Information within care records was not always up-to-date or reflective of people’s needs. This meant that people were at risk of not having their needs met because there was a lack of accurate and up-to-date information about their needs and how to meet them.

Audit systems did not always identify where improvements were needed. For example, care plan audits had not picked up on information being out-of-date and safeguarding audits had not identified incidents as safeguarding concerns. This impacted upon the registered provider’s ability to generate improvement and to protect people within its care.

Systems were not in place to notify the CQC of serious incidents, which meant that the registered provider was not operating in accordance with the law.

The registered provider had not been completing checks on the water system to ensure that it was free from harmful bacteria. This placed people at risk of infection.

There were enough staff in place to meet people’s needs. Staff had a good understanding of the different types of abuse and they told us how they would go about reporting any concerns. This meant that people were protected from the risk of harm.

People told us that staff were caring and that they were supported in a respectful and dignified manner. People also told us that they enjoyed the activities that were available, and that the food was nice. People with special dietary requirements told us that kitchen staff were supportive in trying to make food options more varied.

People told us that they knew who the registered manager was, and that they would

We spoke with six people who lived at Sandiway Manor.

All the people we spoke with said that their needs were met and they were happy with the care provided. Comments included: "I'm happy here"; "I've no complaints"; "I like the personal attention and that I'm treated as an individual".

Recruitment procedures ensured that suitable staff were employed. People said the staff treated them with respect, maintained their privacy and dignity and only assisted them to do things they were unable to do themselves. Comments included: "They're very good, really"; "The staff are lovely and very caring"; "They're very helpful and respectful".

People received their medicines as prescribed by their GP.

We spoke with a visiting GP who said that they had no concerns about the care provided to their patient.

The people we spoke with said they knew how to raise any concerns and a satisfactory complaints procedure was included in the 'service user guide' in every room.

We spoke with four people living at Sandiway Manor. They said that the support the home intended to provide was agreed with them before admission and that any changes in their care plan were agreed before being implemented.

All the people we spoke with said that their needs were met and they were happy with the care provided. They said they felt safe in Sandiway Manor and knew how to raise any concerns. People said that call bells were answered promptly and staff were very caring. Comments included; "the staff are very good", "they are very obliging", "they come promptly when I call them".

People said they were able to pursue their own hobbies such as reading, doing crosswords and sewing. Two people told us they enjoyed walking round the garden when the weather was fine.

The people we spoke with were generally positive about the meals provided. When asked to describe the food two people said it was "good" and two said it was "reasonable". Two people said "we get plenty to eat" and one person said "I have a healthy appetite and would like bigger portions".

There had been one complaint in the last year that had been resolved to the satisfaction of the complainant.

People who use the service were complimentary about the care they received and said they felt safe in Sandiway Manor. They said that staff were very caring and attended to their needs promptly. They said they were consulted about their care, but the residents we spoke with were unaware of their care plans, although a visitor said they had seen and agreed to the care plan for their relative.

People said the home was always very clean and the laundry provided a good service.

People had mixed views about the food, some were very happy with it but some said it wasn’t always good.

We visited this home on 29 and 30 December 2014 and the first day was unannounced. The last inspection was carried out in August 2013 and we found that the home was meeting the regulations.

Sandiway Manor Residential Home is owned by a charitable organisation that runs three care homes for older people. Each home is independently run by a committee. This home was formerly a large private house that has been renovated and extended for use as a care home. People are accommodated on the ground and first floors, providing 28 single bedrooms with en-suite toilet facilities. There are large enclosed mature gardens with walkways and seating areas available for people to use. On the day of the visit there were 23 permanent and three short stay people living at the home.

The service has a registered manager in place. 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 that the home required improvement in regards to the safety of the people who lived there and the effectiveness of the service. We found the service did not meet the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). From discussions with the registered manager although she was aware of her obligations under the MCA she had not completed any DoLS applications for people who were living at the home. Also within the care records there were no mental capacity assessments or records of best interest meetings to assess people’s mental capacity.

We found that some of the recruitment practices required improvement. Documentation relating to the care staff team was good, however, records regarding ancillary staff were poor. This was due to ancillary staff up until recently not being directly employed by the home. The provider was currently addressing this issue.

We looked at the maintenance and cleanliness of the home. We found the home was clean and hygienic in all areas seen. However, we saw that some radiators did not have guards to protect the safety of people who lived in the home. A recommendation was made regarding this.

People told us that they were happy living at Sandiway Manor and they felt that the staff understood their care needs. People commented “I like my bedroom”, “The staff are very pleasant”, “I feel safe here” and “The staff are kind and helpful.” Relatives commented “I visited with my relative prior to admission and we were shown around the home” and “I have no complaints.”

Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

The care records contained detailed information about the support people required and were written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that all records were completed and up to date.

We found the provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults. Therefore staff had documents available to them to help them understand the risk of potential harm or abuse of people who were living at the service.

People spoke positively about the registered manager at the home and told us she listened and acted on comments and concerns. Staff told us they felt supported and listened to by the registered manager and they felt able to raise any concerns or questions they had about the service.

You can see what action we told the provider to take at the back of the full version of the report.