This inspection took place on 24 September 2018 and was unannounced.

Sandley Court Residential Care Home is registered to provide nursing and personal care for up to 23 people and provides care to older people, including those living with dementia. At the time of the inspection there were 22 people living at the service. The service is a converted Victorian house situated in a residential suburb of Southport. There is a ramp access to the front of the property to assist people with limited mobility. The dining room and lounge are situated on the ground floor. There is also a quiet lounge located on the first floor where people can entertain their visitors.

Sandley Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with CQC 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 the previous inspection in February 2018, the service was rated ‘Requires Improvement’. This was because staff training records were not up to date, the environment required improving to meet the needs of people living with dementia and audit process were not always effective in identifying compliance with safety and quality standards. During this inspection we checked to see if improvements had been made and found that they had.

We saw that staff had recently received refresher training in mandatory subjects such as fire safety, safeguarding and moving and handling. In addition, all staff had been booked on a dementia awareness course whilst some staff had already completed it. We also saw evidence that diabetes training was planned in addition to training around stroke awareness.

During this inspection we checked to see if improvements had been made to the environment and found that it had. The service had new carpets fitted to all floors. The carpet was plain in design making it easier for people to orientate themselves. We also saw evidence of better signage, for example, more highly visible door numbers for people’s bedrooms and signs to point out the location of shared spaces such as lounges, bathrooms and toilets. This helped people living with dementia navigate their environment more easily and so potentially reduce their levels of anxiety and distress.

We checked to see if improvements to audit processes had been made since the last inspection and found that they had. Audits were now more structured in their approach and identified any areas of concern and the action required to resolve them.

Each of the people we spoke with told us they felt safe living at Sandley Court. Staff understood their responsibilities in relation to safeguarding people from abuse and mistreatment and were able to explain how they would report any concerns.

Arrangements were in place with external contractors to ensure the premises were kept safe. The service also employed a maintenance person who attended to the premises on a daily basis.

We found that medicines were managed safely. Medicines were stored correctly and were administered by staff who were competent to do so.

We looked at how accidents and incidents were reported in the service and found they were managed appropriately.

We looked at the recruitment processes which were in place. We reviewed records for four members of staff. We saw that each staff member’s suitability to work at the service had been checked prior to employment to ensure that staff were suitable to work with vulnerable people.

We looked at care records belonging to four people. Ap

This unannounced inspection took place on 19 February 2018.

The last inspection of the home took place in July 2017 when we found breaches of regulations 12 and 17 of the Health and Social Care Act 2008 Regulated Activities (Regulations) 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-Led to at least good.

Sandley Court 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.

Sandley Court is registered for a maximum of 23 older people and is owned by Accommodating Care (Southport). The building has been converted from a former house and has an enclosed rear garden and with parking spaces at the front. There is a ramp at the main entrance to assist people with limited mobility. Bedrooms, bathrooms and lounges are situated on the ground and upper floors.

At the time of our inspection there were 22 people living at the home.

During our inspection in July 2017 we identified a breach of regulation because medicines were not safely managed. Following the inspection the provider submitted an action plan which detailed how the necessary improvements would be made and by when. As part of this inspection we checked to see if the improvements had been made and sustained.

The administration of medicines was directed by a new medication policy. The provider had made changes in accordance with their action plan and national guidance and completed regular audits of administration and records. The provider was no longer in breach of regulation in relation to the safe administration of medicines.

During the last inspection we identified a breach of regulation because risk assessments were not sufficiently detailed to instruct staff and keep people safe. We saw evidence that risk assessments had been thoroughly revised since the last inspection. The provider was no longer in breach of regulation in relation to the management of risk.

At the last inspection we identified a breach of regulation because care records were difficult to navigate and contained inaccurate or out of date information. As part of this inspection we checked to see if the necessary improvements had been made and sustained. We looked at six care records and saw that person-centred information and care plans had been re-written and regularly reviewed. Care plans were broken down into morning, daytime, afternoon and night time routines. This made the information easy to understand. The provider was no longer in breach of regulation relating to record keeping.

At the last inspection we identified a breach of regulation because audits were not extensive and had not always proven effective in identifying issues and areas for improvement. The registered manager completed a series of regular audits including; medicines, care plans and infection control. An area manager provided support to the registered manager and completed their own visits and audits. The provider was no longer in breach of regulation regarding audit processes.

Staff were safely recruited and staffing numbers were adequate to meet the needs of people living at the home. A minimum of three care staff and one senior carer were deployed on each daytime shift. This reduced to three staff overnight.

Staff had completed training in adult safeguarding procedures and were able to explain what action they would take if they suspected abuse or neglect. The home had up to date policies which provided guidance and information to staff regarding adult safeguarding procedures and whistleblowing (reporting concerns to an independent body).

We saw that health and safety checks with regards to the electricity, lifts, gas and water testing were completed in line with legislative requirement

This inspection took place on 13 July 2017. This inspection was unannounced.

The last inspection of the home took place in November 2016. The inspection was a focused inspection to check on breaches and a warning notice served by CQC at the previous comprehensive inspection. During the focused inspection in November 2016 we found that the registered provider had made the required improvements. However, during this inspection we found breaches of regulations 12 and 17 of the Health and Social Care Act 2008 Regulated Activities (Regulations) 2014.

Sandley Court is a care home for 23 older people and is owned by Accommodating Care (Southport). Sandley Court is a converted house with an enclosed rear garden and with parking spaces at the front. There is a ramp at the main entrance to assist people with limited mobility. Bedrooms, bathrooms and lounges are situated on the ground and upper floors.

At the time of our inspection there were 21 people living at the home.

Prior to this inspection we received concerns about the management of medication. We looked at those concerns as part of this inspection. We found that medicines were not always managed safely or correctly. Some people’s medicine records were incomplete and plans were not in place for people who were prescribed medication to be given when required.

Risk assessments for some people were in place and had been recently updated, however we found that not all risks that effected the health and safety of people living in the home had been assessed appropriately. They did not contain sufficient information around how to minimise the risk of harm to people and keep them safe.

Some records relating to people’s care and staff training had not been updated. Some records dated back to 2012, and were mixed up with current information in people’s care plans so it was difficult to see what information was relevant for people. There was a ‘contents sheet’ at the front of each person’s care file, however, the care files did not follow any order.

We saw that audits were not always taking place, there were some audits in place for the environment, however there were no care plan audits being conducting to ensure information was correct and updated. Medication audits were also not robust and had failed to highlight some of our concerns.

We have made a recommendation about the need for consent. The registered provider was working in accordance to the principles of the Mental Capacity Act and DoLS (Deprivation of Liberty Safeguards) however, some information recorded in care plans was not always accurate and was confusing. There were activities taking place in the home, and people’s care files contained photographs of people engaging in activities. Most of the people we spoke with, however, told us they were bored and there was not much for them to do.

People told us they felt safe living at the home. Staff knew what action to take to be able to recognise potential or actual abuse.

The home was clean and tidy and there was a pleasant smell throughout. Staff used personal protective equipment (PPE) appropriately such as gloves and aprons.

Staff were recruited safely, and most of the staff had been in post at the home for a number of years.

We saw that staff had recently completed some training, and we saw certificates for this in their files, staff were able to discuss their training with us. However, the training matrix was not updated to reflect this.

Staff underwent regular supervision and had had an annual appraisal of their work. Staff underwent an induction process in line with the registered provider’s policies and procedures and national guidance.

People said the food was good. There was a menu available which people could choose from. There was no evidence that people had input into the menus, however there was a book which showed which meals had been served and declined. This showed that people could mostly choose whatever they wanted to eat.

People had

We carried out an unannounced comprehensive inspection of this service on 27 & 28 July 2016, 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 management of medications, safe care and treatment, person centred care and governance. They said they would meet all the legal requirements by 18 September 2016.

We undertook a focused inspection on the 29 November 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This action has now been completed.

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 'Sandley Court' on our website at www.cqc.org.uk'

Located near Southport town centre, Sandley Court provides accommodation and personal care for up to 23 older people and is owned by Accommodating Care (Southport). The home is a converted house with an enclosed rear garden and parking spaces at the front. There is a ramp at the main entrance to assist people with limited mobility. Bedrooms, bathrooms and lounges are situated on the ground and upper floors. A lift is available for access to the upper floors. There is an enclosed garden to the rear of the building and parking to the front. A call system operates throughout the home.

There was 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.

During our last inspection in July 2016 we found there were risks associated with the safety of people living in the home. We found a number of windows in people’s bedrooms did not have window restrictors fitted. We saw that all bedrooms now had restrictors fitted, which meant the risk of people falling from windows and sustaining serious injury were reduced. Faulty fire doors had been replaced and we saw that new doors closed quickly and securely to prevent a fire spreading and therefore helping to protect people.

Dirty and rusted equipment and broken furniture found at the last inspection had all been replaced.

We found that risks associated with poor cleanliness and infection control had improved. We found all areas of the home clean with no unpleasant odours. Staffing had been increased to ensure the home was cleaned each day.

We found that the risks associated with the administration of medications were improved.

Care records were securely stored.

We saw that people received support from other medical professionals when needed, and had their care provided in way which was meaningful to them. Care records contained sufficient information to enable staff to support people safely.

Meaningful activities were provided on a daily basis. People had the opportunity to go out and people spent time on a one to one basis with dedicated activity staff, if they wished.

There were audits in place to monitor the concerns identified at our last inspection, and we saw during this inspection the provider had made significant improvements to their auditing systems.

This inspection took place on 27 and 28 July 2016 and was unannounced. A previous inspection, undertaken in July 2014, found there were no breaches of legal requirements.

Sandley Court is registered to accommodate 23 older people. It is a converted house with an enclosed rear garden situated in a residential area of Southport. There is ramped access to the main entrance to assist people with limited mobility. Accommodation is provided over four floors, including the basement area. There is a central lift and a number of stair lifts to support people’s movement around the building.

The home had a registered manager in place, who was also the registered provider, and our records showed she had been formally registered with the Care Quality Commission (CQC) since December 2012. A registered manager is a person who has registered with the CQC 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 said they felt safe living at the home and said the staff treated them well. Staff had received training regarding safeguarding and the protection of vulnerable adults. They said they would report any concerns to the registered manager. There were processes in place to monitor and review the safety and maintenance of the premises. However, we found a number of issues with the premises and equipment at the home. Some windows did not have restrictors, to limit their opening that met with current Health and Safety Executive guidance. Checks on other safety systems were in place.

Some areas of the home were not clean. Shower rooms and toilets required cleaning and some rooms had unpleasant odours. Commodes used at the home were rusted and could not be cleaned effectively. A sluice area had been left unlocked, meaning there was public access and a risk of infection. Clean clothes were stored in the staff area where they could become soiled.

Suitable recruitment procedures and checks were undertaken, to ensure staff had the skills and backgrounds to support people. People said they did not have to wait long for support. However, the registered manager did not carry out an assessment of people’s dependency meaning we could not be sure appropriate levels of staff were always available.

Medicines were not always dealt with safely and appropriately. Staff signed for medicines they had not observed being taken, a cupboard containing medicines had been left unlocked and administration records were unclear or had been altered.

People were happy with the standard and range of food and drink provided at the home and could request alternative dishes, if they wished. Food for people who required soft or pureed diets was presented in a manner that supported their dignity.

People told us staff had the right skills to look after them. Staff confirmed they had access to a range of training and updating. Regular supervision took place and staff received annual appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The manager told us one person was subject to a DoLS and further applications had been made. Assessments had taken place to check whether people met the criteria for a DoLS application. There was some evidence that care decisions had been taken in line with best interests guidance.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff.

People told us they were happy with the care provided. We observed staff treated people appropriately, supportively and with an understanding of people’s needs. People said they were treated with respect and their dignit

We considered all the evidence we had 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?

This is a summary of what we found-

Is the service safe?

During our inspection, we saw people being treated with respect and in a dignified manner. Staff members knocked on people`s doors before entering and asked first before assisting with any care or support needs.

We spoke to one person who used the service who told us, "I feel very safe here. The staff look after us very well." We saw the staff training matrix which showed staff had received effective training related to safeguarding policies and procedures.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The Registered Manager told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

People who used the service and when possible, their families had been involved in developing their care plans. The care plans we saw included people`s choices and preferences which reflected their current care needs. This helped ensure staff members had up to date information related to the needs of the people they cared for.

We spoke with a family member who told us, "I come in quite a bit when I can make it. There`s no set times for visiting. You just come in when it suits." We noted people could meet up in private or spend time in the communal areas.

Is the service caring?

We saw that people who used the service were cared for, and supported by, caring and patient staff members. Staff had read people`s care plans and so had a good understanding of their care needs and wishes. One person told us, "It`s first class here. People are so warm and friendly."

We spent time in a communal lounge during our inspection and noted people were left unsupervised for over twenty minutes. The provider may find it useful to note this had the potential to put people who used the service at risk, particularly if they had needed support during that period. However, in other areas of the care home, we observed staff interacting with people in a positive and caring manner.

Is the service responsive?

We saw five people playing dominoes in a communal area during the afternoon. They told us they played quite often and enjoyed it. We did not observe any other activities during our inspection. People who used the service had their religious needs and choices met. Lay people attended the care home at regular intervals and conducted a service for those who wished to attend.

We saw evidence that the provider had an effective complaints procedure in place. We saw copies of the complaints process were displayed on the entrance wall and also within the service use handbook.

Is the service well-led?

We saw the Registered Manager had a multi-professional approach to providing care which helped ensure people who used the service had their care needs met effectively. Staff members we spoke to had a good understanding of their individual roles and responsibilities.

The provider had quality assurance procedures in place and we noted any identified shortfalls had been addressed. This helped ensure that the service provided to people who used the service continued to improve.

We spoke with 12 people who lived at the home and two relatives so they could tell us their experiences and share their views about life at Sandley Court. People's comments included, "I am happy with the care I get from the staff; I feel the home is a good place to live, the girls know how to look after me and “Best care home I’ve been in.”

People had a plan of care and this recorded details about their individual care needs and the level of support given by the staff to ensure their health and well-being. We spoke with staff and they were knowledgeable about people's needs and their daily routines. People had consented to their plan of care and care records had been updated to evidence any changes in respect of the support people needed.

People told us they enjoyed the meals and that the food was well cooked and presented. The menus were displayed for people to see and they were able to choose an alternative meal if they wanted something different. The staff had sought advice and support from a dietician if they had concerns about people's diet. A person said, "The food is first class."

People at the home were supported by sufficient numbers of staff. The staff had the skills, competencies and experience to support people safely. Staff told us they had access to a good training programme and support from the manager.

We looked at different areas of the home and found it to be well maintained and subject to an on-going decoration and refurbishment plan.

We spoke with six people at Sandley Court and they were able to tell us what it was like to live at the home and how the staff provided the care and support they needed. All the people we spoke with told us they were happy living at the home.

People spoken with confirmed they were encouraged to express their views openly. They were of the opinion their views were listened to and that their opinions mattered.

People informed us they had been asked about their care and treatment and understood and consented to it. People also told us had been informed about any changes made to their care, treatment and social support. People made the following comments, “I am very pleased with the care and help I get” and “The carers are good at looking after me."

People confirmed they could spend their day as they wanted and there were no restrictions. A person said, “I choose to have my meals in my room and staff respect this wish.” We were also told the staff arranged lots of social activities and people could decide whether they wished to take part.

A person told us they liked the fact the staff respected their independence and this included an active role in monitoring their own health and well being.

A relative informed us they were involved with care decisions for their family member and the staff were good at phoning if they needed to tell them something. Likewise, another relative said, “You could not have better care.”

We did not ask people directly about staff training however people told us the staff were kind and considerate when caring for them. People also told us they felt comfortable and at ease with the staff.

People told us they were happy with the way in which the home was run. This was also confirmed by relatives we spoke with. A person said, “The manager makes sure things are organised.”

The home’s complaint procedure was displayed for people to see and a relative told us they would not hesitate to speak up if they had a concern. They also said they knew the staff would listen to them and look into the matter.