Sandmar is a care home that offers accommodation and personal care for up to 13 people with mental health care needs. 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.

This inspection took place on the 9 and 14 January 2019 and was unannounced. At the time of the inspection there were 11 people accommodated.

A registered manager was 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.

There were a range of quality audits undertaken by the owner /manager however they were not always effective. Care plans had been reviewed but there were no set standards for auditing the quality of care plans. For example, ensuring care plans were person centred and monitoring of daily reports. We have made a recommendation to develop audits that assess and monitor the quality of service delivery.

Medicine audits were carried out weekly. Audits for reviewing policies, assessing staff training and infection control the were completed every three months. Where there were shortfalls the action taken was listed.

The views of people and staff were gathered to enable the provider to make improvements. Surveys were used to gather the views of people regarding food, personal care, daily living and the management of the home. People and staff had assessed the home to be good to very good.

Risk management systems were used to assess people’s individual level of risk. However, some guidance was not detailed and for others the risk assessments were not reviewed where the level of risk had changed.

Medicine Administration Records (MAR) were completed appropriately. Medicines no longer required were disposed of appropriately.

However, where people had medicines prescribed to be taken “when required” protocols were not always sufficiently detailed.

People told us they made their day to day decisions and who helped them with more complex decisions. Staff were knowledgeable about the principles of the Mental Capacity Act (2005) and there was guidance on display for staff’s reference. Mental capacity assessments were in place where needed. There were some restrictions imposed for activities such as smoking and having alcohol. Where people had capacity, agreements were in place for these restrictions. However if the agreements were not upheld they were not reviewed.

Some people have community treatment orders (CTO) imposed. The care plans were not clear on the conditions, how staff were to support the person and the action to take when the conditions were breached.

Where people had capacity and restrictions were imposed, agreements were in place. For example, not smoking indoors and having alcohol and illegal substances in the building. People signed the agreements and told us about these restrictions. However, these agreements were not reviewed when they were not adhered to.

People were aware they had care plans in place and told us their keyworkers went through their care plans with them. However, some care plans lacked detail on how staff were to support people effectively. At the time of the inspection the care coordinator linked to Sandmar agreed to support the home with developing the care plans.

Although there was a framework for staff to have daily one to one time with people these discussions were not based on pursuing hobbies or supporting people to retain or regain their independence. People told us they mainly watched the TV and the records supported their comments.

People told us they felt safe living at the home and the staff gave them a sense of security. The staff we

Sandmar is a privately owned care home that offers accommodation and personal care to up to 13 people with a mental health disorder. At the time of our visit, 11 people were living in the home. The inspection took place on 8 August 2016. This was an unannounced inspection and the home's first rated inspection.

A registered manager was in post when we inspected 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. The registered manager was present and approachable throughout our inspection.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Documents relating to people’s finances had not always been stored safely. We saw these had been placed in some people’s care plans. This meant that staff had access to information of a personal and private nature. We raised this with the management team who said they would remove all financial paperwork from people’s care plans and keep them in a locked cabinet so access was restricted.

Staff raised concerns with us around some people smoking in their bedrooms. We saw that staff had previously raised this concern during their supervisions with their line manager. The home had taken measures to prevent this occurrence which included reminding and educating people about the no smoking policy in their bedrooms and about the dangers this could cause.

Staff were appropriately trained and skilled. All new staff received an induction when they started working for the service, which included shadowing a competent member of staff. They demonstrated a good understanding of their roles and responsibilities.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “I like living here, the staff are nice and friendly” and “I do like living here, it’s a happy place”.

People were supported to have a meal of their choice by organised and attentive staff. The menu was displayed outside of the dining room with a notice that said if anyone did not like the choices they could inform the kitchen who would prepare something else for them. We saw this happening throughout our inspection.

Scheduling activities for people had previously been difficult and the management explained this was in the process of being reviewed. The staff had spent time asking people on an individual basis what activities they would like to have available in the home and this was in the process of being matched with staff so they could action on a one to one basis.

The provider regularly assessed and monitored the quality of care provided at Sandmar. The service encouraged feedback from people which they used to make improvements.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We looked at the care files belonging to three people in the home. We saw these people’s care needs had been assessed by senior care staff and their care was planned accordingly. This was contained in a document called a “home care programme”.

During our visit we looked around the premises and we found all the communal areas were clean, tidy and well furnished. The kitchen, lounges and bathrooms were in good condition and provided a pleasant and safe environment for people to use. There was also a games room for people to use which had a pool table, TV, games console and a variety of board games.

The manager told us about their recruitment process. All successful applicants were offered a post subject to appropriate references and completion of a six month probationary period. During this period staff had monthly supervision to track their progress and development and we saw records to confirm this.

We saw the manager maintained a record of training attended by staff during the past year. We also saw from training records staff had a regular training programme to update their knowledge and skills in areas relevant to their role. This included such subjects as, the safeguarding of vulnerable adults, moving and handling and mental health. The majority of training materials were sourced from an external company and accessed via DVD’s. First aid and medication awareness training was accessed via face to face sessions from another training provider.

We saw the home had a current procedure and policy for the investigation of complaints. We saw a copy was clearly on display in the entrance hallway and t each person had been supplied with a copy as part of the homes information pack. This had been reviewed by the provider in 2013. It included details of how someone could complain and the timescales for receiving a reply. It also gave information on how to appeal if they were not happy with the outcome, and other agencies to contact to provide support for the complainant.

People living in the home told us that they were happy with the support they received and evidence indicated that they were consulted and involved in how they wished to live their lives.

We found that peoples health and welfare needs were being met and that support given was individualised and person centred.

Evidence informed us that systems were in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that staff were available in enough numbers and had experience to meet the needs of the people living in the home.

We found the quality of the service was being monitored and evidence indicated that concerns were promptly acted upon.

We received information before our visit that one person was displaying particular behaviours, which staff were not addressing in a way they felt comfortable with. We looked at this area during our visit and found that staff had discussed behavioural management strategies with relevant health care professionals. Agreed guidelines were in place and were being followed and monitored.

People told us they could make decisions about their daily lives and be as independent as possible. They said they could go out when they wanted to. People generally maintained their own personal hygiene routines yet staff were available to give support as required. People could assist with cooking and housekeeping tasks although staff said they generally chose not to be involved. People could give their views about their support within residents meetings. They said they had time to talk to staff about any issues arising.

People were generally pleased with the support they received. However some people raised concern about the behaviours of others and how this impacted upon them. They said the food could be improved upon and there was little to do during the day. Staff told us that these areas were being addressed.