Sanford House Nursing Home provides accommodation and nursing and personal care for up to 40 people. There were 39 people living in the home on the day of our inspection. The home is divided into two areas. The Carrick unit provides care to people who have nursing needs. The Shannon unit provides care to people who are living with dementia.

This inspection took place on 31 January 2017 and was unannounced.

A registered manager was in post at the time of our inspection. 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 the last inspection December 2015, we asked the provider to take action to make improvements to the cleanliness of some areas of the home and equipment that people used. At this inspection, we found that the necessary improvements had been made. Most areas of the home were clean as were people’s rooms and the equipment they used.

People received good quality care from staff who were well trained, kind and compassionate. There were enough staff working in the home to meet people’s needs and preferences. Staff were polite, thoughtful and treated people with dignity and respect.

People were able to make choices about their care and they were encouraged to maintain their hobbies and interests to enhance their wellbeing.

Systems were in place to protect people from the risk of abuse and avoidable harm. Risks to people’s safety had been assessed and actions taken to reduce these risks as much as possible. Most people had received their medicines when they needed them.

People received enough to eat and drink to meet their needs and were supported to maintain their health. Their consent was sought when this was appropriate and where people could not consent to their care themselves, any decisions made for them by the staff were done in the person’s best interests. This was in line with relevant legislation.

There was an open culture within the home. People and staff were involved in the running of the home and were able to contribute their ideas on how to improve the quality of care people received. These were listened to and implemented. People and staff could raise concerns without hesitation and these were listened to and dealt with quickly for the safety and satisfaction of the people living there.

Good leadership was demonstrated. The registered manager and staff understood their roles and responsibilities. The registered manager improved their knowledge about social care by keeping up to date with best practice within this area. This was used to drive improvement in the quality of care provided to people.

This inspection was unannounced and took place on 15 December 2015.

Sanford House Nursing Home is a care home that provides accommodation and nursing care for up to 40 older people, some of whom may be living with dementia and/or a physical disability. The home is on one floor and is split into two wings. These are a nursing wing that can accommodate up to 25 people and a dementia wing that can accommodate up to 15 people. On the day of the inspection, there were 39 people living at the home, 24 in the nursing wing and 15 in the dementia wing.

There was a registered manager employed at the home. 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 and associated Regulations about how the service is run.

Some areas of the home and equipment being used were not clean and the staff did not always follow good infection control practices. The principles of the Mental Capacity Act 2005 had not always been followed when decisions had been made on behalf of people who could not make them for themselves. Therefore, their human rights may not have been fully protected.

Staff treated people with kindness and compassion. However, some staff did not always treat people with respect.

People who were able to provide us with their feedback on the care they received and the relatives we spoke with were happy with the care provided at Sanford House Nursing Home. They recommended it as a place to live.

People’s care needs and individual preferences of how they wanted to be cared for had been assessed and were being met by the staff. There were enough staff to provide people with the care they needed and they knew the people they cared for well and people felt listened to. People received their medicines when they needed them.

People received enough food and drink and they were quickly referred for specialist advice if there were any concerns about their health. The staff had received enough training to give them the knowledge to provide people with effective care and they felt supported in their job. The staff knew how to protect people from the risk of abuse and people had access to activities to complement their hobbies and interests.

People and their relatives knew how to complain if they were unhappy about anything and were confident to approach the staff or registered manager if they had any concerns. People and their relatives were encouraged to be involved in the running of the home and were regularly asked for their opinion regarding this. The quality of care that was provided was monitored regularly.

There was one breach of the Health and Social Care Act 2008, Regulated Activities (2014) and you can see what action we have told the provider to take at the back of this report.

We have made a recommendation regarding following the principles of the Mental Capacity Act 2005 when making best interest decisions on behalf of people.

One adult social care inspector inspected Sanford House. At the time of the inspection there were 39 people using the service. 15 people were cared for in the dementia unit and 24 people in the nursing unit.

We spoke with four people who used the service, three people’s relatives and seven staff members. We pathway tracked and reviewed the records for six people who used the service. We also reviewed a selection of other records that included staffing rotas, the provider’s policies and procedures, training records and audit results in relation to all aspects of the service.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The management team had been trained and understood their obligation to apply the principles of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS). People who used the service had received appropriate mental capacity assessments and a number of ‘best interest’ decisions were recorded. At the time of this inspection the registered manager told us that a number of people had a Deprivation of Liberty Safeguard (DoLS) in place. This was in the form of a standard authorisation or an urgent authorisation. We saw evidence that the registered manager had acted in accordance with the law in relation to the MCA and DoLS.

People who used the service and their relatives told us that they felt there were enough staff on duty to meet people’s needs at all times. This included the needs of people who required one to one care and support.

There were effective systems in place to record and investigate accidents and incidents. Trends analysis was undertaken by the manager and action plans put in place to reduce the risk of repeat occurrences.

Risk assessments had been completed in relation to people’s needs with documentation as to how risks could be minimised. Examples of this included the use of a hoist and walking aids for people with mobility problems. This helped to ensure that people’s safety and welfare was maintained.

Staff were up to date with their mandatory adult safeguarding training and told us the procedures they would follow if they suspected actual or potential abuse. The provider’s safeguarding policy and procedure was in date and referred to the local authority’s safeguarding procedure.

The provider had effective arrangements in place to manage foreseeable emergencies. These included plans in relation to fire and evacuation, loss of utilities and the loss of the nurse call bell system.

Is the service effective?

People’s needs were assessed, and care and support was planned and delivered in order to meet these needs. Nationally recognised tools were used in the assessment of people’s needs. This included the ‘Malnutrition Universal Screening Tool’ (MUST) for people at risk of malnutrition or obesity.

During the review of six people’s care plans we saw robust evidence that the provider worked closely with other health and social care professionals. This meant that people received care and treatment from a multidisciplinary team that helped to address all of their needs. .

We noted that new care booklets had been recently introduced to the service. We reviewed the booklets that related to nutrition and hydration, and wound care management. We saw evidence that the information contained within the booklet was evidence-based and included nationally recognised screening tools and guidelines.

Staff were competent and had undertaken their induction and mandatory training. Additional specialist training was undertaken after the person had completed their induction training. All of the staff we spoke with told us that they felt well supported and received regular appraisals and supervisions.

Is the service caring?

All of the people who used the service and their relatives who we spoke with were positive about the service. One person said, “I am very happy here. I am well looked after. I have no complaints. I choose what I want to do each day and if I want, I join in with things. The staff are very good.” Another person said, “I am happy living here and choose to stay in my room. I am able to open my patio door to go into the garden to have a cigarette if I want to.”

One of relatives we spoke said, “I am very satisfied with this home. The care given to my (relative) is excellent. Staff attend to my (relative’s) personal needs and all the care is wonderful. The home’s design, premises and environment is great. I have no concerns about my (relative’s) safety, I feel fully involved in their care planning and support because my (relative) does not have capacity.”

During our inspection we observed the interaction between the staff and the people they cared for. Staff were compassionate and respectful at all times, and people’s privacy and dignity were maintained.

Is the service responsive?

People’s care plans responded to and reflected their physical and mental health needs as well as their social and spiritual needs. Staff were able to support people with complex needs. This included the needs of people living with advanced dementia.

People’s care plans included an easy read format for personal care. This helped the person understand how the staff could assist them in meeting their personal care needs.

The environment was conducive to people living with dementia. The premises were spacious and there were activities and objects available to help meet the needs of people. We have highlighted our concerns to the provider in relation to the seating arrangements in the lounges in both the nursing and dementia units as well as the lack of ventilation in the lounge in the dementia unit.

Although there were minimal complaints received by the service, we saw evidence that learning from complaints and concerns took place.

Is the service well-led?

Sanford House was well led. Governance, risk management and quality measurement was effectively addressed on a daily basis, and formally on a monthly basis. Both the registered manager and the regional manager undertook monthly audits that addressed all areas of the service.

All of the people we spoke with who used the service and their relatives told us that they felt the service was well led. One relative said, “The manager is wonderful. We are invited to meetings and complete the satisfaction surveys left in the doorway. The manager has an open-door policy and if we have any problems then they just sort it out. We have no complaints.”

All of the staff we spoke with told us that they felt they were well supported and that the registered manager was approachable and would always listen to what they said.

The management team told us that they were supported to try new ways of working to improve the efficiency and effectiveness of the service. This included a new initiative for new members of staff to wear a different coloured uniform. They said that this would help prevent other staff requesting their assistance before the person had received their necessary training and been signed of as being competent.

This inspection visit of October 2013 was carried out following some concerns raised during the July 2013 inspection. The provider of this home was not compliant with 'respecting and involving people who used the service' and 'care and welfare for people who used the service.’

Following the July 2013 inspection an action plan completed by the manager was sent to us stating all the actions required for the home to become compliant would be completed by 9 September 2013.

During this October visit we found that people's care needs were more individually focussed. More choices were available that allowed people living with dementia to understand what those choices were. We also found that they were more involved in their day to day lives that promoted their independence.

We found the home had carried out improvements to the methods used to manage behaviour that may create challenges for staff and that the care and support required was documented and followed by staff to meet people’s individual needs. This would ensure care was delivered safely and appropriately.

We spent time observing people in the designated unit where people who were living with dementia required close monitoring. We spoke with those who were able to answer some of our questions. One person said, “The staff are nice.” Another said, “I like the food.”

We found the staff team were attentive, respectful, polite and courteous. However, due to the complex needs of some of the people living in this home we could not be assured that their individual needs were always met. We found that people were not always supported as stated in their care plan or that the support required was not always recorded.

Although people's nutritional requirements were met there was a need to improve the meal time process. Choices were not offered appropriately to people who could not understand. Food was not offered by methods that would promote people's independence.

The home had a safe and suitable system that ensured medication was managed safely.

There were different methods used within the home to check the quality and suitability of the service. We saw records of company audits and actions that had been taken on the findings. A survey of the views of people involved with the service about service quality was partly completed.

We spoke with several people living in the home. However, many of those people were unable to verbally communicate their experience of using the service. We spent time, in the communal areas, observing their experience and their responses to the care given. Whilst staff were encouraging to the people they were caring when they did interact with them, we found that there was limited opportunity for staff to spend with people during the morning and people were left on their own for long periods of time.

People we were able to speak with however told us that the service was “Nothing short of excellent and it is now my home” and that “the staff are a wonderful bunch”.

One of the people with whom we spoke told us, “The staff are lovely.” This person also told us that they are involved in planning their care and that they know what is in their care plan. One person told us that they have to wait for “some time” when they ring their bell, whilst another person told us that they “do not have to wait long for someone to come”. A relative with whom we spoke commented very highly about the care provided to their spouse.

Two people with whom we spoke both told us that the food is nice and that they are always offered a choice. On the day of our visit the cook had made both people an alternative meal as they had not wanted what was on the menu.

When we asked two people living in the home why their bedroom doors were propped open they told us that they do not like the door being shut but that the door will not stay open unless propped with something.