About the service:

Sailaway is a residential care home that provides personal care for up to 18 people aged 65 and over. At the time of inspection 16 people were living at the service including those with Parkinson’s disease, diabetes and people living with dementia.

People’s experience of using this service:

¿The registered provider is the person who is usually in day to day charge of the service. They had been absent from Sailaway for a period of more than 28 days during November and December 2018. On the 20 February we were told by the manager that the provider had been absent since the 10 February and was not due to return until the end of April.

The person left in charge during the manager’s absence is referred to in this report as ‘the manager’. This person was not registered with the Care Quality Commission and was not legally responsible for how the service is run or for the quality and safety of care provided.

The manager did not demonstrate an understanding of the knowledge and skills required to manage a care home. We observed that they did not have the skills and competencies to meet people’s assessed needs and keep them safe. The manager had visited the service up to three times a week. When they were not in the service there was no clear leadership or responsible person in charge.

¿People were not always protected from abuse and improper treatment. Systems and processes to protect people from abuse were not operating effectively. The manager and provider had not always reported incidents to the local authority safeguarding team. Staff did not know how to report a safeguarding incident or concern. This placed people at significant risk of harm as allegations and injuries were not being responded to appropriately.

¿Incidents were not always recorded or addressed appropriately, risk assessments were not robust and did not always cover relevant risks.

¿New staff had not always been recruited safely. Processes were not in place to ensure people were suitable for the job they were applying for or that new staff were of good character.

¿The rota did not always ensure that there were medicines trained staff on duty. This meant that some people did not always have access to “As required” medicines for pain relief and other prescribed medicines.

¿Advice and recommendations of external healthcare professionals were not always followed.

¿People did not always receive person centred care that met their needs and preferences. There was a risk that new or agency staff would not know how to meet people’s needs safely or in accordance with their personal wishes and preferences as care records were not always up to date.

¿Risks were not always clearly assessed for people. The action staff may need to take to safeguard people from harm or to provide person centred care was not always detailed in their care records.

¿People did not have any meaningful stimulation and occupation. People told us that there was little to do and they spent most days in the lounge with the television on. They did not get an opportunity to go out unless it was with a relative or friend.

¿Aspects of leadership and governance of the service were not effective in identifying some significant service shortfalls, such as failing to assess, monitor and mitigate risks relating to the health and safety and welfare of people.

¿Some parts of the premises were not secure, clean or properly maintained.

¿The provider could not evidence that there was an accessible complaints process and whether complaints were investigated. People were unsure of how to raise a complaint.

¿Information about the service was not always in an accessible format for people to understand.

¿There was limited information for staff on people’s communications needs in accordance with the Accessible Information Standards (AIS).

¿People told us that the food was very good and they had enough to eat and drink.

Rating at last inspection:

Good. (The last inspection report was publi

Sailaway Residential Care Home provides care and accommodation for up to 18 people, including people living with dementia. Nursing care was not provided. At the time of our inspection, 14 people were living at the home. Accommodation was over two floors with a stair lift to assist access. There were bathroom facilities on both floors. Communal areas were on the ground floor and consisted of a lounge, dining area and a conservatory.

The home was managed by the provider who is in day to day charge and worked alongside staff in order to provide care to people. The provider is a registered person and 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 to the service in November 2015 we found one breach of regulations. The provider had not ensured there were systems and processes to adequately protect people from abuse and improper treatment. Concerns were also identified with regard to medicines received into the home when people were on short stay or respite care. We asked the provider to take action and the provider sent us an action plan In February 2016 which told us what action they would be taking. At this inspection we found that improvements had been made and the regulations were now met. As a result of improvements made, the service’s overall rating had improved to “good.”

People told us they felt safe. Relatives told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm.

There was a system in place to ensure that medicines were managed safely. All staff authorised to administer medicines had received training and the competency of staff administering medicines was checked on a regular basis.

Risks to people’s safety were assessed and reviewed. Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely.

People were involved as much as possible in planning their care. Each person had a plan of care which provided staff with the information they needed to support people and meet their needs. Care plans contained information which was relevant to each individual and enabled staff to provide effective support to people.

Staff received regular training and there were opportunities for them to study for additional qualifications. Staff were supported by the management through supervision and appraisal. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider and staff understood when an application should be made and how to submit one and was meeting the requirements of DoLS. The provider and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. People spoke positively of the food and the choice they were offered. We were told, “The food is good, there is always a choice”. Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. People were supported by a range of health professionals and appropriate referrals were made for guidance or additional support.

People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiled and laughed with people and offered support. There was a good rapport between people and staff.

The provider and staff were flexible and responsive to p

This inspection took place on 12 November 2015 and was unannounced. The home provides accommodation for up to 18 people, including people living with dementia. There were 11 people living at the home when we visited. The home is owned by the registered provider who also acts as the manager.

The home consists of communal areas of a conservatory, lounge and dining area, which people were observed using. Three bedrooms can accommodate two people but at the time of the inspection each bedroom was occupied by one person. Five bedrooms have an en-suite toilet. The home has three bathrooms with either a shower or a bath. One of these was not being used as it was due to be refurbished. This was the bathroom on the first floor which meant there was no communal toilet in this area.

The service provider, Mrs Dahiya, also works at the manager. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This comprehensive inspection was carried out to check on the service’s progress in meeting the requirements made as a result of the inspection on 9 and 13 April 2015 and for another inspection on 23 September 2015. The inspection of 9 and 13 April 2015 resulted in the service being rated Inadequate and was placed in Special Measures. This meant we started to use our enforcement powers to monitor and check the service and if no improvements were noted we could cancel or vary the conditions of the provider’s registration. The previous two inspection reports identified the service was not meeting the following standards:

• How risks to people, such as falls were managed as well as the safe management of medicines and preventing the spread of infections.
• Staff recruitment procedures were not adequate.
• The provider was not following the Mental Capacity Act 2005 and its associated Code of Practice, where people lacked capacity to consent to their care and treatment.
• Staff training and supervision was not adequate to enable staff to carry out their duties.
• People’s care needs were not adequately assessed and care was not always arranged to meet those needs.
• The provider did not have adequate systems to assess, monitor and improve the service.

At this inspection we found the provider had taken action to address these breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Further improvements, however, were needed regarding the recording of medicines brought into the home for those on a short term respite basis. This was a continued breach of the Regulations regarding the safe management of medicines. We identified a new concerns regarding procedures for protecting people at risk of abuse.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm. There were systems in place to review any accidents or incidents to people to prevent the likelihood of any reoccurrence.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in care were employed.

The service was clean, hygienic and free from odours. Procedures were followed regarding the prevention of possible infection.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People’s capacity to consent to their care and treatment was assessed. Where people had limited capacity to consent to their care and treatment the provider had carried out capacity assessments which were specific to different aspects of individual people’s care. Applications were made to the local authority where people were assessed as needing a DoLS authorisation as their liberty needed to be restricted for their safety. Not all staff had a full understanding of these procedures and a best interests decision was not recorded where a decision was made on behalf of someone regarding their medicines.

There was a choice of food and people were complimentary about the meals. The manager consulted people about the food and meal choices. Nutritional assessments were carried out and referrals made to the appropriate health services where there was a risk of malnutrition.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed.

Staff were observed to treat people with kindness and dignity. People said the staff treated them with kindness. People were able to exercise choice in how they spent their time.

People said they were consulted about their care and care plans were individualised to reflect people’s choices and preferences. Each person’s needs were assessed. Care plans showed how people’s needs were to be met and how staff should support people.

Activities were provided for people and a schedule of activities for the week was displayed in the lounge. People were observed taking part in activities or reading in the lounge.

The complaints procedure was available and displayed in the entrance hall. People said they had opportunities to express their views or concerns.

Staff demonstrated values of treating people with dignity, respect, and, as individuals. The provider had introduced a system to ask people their views on the standard of the service they received.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out a focused inspection on 23 September 2015 in response to concerning information about the management of risks at the home. This report only covers our findings in relation to this topic in the “Safe” domain.

The home provides accommodation and personal care for up to 18 people, including people living with dementia. There were nine people living at the home when we visited. The home is owned by the registered provider who also acts as the manager.

We found people’s safety was compromised in some areas. Checks to ensure staff were suitable to work with the people they were supporting were not always conducted.

The risk of people falling was not managed effectively. For one person, only one piece of falls-prevention equipment could be used at a time, which put them at risk in some circumstances. Where people had fallen, there was no system in place to analyse them and identify any patterns across the home, in order to prevent further falls.

Window restrictors were not in place to prevent people from falling from first floor windows. Two members of staff were using equipment to support people to move that they had not been trained to use, which put people and staff at risk of injury.

Where people had been identified as at risk of developing pressure injuries, consistent action was not always taken to reduce the risk.

Suitable arrangements were in place for the obtaining, handling, safe keeping and disposal of medicines. However, staff did not always record or account for medicines accurately. One medicine was not given at the correct time, so may not have been effective.

People and their relatives told us they felt safe at the home. Risks relating to the environment were managed effectively.

We found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 from our previous inspection in April 2015. We are reviewing the action we will take in relation to these breaches and others identified at the April 2015 inspection. We will publish any action we take when this is completed.

We spoke with four people who lived at Sailaway Residential Care Home. They told us that they were happy at the service and with the support they received with their medication. One said, “It’s very good”. Another told us, “I’d recommend it, I haven’t got any complaints”.

We looked at the processes, procedures and records held by the service relating to the use and management of medicines. We observed that medicines were stored securely.

We reviewed the administration records and supporting information. These records were complete, and included supporting information to ensure that staff would administer the medicines in a consistent manner.

The provider had a system in place to monitor how medicines were used in the home and to check that it was safe.

Sailaway Residential Care Home was inspected on 17 October 2012 and 3 April 2013. At these visits we found that they were not complying with aspects of Regulation 13 relating to the management of medicines. This visit was carried out by a specialist pharmacy inspector who looked at the use and management of medicines within the home.

We observed the administration of medicines at lunchtime. One person that we spoke with told us that they were happy with the way that they received their medicine. They told us, “I get what I need when I need it”. We spoke with two members of staff and the manager. One member of staff told us, “The staff are regular and we all know the people”.

We noted that the provider had taken some action to address the compliance action we set at our inspection in April 2013 concerning the recording and safe administration of medication. We found that the majority of medication was administered safely. However, medications with variable doses or that were prescribed on a ‘when required’ basis were not appropriately recorded. We also found that some medication was not stored appropriately. Further action was required to ensure that people were protected from unsafe or inappropriate care.

There were 12 people living at Sailaway Residential Care Home at the time of our visit.

We spoke with four people. They told us that it was a good home and that they felt supported. One said, “There’s not much I could say against the place”.

We spoke with two relatives. One told us, “I think it’s great actually, it really is”. The other said, “I think it’s very well run; they look after people well”.

We spoke with three members of staff and the manager. One member of staff told us, “I really like this job”. The manager said, “I’ve got really good staff, we work like a family”. We observed that staff had a good relationship with people and knew them well.

We noted that the provider had taken action to meet the compliance action we set at our inspection in October 2012 concerning the storage of medication. We found, however, that some other aspects of the management of medicines required action to ensure that people were protected from unsafe or inappropriate care.

We spoke with four people who have been accommodated at Sailaway. We also spoke with a relative who was visiting the service.

They told us about the care and support they had received and confirmed they were satisfied. One person told us, “As places go, I would give it eight out of ten!” Another person told us, “The staff are very nice, very friendly, I feel I am very lucky here.” A relative said, “Sailaway is warm, friendly and caring. It’s got soul; it’s not sterile. It’s not posh but it’s homely. The residents always come first.”

People we spoke with told us they felt safe. They confirmed that they found care staff were competent and skilled when providing for their needs. They also confirmed that the provider often spoke to them to ensure they were satisfied with the service provided. We were informed they found the provider was approachable and their views about the service had been taken into account.

This inspection took place on 9 and 15 April 2015 and was unannounced. The home provides accommodation for up to 18 people, including people living with dementia. There were 9 people living at the home when we visited. The home is owned by the registered provider who also acts as the manager.

At our previous inspection on 22 and 23 October 2014, we identified breaches of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action and required the provider to make improvements. We issued three warning notices in relation to care and welfare, infection control and quality assurance. We also set compliance actions in relation to safeguarding, meeting nutritional needs, safety and suitability of premises, consent to care, requirements relating to workers and supporting workers. The provider sent us an action plan on 29 January 2015 stating they would be meeting the requirements of the regulations by 1 February 2015.

At this inspection we found the provider had not completed all the actions they told us they would take. As a result, they were continuing to breach regulations relating to fundamental standards of care.

People’s safety was compromised in some areas. The kitchen door was wedged open contrary to advice from the fire service; the needs of two people whose safety would be at risk in the event of a fire had not been catered for; not all staff had received fire safety training; and the garden fence, intended to protect people from the risks of traffic on a nearby road, was not secure.

Infection control guidance issued by the Department of Health had not been followed, and infection control risk assessments had not been completed. Not all staff had been trained in infection control. Cleaning check sheets had not been completed, although we found the home was clean.

Suitable arrangements were in place for managing medicines, but the recording of some medicines did not follow guidance issued by the National Institute for Health and Clinical Excellence. The risk of people falling was not always managed safely. People’s risk assessments were not reviewed following falls and specialist advice was not always sought.

Recruitment procedures were not effective as appropriate checks were not always completed before staff were employed. People felt safe and most staff had an understanding of how to safeguard people from abuse. However, not all staff had received training in how to identify, prevent and report abuse.

Staff did not follow legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests. The manager was not clear about the legal process used to deprive people of their liberty, in order to keep them safe.

People felt staff were competent and skilled in their roles, although not all staff had received essential training. For example, some staff were using a hoist to move people when they were not trained in its use. Other training records were disorganised and the provider could not confirm which training staff had received. Not all staff were supported appropriately through the use of one-to-one sessions of supervision, and none had received an annual appraisal.

There was a lack of information about the support needed by people who displayed behaviour that challenged staff. The care plans for two people had not been updated to reflect their current needs. Consequently, people may not have received appropriate, consistent care and support.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of service. The provider did not send us information we requested about action they had taken in response to health and safety concerns identified by an external specialist.

There were enough staff to meet people's needs. People and their relatives felt staff provided effective care. Care plans contained information about people’s personal histories, preferences and interests and comprehensive guidance about how people liked to receive personal care. Records were up to date and confirmed people had received all care and support that had been planned.

People spoke positively about the variety of activities they could access and parties were held for special occasions. The manager sought feedback from people through ‘residents’ meetings’. These showed people were listened to and changes made to menus and activities as a result.

People liked the manager and spoke with them often. Visitors were made to feel welcome. The manager and deputy manager promoted positive values and attitudes towards people which helped create a family atmosphere in the home.

People were cared for with kindness and compassion and treated with affection. All interactions were warm, friendly and respectful. Staff knew people well and communicated effectively, using appropriate techniques. People’s privacy and dignity were respected and they were involved in planning the care and support they received.

Most people were satisfied with the quality of the food. People received appropriate support to eat and drink enough. Staff closely monitored the food and fluid intakes of people at risk of malnutrition or dehydration and took appropriate action where required.

People were able to access healthcare services. Some adaptations had been made to make it suitable for older people, such as a stair lift and level access to a garden with an area of decking, which people enjoyed using.

The manager spent most of their time working with staff on a daily basis, helping to deliver care and support to people. Staff appreciated this and described the manager as “approachable”. They felt able to make suggestions to help improve the quality of service provided.

Following the inspection, we discussed our concerns with West Sussex Fire and Rescue Service.

At this inspection we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, some of which were continued concerns from our previous inspection. You can see what action we have told the provider to take at the back of this report.

The overall rating for this provider is ‘Inadequate’. This means that it is in ‘Special measures.’ Special measures in Adult Social Care provides a framework within which CQC can use our enforcement powers in response to inadequate care and can work with, or signpost to, other organisations in the system to help ensure improvements are made.

Services in special measures are kept under review and, if we have not taken immediate action to cancel registration, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.