Sandalwood 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. The home is registered to accommodate 60 older people; at the time of our inspection, there were 43 people living there.

At our last inspection in August 2017, this service was rated overall as requires improvement. At this inspection, although some improvements had been made there were areas that needed further improvement. The service remains rated overall as requires improvement. The inspection took place on the 9 July 2018 and was unannounced.

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.

The systems in place to monitor the quality of the service were not always effective. Audits needed to be consistently undertaken so that any shortfalls were identified and addressed. Detailed care plans were in place, which enabled staff to provide consistent care and support in line with people’s personal preferences and choices but risk assessments were not always in place.

People were supported to have maximum choice and control of their day to day lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. However, people did not always feel fully consulted and involved with their care plans.

People received care from staff that were kind, compassionate and respectful. The staff were friendly, caring and passionate about the care they delivered. People had formed positive therapeutic relationships with staff and felt they were treated as individuals.

There were activities available for people to participate in however these could be improved and developed further. Family and friends were welcomed to take part in events at the home.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had. End of life wishes were discussed and plans put in place.

Staff were appropriately recruited and there were sufficient staff to meet people’s needs; staffing levels were kept under review. People were protected from the risk of harm and received their prescribed medicines safely. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day-to-day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

Staff had access to the support, supervision and training that they required to work effectively in their roles. Development of staff knowledge and skills was encouraged.

The service had a positive ethos and an open culture. The provider and registered manager were committed to developing the service and actively looked at ways to continuously improve.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

This inspection took place on the 18 and 26 July 2017 and was unannounced.

Sandalwood Court provides accommodation for older people requiring support with their personal care. The service can accommodate up to 60 people. At the time of our inspection there were 49 people living at the home. The home is divided into three distinct areas which are situated on three floors of the home. On the ground floor care was provided for people living with dementia; on the first floor care was provided to older frail people with varying levels of care needs; and on the top floor there was a separate area for people living with dementia and an area which provided respite care. At the time of the inspection there were three people using the respite care facility. People live in the area that is best suited to their assessed needs.

At the last inspection in February 2016 the service was rated as Requires Improvement. At this inspection we found that the service remained as Requires Improvement. Although measures had been taken to ensure that staffing levels reflected people's basic care needs they did not take into account a more holistic approach to meeting people's social and care needs.

There was a registered manager 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.

There was not always sufficient staff deployed to be able to spend time with people outside care tasks and to deliver care in a timely way.

The systems in place to monitor the quality of the service were not effective enough to ensure that the level of cleanliness and hygiene throughout the home was maintained.

People received care from staff that respected their individuality and were kind and compassionate. They were encouraged to take part in activities and to pursue their interests.

There were appropriate recruitment processes in place which protected people from receiving care from people who were not suitable. People felt safe and secure in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

Staff were supported through regular supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People’s needs were assessed prior to coming to the home and individual care plans were in place and were kept under review. Staff had taken time to understand people’s likes, dislikes and preferences.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and engaged in conversations with them. Relatives commented positively about the care their relative was receiving.

There was a complaints procedure in place and people were encouraged to give their feedback, although people did not always feel listened to when they did.

This unannounced inspection took place on 11 January 2016. The service provides support for up to 60 older people who require support with their personal care. At the time of our inspection there were 51 people living at 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.

People felt safe living in the home and most people were able to receive support when they needed it however improvements were required to ensure consistent staffing levels were in place and people received good quality care in a timely manner at all times.

The staff team worked well together but evidence showed that there were concerns about the approachability and accessibility of the management team which also impacted on staff morale. People were supported by staff that had been suitably recruited and adequate checks were made before staff started work. The ethos and values of the home put people at the forefront of the service, and people were given a choice in every aspect of their care.

Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Care records contained individual risk assessments to protect people from identified risks and help keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Accidents and incidents were recorded and reviewed and further action was taken to prevent similar incidents reoccurring. People were supported to take their medicines as prescribed and suitable arrangements were in place to dispose of any excess or unused medication.

Staff received suitable training to meet people’s needs and this was monitored by the management team to ensure people’s training needs were regularly updated. Staff were provided with formal supervision on a monthly basis and received support on a day to day basis from their peers.

People were actively involved in decision about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and appropriate documentation was in place to record the process staff had followed.

People’s healthcare needs were regularly reviewed and action taken when concerns had been identified. People were supported to maintain a balanced diet and eat well, and had their nutritional needs met with freshly prepared meals.

Staff treated people with care and compassion and people told us that the staff were very good to them. People were consistently asked for their opinion and feedback whilst they were receiving care from staff to ensure people were comfortable and happy with the care they received.

Staff responded promptly when people became distressed and offered comfort appropriate to each individual. People’s dignity and right to privacy was protected by staff and visitors and relatives were made to feel welcome at the home.

People’s care and support needs were assessed before people came to live at Sandalwood Court to ensure the service could meet their needs. The assessment and care planning process also considered people’s life history which provided staff with the opportunity to have meaningful conversations with people.

People’s care plans were reviewed and updated by staff as people’s needs changed. People were able to choose to participate in a variety of activities that they enjoyed, and there were opportunities for people to provide their views on the running of the service. Formal complaints were investigated and resolved in a timely manner.

The service encouraged people and their relatives to complete quarterly questionnaires and action was taken to resolve negative comments. Quality assurance systems were in place which reviewed many aspects of the service that people received and the registered managed had developed relationships within the community and healthcare sector to share and promote best practice for people requiring care and support.

One person who used the service told us "It can be chaotic particularly at breakfast, it is ok for me I am mobile but many are not and we get left." Another person told us "The staff are brilliant they work so hard."

A member of staff told us "We are very busy with our work and just don't get time to sit and talk with the residents."

The provider may wish to note however that staff and residents commented that there were not always enough staff to call upon when they needed help.

We saw however that the staff were working hard carrying out numerous tasks and were polite and treated the people who used the service with respect and dignity at all times.

Overall we found that Sandalwood Court was compliant with the regulations we examined against.

We spoke with one person who used the service who said "The staff are brilliant, this home is the best." Another said "I think the staff do a fantastic job."

At the time of our visit a residents meeting took place, 8 people in attendance. We asked had there been any improvement since our last visit and were told "Yes, it's not bad at all honestly."

We spoke with relatives,one said "I looked around at other places but this one was just right for xxx." Another commented "It is much better now, more staff means they can sit and talk awhile instead of running around so much."

A staff member said " I can now concentrate on my job instead of being pulled off to help with serving food and the like." Another said "Much better now, more staff means better outcomes for the residents and less stress for all."

We found Sandalwood Court to be compliant with the regulations we inspected against.

We spoke with a number of care staff, people who lived at the home and relatives. The care staff we spoke with told us that the work environment was very stressful, rushed and they felt unsupported by the management. There was an increased workload due to the number of people needing two care staff. This resulted in other residents left unattended while care staff provided double up care. A member of staff told us, ‘’I feel really sad. I would like to have the time to give the residents a wash dress them in clean clothes and have a chat. Those days are gone. Now I just rush from one task to another’’. Another carer told us, ‘’The place is falling apart and the residents are paying the price.’’ Another said, ‘’We use all available staff to provide care. The laundry staff, the housekeepers and the activity coordinators have all chipped in today to provide care. And this is not a one off, it happens every day’’.

Residents told us that recently there had been fewer care staff. One person commented, ‘’I help the staff on most days by washing up the cups and saucers and that releases them to do caring’’. Another said, ‘’They have to use everyone they can find to provide care, clothes are not ironed. This is because the laundry staff have been helping to provide care’’. A relative confirmed this and told us that they sometimes had helped with the washing up and other chores.

We found the home to be non compliant with the regulations we inspected against.

The people that could speak to us said that they loved living at the home and that the care workers made them feel comfortable and safe. They were happy with the way the care workers supported them and they assured us that they were treated with dignity and respect.

We observed people being supported throughout the day of our visit. Care workers were actively involved in assisting people with meals and drinks.

We saw care workers actively assisting residents with recreational activities.

One of the relatives we spoke with told us, "It is nice that the family can sit and have a meal altogether occasionally." Another said, "I think it is very good here, there was an issue with some missing clothing but the manager sorted it out straight away." A person who used the service told us "I love it here, the staff they really look after me."

Sandalwood Court provides accommodation for up to 40 for people in various stages of dementia, ten for people who were frail and ten for people who require respite care.

The people that could speak to us said that they loved living at the home and that the care workers made them feel comfortable and safe. They were happy with the way the care workers supported them and they assured us that they were treated with dignity and respect.

We observed people being supported throughout the day of our visit. Care workers were actively involved in assisting people with meals and drinks. They showed sensitivity in their enquiries about personal care needs.

Relatives appreciated regular information updates from care workers about the welfare of their family members.