We inspected Sandfields on 4 and 5 July 2017. Sandfields provides accommodation and nursing and personal care for up to 90 older people and people living with dementia. At the time of our visit, 68 people were using the service. Sandfields is split over six units, at this inspection one of these units was currently not being utilised. This was an unannounced inspection. At this inspection, we also followed up on concerns raised following a HM Coroner’s inquest in March 2017.

We last inspected the home on 30 and 31 July 2015. At the July 2015 inspection the service was meeting all of the requirements of the regulations and was rated as “Good”. However we found that good practice had not always been established and maintained in relation to maintaining people’s care records. During this inspection we found the provider had improved the recording of people’s risk management plans and staff had the information they needed to know how to keep people safe.

There was a registered manager in post. The registered manager was also the provider of 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.

People enjoyed living at Sandfields. People and their relatives told us they or their relatives were safe at the service and enjoyed active and social lives. People had access to activities which were tailored to their individual needs and preferences. People felt cared for and happy.

People were supported with their ongoing healthcare needs. Care and nursing staff supported people to access the healthcare support they required. People told us they enjoyed the food they received within the home, and had access to all the food and fluids they needed. Where people needed support to meet their nutritional needs, these needs were met.

People were supported by care and nursing staff who were supported and trained to meet people’s individual needs. Staff were supported to develop and access additional training to further improve their skills. All staff we spoke with felt supported and were positive about working at the service.

People and their relatives spoke positively about the management of the service. The registered manager ensured people, their relatives and external healthcare professionals’ views were listened to and acted upon. The registered manager had systems to assess, monitor and improve the quality of service people received at Sandfields.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with the registered manager, three members of staff and five people who lived in the home. We also spoke to relatives and visitors. We observed staff interacting with people who lived in the home. We reviewed the care records relating to the management of the home which included five care plans, daily care records, accident and incident records and quality assurance systems.

Below is a summary of what we found. The summary describes what people who lived in the home and staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff understood the needs of the people who lived in the home. Care was delivered as planned in people’s care records. The home was cleaned and maintained. Maintenance records showed the home was regularly checked and maintained. The registered manager and staff were aware of their role in the prevention of harm to vulnerable people. Emergency procedures were in place should they be needed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

Is the service effective?

People received an effective service because staff had a good understanding of people's needs. Relatives said, "Staff are very good, very friendly”. We saw staff supporting people who got upset in an appropriate manner. People were involved in their care planning. People had a choice of foods and drinks.

Is the service caring?

People received a service which was caring because people's wishes were acknowledged and respected. As people’s needs changed, staff knew how to manage and adapt their care effectively. Staff were observed communicating with people in a kind and sensitive way. People who lived in the home were calm and relaxed around staff. Staff supported and orientated people if they became confused.

Is the service responsive?

This service was responsive because people received support and care when they needed it. A visitor said, "Staff will listen and help if we have a concern". The registered manager managed complaints in line with the provider’s policies and procedures. Relatives told us they could always speak to the registered manager if there was a problem. We saw the registered manager responding to an incident when a person became upset about a member of staff. This was dealt with immediately and appropriately.

People’s health needs were regularly monitored and reviewed by the local GPs. Referrals were quickly made to health services when people’s needs changed. People’s care needs were reviewed monthly to ensure that the support and care provided was appropriate.

Is the service well-led?

The service was well led as there were effective arrangements in place to review and monitor care practices in the home. The management team understood the principles of quality assurance to improve the service and quality of life for people who lived in the home.

This inspection took place on 30 and 31 July 2015 and was unannounced. Sandfields is a purpose built new home which provides accommodation for up to 90 people who require nursing and personal care over three floors. Each floor was divided into two 15 bedded units, with its own dining room and lounge. At the time of our inspection, there were only four of the six units open, of which 49 bedrooms were occupied. Each bedroom had private toilet and shower facilities. People had access to a secured garden, cinema, coffee area and hobbies room as well as the hair salon.

A registered manager was in place as required by their conditions of registration. 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 told us they enjoyed living at Sandfields. People’s individual risks had been assessed however, guidance on how to reduce people’s risk was not always recorded. Staff knew people well and were able to support people with their needs and risks. Their individual needs were thoroughly assessed before they moved into the home. People received additional care and treatment from other health care services when needed. Staff encouraged people to have a well-balanced and nutritional diet. Group and individual activities were provided at Sandfields. People’s medicines were administered and stored effectively.

Staff knew how to report any concerns of abuse to the relevant safeguarding authorities. Policies to protect people were in place to give staff guidance. People told us they felt safe at the home and there were enough staff to meet their needs. Thorough recruitment checks and an induction programme were carried out with new staff before they provided care to people. Training plans and systems were in place to ensure people were cared for by staff who received regular training and support from their line manager. Staff told us they felt supported and trained to carry out their role.

People and their relatives spoke highly of the staff and the registered manager. Relatives told us any day to day concerns, which they had raised, were always dealt with immediately. The registered manager valued people’s feedback and responded to any concerns. Complaints were managed effectively and actions were put in place to prevent the concern reoccurring.

Monitoring systems were in place to ensure the services were operating effectively and safely. Internal and external audits were carried out to continually monitor the overall services provided.