The inspection took place on 12 April 2018 and was unannounced. This meant that the service did not know we were coming. The service was previously inspected on 30 August, 8 and 9 September 2016, when it was rated as requires improvement in the areas of safe, effective, caring and well led and good in responsive. The overall rating at that inspection was requires improvement. There was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Need for consent. This was because consent to care and treatment had not always been obtained.

We also made recommendations about the management of mealtimes, the recording of local applications of creams, the recording of drug fridge temperatures and a more structured auditing system.

Following the last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, caring and well led to at least good. During this inspection, we found the service was meeting the requirements of the current legislation.

Sandy Banks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sandy Banks accommodates up to 39 people in one adapted building. It provides accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for people living with a dementia, people with mental health needs, older people, and people detained under the mental health act and younger adults. There were 29 people in receipt of care at the service at the time of our inspection.

The service had 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 was run.

Staff demonstrated understanding of actions they needed to take if they suspected abuse. Training records confirmed staff had undertaken safeguarding training.

Improvements had been made to the management of medicines. We observed staff administering medicines safely. The management team told us improvements in the competency checks for staff were being implemented.

Individual and environmental risk assessments had been completed. Evidence confirmed regular servicing and audits of the environment were undertaken.

A safe recruitment procedure was in place that ensured only staff who were suitable to work with vulnerable people were employed. Duty rotas confirmed staff allocations for each shift. Where agency staff were utilised to cover shifts we saw regular consistent staff were accessed. Staff were provided with a variety of training that ensured they had the knowledge and skills to deliver effective care to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Best interest decisions and capacity assessments had been completed for people who used the service. Where required, Deprivation of Liberty Safeguard applications had been submitted to the relevant assessing authority.

People were supported to eat their meals in a timely manner. Meals looked appetising and people were offered choices of what they wanted to eat.

We received positive feedback about the care people received in the home. People were treated with dignity and respect. Staff were seen talking with people nicely and it was clear people who used the service were comfortable in the presence of staff.

Family members told us the home involved them in

Sandy Banks Nursing Home is located in a residential area of Leyland. The home provides nursing and personal care. It is registered for up to 39 adults, who require help with personal and nursing care needs, including those who are living with dementia and those who have mental health problems.

Accommodation is provided at ground floor level. There are some amenities and public transport links close by. The city of Preston, the market town of Chorley and Bamber Bridge village centre are within easy reach. A small car park is available at the home. However, on road parking is also permitted.

This was the first inspection of Sandy Banks Nursing Home by the Care Quality Commission [CQC], since the current management team took over the management of Sandy Banks Care Home under the new provider's registration in May 2016. Although some improvements are still needed at Sandy Banks, we did note that significant improvements had been made since our last inspection under the previous provider and it is important that improvements continue to be made in order to maintain sustainability.

This inspection was conducted over three days, 30th August 2016, 8th and 9th September 2016. The first day was unannounced, which meant that people did not know we were going. Although the registered manager was off duty on the first day of our inspection he did attend shortly after our arrival, so that he could be fully involved with the inspection process. The home was given short notice of the second and third days of our inspection. The manager was on duty on both these days.

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 of the Health and Social Care Act and associated regulations about how the service is run.

There were sufficient numbers of staff on duty to keep people safe. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at Sandy Banks. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.

Medicines were, in general being well managed. However the application of local creams was not always being recorded on the appropriate charts. We have made a recommendation about this.

During the course of our inspection we toured the premises and found that the environment was well maintained and in general the home was clean and hygienic throughout.

Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. We saw evidence that a wide range of environmental risk assessments had been conducted. However, some of these were not up to date. We have made a recommendation about this.

Staff we spoke with were able to discuss the needs of people well and were confident in reporting any concerns they may have had about the welfare of those who lived at Sandy Banks.

Certificates of training showed that a broad range of learning modules were provided for the staff team and those we spoke with provided us with some good examples of learning they had completed. However, the training matrix was not up to date, in order to reflect the current level of training provided. We have made a recommendation about this.

Evidence was available to demonstrate that supervision sessions were conducted for staff, as well as annual appraisals, which enabled them to discuss their work performance and training needs with their line managers.

Although staff were seen to be kind and caring interaction with those who lived at the home could have been better, particularly during meal times. We discussed this with the managers of the ho