About the service: Sandybrook is a residential care home that was providing personal care to 25 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

• The service had deteriorated in some domains since our last inspection.

• The service met the characteristics of requires improvement in four out of the five key questions.

• We found three breaches of the regulations in relation to recruitment, consent and good governance.

• Staff were not always recruited safely.

• The registered manager was not following the principles of the Mental Capacity Act 2005.

• People were not always assisted to have maximum choice and control of their lives.

• Risks to people’s health and safety were not always managed safely.

• Care records were not always up to date to reflect people’s current health care needs.

• We have made three recommendations in relation to the management of risks to people’s health and well-being, infection control and the storage of some medicines.

• There were also good practices within the service.

• People liked living in the service. We observed a homely and friendly atmosphere.

• People were protected against abuse, neglect and discrimination through good safeguarding processes.

• Staff we spoke with were positive about their roles and wanting to do their best for people.

• Staff we spoke with knew people well. They had developed good relationships with people. People who used the service clearly enjoyed the presence and attention from staff.

• More information is in the full report.

Rating at last inspection: At our last inspection the service was rated good overall. Our last report was published on 10 May 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

Sandybrook is registered to provide personal care and accommodation for up to 25 older people. The home is located in Darwen, near Blackburn Lancashire. It is a detached building in its own grounds with car parking at the front of the building. Public transport is within easy access of the home. There were 25 people accommodated at the home on the days of this inspection.

The service were last inspected in May 2014 when the service met all the regulations we inspected.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, including the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

We found the administration of medicines was safe, the system was audited to look for errors and staff had their competency checked regularly.

People who used the service said food was good. People were given a nutritious diet and had choices in the food they were offered. We saw meals were unhurried and staff interacted well with people to make it an enjoyable experience.

Some staff had been trained in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there was a good interaction between staff and people who used the service. Family members told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record of people's end of life wishes to ensure their needs could be met at this time.

There was a record kept of any complaints (none since the last inspection) and we saw the manager took action to investigate and reach satisfactory outcomes for the concerns, incidents or accidents to reach satisfactory outcomes.

Staff, people who used the service and family members all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The environment was maintained at a good level and homely in character. We could see that where some areas of the home needed upgrading work had commenced to improve the décor.

We spoke with two family members, the registered manager, a staff member and a district nurse during this inspection. We also looked at the quality assurance systems. This helped answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and all people who used the service had their mental capacity assessed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw that applications had been made, when appropriate, to the local authority safeguarding team. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. There were policies and procedures for the control of infection. Two family members told us, "The home is always clean and tidy". A district nurse said," The home is very clean".

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. Family members said, "They keep us informed of any incidents or if she is ill. We go through the care plan. The care she gets is what she needs. She is well looked after".

Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

We saw that medication policies and procedures were adhered to in order to ensure people who used the service had the correct medication administered at prescribed times.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Family members told us, "We come every day to see her. We can come when we like. The staff are all very good and she is being well looked after". A district nurse said, "The staff are helpful and very obliging. They seem to know what they are doing and the manager makes herself available".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service or a family member were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

Was the service responsive?

People completed a range of activities in and outside the service regularly. We were told by the registered manager that people particularly enjoyed singing together with staff. Entertainers visited the home once a month. Other activities included arts and crafts, baking and special event days such as the Mexican day that was being held on the day of the inspection.

The registered manager held regular meetings with staff, family members and people who used the service. The registered manager also held a weekly 'surgery' in the evening for anyone to come in to the home and talk about the service.

We saw that quality assurance questionnaires had been used to collect people's views of the service. We looked at the quality assurance summary and found answers to be very positive. Cleanliness was either excellent or good, as was meals although three people did not know, activities in general was good, quality of service was good or excellent, staff attitude was excellent or good although one person thought fair. The homes decor was thought to be good or excellent as was staff courtesy.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

The service had good quality assurance systems. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

People who resided at this home had complex conditions which made communication difficult. However, we were able to talk to some people who used the service who gave us answers to simple questions. They said food was good and staff were kind and caring. Two visitors told us, "We are very satisfied with the home. It is a fantastic home. Like a home from home. They are like a family to us and we get involved in the activities because they include us". We observed care and spent some time in a lounge area. The interaction between staff and people who used the service or family members was open and caring. The atmosphere was calm and good natured. People were looked after by compassionate staff.

Plans of care contained up to date information for staff to deliver effective care.

Two staff member we spoke with said, "I like working here. We have a very good team. You get satisfaction knowing that you have done something good by looking after vulnerable people" and "I like working here. You get peace of mind knowing you are keeping people safe and you have looked after them to the best of their ability. They are very well looked after". Staff were motivated and supported to meet the needs of people who used the service.

We were not able to talk to people because of their complex mental health needs. We looked at records, talked to staff, a visitor, observed care and analysed 15 quality assurance questionnaires.

Quality assurance questionnaires indicated most people thought the home delivered an excellent or good service. One visitor said, "I find it wonderful. They always treat people with respect and dignity".

Comments from quality assurance questionnaires included, "I have been impressed by the appearance of my relative and she is happy", "Staff have appeared competent and kind. Keep up the good work" and " I know it is difficult to provide activities but I would be willing to help out. It is good overall bearing in mind the difficulties of looking after people with dementia. It must be hard to look after them".

Quality assurance questionnaires informed us most of the 15 participants thought care was excellent or good. One visitor told us, "The care is good and seems to be tailored to each individual".

Two staff members questioned told us, "I get supervision and we can put our views forward. I like working here. There is a good staff team and the managers are supportive" and "I get supervised on a regular basis and the manager is approachable and will help out. I love working here. It is very good. I like looking after the residents and finding out about them. The majority of time there are enough staff here to meet the needs of people who use the service".