SONAcare was inspected on the 28 and 29 November 2018 and the first day was unannounced.

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

Sonacare is a detached property situated in a residential area close to the centre of Cleveleys. The home is registered to care for up to fifteen people assessed as requiring residential care. Accommodation is located on the ground and first floor of the building that can be accessed by a passenger lift. There is a communal dining room with a lounge area as well as a quieter lounge area for people to sit.

The majority of bedroom accommodation is for single occupancy although there are some shared bedrooms for people who would prefer this option. A range of aids and adaptations are in place for people whose mobility might be affected.

At our last inspection in March 2018, the service was rated as ‘Requires improvement’. We found a detailed employment history of prospective employees was not always obtained. This was a breach of Regulation 19 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection, the registered provider sent us an action plan indicating how improvements would be made and compliance with the regulation reached. The action plan indicated the service had taken action to ensure it met the requirements of Regulation 19 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection in November 2018 we found improvements had been made. We looked at two files of staff who had recently been recruited to work at the home. We found the files contained employment checks, references and a full employment history.

We found individual risk assessments were carried out in key areas such as nutrition, falls and skin integrity. Care records continued sufficient information to enable staff to support people. Care records also contained information regarding people’s preferences and social histories. People and relatives we spoke with confirmed they were consulted in decision making and the planning of care.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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 and relatives told us staff were friendly and respectful and caring in nature. We observed interaction between people who lived at the home and staff. We saw staff were gentle and patient with people and encouraged them to maintain their independence whenever possible.

We found the home was clean and tidy and staff were seen to wear protective clothing when this was required. We noted the temperature of two hot water taps at the home were warm, but not hot. The registered provider told us they would address this. Prior to the inspection concluding the registered provider confirmed action had been taken and additional steps taken to identify any future changes in water temperature.

We saw documentation which evidenced the service sought feedback from people who lived at the home and relatives. Documentation asked people to share their opinions on what the home did well and what needed to improve. The registered provider told us they were committed to improving the service provided.

People told us they did not have to wait for help and staff were attentive to their needs. We timed two call bells which were answered promptly. We observed staff were patient and spent time with people chatting and supporting them when they needed h

This unannounced inspection took place on 23 and 31 January 2018.

SONACare is a care home in Cleveleys and is registered to care for up to fifteen people assessed as requiring residential care. The home has two communal rooms and a dining area. Bedrooms are available over two floors which are accessible via stairs or a lift. At the time of the inspection visit 10 people were receiving care and support at the home.

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

At the time of our inspection visit there was no registered manager in place. 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 registered manager cancelled their registration with the Commission in January 2018. The registered provider said there were plans in place to replace the registered manager. They had not yet however commenced the registration process.

When we completed our previous inspection in May 2017 we found concerns relating to the environment at the home. At this time this topic area was included under the key question of Safe. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of Effective. Therefore, for this inspection, we have inspected this key question and also the previous key question of safe to make sure all areas are inspected to validate the ratings.

At the last inspection visit carried out in May 2017, we found not all requirements had been met and the registered provider was not meeting all the fundamental standards. The registered provider did not meet the requirements of the regulations during that inspection as breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to safe care and treatment, staffing, dignity and respect, safeguarding people from abuse, good governance, person centred care, premises and equipment and failure to display the up to date performance assessment. At the inspection, the service was placed in special measures by the Care Quality Commission, (CQC.)

Following the inspection visit we asked the registered provider to complete an action plan to demonstrate how they intended to make the required improvements. We used this inspection process to check to see if the improvements had been made.

During this inspection in January 2018, we found some improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

Although we found improvements had been made, during this inspection process we identified a breach to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure recruitment documentation included a full employment history for all staff.

Following the inspection visit carried out in May 2018, the registered provider had reflected on concerns identified during the inspection and had reviewed safeguarding processes to promote peoples safety and well-being. At this inspection visit we found staff understood their responsibilities for reporting safeguarding concerns and were aware of how to report safeguarding alerts. The registered provider had become a safeguarding champion, working alongside professionals with up to date knowledge of safeguarding processes and best practice.

The re

This unannounced inspection took place on 25 and 30 May 2017.

Sonacare is a detached property situated in a residential area close to the centre of Cleveleys. The home is registered to care for up to fifteen people assessed as requiring residential care. Accommodation is located on the ground and first floor of the building which can be accessed by a passenger lift. There is a communal dining room as well as a lounge area. The majority of bedroom accommodation is for single occupancy although there are two shared bedrooms for people who would prefer this option. On the morning of the first inspection visit 11 people resided at the home. An additional person moved in later that day.

There was a registered manager in place. 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 service was last inspected 07 April 2015. At this inspection we found the service was meeting all the fundamental standards and was rated as, ‘Good.’

At this inspection visit carried out in March 2017, we found not all requirements had been met and the registered provider was not meeting all the fundamental standards.

Deployment of staffing did not always meet the needs of the people who lived at the home. Two people we spoke with told us staffing levels did not always meet needs. This meant they sometimes had to wait for assistance. We saw evidence of this occurring at the inspection visit. We found deployment of staffing was inconsistent which meant oversight in communal areas was not always achieved. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing).

We looked at how the service managed risk to keep people safe. We found risk was not consistently addressed and managed. When risk assessments were present they were not consistently followed. We also found when risks were evident; these were not always addressed proactively. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

Person centred care was not always considered and provided. One person asked for something to eat but this was denied. Three people had asked the provider to support them with their cultural needs. We found no evidence these requests had been addressed and actioned. This was a breach of Regulation 9 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Person Centred Care).

Infection control and standards of hygiene within the home were poor. Communal chairs and carpets were stained. There was no evidence deep cleaning had taken place at the home. Hand washing facilities were not always adequate. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

We looked at how medicines were managed at the home. We found good practice guidelines were not always followed. Documentation of medicines management was poor. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, through the inspection process we identified an incident which had not been reported to the local authority safeguarding team and the Care Quality Commission (CQC) for review. Following the inspection visit we raised a safeguarding alert with the local authority safeguarding team. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safeguarding service use

During our inspection we looked at the way people were cared for and supported, the safe management of medicines, staffing arrangements, the way staff were supported and quality monitoring systems. We spoke individually with two people living at the home, two members of the care staff team, the home owner and the home’s manager. Care practices were also observed.

This helped to 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?

Is the service safe?

People spoken with told us that they were treated with dignity and respect by the staff team and that they felt safe and secure living at the home.

The home had proper policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) although no applications had needed to be submitted. Staff had received recent training with regard to the MCA and DOLS and understood when an application should be submitted. This meant that people would be safeguarded as required.

Medication practices were robust. Only staff that had received appropriate medication training had responsibility of the administration of medication. A monthly medication audit was in place. This helped to ensure that medication practices remained safe, by ensuring that any shortfall was quickly identified and addressed.

The home’s manager set the staff rotas, which took people’s care needs into account when making decisions about numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

It the service effective?

The two people we spoke with in private told us that they were pleased with the level of care that was being delivered to them and that their needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. One person told us, “It is very comfortable, I have no complaints at all”.

People’s health and care needs had been thoroughly assessed before they moved into the home. From this information, an initial care plan was developed detailing the wants, needs and wishes of the individual. Specialist dietary, mobility and equipment needs had been identified in care plans when required. A range of risk assessments were in place and reviewed periodically along with the care plans. The premises had been arranged to ensure that people could move around freely and safely.

Staff told us that they were well supported by the management team. Good supervision arrangements were in place and staff training had been given some priority.

Is the service caring?

We observed people were supported by kind and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. In the main, the staff group was stable and experienced meaning they had a good understanding of the individual needs and preferences of each person.

People using the service and their relatives and friends were given opportunity to complete a satisfaction survey every six months. Where any suggestions or concerns were raised, these considered and where possible, addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. The homeowner and the home’s manager worked alongside staff on a daily basis. This meant that the care and support provided by the staff team was constantly monitored so that immediate action could be taken if there was any concern with regard to staff performance.

Is the service responsive?

The people we spoke with were not really sure whether they were clear about the home’s complaint procedure but were unconcerned about this. These people did however know who they would complain to if they were unhappy about anything. One person said, I have no complaints at all, they do look after us well and I am quite content. I would speak with one of the girls if anything was wrong.”

We looked at the home’s complaint procedure. Most relevant information was included, including the timescale for a written response. However the name of the person a formal complaint should be addressed to was not included. We were told that the document would be reviewed and amended as a matter of priority. This would ensure that all current and up to date information was incorporated in the procedure.

Is the service well-led

There was a wide range of quality assurance systems in place. This helped to ensure that the quality of the service was continually improving. People told us that they felt listened to and that staff were attentive to their wants and wishes. This helped to ensure that people received a consistent service at all times.

Staff told us that they were clear about their role and responsibility and that they felt very well supported by the management team. Staff confirmed that good supervision arrangements were in place, that they had their say that helped influence change. We were also told that staff team worked well together for the benefit of the people living at the home.

A range of routine audits were in place including medication, health and safety, infection control, housekeeping and fire safety. Records seen by us showed that any identified shortfalls were addressed promptly. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

As part of this responsive follow up inspection we spoke with the provider, manager, three staff and a number of people currently living at the home. We did this to take account of the views of people living and working in the service.

Staff we spoke with told us things had changed, in that, people’s needs had been reviewed. Comments included, “It makes sense for residents to move on when their dementia becomes too much to manage here”. Also, “It’s a lot calmer now, we have the time to do more things with residents”.

People we spoke with told us they had a choice of meals.Staff responsible for food preparation told us they got to know individual likes and dislikes so they could prepare food to meet the individual needs of people. Comments included, “I am preparing three different lunches, that’s because I get to know what residents like”. Also, “The foods lovely here you get what you ask for”.

People told us they liked the way the home provided an environment which made them feel comfortable. One person said, “It’s a home from home”, another told us, “My room is as I like it.

Staff we spoke with told us rotas had been changed and that there were enough staff to care for people living at the home. Comments included, “We work well as a team, there are enough of us to get on with our jobs”. Another told us, “I haven’t been here that long but all the staff are supportive”.

When we spoke with people about time staff had to spend with them they told us there was always someone around to help them. Comments included, “Its calmer at the moment, the girls have time to spend with us”

We spoke with a range of people about their experiences living at Sonacare. They included the registered manager, staff members, and some of the people who lived there. In addition we had responses from external agencies including social services and Infection control practitioner in order to gain a balanced overview of what people experienced. We had been contacted prior to visiting the home with concerns about staffing, environment, nutrition and meeting the needs of people with dementia conditions.

Some people living at this home had a range of dementia conditions. This affected how they communicated with us. For this reason we spent time in communal areas, so we could observe how the home was operating and how staff communicated and helped people. One person told us, “I usually spend my morning in the lounge but like to go to my room in the afternoon. Its very relaxed I can come and go as I please”. Two other people commented on its 'relaxed and homely atmosphere'. One person told us, "I like it here but I am looking forward to going to my own home”. Also, “I get everything I need here, but the staff can be very busy”.

Comments we received regarding the numbers of staff on duty included, “Their aren’t enough of them”, “They are always busy I don’t like to bother them”. Also, “They do what they can but there are some very demanding people”.

We visited this home unannounced on Wednesday 20th June 2012. During the course of the site inspection we spoke with the registered manager, two staff members, and six of the nine people living at the home. There were no visitors at the home at any point during the inspection process. We spent time in various parts of the home, in order to gain a general overview of the service. This included the lounge and dining room as well as talking to people at their invitation in their own room.

Of the people we spoke with they told us staff were respectful and treated them in a dignified way. One person said, "The staff are very good, I have no complaints.” Another person we spoke with told us, "I’ve been here for a while now and I have to say the staff make it all very homely.” All the people we spoke with said good things about the way they were treated by all members of staff.

People we spoke with throughout the inspection process were satisfied living at Sonacare. They told us it had a homely and comfortable environment. One person living at the home told us, “I like the way I can make my room homely with things from my own home.” They told us they could go about things in their own way. One person told us, “I am lucky I can get about and go out when I want to. The staff are around if I need them though.”

We spoke to a number of people living in the care home as well as staff members and the manager. The following are comments about experiences people told us about during the review.

People who use the service told us staff treat them with dignity and respect. They told us they have time to spend with them and help them with personal tasks. Comments included, "They have all the time in the world for us".

People we spoke to told us they are involved in their care plans wherever possible. "I am asked about things about my care and how I would like things doing".

By talking to people using the service we found they were very happy with the care they receive. “The staff have been here a long time and they have got to know all our likes and dislikes"; “They know just what I need and they seem to be able to keep on top of things for us all".

In general people told us they thought the food was good, or OK. Some people said they only had a choice at the last minute, "I usually ask for something else if I see I don’t like something. "I like the food its.OK". One person told us "I would like a cooked breakfast now and then but there is only cereal and toast".

People using the service told us they have good access to their GP or any other healthcare professional should they require it." I only saw the doctor the other day".

People who use the service told us they thought they are treated well by the staff. “I think all the staff are very kind".

Most of the staff told us they have had training either in this home or at previous care homest in protecting people. "I have had safeguarding training", “I did do it some time ago but I think we are all going to get updates this year".

People we spoke to told us they thought the home was clean and did not have any offensive odours. "They make sure the home is clean and tidy".

Staff we spoke to told us they have specific duties to carry out in respect of maintaining the homes cleanliness. “We work as part of a team and we have had infection control training as well as having our own policies and procedures to follow".

We saw people being given their medication. Staff were following safe practices in the way they administer and record medication.

"We follow the guidance about how we administer medication so it's safe".

People we spoke to told us they like the way they can move around the home. They said they liked the way they can keep their rooms and have their own personal items with them. "I’ve brought all the things I need with me, and they are going to put up a shelf so I can show off my collection". "We like to make the place homely for people, so they feel comfortable".

The staff we spoke to said they had been through a thorough recruitment process before they started to work in the home. " They made sure all the checks were done before I started work". Staff told us they felt they had a good opportunity to train in different areas of care. “I have done a lot of training mainly in the other home, but it all relates to what I do here".

People we spoke to told us "the staff can’t do enough for you". They told us they liked the fact there are not many changes to the staff team so that they can get to know them. Staff we spoke to said they felt there is a good staff team.

We spoke to people who told us they thought the staff were competent. "They seem to know their stuff". "I couldn't do without them".

People we spoke to told us they felt confident they could raise an issue of concern or complaint to the manager if they felt they needed to. "I think I am happy enough telling people if I am not happy abut something". "We are told what to do if we are not happy abut something when we come in".

People we spoke to were aware they had care plans and written information about them. " We are aware of how we must maintain records about people and to make sure they are confidential"."We have had to develop all the records in the home since the fire".

"The owner comes over every week usually the week-end".

"If we need anything it usually gets sorted out".

People told us they see the owner at week-ends, and they can talk to her about things if they feel they need to.

We received two telephone calls prior to the home reopening. They were from a relative of one person living at the home and another from a social worker responding to concerns from a person living in the home prior to the fire incident. Comments included;

"My relative is very anxious to return to the home and does not like living anywhere else"

"My client is very concerned the home will not open. They say they are missing their room and the friends they have in the home".

This inspection visit took place over two days on 2nd and 7th April 2015 and was unannounced.

At the last inspection on 13th May 2014 the service was meeting the requirements of the regulations that were inspected at that time.

Sonacare is a detached property situated in a residential area close to the centre of Cleveleys. The home is registered to accommodate for up to fifteen people assessed who do not require nursing care. Accommodation is located on the ground and first floor of the building that can be accessed by a passenger lift. There is a communal dining room as well as a lounge area for people to sit and engage in activities. At the time of our visit there was thirteen people who lived there.

The majority of bedroom accommodation is for single occupancy although there are some shared bedrooms for people who would prefer this option. A range of aids and adaptations are in place for people whose mobility might be affected.

There was a registered manager in place. 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 registered manager had arrangements in place to protect people from abuse and unsafe care. The registered manager and her staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. People we spoke with said they were receiving safe and appropriate care which was meeting their needs. One person said, “I like it here and I get good care and good food. The staff are very kind to me and I do feel safe here.”

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required.

We looked at how the home was staffed. We found sufficient staffing levels were in place to provide the support people required. We saw staff members were responsive when people required assistance. Call bells were answered quickly and people requesting help were responded to in a timely manner.

Equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

Suitable cleanliness standards were in place for keeping the service clean and hygienic to facilitate the prevention and control of infections. The people we spoke with said they were happy with the standard of hygiene in place.

We found medication procedures in place were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place. People told us they received their medicines at the times they needed them.

We found people experienced care and support that met their needs and protected their rights. This was because plans and procedures were in place for dealing with changes in peoples` care and how best to support and protect people. We also found that the planning and delivery of care took account of how best to meet people`s individual needs.

The services recruitment procedures were safe with appropriate checks undertaken before new staff members could commence their employment. Staff spoken with and records seen confirmed a structured induction training and development programme was in place

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager and her staff had been trained to understand when an application should be made and in how to submit one. This meant that people would be safeguarded as required. When we undertook this inspection three applications had needed to be submitted. Appropriate procedures had been followed and the service was waiting for the applications to be dealt with.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included annual satisfaction surveys, resident meetings, care reviews and audits. We found people were satisfied with the service they were receiving. The registered manager and staff members spoken with were clear about their role and responsibilities. They told us they were committed to providing a high standard of care and support to people who lived at the home.