This unannounced inspection took place on 5, 6, 11 and 18 October 2017.

The Sands Care Home is registered to provide care and accommodation for up to 96 older people. The home cares for people who require nursing or personal care. Care is provided on a 24 hour basis by registered nurses and care staff, including waking watch care throughout the night. There is a lift to access all five floors of the building. The home is situated on the promenade overlooking Morecambe Bay. The home is organised into separate units over 4 floors. The Keswick unit provides the regulated activity personal care. Grasmere, Derwent, and Langdale provide nursing care to people. In addition, since the last inspection visit Derwent unit has been made into a unit specialising in supporting people who are living with dementia. At the time of inspection 96 people were residing at the home and the registered provider employed approximately 170 staff.

At the time of the inspection 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. A new manager has been identified and we noted from our internal communication system they were currently completing the registration process with the Commission.

The service was last inspected in December 2016. We identified a breach to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We found systems for managing medicines were not consistently safe and risks were not always identified and addressed. In addition, the registered provider had failed in their duties to report statutory notifications as required to the 2009 Care Quality Commission (CQC) Registration Regulations. We used this inspection visit to ensure improvements had been made.

At this inspection visit in October 2017, we found improvements had been made. We reviewed care plans and risk assessments and found risk was suitably addressed and mitigated. When people were at risk of harm there were a number of risk assessments in place to manage risk. These were regularly reviewed and updated when people’s needs changed.

Following our inspection visit in December 2016, the registered provider had developed links with a pharmacist and had commissioned them to audit medicines and review systems for administering medicines. The pharmacist visited the home on a weekly basis. In addition, the registered provider had reviewed systems for administering medicines and had implemented a new electronic system. This had highlighted some concerns and the home was currently in process of implementing another new system to meet the needs of the service and to reduce risk. In the interim period, additional checks had been put in place to reduce any risk.

After the December 2016 inspection visit, one member of staff had been delegated responsibility for ensuring all statutory notifications were sent to the Commission. During this inspection in October 2017, we reviewed all accidents and incidents that had occurred at the home. We noted all statutory notifications had been submitted without delay.

People told us they were included in developing their plan of care when they started receiving a service. Care plans were reviewed and updated at regular intervals and information was sought from appropriate professionals when required. Although care plans were updated in a timely manner, people who lived at the home told us they were not always involved in reviewing their plan of care. We found the quality of person centred information held within care plans was variable. We have made a recommendation about this.

Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Good pract

This unannounced inspection took place on 30 November and 02 December 2016.

The Sands Care Home is registered to provide care and accommodation for up to 96 older people. The home cares for people who require nursing or personal care. Care is provided on a 24 hour basis by registered nurses and care staff including waking watch care throughout the night. There is a lift to access all five floors of the building. The home is situated on the promenade overlooking Morecambe Bay. At the time of inspection 86 people were residing at the home and the registered provider employed approximately 150 staff.

There was not 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 previous registered manager cancelled their registration in December 2015. A new manager has been identified and we noted from our internal communication system they were currently completing the registration process with the Commission.

The service was last inspected over several days in February and March 2016. At this inspection we found the service was not meeting the required fundamental standards. We identified breaches to Regulation 17 (Good governance) of the Health and Social Care Act, (2008) Regulated Activities 2014, as suitable systems were not in place to monitor, assess and improve the quality of services provided and care records were not always complete and accurate. We also identified a breach to regulation18 (Staffing) of the Health and Social Care Act, (2008) Regulated Activities 2014, as staff were not appropriately deployed to meet people’s needs.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Sands Care Home on our website at www.cqc.org.uk

We used this inspection carried out in November and December 2016 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out the comprehensive inspection to review the rating of the service.

At this inspection visit, we found improvements had been made to staffing. Following the previous inspection visit the management team reviewed staffing levels and deployed additional staff at peak times. New roles were created within the service to support the staff team responsible for delivering care and support. People who lived at the home consistently told us their needs were met by the staff team and they did not have to wait when they required assistance. Staff told us staffing levels had improved and staffing levels now allowed them to spend quality time with people who lived at the home. During the inspection visit we saw this occurring.

We found improvements had been made to ensure paperwork was completed in a timely manner. The registered provider had invested in an electronic care planning system. At the time of this inspection visit in December 2016 we found the service was in the process of transferring care planning information from paper copy to an electronic format. Staff were being provided with on-going training to use the system. The new system alerted staff if a person’s care required assessing. Care plans were developed and maintained for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

We found some improvements had been made to ensure auditing systems were implemented within the home. Following the last inspection visit, members of the management team had received training to enable them to carry out audits. A staff member had been identified to carry out audits as part of their job role. We noted some

This unannounced inspection took place on 22, 23, 29 February and 07 March 2016.

The Sands Care Home is registered to provide care and accommodation for up to 90 older people. The home cares for people who require nursing or personal care. Care is provided on a 24 hour basis by registered nurses and care staff. There is a lift to access all five floors of the building. The home is situated on the promenade overlooking Morecambe Bay. Eighty eight people were residing at the home on the day of inspection.

There was not a registered manager in place. The registered provider informed us they were in the process of applying for registration as the 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 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 17 May 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in February 2016, feedback from people who lived at the home, relatives and visitors was mixed. People, relatives and health professionals said staff were caring. People were aware of their rights to complain.

However two people were unhappy as sometimes they had to wait to have their needs met. Relatives and staff said staffing levels were not always conducive to meet people’s needs. We observed staff rushing around and people having to wait to have their needs met. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Arrangements were in place to protect people from the risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. Recruitment procedures were in place to ensure staff were correctly vetted before being employed.

Staff retention was good and relatives said people benefited from having regular staff. Staff were provided with training and supervision to support them in their role.

The home employed an activities coordinator who was responsible for developing social activities for people who lived at the home. People told us activities took place. Care staff said they provided social activities when they had time to do so.

Arrangements were in place for managing and administering medicines. However the registered provider was not consistently working within good practice guidelines. The registered provider took immediate action to improve systems of medicines management. We have made a recommendation about this.

Feedback from health professionals was positive. People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed. The registered provider had built links with other health professionals. This allowed good practice to be shared and developed within the home.

The registered provider was working in liaison with the local hospice to promote end of life care and prided themselves on their achievements in this area of work. Health professionals commended the way in which they managed end of life care.

We found care plans covered support needs and personal wishes. However plans were not consistently reviewed and updated. Paperwork was incomplete and there were no audit systems in place to identify consistencies within paperwork. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Feedback on the quality of food provided was positive. People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available to people between meals.

Staff were positive about the way in which the home was managed. They confirmed they were supported by the registered

On the day of our visit we spoke with the owner/manager, staff, relatives visiting the home and residents. They 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?

As part of the inspection visit we looked at how people were being cared for and supported. We looked at how they recruited staff to ensure they were safe and suitable to meet the needs of people living at The Sands Care Home. We also looked at quality assurance systems and what procedures were in place to enable people to raise comments and complaints about their care and support.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people living at home, staff supporting them, relatives and by looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at The Sands Care Home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. One staff member said, “We have undertaken training and it is ongoing for staff.”

People were treated with respect and dignity by the staff. People told us they felt safe. One relative we spoke with said, “I come here nearly every day, the staff are so polite and always make me feel welcome.” We spoke with several residents and received only positive comments about the care they received. They included, “The staff are wonderful it is a peaceful home run by caring people. It makes me feel safe knowing I can call on them at any time.”

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

People’s health and nursing care needs were assessed with them, and they were involved in developing their plans of care where possible. Relatives views were also sought to ensure people received the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required. There was also an ongoing review process to ensure people’s needs were continuously monitored and changes made when needed.

Is the service caring?

We spent part of the day observing staff interaction with residents. Staff were talking and supporting people in a kind and attentive way. We saw staff showed patience and gave encouragement when supporting people to move around the home. One resident said, “I cannot fault the care and attention we receive here they are all caring people, some better than others.””

Is the service responsive?

People completed a range of activities in the home regularly. We saw evidence of daily activities in place and delivered by various staff. They employed an activities person to support people to undertake chosen interests and activities. One member of staff said, “She is off today but the residents love here she is very good.” A resident we spoke with said, “There is always something going on around the home.” Another person who lived at the home said, “I don’t join in much but I have to say she is always trying to put things on for people.”

Is the service well-led?

We had responses from external agencies including social services .They told us they had a working relationship with the owner/manager and staff to make sure people received their care and support they required.

There were a range of audits and systems put in place in by the home to monitor the quality of the service being provided.

We spoke individually with the deputy manager and five staff at The Sands. We also discussed care with relatives and four people living at the home. We reviewed care records, policies and procedures, audits and risk assessment documentation.

The service demonstrated good practice that ensured people were cared for in a supportive and dignified manner. One person told us, “It’s great here. I found it hard to leave my home, but came here because of its reputation. The home deserves its reputation and I’m glad I’m here now”. Another person said, “I’ve lived here a long time and can tell you it’s a wonderful home”.

Additionally, care records were of a good standard. Care plans and risk assessments were in-depth, signed and regularly reviewed. Daily records demonstrated where other providers had been involved in people’s care. This showed good communication within the home.

People were recruited appropriately because the home had followed its procedures. One staff member told us, “I’m happy here – I think it’s a really good home”. The Sands additionally had appropriate processes in place to monitor the quality of its service.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. We talked with eight staff and four people who live at the home as well as a family member.

We looked at the care plans for four people who lived at the home to see how their needs should be met.

People living at the home who were able, told us that they were satisfied with the care provided by the home and if they were not satisfied with their care they would tell staff.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

We spoke with a number of people who live at the home during our visit. We received some very positive feedback and comments included;

''Staff are lovely, and work hard. I am cared for very well.''

‘’They are grand here, they are very good, they can’t do enough for you.’’

‘’This is a smashing place, they are very good to us, we have a lovely home.''

‘’When I came into this home I could not move very well. Two members of staff were instrumental in getting me to where I am now. One of them is my key worker.''

‘’Some staff are not so good others are very good.''

‘’You won’t get a better place than here, my daughter is a nurse, she went everywhere and this is where she chose – it’s the best.’’

''We have the best position here and some lovely friends, what more can you ask for.’’

‘’I feel safe here, especially at nights, it’s good to know there is someone here if you need them.’’

Two residents with their relatives had chosen this particular home because they liked the views of the sea and it looked a clean and friendly home. It had lived up to their expectations.