Sanctuary Life Care Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Risk associated with people’s needs and their home environment were assessed. However, further improvement was needed to ensure risk assessments detailed what had been considered during the assessment, what the risk level was and how any agreed action mitigated the risk. Relatives were confident their family members were safe when receiving care and support, and staff had the skills need. Staff were recruited safely. There were sufficient staff to ensure people received their planned care and support from staff they knew. Care records were up to date and provided staff with the information they need to provide safe care. Medicines were managed in line with regulatory requirements and best practice guidelines.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider had processes in place to ensure safe system, pathways and transitions were maintained. This included an initial needs assessment at the start of a service being provided. Care records detailed the health care professional responsible for the clinical management of people’s health conditions. Daily records completed by staff showed staff had followed recommendations made by health care professionals and joint visits had taken place.

Staff understood the importance of following health care professionals’ recommendations to promote people’s health and well-being. One staff member, “We always follow the care plan at each visit. We ring the district nurses if anything is wrong or we need advice.”

Relatives confirmed staff worked in partnership with other health care professionals. One relative explained their family member had a longstanding condition which staff supported them to manage by following the recommendations of the district nursing team.

People were cared for and supported in a way that protected them from the risks of abuse. Relatives had no concerns about their family member's safety. One relative told us, "I am confident [Person's Name] is safe with staff. All the staff are very pleasant, friendly and nice.” Another relative told us, "In the early days there was one missed call. The manager contacted us and apologised, it has not happened since.”

The provider had a safeguarding policy in place and had shared this with staff who had been trained in safeguarding people from abuse. The provider told us, as legally required, about specific incidents that happened. Any incidents that occurred were investigated and appropriate actions taken. Records showed people's consent to care was sought. Where relatives, or others involved in people's care had the authority to make decisions on people's behalf, this was recorded in their care records. This included what decisions the person had authorised them to make.

Staff had been trained in protecting people from the risks of abuse and told us they would report any concerns to the registered manager. The registered manager had an understanding of their responsibilities in relation to duty of candour. They understood their responsibility to raise any safeguarding concerns with the local authority and CQC. The registered manager told us, “I would have to complete a CQC notification and send a referral to the local authority.”

Processes were in place to assess risks associated with people’s care and their home environment. Information from assessments was recorded in care records. For example, staff were instructed to ensure one person had their walking stick when moving around their home to reduce the risk of falling. However, it was not clear from the information in people’s care plans what factors had been considered during the assessment or how the action agreed reduced the risk. We shared our findings with the registered manager who welcomed our feedback. They said, “I see. We will be doing separate ones in future.”

People and relatives were involved in identifying, assessing and mitigating known and new risks. One relative described how the registered manager had recently alerted them to a damaged door handle in their family members home they told us, “The manager rang me and I went out and fixed it. Communication is very good.”

Conversations with staff confirmed they were aware of the risks associated with people’s care and the action they needed to take to keep people safe. One staff member said, “We read the risk assessments. We have a secure electronic app on our phones so any changes needed are quickly communicated.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Systems and processes were in place to ensure staff were recruited in a safe way. We reviewed 5 staff employment records and found pre-employment checks had been completed by the provider. Staff had received training, however, the registered manager had not kept an overview of staff training to enable them to track when refresher sessions would be needed. They told us this would be put into place to give them oversight.

Staff had no concerns about staffing levels. One staff member explained, “We don’t have many clients and there are plenty of staff. We get our rotas the week before. We know when we are working. We tell client each day who will be doing the next visit.” Staff spoke positively about the training they completed and the support they received. One staff member told us, “We do all our training. The managers check we are doing things right. They come and watch. If anything is not done right, they tell us, and they explain the correct way.” Another staff member commented, “There are weekly meetings so we can talk about training and everything. The manager is very good at helping if we don’t know something.” The management team were completing a train the trainer qualification to enable them to deliver additional face to face training and on-going guidance to the staff team.

Relatives confirmed their family members received their care and support from a small team of staff they knew, at and for the length of time agreed. A relative told us staff were reliable and described them as, "friendly" and said, "They always keep us updated, I have no concerns. The staff seem to know what they are doing. They share information with the district nurse if they are worried about my relative's skin. It all works well.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s care records provided staff with the information they needed to manage people’s medicines safely, including when to report concerns to the management team for example, if a person refused their prescribed medication. Medication administration and daily records had been completed in line with the provider’s medication management policy.

People received their medicines as prescribed. A relative told us, “[Person's Name] can do their own medication. It comes in a box from the chemist but they don’t always remember to take them. It was agreed staff would remind my relative. It works okay.”

Staff had completed medicines training and their competency to continue to safely manage people’s medicines was regularly assessed. Discussion with staff confirmed they understood how to manage people’s medicines safely. One staff member told us, “We (staff) apply creams but we don’t do the tablets. The manager is arranging face to face training with the chemist so then we will do the tablets.” Records confirmed this.