Sandhurst Residential Care Home 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. They provide accommodation with personal care to a maximum of 23 people. The home provides care for older people, some of whom are living with dementia.

This unannounced comprehensive inspection took place on 18 and 20 April 2018. It was carried out in response to the home being placed in Special Measures following an ‘inadequate’ rating at its last Care Quality Commission (CQC) inspection on 29 September, 4 October, 10 and 16 October 2017. There were seven breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the last inspection, we were in further contact with the registered manager and the provider. They assured us they wished to improve the service. We received a service improvement plan which logged the timescales that improvements would be made by. This was reviewed by the registered manager on an on-going basis and updates made.

We imposed a condition which required the provider to send us a monthly report of how they were addressing breaches of regulation and improving the quality of the service. These have been sent and been reviewed by CQC as part of our risk assessment for the service.

After the last inspection, Devon County Council took the decision not to admit any further people to the service and they reviewed the people living there. The provider agreed to voluntarily restrict admissions and to liaise with the local authority and CQC before they considered a new person moving to the home.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures. Following this most recent inspection, we judged this service had demonstrated improvement and had not been rated as inadequate in any of the five key questions.

On this inspection, some areas of management and auditing of medicines still required improvement. This meant there was a continued breach of regulation. However, the other six breaches identified at the last inspection had been met.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. In March 2016, this service was registered with CQC under a new legal identity; this is the second comprehensive inspection in connection of that registration. The registered manager and the provider have not changed.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.

At the time of the inspection, there had been a number of improvements. There was a more consistent approach to making applications to the local authority in relation to some people who lived at the service. People were now routinely involved in their assessments, care plans or reviews so their consent was gained. Documentation linked to lasting power of attorney for health and welfare was now requested. These practices meant people’s legal rights were now better protected. Staff recognised further training would help them fully understand

Sandhurst Residential Care Home provides accommodation with personal care to a maximum of 23 people. The home provides care for older people, some of whom are living with dementia. When we visited 22 people lived at the home, some of whom were staying temporarily. The bedrooms are on all three floors, which can be accessed by stair lifts.

This unannounced comprehensive inspection took place on 29 September, 4 October, 10 October and 16 October 2017. It was carried out in response to reports from community nurses relating to how people’s pressure care was managed. We found improvements were needed to reduce the risk of pressure damage for people living at the home.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. In March 2016, this service was registered with CQC under a new legal identity; this is the first comprehensive inspection in connection with the new legal identity. However, the registered manager and the provider have stayed the same.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, there was not a consistent approach to making applications to the local authority in relation to some people who lived at the service. People were not routinely involved in their assessments, care plans or reviews so their consent was not gained. Best interest decisions were not recorded and documentation linked to lasting power of attorney was not requested. These practices meant people’s legal rights were not protected.

Some risks to people’s health were not well managed, for example monitoring people’s weight. Lessons had not been learnt from an incident relating to poor pressure care. Staff had to be prompted to check the setting of a person’s pressure mattress. It was incorrectly set on two separate occasions and put the person at increased risk of pressure damage. They had also been at risk of entrapment in their bedrails, which staff had not noticed. We ensured action was taken during the inspection to reduce these risks to the person’s health and safety.

Recruitment practice did not ensure all the necessary information was in place before staff started working at the home. Staff training did not routinely include practical training, although the registered manager began to book this type of training during the inspection. This was in recognition that staff benefited from hands on training for some areas of care, such as using moving and handling equipment. We saw examples of kind care, with staff showing affection and compassion towards people. However, there were also practices which undermined people’s dignity and privacy.

People were supported to see, when needed, health care professionals. Care staff recognised changes to people’s physical well-being and visitors said they were kept well informed by staff regarding their relative’s health and well-being. The management and storage of medicines required improvement. People were supported with their meals, where needed, but people’s weight and fluid intake was not monitored in a robust way.

Safety checks were carried out but the systems in place were not thorough and potentially left people at risk of harm. Some areas of the home were potentially unsafe to people living with dementia. Staff practice showed a lack of understanding of infection control. Some items of furniture were damag