Sandmartins provides residential care for up to 40 older people. Some people living at the home needed support with mobility and physical needs and others were living with dementia. At the time of inspection there were 20 people living at the home. Sandmartins is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager at the home. 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.

This was a comprehensive inspection which took place on 9 and 10 July 2018 and was unannounced on the first day. Since the last inspection the home had changed its name. The home was formerly called ‘Homeleigh’. Homeleigh was a nursing home with a registered nurse manager. The location is now named Sandmartins and provides a residential care service. People, staff and the registered manager moved from a former home, owned by the provider, to this home. The home no longer provides nursing care.

At the last inspection in May 2016 the overall rating for this service was Requires Improvement with two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014, this was because the registered person had not ensured the care and treatment of service users was appropriate, met their needs and reflected their preferences and they had not ensured staff had received appropriate training, necessary to enable them to carry out the duties they were employed to perform. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of effective and responsive to at least good.

At this inspection, we found continued issues relating to staff training and person-centred care which had resulted in continued breaches of regulation. We also identified issues relating to the governance and management oversight of the home. This is the second consecutive time that the home has been rated as Requires Improvement.

People told us they felt safe at the home but did not feel they were able to take risks and risks were not consistently assessed for people. We have made a recommendation regarding assessing risks. People and staff gave mixed feedback about staffing levels, there were enough staff to meet people’s care needs at the inspection, however people’s social and wellbeing needs were not always met.

The registered manager did not have clear oversight of staff training needs, not all staff had received refresher training, in line with the provider’s policy, to ensure their knowledge and skills were up to date. People’s needs were known by staff but these were not always documented and assessments were not consistently accessible for staff. There were a number of agency staff working at the home who did not know people’s needs as well as permanent staff, this posed an increased risk of people’s needs not being met in line with their preferences.

People were not consistently involved in the development of their care plan. One person told us “There’s a care plan, but I haven’t seen it” and a relative told us, when asked if they were involved in the reviewing their loved one’s care plan said, “They haven’t done that here.”

There was inconsistent access to meaningful activity at the home and people gave variable feedback about their access to activities. One person said, “We sit here for hours and hours on end every day.” Some people had access to meaningful activities such as being involved in the gardening and household tasks which were things they enjoyed doin

This inspection took place on 19 and 20 May 2016 and was unannounced.

Homeleigh provides accommodation, support and nursing care for up to 38 older people. At the time of this inspection, there were 25 people living at the home, nine of whom were living with different stages of dementia.

A registered manager was in post when we visited. 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 current registered manager was appointed in December 2015 following the retirement of the previous manager. One senior member staff had also chosen to retire, and two staff have been absent due to sickness for an extended period of time. This meant that a large number of staff have had to be employed on a temporary basis via employment agencies to ensure appropriate staffing levels have been maintained. Whilst the provider and registered manager have demonstrated they have been taking steps to recruit new staff the evidence gathered during this inspection has indicated that the number of current staff vacancies has had an impact on the provision of care.

Not all staff had received up to date training to ensure they had the necessary skills and knowledge to provide care effectively to meet the needs of people accommodated.

We observed mixed experiences of people being treated with dignity and respect. Some staff on duty were seen to be kind and caring towards people accommodated. However, we also observed examples where staff practice did not always respect people’s right to privacy and dignity. For example, we saw staff entering people’s rooms to clean even though they were in bed and asleep.

People living with dementia and people who were cared for in bed were not provided with sufficient activities to ensure they were not a risk of social isolation.

People had not always received person centred care. For example, the needs of one person with a sensory impairment had not been met. The support provided to some people required was not sufficient to ensure they had enough to eat and drink.

Medicine Administration Record (MAR) sheets had not been kept up to date to confirm medicines had been administered as prescribed. Medicines had been stored safely.

People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything.

Care plans had been drawn with the involvement of people and their families.

The registered manager understood the principles of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and how they affected their work. These safeguards protect the rights of people by ensuring if there were any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm.

Newly appointed staff told us they felt well supported by the registered manager. They had been provided support and assistance during induction to help them understand their role. The registered manager had set up a programme of supervision for all staff to ensure they received the support they needed.

The registered manager had arranged meetings with people and their relatives meetings to enable people to express their views and to be involved in making decisions about the service.

A written complaints procedure was in place that showed that, where concerns or complaints had been raised, the registered manager would respond to them on an individual basis in writing.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with 10 people, two relatives, five staff including the manager and the general manager.

The home was neat and clean throughout and was free from offensive odours.

We spoke with a visiting community physiotherapist who told us the staff at the home were good at following any instructions given to aid people's rehabilitation.

People told us they were very happy in the home. One person told us "The staff are very jolly, helpful and cooperative". Another told us "They come quickly when the call bell is rung". All people spoken with told us they were very happy with the staff, the food and life in the home.

The two relatives spoken with told us that they were very happy with the home and the standard of care on offer. One told us that their family member had been in another home previously and that in comparison this one was "excellent". Both said that communication was very good.

We saw that people were treated with respect and that their privacy was protected. One person, when asked about privacy being protected replied "Absolutely".

We saw that care needs were assessed, recorded and met. Medicines were handled appropriately in the home.

Staff told us they felt supported in the home, however, staff supervision was not up to date as per the provider's policy.

Complaints were handled appropriately in the home.

The people we spoke to told us they liked living at the home. They said that the staff were wonderful and very kind. One person told us that they had been well cared for since they had been at the home. They said: “My husband spoke on my behalf and told the Manager what my needs were before I came here, since I have been here the staff have always carried out my care in the way my husband asked them to”

People told us they felt safe but if they had any concerns or wished to raise a complaint they would tell the manager.

Visitors we spoke with made us aware they were happy with the care their relatives received. One visitor told us: “This is a very caring home, I have no complaints, the staff treat all the people living here with dignity and respect”.

We saw that people's privacy and independence were respected. People experienced care based on detailed care plans and risk assessments that documented people’s preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

Staff records evidenced that the provider had robust recruitment procedure in place.

The Provider had effective systems in place to monitor quality assurance and compliance.

We spoke with people living in the home, We were told by people living in the home that they were happy with the care in the home, that the staff were kind and polite and that they were happy with the food.

We spoke to a relative who told us that the home was “first rate”. We were told that the registered manager was approachable, that changing needs were coped with very well. We were also told that there was excellent communication and that there were lots of activities.

We spoke with a health professional and we were told that they were called in appropriately. They also told us that the home was organised and that people's privacy and dignity was respected as all consultations took place in people’s rooms.