The inspection took place on the 12 and 20 December 2018 and was unannounced.

Sandown Nursing Home is registered to provide accommodation for up to 39 older people. There were 33 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over two floors. Most bedrooms were for single occupancy and many had ensuite facilities. Bathrooms and toilets were provided on both floors. There was a lift and stairs available to access the first floor. There was level access to an enclosed patio and garden.

Sandown Nursing Home is a ‘care home’. People in care homes receive accommodation, nursing and 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. We found the home to be clean and well maintained throughout the inspection.

A registered manager was 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.

People and visitors found staff to be kind and caring. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people's individuality, privacy, dignity and independence.

The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

The provider had arrangements in place to protect people from risks to their safety and welfare.

Arrangements were also in place to store medicines safely and to administer them according to people's needs and preferences.

People were supported to access healthcare services, such as GPs and specialist nurses and doctors. At the end of their lives people received the care they required to remain comfortable and

pain free.

Care and support were based on plans which considered people's needs and conditions, as well as their abilities and preferences. Care plans were adapted as people's needs changed, and were reviewed regularly.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only workers who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

Staff were aware of the need to gain people's consent to their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The arrangements included processes and procedures to protect people from the risk of abuse.

People were supported to eat and drink enough to maintain their health and welfare. They could make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

People could take part in leisure activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. The provider acted where these systems found improvements could be made.

The inspection took place on the 24 and 28 November 2017 and was unannounced. Two inspectors and an expert by experience in the care of older people carried out the inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Sandown Nursing Home is registered to provide accommodation for up to 39 older people. There were 33 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over two floors, the ground floor offering dining and lounge areas and bedrooms. The first floor had further bedroom accommodation. The majority of bedrooms were for single occupancy and had ensuite facilities. Bathrooms and toilets were provided on both floors. There was a lift and stairs available to access the first floor. There was level access to a patio and garden area.

Sandown Nursing Home is a ‘care home’. People in care homes receive accommodation, nursing and 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. We found the home to be clean and well maintained throughout the inspection.

A registered manager was 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 previous inspection of the service in November 2016 had identified that the service had breached regulations in relation to infection control and medicines management. Improvements in relation to those breaches had been made.

At this inspection we found that there were not the required records in place to show how best interest decisions to provide care using restrictive practices had been made and discussed with relevant others as is required by mental capacity legislation. Systems in place to make sure the quality of service was monitored and reviewed had failed to address this issue.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people’s needs and preferences. People were supported to access healthcare services, such as GPs and community nursing teams.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only staff who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

There were processes and procedures in place to protect people from the risk of abuse.

Care and support were based on plans which took into account people’s needs and conditions, as well as their abilities and preferences. Care plans were adapted as people’s needs changed, and were reviewed regularly.

Staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed. People and external health professionals were positive about the service people received.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

People found staff to be kind and caring. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, dignity and independence. Equality and diversity was seen to be actively supported with people bei

This inspection took place on 15 and 17 November 2016 and was unannounced. Sandown Nursing Home provides accommodation and personal care for up to 39 adults, including people with dementia and physical disabilities, who require nursing care. There were 33 people living at the home when we visited.

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.

People were not always protected from the risk of infection. We found staff did not always follow best practice guidance, the infection control arrangements were not clear or robust and some equipment was shared between people.

Medicines and some risks to people were not always managed effectively. Some regular medicines were administered too close together and some risks were not assessed or safely managed. This included the risks from fluid thickening powder and pressure relieving mattresses were not all set appropriately for the person’s weight.

A quality assurance process was in place, however, this had not identified the areas of concern relating to some medicines being administered too close together, regular audits of medicines management were not being completed and infection control concerns.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed although documentation had not always been completed to demonstrate this. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. At the end of their life, people received appropriate care to have a comfortable, dignified and pain free death.

There were enough staff to meet people's needs. Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and external health professionals were positive about the service people received. People were positive about meals and the support they received to ensure they had a nutritious diet.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

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

The purpose of this inspection was to check whether Sandown Nursing Home had complied with one compliance action we had made following an inspection in May 2014 in relation to the notification of incidents to us. The inspection was carried out by an adult social care inspector. We considered all the evidence we gathered under the outcome we inspected.

We found the service had taken action to ensure procedures were in place to ensure we were notified appropriately about incidents which occurred. Our records confirmed that we had received notifications as required. Staff were aware of what they should notify us about.

We spoke with six people using the service and three family members of people who were unable to communicate with us. They told us they were receiving the care and treatment in a way they, or their relative, wished. They said staff always treated them with dignity and respect. One person said, “They’re always polite”.

We looked at six care plans and related records of care. We discussed these with the matron and three members of staff. Each showed a good understanding of people’s needs and how they should be met. People we spoke with told us their needs were met. A family member told us, “They look after [my relative] very well”.

We looked at records showing staff had received training in safeguarding within the last year. Staff we spoke with showed a good understanding of safeguarding principles and the mechanisms for reporting abuse. We also saw records of safeguarding referrals which were properly documented.

We looked at four staff recruitment files. We saw the home employed qualified nurses and care support workers. Appropriate checks were undertaken before staff began work. People were cared for by staff who were appropriately trained and qualified.

People who use the service were asked for their views about their care and treatment and they were acted on. We looked at records of a survey conducted by the provider which identified that people sought more activities. The manager told us about a number of initiatives taken in response to these findings.

We spoke with seven of the 32 people at the home. We also spoke with five relatives, the registered manager and staff. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.

We considered seven outcomes during this inspection. These being

Outcome 2 Consent to care and treatment

Outcome 4 Care and welfare of people who use services

Outcome 8 Cleanliness and infection control

Outcome 10 Safety and suitability of the premises

Outcome 14 Supporting workers

Outcome 16 Assessing and monitoring the quality of the service

Outcome 20 Notification of other incidents

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

People told us they were happy with the service they received. They said they had consistent care staff who knew what support they required. We also spoke with five relatives. They were also positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people’s safety or welfare.

Risks to people's health and safety had been assessed and plans were in place to reduce these risks. We saw specific equipment identified in people’s care plans was in place to reduce risks and keep people safe. This included equipment such as pressure mattresses and moving and handling equipment. Staff told us they had received training to use equipment and we observed this being used correctly in communal areas. Systems were in use to ensure the home was clean and infection control concerns appropriately managed.

The home was meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

Is the service effective?

Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. Staff told us about the care they were providing for specific people which matched information in the person’s care plan. The registered manager and staff were aware of who to contact for specialist advice and when this may be required. We spoke with two external health professionals who said the home met people’s needs well. We found there were arrangements to meet the wound care needs of people. We saw where two people had been admitted with extensive pressure injuries, the home had sought advice from the tissue viability nurse and these wounds were either healed or improving. This showed the treatment was effective.

We spoke with people who used the service and visitors, all of whom were positive about the service provided. Visitors said their relative’s health needs were met and they were kept informed when medical professionals had attended.

Is the service caring?

People were supported by kind and attentive staff. People said they were treated with respect and dignity by the nursing and care staff. People also told us the staff were very kind and gentle. One person told us “I was really anxious when the hospital said I needed a nursing home however, it’s wonderful here and I would recommend it to anyone”. Another person said “The staff are all nice”. A third person told us “I’ve been in before for respite and it’s so nice I wasn’t worried when I had to come back”. We spoke with five visitors. One commented their relative “always looks clean and looked after, clean clothes, clean sheets and the home never smells”, another said, “I didn’t want (my relative) to come into a nursing home but the staff here have been wonderful, very impressed”. A third said their relative had been at the home several years and they “had no concerns about anything”. Similar comments were made by the other visitors.

Staff said they had time to meet people’s identified needs and could provide care at times people wanted it. Staff were able to talk about the individual preferences of people such as favourite television programmes or type of music. Staff told us how they had learnt a few words of a foreign language to support a person whose first language was not English. Staff were aware of people’s rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. Discussions with the registered manager showed they were aware of how to get advice and support when required. We saw additional staff could be made available at short notice when an off duty nurse was contacted to work on the day of the unannounced inspection to release the registered manager from a nursing shift.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. We were told how the service had managed when the lift had been unavailable due to planned maintenance for three weeks in 2013. People who regularly spent time in the ground floor communal rooms were moved to ground floor bedrooms and activities staff had provided additional activities on the first floor.

Is the service well-led?

There was a clear management structure with the registered manager having lead role for nursing and care and the business manager having the remaining management responsibilities. An administrator was also employed with specific responsibilities. This meant key management tasks were completed by people with the correct skills to undertake them. There were procedures in place to monitor the quality of service provided with audits, such as for care plans and infection control, being completed.

A survey of the views of people, visitors and external professionals had been completed in May 2013. This had shown people and external professionals were satisfied with the service provided. This also showed there had been an increase in respondent’s satisfaction with the service from the previous survey. Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the management team. Staff stated they could rely on the registered manager for support at all times.

We identified that we had not been notified about all incidents which the registered person was required to inform us about.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring we are informed about all notifiable incidents.