Our inspection took place on 9 January and 10 January 2017 and was unannounced.

Sandown Park Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Sandown Park Care Home can accommodate 95 people across three floors, each of which has separate adapted facilities. The service cares for adults, including people living with dementia. The premises are modern and purpose-built. People live in their own bedrooms and have access to communal facilities such as a dining, lounge and activities areas. There is an expansive landscaped sensory garden surrounding the building. At the time of our inspection, there were 84 people living at the service.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a registered manager in post.

The risk of harm to people was significantly reduced by the systems and processes in place at the service. This included prevention of harm by abuse, neglect, discrimination, injuries and accidents. People’s care documentation and the support they received ensured their maximum safety. When harm occurred, this was swiftly acted on and the service used any incident as a point for reflection and to put strategies in place to prevent similar events in the future. There was a safe amount of staff deployed and robust recruitment processes. People were protected from the risk of infections. The service was clean and well-maintained. The management of people’s medicines was robust.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were assisted 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 practise.

Staff induction, training, supervision and performance appraisals were extensive and ensured workers had the necessary knowledge and skills to effectively support people. People’s care preferences, likes and dislikes were assessed, recorded and respected. We found there was appropriate access to other community healthcare professionals. People were supported to maintain a very healthy lifestyle. People complimented the food and drink and we found the risks of malnutrition and dehydration were satisfactorily managed.

The service remained very caring. There was overwhelming complimentary feedback from people who used the service, their family and community healthcare professionals. People told us they were able to participate in care planning and reviews and we saw evidence of decision-making that promoted people’s independence. People’s privacy and dignity was respected when care was provided to them. We observed respectful care by staff.

The service continued to provide outstanding person-centred care. Care plans were thorough and contained information of how to support people in the best possible way. We saw there was complaints system in place which included the ability for people to contact any staff member or the management team. Questionnaires were used to determine people’s satisfaction with the care. People and their families had a say in the everyday decision-making and operation of the service.

The service was run by a committed management duo and care was provided by a passionate, effective team of staff. There were numerous positive opinions about the management and leadership of the service. The

Sandown Park Care Home is a care home with nursing that is based in a residential area of Windsor, Berkshire. The location is registered to provide care and support for up to 80 people. Sandown Park Care Home is located in a modern-built premises with three floors where people live. The building is surrounded by expansive gardens. The service provides care for older frail adults and people with dementia illnesses. At the time of the inspection the provider had applied to the Care Quality Commission to add an additional 15 beds to the service’s registration. However the decision outcome from this separate process was not available on the days of our visit. Therefore this inspection report relates to the operation of the existing 80 beds of the registration only.

At the time of the inspection, 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.

The last inspection was conducted on 8 July and 11 July 2014 under the 2010 Regulations. At the last inspection, we asked the provider to take action to make improvements to people’s care and welfare, cleanliness and infection control, staffing numbers and staff training. The provider sent us an action plan on 16 December 2014. The current inspection occurred over two days on 19 November and 20 November 2015 and was unannounced. We consider that compliance has been obtained by the provider with regards to the previously breached regulations and that no further breaches are evident under the 2014 Regulations.

People we spoke with considered they were safe at the care home and did not express any concerns about their care. We found the service used a comprehensive nursing assessment and care planning philosophy which ensured that people’s care was detailed and holistic. Staff we observed interacting with people were professional and ensured that risks were reduced as far as possible. There were sufficient staff to meet people’s needs at all times, however the care home did not have a robust method of determining correct staff deployment. People’s medicines were administered, stored and documented appropriately. Cleanliness and infection control systems had improved since the last inspection. We have made recommendations about determining staffing levels, infection control, building access for disabled people and fire and electrical safety.

Staff received extensive induction, training, supervision and performance appraisal for their roles. The service had embraced Skills for Care’s ‘Care Certificate’ for new care assistants and there was evidence that staff had successfully completed the many components. The care home operated within the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Applications had been made to relevant local authorities when a person did not have mental capacity and had been under continuous supervision in the care home. Further applications for more people were in the process of being made. The service was not always abiding by the conditions of approved DoLS authorisations and the policies needed updating to ensure currency of information.

People were offered ample food and drink and the risk of people’s malnutrition and dehydration were monitored. People also had good health outcomes as the care home ensured regular access to the multidisciplinary healthcare team from the community. One GP we spoke with was impressed with the standard of care that people received and the effectiveness of the management and staff team in caring for people.

We found staff were kind and generous. People’s comments mirrored our observations from the inspection. One person we spoke with told us: “[I] could not wish to be in a better place

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection. This was the first inspection since the provider had re-registered the service in March 2014. The home opened in 2010 and at previous inspections we found no concerns.

Sandown Park Care Home provides accommodation and nursing care for up to 80 people who are frail and older, or have nursing or dementia care needs. There were 75 people living at the home when we visited. The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Although people said they felt safe and well looked after, and relatives were satisfied with the care people received, we found people were not always safe. Not all areas of the home were clean, and the provider was not following best practice in infection prevention and control. We observed some people being assisted to move by staff. While some people were safe, others were not. We saw moving and handling practices that were unsafe and put people at risk of injury.

While some staff we observed were caring others were not. We saw staff helping people in a caring way but we also saw people who were not supported by staff when they were in obvious distress. Feedback from people about staff was also mixed. One person said “carers are wonderful”, but another person told us they would like staff to show them more respect.

Feedback from people about the numbers of staff was mixed. Some people felt there were not enough staff on duty at times. We looked at the provider’s staffing rotas and found there were several shifts which had been understaffed. There was a risk that people’s safety would not be protected or their care needs met due to a lack of staff.

Whilst there was enough food and drink available, feedback about the quality and choice was mixed. Some people said the food was good while others described it as fair and “it gets a bit routine”. People’s meal time experience was also variable. Some people were supported to choose food and to eat their meal in a caring way, while others were not. We saw some people who were not being helped with their food when they needed it and other people being rushed.

Not all of the staff were up to date with training, supervision and appraisals. 10 staff had not completed recent training in dementia awareness and 27 staff had not completed training in the Mental Capacity Act 2005 (MCA). Most, but not all of the appropriate recruitment checks had been carried out before staff began working at the home. There was a risk people’s safety would not be protected because the provider could employ people who were not suitable for the role.

Staff knew about keeping people safe from abuse and what they should do if they thought someone was at risk of harm. The manager was knowledgeable about Deprivation of Liberty Safeguards (DoLs) and the Mental Capacity Act 2005 (MCA) and had taken the right action to ensure people’s rights and liberties were protected.

People were assessed for risks to their health such as pressure ulcers and malnutrition. Appropriate action was taken to manage identified risks such as the use of pressure relieving equipment or special diets.

Although regular audits were carried out by the manager and other senior staff, they were not always accurate. The most recent audit had failed to identify the concerns with cleanliness that we found during this inspection.

The environment of the home was appropriate for people with dementia and the manager had considered recent research when redecorating the home. People had memory boxes at the door to their room and there was a reminiscence room. This helped to stimulate the memory of people with dementia. A range of activities was offered to people including singing and afternoon tea. Some of the people we spoke with said they would prefer some activities that were more suitable for younger people.

People were involved in decisions about their own care and treatment. Care records provided staff with detailed information about how to meet each person’s needs, their preferences and choices. Care needs were also reviewed regularly. People had access to health care professionals such as the GP or physiotherapist. Appropriate referrals were made if there were changes to people’s health needs.

Staff said they felt well supported by senior staff and the manager was approachable. They said they felt comfortable providing feedback to managers and felt this would be acted on. Care workers said the home “was a very good place to work” and “it’s a lovely nursing home”. People and their relatives were encouraged to give feedback about the service. Regular residents meeting were held and the home was in the process of completing a satisfaction survey. Everyone we spoke to knew how to raise a complaint and said they were confident they would be listened to if they ever did so. The provider had a good system in place to manage complaints.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.