The Inspection took place on the 11 September 2017.

Sandringham provides accommodation and personal care for up to 20 people some of whom may be living with dementia. At the time of our inspection 20 people were living at the service.

At our last inspection the service was rated as Good. At this inspection we found the service remained Good.

The registered manager had left the service and a new manager will be registering with the CQC.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The chief executive had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough so as to ensure they maintained a balanced diet. Referrals to healthcare professionals were made when required to ensure people’s healthcare needs were preserved.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions. Suitable arrangements were in place to ensure people were treated with respect and dignity.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The provider responded to complaints in a timely manner.

The service was well-led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

The inspection was completed on 20 August 2015 and there were 18 people living at the service when we inspected.

Sandringham provides accommodation and personal care for up to 20 older people and people living with dementia.

A registered manager was not in post at the time of the inspection. The Care Quality Commission had received a notification advising that the registered manager had retired in July 2015 and in the interim the service was being managed on a day-to-day basis by the provider’s Operations Manager. At the time of this inspection the provider had appointed a new manager and they are due to commence employment in October 2015. 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.

Although there was an effective system in place to regularly assess and monitor the quality of the service provided, improvements were required to show that actions highlighted had been addressed and dealt with.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests but required improvement as information was not robust. The provider was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

People and their relatives told us the service was a safe place to live. There were sufficient staff available to meet their needs and appropriate arrangements were in place to recruit staff safely.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety. Care plans reflected people’s care and support needs and people received appropriate support to have their social care needs met.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed and people told us that their healthcare needs were well managed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support.

People and their relatives told us that if they had any concern they would discuss these with the provider. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

As part of this inspection process we spoke with the provider, a senior member of staff, three members of staff, the chef and three people who used the service.

Our observations indicated that people living at the service were happy, that they felt safe and were well cared for. It was evident that people who used the service had a good relationship and rapport with the staff who supported them. Comments included, "I have no complaints it's fine" and, "Oh its fine, the staff are very nice."

People's health and personal care needs were assessed and there were care plans in place for the majority of people who used the service. Improvements were required to ensure that people who used the service had robust information recorded in relation to their social care needs. Staff spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported.

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. We found that people had their dietary and hydration needs met and that the dining experience for them was positive. We also found that cleanliness and infection control procedures at the service were appropriate. Improvements were required to ensure that the service was appropriately staffed and/or the rosters were maintained to accurately reflect staff on duty at all times.

Where people were unable to provide a verbal response to tell us verbally their experiences, for example as a result of their limited verbal communication or poor thought processes, we noted their non verbal cues and these indicated that people living at the home were relaxed and comfortable and found their experience to be positive.

We spoke with four people who use the service. People told us that they were happy living at Sandringham and they liked the staff who provided support. Comments were generally very positive and included "The staff are very kind and caring", "I like it here" and "It's a lovely home." One person confirmed that their ethnicity was different to the majority of people living at Sandringham. They told us that this did not pose any difficulties and that they were treated the same. Three relatives spoken with told us that they were very happy with the care and support provided at Sandringham for their member of family and that in their opinion the service was meeting their relative's needs. We spoke with a healthcare professional and they confirmed that they were alerted in a timely manner where there were prospective areas of concern relating to an individual person who uses the service.

Two people spoken with suggested that they felt safe and that, if they had any concerns or worries, they would discuss them with their relative and/or member of staff. Three relatives spoken with told us that they were confident that any concerns raised would be listened to, taken seriously and acted upon.

The deputy manager confirmed that the views of people who use the service and/or their representatives and staff about the quality of service provided at Sandringham were sought annually. Records showed that this was last undertaken in January and February 2012. Comments included "We feel that there is a friendly and homely atmosphere within the home and the needs of our relative are catered for. Our relative is happy in the home and that is all we can ask". People who use the service confirmed that they liked living at Sandringham, felt well cared for and treated well by care staff. Not all relatives were aware of how to make a complaint.

Most people living at Sandringham had varying levels of dementia and different

communication needs. People were therefore unable to fully describe in detail their

experiences of using the service.

Some people were able to tell us about the choices they were enabled to make such as

their preferences for daily routines, for example the times they wished to get up in the

morning and go to bed at night, preferences for meals and the types of activities they liked

to participate in.

People we spoke with told us that they were well cared for by staff. One person told us ''I am well cared for here. I have no complaints about the care or how I am treated.’’ Another person said '' I have been here for many years now and I have always been very happy here.''

People told us that they were well cared for and that they felt safe in Sandringham. One person told us ‘’Staff here are kind, patient and caring.”