The inspection took place on 22 February 2017 and was unannounced.

Surrey Hills is a care home registered to provide accommodation and nursing care to up to 45 people. At the time of our visit, there were 32 people living at the home. Many of the people living at the home were living with dementia and some had more complex health needs.

There was a registered manager in post. 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 our last inspection in October 2015 we identified concerns regarding infection control. At this inspection we found actions had been taken to ensure the regulations had been met and the service had improved.

People lived in a clean and safe environment. Improvements were made in cleaning processes and the provider undertook regular audits of the home environment, as well as the care that people received.

People were supported by staff who knew how to respond if they suspected abuse. Risk assessments were regularly carried out and measures were in place to protect people. Staff supported people in a way that promoted their independence whilst risks were managed. Where incidents or accidents occurred, measures were put in place to prevent a reoccurrence.

Staff were given appropriate training for their roles. Staff felt supported by management and had input into how the home was run. The provider was working with staff to implement new models of practice that would improve the quality of care that people received.

There were sufficient staff present to meet people’s needs. Caring interactions between people and staff were positive as staff had time to spend with people. Staff knew people well and had access to person-centred care plans. People’s needs were regularly reviewed and changes in need were met. The provider had carried out checks to ensure that staff were suitable for their roles.

People received their medicines safely. We recommended that the provider ensures best practice is followed when recording administration of creams. Staff worked alongside healthcare professionals to meet people’s needs.

Staff offered people choices and involved them in their care. People told us that staff routinely asked them for consent and respected their privacy and dignity. Staff worked in accordance with the Mental Capacity Act (2005) and people’s rights were protected.

People and relatives were regularly asked for feedback. Meetings took place for people and relatives where any changes or concerns could be discussed. People were told how to complain and complaints were responded to appropriately. Where feedback or complaints were received, these were actioned by management.

This was an unannounced inspection that took place on 12 November 2015.

Surrey Hills is registered to provide accommodation with nursing care for up to 45 people. At the time of our visit, there were 31 older people living at the home. The majority of the people who live at the home are living with dementia, some have complex needs. The home also provides end of life care. The accommodation is provided over two floors that were accessible by stairs and a lift.

There was a registered manager in post. 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 at risk because there were not effective systems and arrangements to protect people from the spread of infection. Appropriate standards of cleanliness were not being maintained and staff were not following the provider’s Infection control policies and procedures.

People were safe at Surrey Hills. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There was sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff started work. Staff worked within best practice guidelines to ensure people’s care and support promoted well-being and independence.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the person’s GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The home had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding and power cuts.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

The registered manager ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. We found the staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People’s needs were assessed when they entered the home and on a continuous basis to reflect changings in their needs.

People were encouraged to voice their concerns or complaints about the home and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the home.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the home had in place. There were a range of activities available within the home and community.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the home.

People’s care and welfare was monitored regularly to ensure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the care provided.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive.

We found a 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 people who used the service all experienced dementia. We used our Short Observational Framework for Inspection (SOFI) tool to observe people's experiences of the care they received. We spoke with four relatives and two professionals who were contracted to provide services at the home, about the care people received. People’s relatives told us that overall they were satisfied with the care provided. One said “I am very pleased”, another commented “The care is good.”

We found that people’s care needs had been assessed. We found that some people did not have skin care plans in place, although the risks to them had been assessed and managed. We spoke with the manager who took immediate action to address this.

We found that staff understood people’s care needs and that they were caring.

The home was clean and processes were in place to manage the risk of infection.

Appropriate checks had been completed in relation to new staff.

Although new staff had received training as part of their induction. The provider had not ensured that all staff had kept up to date with their required training. Staff had not received an annual appraisal of their work.

There were processes in place to monitor the quality of the service provided.

People’s records had been stored securely.

We used a number of different methods to help us understand the experiences of people using the service. Some people using the service were able to tell us about their experiences and their comments have been included within the report.

Other people using the service had complex needs or experienced cognitive impairment due to dementia which meant they were not able to tell us their experiences.

In order to help us to understand the experiences people have we used an expert by experience who observed and spoke with people using the service to help us to get a clearer picture of what it is like to live in or use the service.

We also gathered evidence of the service provider's performance through speaking with people’s relatives, and sampling records and documents before and after our visit.