The inspection took place on 25 July and was unannounced.

Tandridge Heights is a purpose-built care home that provides nursing and personal care for up to 75 older people. People in care homes receive accommodation and nursing or 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.

At the home, people were cared for over three separate floors. One of the floors specialised in providing nursing care to people living with dementia. At the time of our inspection, there were 61 people living at the home. There were seven people living with dementia on the specialist unit.

The home is run by a registered manager who was present for the inspection. 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 last inspection in April 2016, we reported that the service was ‘Good’. At this inspection, we found staff did not always respect the dignity for the people they cared for, or understand the impact of their actions on people. Care plans did not always reflect a personalised approach in the way they were written and people were not always involved in agreeing their care.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made one recommendation. The provider demonstrated they had begun to take action following the inspection.

People felt safe at the home and staff knew what actions to take to protect people from abuse.

Risks were being assessed, recorded and reviewed and staff knew what to do to safely meet individual needs. Care was provided to people by enough staff who had received training to carry out their role. The service followed safe recruitment practices.

People lived in a safe and clean environment and they were protected from the spread of infection.

People’s medicines were managed and administered safely. Processes were in place in relation to the correct storage and auditing of people's medicines.

People’s needs were assessed before they moved into the service to help ensure that their individual care needs could be met by staff. The staff supported people to maintain their health, making referrals to healthcare professionals when required.

People had sufficient to eat and drink and the mealtimes and food were enjoyed. Any risks to people with their nutrition or weight loss was monitored and plans were in place to ensure support was given.

People were supported by staff who worked together and who received support to understand their roles and responsibilities through supervision and an annual appraisal.

The building and premises was well maintained. On the ground floor we saw people and relatives were enjoying meeting each other in the open entrance hall.

The service was working within the principles of the Mental Capacity Act, and the conditions for an authorisation to deprive a person of their liberty were being met.

People felt emotionally supported by staff and told us they were kind. People’s independence was promoted and they were encouraged to make decisions about their care. Relatives were welcomed at any time to visit.

The registered manager and staff responded to complaints that were raised with them. People and their relatives felt their concerns were listened to and dealt with.

The service worked with other healthcare services when people were at the end of their lives to ensure, as much as was possible, that they were pain and symptom free.

The registered manager promoted a positive culture with their staff and engaged with people and their relatives in an open and honest way. People were given oppo

Tandridge Heights is a purpose built care home that provides nursing and personal care for up to 75 older people. The ground and first floor provide accommodation for people who may require respite care or have a medical condition, such as a stroke. The first floor has a separate unit for people needing intermediate care and the second floor is allocated for eight people living with dementia. At the time of our inspection 66 people were receiving care and support.

The intermediate care is for people who require a period of rehabilitation following for example, a hip operation. People living on this floor will only live in the home during their period of recuperation. All areas of the home are staffed by Barchester Healthcare staff, apart from people living on the second floor who also receive care from external community staff.

This inspection took place on 14 April 2016 and was unannounced.

The home is run by a registered manager, who was present on the day of the inspection. 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 and associated Regulations about how the service is run.

At the last inspection on 11 February 2015 we asked the provider to take action to make improvements (for example to staffing levels), and this action has been completed.

People told us care staff treated them with dignity and that they felt safe. Staff had written information about risks to people and how to manage these in order to keep people safe. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

People felt safe and staff knew what actions to take to protect people from abuse. Staff had received training in safeguarding adults and were able to tell us the procedures to follow should they have any concerns.

Care was provided to people by a sufficient number of staff who were appropriately trained. People did not have to wait to be assisted.

The service followed safe recruitment practices. Staff were skilled and experienced to care and support people to have a good quality of life. Staff received support to understand their roles and responsibilities through supervision and an annual appraisal. They received training during their induction and then on an on-going basis.

Peoples’ medicines were managed and administered safely. Processes were in place in relation to the correct storage and auditing of people’s medicines. Medicines were disposed of in a safe way.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or needed to be restricted to keep them safe.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit or leave the home.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed. For example, details of doctors’ and opticians’ visits had been recorded in people’s care plans.

People said that they enjoyed taking part in the activities provided at the home and that they felt t

Tandridge Heights is a purpose built care home that provides nursing and personal care for up to 75 older people. The ground and first floor provide accommodation for people who may require respite care or have a medical condition, such as a stroke. The first floor has a separate unit for eight people living with dementia and the second floor is allocated for intermediate care. This floor can accommodate up to 10 people who require a period of rehabilitation following for example, a hip operation. People living on this floor will only live in the home during their period of recuperation. All areas of the home are staffed by Barchester Healthcare staff, apart from people living on the second floor who also receive care from external community staff.

At the time of our inspection 46 people were living on the ground and first floor and 10 people were living on the second floor.

This inspection took place on 11 February 2015 and was unannounced.

The home is run by a registered manager, who was present on the day of the inspection. 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 and associated Regulations about how the service is run.

There was a very welcoming atmosphere on the ground floor of the home with a lot of visitors and people sitting chatting with each other. However, the unit for people living with dementia was quite different. The furnishings and fittings were not as bright and there was no free access to outside space for people. The registered manager recognised this could be improved.

We found staff did not always ensure correct cleanliness and hygiene procedures were followed to ensure people were not at risk of infection.

Staff had carried out appropriate checks to make sure any risks of harm in the environment were identified and managed. People were supported to take risks within a supportive environment. For example, to walk independently. However, we found staff did not have a good understanding of how to ensure they used the correct sling for a person who required to be moved by a hoist.

Medicines were managed effectively and staff followed correct and appropriate procedures in relation to medicines. Medicines were stored in a safe way.

Staff knew how to recognise the signs of abuse and had received training in safeguarding adults. People told us they felt safe and staff had access to written information about risks to people and how to manage these.

Care was provided to people by staff who were competent to carry out their role effectively. There were enough staff in all areas of the home and the number of staff was varied to meet the needs of the people that lived there. People did not have to wait for staff to attend to them and it was evident staff had developed good relationships with people and knew them well. Staff told us they did not always receive supervision or an appraisal. We spoke with the registered manager about this who told us they were working on this.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to homes. Where restrictions were in place, staff had followed legal requirements to make sure this was done in the person’s best interest. The registered manager had submitted Deprivation of Liberty Safeguards (DoLS) applications to comply with their responsibilities. Processes in relation to the Mental Capacity Act (MCA) 2005 required some improvement by staff.

People were involved in their care and support and were encouraged by staff to do things for themselves, for example make a hot drink when they wished one. People were provided with a choice of meals and facilities were available for people or staff to make drinks or snacks throughout the day.

The GP visited the home each week and staff ensured people were referred to healthcare professionals to keep them healthy or when their health needs changed.

Care plans contained information to guide staff on how someone wished to be cared for. However, we found care plans did not always contain up to date information about people in relation to their care which meant staff may not be following the latest guidance. People did not always have personalised care responsive to their needs. For example, in relation to being checked by staff regularly.

Staff told us and we saw ways in which staff supported and enabled people to maintain their independence and take part in various activities to reduce the risk of social isolation. Staff took the time to work at people’s own pace and they never hurried or rushed people. Although We observed occasions when staff did not give people consideration or the attention they required.

Complaint procedures were accessible to people. We read the registered manager had responded to complaints in a timely manner.

The provider asked relatives for their views on the service and made changes to improve the service when appropriate in response to these views.

The registered manager was involved in the day to day running of the home and had a good understanding of the aims and objectives of the service. This was supported by our observations and staff comments.

We saw evidence of regular quality assurance checks carried out by staff to help ensure the environment was a safe place for people to live, although actions identified were not always taken, and the checks did not identify all issues.

During the inspection we found some 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 the report.

We saw that people who used the service and their relatives were provided with the appropriate information to help them to make a choice regarding the home.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they liked living in the home and they had a comfortable room. They said the staff were kind and caring and nothing was too much trouble for them.

We had very good feedback regarding the standard of catering and people told us that they were able to choose from a wide range of food.

We saw an activities programme displayed in the reception hall and this offered a variety of choice. One person said they were having respite care and came to the home for a rest. Other people told us that they enjoyed the music provided and their daily newspaper.

Staff told us they enjoyed working in the home and felt they had the training and support necessary to undertake their role.

There was an effective complaints procedure in place.

We spoke to people who use services. They were unhappy with the service that was being provided by the provider. People told us that they has serious concerns about the lack of staff and management. People told us that there was no care and attention to people's concerns from the registered manager. They told us that on the day of the visit they had requested for family member to be seen by the GP who was visiting the home. They told us that they were about to inform them about reasons of this but relative was not willing to listen. The deputy manager told us that an appointment had been made.

They told us that they had been requesting for a residents meeting which was then set for February 2013. People told us that the registered manager had told them that he was not going to around as he was going to be on holiday. Registered manager told people he was happy as it was going to be a slagging match. The regional operations manager was informed of these comments and that this was concerning. The provider was requested to investigate these allegations.

We spoke with three staff who were all happy with their job. They stated that at times can be a struggle due to staff shortages. Staff were aware that they had to ensure people's choice and respect was adhered to. Staff told us that they did not want to take away their independence. We spoke to the activity co ordinator who told us that they involved people in activities that take place.

People told us that they were happy living at Tandridge Heights. One person told us that they liked it so much that they did not want to go home the following week. They felt their wishes and expectations were taken into account when making a choice about living in the home.

There was good feedback regarding the food and we were told that the chef meets with people regularly to discuss individual dietary needs and preference.

People felt that there was sufficient staff employed in the home to meet their needs.

Relatives said they were satisfied with the standard of care provided and they were kept informed of any changes.

People told us that they enjoyed the activities arranged in the day unit and on various units.