Fairlight Nursing Home

Fairlight Nursing Home is situated in Rustington, West Sussex. It is a residential 'care home' which provides accommodation and personal care for up to 62 people. People living at the service have a range of needs including physical disabilities, nursing needs, and needs associated with older age and frailty. Some people were living with dementia. At the time of the inspection there were 57 people living in the home. The home accommodates people over two buildings which are joined together. Both buildings had been adapted to suit people’s needs and one part of the home was adapted for people living with dementia.

People’s experience of using this service and what we found

Since our last inspection it was evident the managers of the service and the staff had made improvements which had raised the standard of care people received. Processes for managing medicines and quality assurance and monitoring systems had been revised and embedded. This had improved managerial oversight and the overall governance of the home.

People were protected from avoidable harm as risks to people's health and safety were identified and assessed. People and their relatives told us they felt safe and were cared for by staff who knew them well. One person told us, “I enjoy it here, I’m well looked after. If I was worried about anything, I’d tell the nurses.” A relative said, “My [person] is in a good place, I feel that they are safe.”

People received their medicines as prescribed and improved practices now ensured medicines were managed safely. Accidents, incidents and safeguarding concerns were reported and investigated as required and actions taken to prevent reoccurrence. People were protected from the risk of abuse and staff were aware of their safeguarding duties and how to report concerns.

People received a comprehensive assessment and felt involved in discussions about their care. People were supported by staff who had completed training in line with people’s needs and were equipped with the skills and competence to deliver safe and effective care. Staff were recruited safely and received supervision where opportunities to develop and feedback about their practice were discussed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had access to external healthcare services and were supported to attend appointments and monitor their health, for example, check-ups with the dentist, optician and audiology.

People were observed in a homely environment adapted for their needs and were supported to drink enough and maintain a balanced diet. People spoke positively about the food and could choose from a varied menu developed by a chef who collated and acted on people’s feedback.

People were treated with kindness, dignity and respect. Staff interactions with people were warm and caring. People were happy and the home had a pleasant atmosphere. A relative told us, “Staff are caring and have a good attitude.”

People and their relatives were complimentary about the service, the staff and the management team. Comments included, “I find the manager approachable and they care staff listen” and, “The staff are caring, my [person] is clean and tidy and the care has improved.”

The culture of the service had improved, and staff told us morale amongst the team was “getting better.” The manager embraced continuous learning and improving care. They told us, "I feel I have oversight of the service. People are feeling content and safe. It's nice."

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

Following an inspection undertaken on 30 November 2020 (report published 5 June 2021) we served a Notice of Decision imposing conditions on the provider's registration. The provider was required to submit monthly reports to CQC to demonstrate their oversight of risks and provide assurance that appropriate actions to mitigate risks had been taken. The last rating for this home was Requires Improvement (report published 11 November 2021). There were continued breaches of regulation in relation to the leadership and management of the home and management of medicines. The conditions of registration remained imposed. The provider continued to submit monthly reports to CQC to provide assurance of the management of risk.

At this inspection enough improvements had been made and the provider was no longer in breach of regulation 12 (safe care and treatment) and regulation 17 (good governance).

Why we inspected

We undertook this comprehensive inspection to check the provider had complied with the conditions imposed on their registration. We also needed to ensure that actions submitted in their monthly reports were embedded and confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairlight Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fairlight Nursing Home is situated in Rustington, West Sussex. It is a residential ‘care home’ providing care for up to 62 people who may be living with dementia, physical disabilities, older age or frailty and who require nursing care. At the time of inspection there were 55 people living at the home.

People’s experience of using this service and what we found

We found concerns in relation to medicines management. One person had not received access to their medicines in a timely way when displaying signs of pain and discomfort. There was a lack of oversight to ensure medicines were available should the person require them.

People, relatives and staff provided mixed feedback about the leadership and management of the home. They told us the provider sometimes lacked empathy and understanding or their needs. Records to document staff’s actions and people’s conditions were sometimes not well-maintained. We found continued concerns in relation to the leadership and management of the home.

The provider planned for there to be enough staff to meet people’s needs, yet staff shortages due to sickness or turnover often impacted staffing levels at short notice. Staff worked together as a team to ensure people's needs were met.

Improvements had been made since the last inspection to improve most people’s care. Safe systems were operated to ensure falls management had improved. Risks to people’s health had been identified and appropriately managed. People were protected from the risk of abuse. When required, referrals to the local authority’s safeguarding team had been made if there were concerns about people’s safety. People were protected by the prevention and control of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Improved quality monitoring helped ensure improvements that had been made were monitored and sustained in practice. Staff were delegated quality assurance roles which helped ensure they were accountable for improvements required. Lessons had been learned and used to help drive improvement and focus staff to continue to improve the standard of people’s care.

People told us they were happy living at the home and valued the support they received from staff. One person told us, "You cannot fault them, they are always cheery and happy to help as best they can." Another person told us, "They are nice, kind people."

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (Report published 5 June 2021). We served a Notice of Decision imposing conditions on the provider’s registration of the home. At this inspection, we found some improvements had been made, yet the provider was in continued breach of regulations.

Why we inspected

At the last inspection on 30 November 2020, we carried out a targeted inspection. Breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) were found.

Prior to this inspection on 7 September 2021, we received concerns in relation to how people were supported with moving and positioning. As a result, and to also confirm the provider was now meeting legal requirements, we undertook an unannounced focused inspection on 7 and 13 September 2021, to review the key questions of Safe and Well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We checked whether the breaches we found at the last inspection for Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met. Although improvements had been made since the last inspection, there were continued breaches of Regulations 12 and 17. Please see the Safe and Well-led sections of this full report.

The overall rating for the service has not changed following this focused inspection and remains Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairlight Nursing Home on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified continued breaches in relation to Regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fairlight Nursing Home is situated in Rustington, West Sussex. It is a residential ‘care home’ providing care for up to 62 people who may be living with dementia, physical disabilities, older age or frailty and who require nursing care. At the time of inspection there were 60 people living at the service.

People’s experience of using this service and what we found

Lessons had not always been learned and people had not always received safe care and treatment when they had experienced falls and head injuries. Staff did not always ensure they followed current infection prevention and control guidance (IPC) when supporting people. Some systems relied upon to provide oversight of all people’s clinical needs were not always effective. The registered manager and provider had not identified the concerns found as part of this inspection in relation to falls management and IPC.

When our concerns were fed back to the registered manager they took immediate action to ensure people received safe care and treatment and systems were implemented to mitigate further risk.

Staffing levels had improved since the last inspection yet required further improvement. We have made a recommendation that consideration is made to the deployment of staff and allocation of additional responsibilities during the COVID-19 pandemic. This will help the provider ensure staff are able to meet people's needs and there is sufficient and effective oversight of people's care.

People and staff told us staff worked as a team to help ensure people’s needs were met. The registered manager had been creative when deploying staff to help ensure staffing levels were used to their best effect.

People’s care had improved in relation to the concerns found as part of the last inspection. This included enhanced oversight of medicines and modified diets.

People told us they were happy and felt safe at the service. They told us they felt well-cared for by staff. One person told us, “I feel safe, we are well looked after. The staff are all kind”.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (Report published 17 January 2020). The registered manager and provider completed an action plan after the last inspection to show what they would do and by when to improve.

Since the last inspection, there had been improved oversight of people’s care in relation to the concerns we had previously found. At this inspection, we found new concerns in relation to some people’s safe care and treatment. Concerns remained about the oversight of aspects of some people’s care. The registered manager and provider were still in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about two specific incidents relating to medicines management and falls. Following one of these incidents, a person using the service died. These incidents are subject to ongoing investigation. As a result, this inspection did not examine the circumstances of the incidents. However, we looked at how the registered manager and provider had learned lessons from the incidents to help ensure people’s safety.

We undertook this targeted inspection to see if the concerns we found at the previous inspection had improved. We checked whether the Requirement Actions we previously served in relation to Regulations 12, (Safe care and treatment), 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked to see that the previous breach of Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 had been met. We looked at the care people had received in response to concerns that had been raised to us since the last inspection. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on enforcement action or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection, we have identified continued breaches in relation to safe care and treatment and the leadership and management of the service. You can see what enforcement action we took at the back of this report.

Follow up

We will continue to monitor information we receive about the service and we will request an action plan from the registered manager and provider to understand what they will do to improve the standards of quality and safety. We will work alongside them and the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fairlight Nursing Home is situated in Rustington, West Sussex. It is a residential ‘care home’ for up to 62 people some of whom are living with dementia, physical disabilities, older age and frailty and who require support with their nursing needs. At the time of the inspection there were 60 people living in the home. The home is spread across two buildings. Staff provide care for people who may require support due to their nursing needs and for those who are living with dementia.

People’s experience of using this service and what we found

People did not always receive safe care. There was a lack of oversight of medicines management and some people had not had their medicines according to prescribing guidance. Systems, to ensure that people who required a modified diet, were not always safe and there was a lack of assurance about the types of food people had consumed. Most risks were managed well, and most people were supported in a safe way that met their assessed needs. Staffing levels were not always sufficient to meet people’s assessed levels of need. People and staff told us that staffing levels did not always enable them to meet people’s needs in a timely way. We found that despite this, the registered manager had been creative with the deployment of staff to make the best use of the staff available. Due to some of the concerns that were found at the inspection, we made safeguarding referrals to the local authority. When there had been other concerns, the registered manager had acted appropriately and had made referrals to ensure people’s safety. Infection prevention and control was maintained.

There was a lack of oversight, and quality assurance process that were in place had failed to identify the concerns that were found as part of the inspection. Systems that had been introduced were not used to their best effect to ensure people were receiving appropriate care to meet their assessed needs. Notifications to inform CQC of incidents that had occurred at the home were not always raised to us. The registered manager and staff worked in partnership with people, their relatives and external healthcare professionals. They were responsive when concerns or suggestions for improvement were raised.

People told us they were cared for by kind and compassionate staff. People were supported to retain their skills and their independence was encouraged. People were treated in a respectful way and their privacy and dignity was maintained. People were involved in their care and were supported to make decisions in relation to it.

Staff were responsive and adapted their support to ensure people’s needs were met. Consideration had been given to the environment and information provided to people to help ensure they were treated equally to others. People were provided with support with their emotional and social needs and were able to maintain their interests. When people and relatives had raised concerns, these had been listened to and changes made as a result. People were supported to plan for and receive appropriate end of life care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s needs were assessed in accordance with best practice guidance. There was a coordinated approach to the care people received. They were supported to access external healthcare professionals to maintain their health and if they became unwell. People were supported to have enough to eat and drink and told us that they liked the food that was provided.

Rating at last inspection and update

The last rating for this home was Requires Improvement. (Published 22 January 2019). There was a breach of regulation in relation to the leadership and management of the home. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, although some improvements had been made, we continued to have concerns and we found the service was still in breach of regulations. The home remains rated Requires Improvement and has now been rated Requires Improvement at the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to people’s safety, staffing, the leadership and management of the home and the registered manager’s and provider’s failure to notify us of incidents that had occurred. Please see the action we have told the registered manager to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow-up

We will continue to monitor the intelligence we receive about this home. We will request an action plan from the registered manager to understand what they will do to improve the standards of safety. We will work alongside the registered manager and the local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Fairlight Nursing Home on our website at www.cqc.org.uk.

At the last inspection in August 2017, we found one breach of Regulation. The provider had not done all that was reasonably practical to mitigate the risks of people choking. We made requirements for this to be addressed and the provider sent us an action plan. We required the provider to complete an action plan to show what they would do to improve people safety. At this inspection, we confirmed the provider had taken sufficient action to address the previous breach of Regulation.

At the last inspection we recommended that references were obtained from previous employers to ensure that checks were made that newly appointed staff were safe to work with people. At this inspection we found that improvements had been made and that complete checks were carried out to ensure that recruitment practices were safe.

At the last inspection we made a recommendation about staff deployment during lunchtime. At this inspection improvements had been made to staff deployment at lunchtime. There were sufficient numbers of staff to meet people's needs but we received mixed views from people about staffing numbers at other times during the day.

Fairlight Nursing Home is a ‘care home’. 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.

Fairlight Nursing Home is registered to provide accommodation with personal and nursing care for up to 62 people with a variety of needs including those living with dementia. At the time of our inspection, there were 58 people living at the home who had varying needs such as those associated with old age, frailty and dementia.

Fairlight Nursing Home has a range of facilities including five lounge-dining rooms with en-suite facilities. There were two buildings joined by a corridor. There were 28 bedrooms in the new building and 34 in the old building. The home accommodates people in units, each of which have separate adapted facilities, but people and staff moved freely around all units. One of the units specialised in providing care to people living with dementia and memory loss. The premises had well maintained gardens which people were seen using, the premises were clean and brightly decorated.

Records were not always fully completed and checks were not always effective. Care records showed any risks to people and people’s needs were assessed. People's health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed. Not all staff knew how to access all documents in the online care planning systems used at the home, this led to shortfalls and gaps identified in record-keeping.

Medicines were given safely but there were shortfalls in checks and audits identifying gaps in recording and checking that we identified during the inspection. The frequency of medicine audits was monthly and there was not a procedure to guide staff on what to when medicines have been stored above average storage temperatures.

Staff said they felt supported in their work. Staff received a range of relevant training and the provider invested in additional training to support staff progression and to increase knowledge to meet people’s needs. We recommended that all staff, including agency, that are deployed to the dementia unit receive training in behaviours that challenge in dementia.

A number of audits and checks were used to check on the safety and quality of the care provided but these had not identified some shortfalls that we found at this inspection.

The home has 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.

Some people and relatives said they were consulted about the person’s care and care plans were individualised to reflect people's needs. Some care plans showed how people's needs were to be met and how staff should support people.

People told us they felt safe at the home. Staff knew how to keep people safe, including in the event of an emergency such as a fire. The complaints procedure was available and people knew what to do if they had a complaint. The registered manager was motivated to continue improving the quality of care at the home.

People's capacity to consent to their care and treatment was assessed for most people and applications made to the local authority where people's liberty needed to be restricted for their own safety. Staff had a good understanding of the Mental Capacity Act (MCA) 2005 and how that was applied to caring for people.

There was a choice of food and people told us they liked the food. Staff treated people with dignity and respect and we observed kind and caring interactions between people and staff. A structured activity programme was provided and an activities member of staff was given protected time to visit people who were cared for in their rooms.

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

Fairlight Nursing Home is registered to provide accommodation with personal and nursing care for up to 62 people with a variety of needs including those living with dementia. At the time of our inspection, there were 61 people living at the home all of whom were over 65 years of age and had varying needs such as those associated with old age, frailty and dementia. Fairlight Nursing Home has a range of facilities including five lounge- dining rooms. Fairlight Nursing Home has 62 bedrooms all with en-suite facilities. 28 are in the new building and 34 in the old building. The service had well maintained gardens which people could use in warmer weather. The premises were well maintained, clean and brightly decorated.

At the time of the inspection the service did not have a registered manager, but there was manager in post who was in the process of registering with the Commission. Following the inspection the new manager was registered with the Commission. 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 took place on 16 and 20 February 2017. At that inspection we made a legal requirement as the provider had not followed the procedure for reporting allegations to the local authority safeguarding team. The provider sent us an action plan to say how this legal requirement would be met. At this inspection we found action had been taken to meet this regulation. The registered manager and staff had a good awareness of when allegations of abuse should be reported.

The inspection was prompted by a notification that one of the people who lived at the service was given food of the incorrect consistency. The person choked due to swallowing problems and died. This is being investigated by the coroner and the social services safeguarding team. Since this incident the manager had introduced a number of changes to mitigate the risks of choking for those with swallowing problems. This involved the input of a Speech and Language Therapist (SALT) to advise on the assessment and safety of people who had problems swallowing. A new system of checks when delivering food to people had been introduced. However, we identified additional monitoring was needed to ensure staff took action to prevent people choking on food. We have made a requirement about this.

Checks were made that newly appointed staff were safe to work with people but references were not always obtained from previous employers. We have made a recommendation about this.

At the time of the inspection the service was undergoing a change of management. The new manager had introduced a number of changes and improvements to the service such as reducing the use of agency staff and employing more care staff and registered nursing staff. There were sufficient numbers of staff to meet people’s needs. However, deployment of staff during lunch time was an area for development. We have made a recommend about this.

Medicines were safely managed although we noted guidance regarding a ‘when required’ medicine for mental health needs was not recorded for one person.

We recognised the positive changes the new manager was making to the service. However, we judged these needed to be sustained and embedded in practice. For example, the service had recruited additional nursing and care staff who would need to be inducted.

People told us they felt safe at the home. Staff were aware of how to report any concerns regarding the safety of people.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

Since the last inspection the manager had introduced a system for planning and monitoring that staff supervision took place which was at the early stages of implementation. Staff said they felt supported in their work. Staff received a range of relevant training.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

There was a choice of food and people were complimentary about the meals. People were consulted about the food and meal choices.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed.

Staff treated people with kindness and respect as well as being patient and gentle. People were able to exercise choice in how they spent their time. Staff took time to consult with people before providing care and showed they cared about the people in the home.

People said they were consulted about their care and care plans were individualised to reflect people’s choices and preferences. Each person’s needs were comprehensively assessed and included information about people’s social and recreational needs. Care plans showed how people’s needs were to be met and how staff should support people.

A good standard and range of activities were provided including entertainment and outings. People said they enjoyed the activities.

The complaints procedure was available and people said they know what to do if they had a complaint. People said they had opportunities to express their views or concerns. There was a record to show complaints were looked into and any actions taken as a result of the complaint.

People’s views about the quality of the service were sought and the service’s management acted in response to issues raised by people. This showed the management of the service was open to suggestions as well as criticism so the standard of care people received improved. The manager was aware of the challenges and improvements which needed to be made and was motivated and enthusiastic. A number of audits and checks were used to check on the safety and quality of the service. However, these had not been effective in embedding change and improvement in the home, and had not identified some shortfalls that we found at this inspection.

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.

Fairlight Nursing Home is registered to provide accommodation and nursing care for up to 62 people with a variety of needs including those living with dementia and when people leave hospital for rehabilitation, which is called ‘step down’ care. At the time of our inspection, there were 60 people living at the home all of whom were over 65 years of age and had varying needs such as those associated with old age, frailty and dementia. Fairlight Nursing Home has a range of facilities including five lounge- dining rooms. All bedrooms are single and each had an en suite toilet. Thirty three of the 60 bedrooms had an suite shower and toilet. Communal bathrooms are also provided. The service has well maintained gardens which people could use in warmer weather. The premises were well maintained, clean and brightly decorated.

The service had 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 took place on 23 and 24 September 2015. At that inspection we made legal requirements for four breaches of our regulations; these were regarding the unsafe management of medicines, not maintaining a safe environment, a lack of adequate training for staff, care records not accurately reflecting people’s needs and preferences and the lack of an adequate system to assess, monitor and improve the quality and safety of the services provided. The provider sent us an action plan to say how these legal requirements would be met. At this inspection we found action had been taken to meet these regulations, but we still found aspects of the service that were requiring improvement.

At this inspection we found the service had policies and procedures regarding the safeguarding of people and staff were aware of their responsibility to report any concerns of this nature. However, the provider had not notified the local authority safeguarding team of an allegation of abuse.

The provider had not always ensured accurate records were maintained. We identified omissions in the recording of care provided to people. This was in regard to care plans and the use of charts to monitor care. Where charts were used to record people’s food and fluid intake these were not always recorded accurately. Where people were repositioned to prevent pressure areas developing on people’s skin the person’s care plan did not always detail how often this should take place. Staff had a good knowledge of when to use ‘as required’ medicines but this was not recorded to ensure staff had the correct guidance of when to administer it. The arrangements for the supervision of staff were not recorded and there was a lack of records to show staff supervision had taken place.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures showed only suitable staff were employed.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

There was a choice of food and people were complimentary about the meals. The food was wholesome and nutritious and people were supported to eat and drink. People were consulted about the food and meal choices.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular checks such as dental and eyesight checks.

Staff were observed to treat people with kindness and dignity. People were able to exercise choice in how they spent their time. Staff took time to consult with people before providing care and showed they cared about the people in the home.

People said they were consulted about their care and care plans were individualised to reflect people’s choices and preferences. Each person’s needs were comprehensively assessed and included information about people’s social and recreational needs. Care plans showed how people’s needs were to be met and how staff should support people.

A good standard and range of activities were provided including entertainment and outings. People said they enjoyed the activities.

The complaints procedure was available and people said they know what to do if they had a complaint. People said they had opportunities to express their views or concerns. There was a record to show complaints were looked into and any actions taken as a result of the complaint.

People’s views about the quality of the service were sought. People and their relatives said they felt able to raise any issues with the home’s management. People and their relatives spoke of the service as ‘family orientated.’ A number of audits and checks were used to check on the effectiveness, safety and quality of the service.

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.

There was no registered manager at the home, however, a newly appointed manager has applied to be registered with us. They were present for the inspection.

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

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found

Is the service safe?

People told us they felt safe because 'There's always someone around' and 'You ring your call bell and they come like a shot.' Staff told us the service was safe for people because of 'The surroundings, the equipment and the staff.'

We found that the home had suitable procedures in place to protect people from abuse. They worked well with other professionals and responded when concerns were raised to them.

Is the service caring?

People who lived in the home said the staff were caring and they felt well looked after. One said 'Very kind, very caring and very quick off the mark. Efficient and caring, top marks.' Everyone we spoke to said they would recommend the home to a loved one. One member of staff told us that a relative of theirs had lived there prior to them working in the home. The said "So I knew it was a good home before I applied for the job."

Staff spoke about people in a caring and respectful manner. They knew people well and treated them as individuals.

Is the service effective?

The service was effective because people were involved in their care planning and their individual needs were recorded in their care plans. We saw examples of how people's needs were met and this was confirmed to us by the people we spoke to. One relative said 'What I like is they don't leave them in bed all day.' This person described how their loved one had been admitted to the home, 'A shrivelled up [person] in bed.' They went on to describe their surprise and delight to find them up and playing bowls within a few days.' They added, 'It's like a hotel.'

Is the service responsive?

We saw the home responded to people's individual needs and preferences. There was evidence that the home responded to concerns and was committed to learning from mistakes and improving the service.

Is the service well led?

The manager was very open and transparent about the improvements they intended to make. People we spoke to said they thought the service was well led. Staff spoke highly of the new manager, they spoke of an 'Open door policy' and one said they got 'Great support from [manager] and the directors.'

We did not meet and speak with any relatives during our visit. However, we noted that comments made on recently completed satisfaction questionnaires were very positive. For example one relative had written, 'I am delighted to say that X has settled in very well.'

We spoke with three members of care and nursing staff, who were on duty. We found that they had a good understanding of their roles and responsibilities. They also demonstrated they knew what was expected of them to ensure people's needs had been met.

We also gathered evidence of people's experiences of the service by looking at a selection of records. This included care records, medication records and staff recruitment records. They demonstrated that people had given consent to the care they had received. We found that the needs of people had been assessed prior to admission. We found that care records provided nursing and care staff with appropriate information to follow with regard to the delivery of care. We found that medication records had been well maintained. This demonstrated that medication had been managed safely. We also found that the provider's recruitment practices were sufficiently robust to ensure nursing and care staff employed were safe to work with vulnerable people.

We looked at the care records of three people that lived at the home and found evidence that people had been involved in decisions about their care. There was a care planning system in place that enabled people to receive care that was appropriate to their needs.

We spoke to three members of staff who worked at the home. They said they enjoyed working there and felt well supported and trained in their roles.

When we looked around the home we saw that it was calm and relaxed but that some improvements were required to the decor. We saw activities being provided for people to take part in. We observed that staff were kind and helpful to the people who lived there, however there were some areas where choice could be improved.