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Inspection carried out on 14 February 2018

During a routine inspection

Sedlescombe Park is a residential care home for up to 24 people, who may live with dementia. The accommodation is arranged over three floors, with a lift to the first floor, to support people to move around the home safely. At the time of this inspection, seventeen people were living at the home.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider had taken action to improve the environmental concerns we had raised during our previous inspection. New kitchen equipment had been installed and the environment had been improved and managed to support more effective infection prevention and control practice. A member of staff had been appointed to act as a health and safety representative. Additional members of the maintenance team had been appointed to ensure there were sufficient time and skills to address maintenance issues as needed and to carry out planned refurbishment work.

People were protected from the risks of abuse because staff were trained in recognising and reporting any safeguarding concerns. The registered manager checked staff were suitable for their role before they started working at the home and made sure there were enough suitably skilled, qualified and experienced staff to support people safely.

Risks to people’s individual health and wellbeing were assessed and their care was planned to minimise the risks. The provider and registered manager regularly checked the premises, essential supplies and equipment were well maintained and safe for people to use. Medicines were stored, administered and managed safely.

People’s needs were assessed using recognised risk assessment tools and staff were trained in subjects that matched people’s needs. People were supported to eat and drink enough to maintain a balanced diet that met their needs and preferences.

People were supported to maintain their health and were referred to healthcare professionals when their health needs changed. People continued to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

People, relatives and staff felt well cared for. Staff understood people’s diverse needs and interests and supported them to maintain their independence. Staff respected people’s right to privacy and supported people to maintain their dignity.

People were supported and encouraged to socialise in the home and in the local community, and to enjoy their lives according to their preferences. People and relatives had no complaints about the service.

People and relatives knew the registered manager well and were invited to share their views of the service through conversations and regular meetings and questionnaires. The registered manager and provider regularly checked the quality of the service to make sure people’s needs were met safely and effectively.

Further information is in the detailed findings below.

Inspection carried out on 19 January 2016

During a routine inspection

We inspected this service on 19 January 2016. The inspection was unannounced.

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.

The service provides accommodation and personal care for up to 24 older people who are living with dementia. Eighteen people were living at the home on the day of our inspection.

There were policies and procedures to minimise risks to people’s safety. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks.

There were enough staff on duty to meet people’s health and social needs. The registered manager checked staff’s suitability to deliver care and support during the recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff until they knew people well. Staff received training and support that ensured people’s needs were met effectively. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one was subject to a DoLS at the time of our inspection, but the registered manager had sought advice from the local authority head of DoLS. The registered manager was in the process of assessing people’s care plans to make sure they had the proper authority to deprive a person of their liberty if it was in their best interests. For people with complex needs, records showed that their representatives or families and other health professionals were involved in making decisions in their best interests.

People were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs, which minimised risks to their nutrition.

People were cared for by kind and compassionate staff who knew their individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

People and their representatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed.

The quality monitoring system included regular reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. Staff were guided and supported in their practice by a registered manager they liked and respected.

Improvements were required in assessing risks to the premises to ensure the building and equipment were maintained to a standard that supported best infection prevention and control practice.

Inspection carried out on 30 April 2014

During a routine inspection

The registered manager named above no longer works at the home. They had not applied to cancel their registration at the time of our visit, so their name still appears above. A new manager had been appointed, but we had not received their registered manager application at the time of our visit.

Twenty people were living at the home when we visited on 30 April. The home manager was not on duty on the day we visited, but we spoke with them the following day by telephone. We spoke with the duty team leader, two staff and seven people who lived at the home. People who lived at the home were not able explain the details of their care and support needs because of their complex diagnoses. However, we looked at people’s care plans and observed how people were cared for.

We looked at five outcomes to answer the following questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s needs and abilities were assessed before they moved into the home and care plans were written to make sure people’s needs were met. The manager identified risks to people’s care and welfare and took action to minimise the risks. A member of care staff told us they knew what to do because, “I read the care plan when a new person moves in.” Staff kept detailed records about whether people ate and drank well which meant changes in people’s needs were recognised promptly.

We found people received their prescribed medicines when they needed them. Staff made all the necessary arrangements to ensure medicines were obtained, managed, administered and disposed of safely. A member of care staff told us, “People’s medicines are reviewed regularly. The review date is shown on the prescription.”

Staff personnel records contained all the information required by the Health and Social Care Act 2008. The provider checked staff were suitable to work with vulnerable people and ensured they had appropriate skills and experience to support people who lived at the home. A team leader told us, “New staff have to shadow experienced staff and have to complete a workbook” before they would be assessed as competent to work independently.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The duty team leader told us that they had not needed to apply to deprive anyone of their liberty. Staff were trained to use distraction techniques to help people avoid harm. No Deprivation of Liberty applications had been needed.

Is the service effective?

Records showed that staff asked other health professionals for advice according to people’s needs. Staff told us that people’s doctors responded promptly when they needed their advice. Staff ensured people had appropriate access to doctors, dentists and chiropodists.

Staff attended mandatory training and specialist training that was appropriate to meet people’s needs. We saw the manager kept a list of when staff attended training, to ensure they attended refresher training promptly. The manager ensured new staff were supported to work towards obtaining nationally recognised vocational qualifications.

Is the service caring?

In the care plans we looked at, we saw people’s likes, dislikes and preferences included life enhancing details, such as, “Likes to wear watch, jewellery and perfume” and “Likes physical touch and cuddles.” We observed staff knew these preferences and responded accordingly. We heard one person say to a member of care staff, “This is a good place isn’t it?”

Care workers encouraged people to be as independent as possible. For example, we saw staff respected one person’s decision when they changed their mind about a decision they had made earlier in the day.

We saw a poster advertising various family events on the front door. People told us, “It is nice here”, “I am growing vegetables” and “We are having a garden party.” Relatives we spoke with told us they could visit any time. One relative told us, “It is working very well.” We saw one family group brought cakes and made tea for themselves, which showed they felt at home.

Is the service responsive?

The manager regularly reviewed people’s care plans and updated them when people’s needs changed. Care staff we spoke with knew and understood the signs they should look for that might indicate the person’s needs had changed. They understood the triggers for changes in people’s appetite or behaviour.

Care staff told us that one person had woken late and had eaten their breakfast later than their usual time. We observed that staff understood the person would not be hungry again by lunch time. We saw staff assisting this person to eat a meal early in the afternoon instead.

Is the service well-led?

We found the service had an effective quality assurance system in place. The provider and manager carried out a regular programme of audits and checks to make sure the quality of the service was maintained. The results of their checks were discussed at regular staff meetings. This meant everyone knew the actions they needed to take improve the quality of the service provided.

Staff we spoke understood their own responsibilities for checking that the premises and equipment were clean and in good working order.

The manager analysed accidents and incidents to check for patterns or trends. This enabled them to take action to minimise the risk of re-occurrence. There were no identifiable patterns in the three months preceding our inspection.

People and their relatives were encouraged to give feedback about the quality of the service. A copy of the complaints policy was on display in the hallway and the provider regularly sent out questionnaires to find out what people thought. Care staff told us they planned to start monthly resident and family meetings again, as they thought some people might be more relaxed about making their views known in an informal environment.

Inspection carried out on 22 May 2013

During a routine inspection

Many of the people who lived at the home were not able to tell us about their care and support because of their complex needs. We observed that they appeared relaxed and at ease with each other and the staff. We saw that staff were compassionate and respectful towards people. Two people we spoke with told us they liked living at the home. They said, “I love it here. Nobody gets at you” and “I have friends in the house.”

In the three care plans we looked at we found risks to people’s health and welfare were minimised. People’s care plans were regularly reviewed and changed to support their changing abilities and needs. We saw staff encouraged people to remain active and engaged with their surroundings and the community.

People were cared for in a clean and hygienic environment because staff followed the Department of Health code of practice for prevention and control of infection. Staff we spoke with explained how the code helped them to minimise the risk of infection.

Staff were supported to care for people through a programme of training and regular one to one meetings with the manager. Staff told us the manager was very supportive. One member of care staff told us, “I enjoy my work. If you don’t enjoy it, you shouldn’t be in it. You are looking after people’s lives.”

The manager had an effective quality assurance system which included checking that people received the care and support they needed. The manager responded to people’s changing needs and abilities.

Inspection carried out on 30 May 2012

During a routine inspection

We carried out this review to check on the care and welfare of people using this service. We talked with the deputy manager, the area manager, four care staff employed by the service, two people who lived at the home and three relatives about the quality of care. One person we spoke with said, "The staff are very nice, very helpful".

Many of the people who lived at the home could not talk to us directly about their care because of their dementia, but we saw that most people were very active and moved freely and independently around the home and garden. We saw that staff worked closely as a team to continuously observe and engage with people who lived at the home.

One person who lived at the home showed us around the garden and told us what they were planning to grow next. Another person told us about the activities they enjoyed and the programmes they liked to watch on television. They said, "I can watch a programme in my room if no–one else wants to watch it".

One relative we spoke with said, "It was a huge relief to know that my parents could come and live here". Another relative said, There are several long term staff which speaks volumes about the place", and "At weekends it is very hands on, very good staff".

We found that the provider asked people who lived at the home and their relatives what they thought about the service as part of their quality assurance system. One person who lived at the home told us, "I would complain or suggest things that need improving to the manager", and, "I like to make up my own mind for certain things and they listen".

Inspection carried out on 16 August 2011

During a routine inspection

There were 20 people using the service on the day of our unannounced visit.

People using the service at Sedlescombe Park have dementia care needs, which meant they might have difficulty engaging in complex conversations with us.

We spent time in the lounge and dining room closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

We saw that care staff noticed when people needed assistance with their hygiene needs and responded quickly.

We observed staff supporting people to make choices about their daily life and promoting their independence by encouraging them to retain their skills.

We observed that people sitting in the communal areas were not left unattended for extended lengths of time. Staff present were often involved in a tasks to support care needs.

We saw several occasions when staff were called away from sitting with a person or group of people as help was needed to assist another person whose need was identified as a priority.

We observed several occasions when people tired to leave the care home and were encouraged by staff to return inside.

Reports under our old system of regulation (including those from before CQC was created)