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Inspection carried out on 29 October 2018

During a routine inspection

Prideaux House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The inspection took place on the 29 October 2018. This visit was unannounced. A second inspection day took place on the 30 October 2018 and was announced.

Prideaux House is situated in Eastbourne and provides accommodation and personal care for up to 20 older people living with Dementia. There were 13 people using the service at the time of inspection. The service also provided short stays for people, otherwise known as respite, however there was no respite care provided at the time of inspection. People’s bedrooms were situated over three floors; some people had ensuites and there were communal facilities on each floor for those that did not.

At our last inspection in August 2017, the service was rated 'Requires Improvement'. During this inspection, we found significant improvements had been made to address areas of concern with some areas that were outstanding.

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.

Everyone we spoke to felt it was “The little touches” that made the service special. People, their relative’s and health professionals considered the responsive nature of the service to be outstanding. Staff were extremely responsive to people when their needs changed and took immediate action to improve their wellbeing. People’s wishes were considered of utmost importance and relatives gave the highest praise about the care and supported provided at the end of people’s lives. Staff were extremely knowledgeable of people’s individual communication needs and ensured that these were always met in a person-centred way. There had been significant improvements to the complaints process since the previous inspection. People and relatives were confident any concerns they raised would be listened to and their views valued. They spoke of the registered manager’s passion to strive to improve. People had choice and control over the activities they wanted to participate in each day. There were a varied activities programme tailor-made to people's likes and dislikes. Links to the community were valued and continually promoted to improve people’s health and social wellbeing.

People were kept safe by staff who had a good understanding of safeguarding processes and how to minimise risks. People received their medicines safely from trained and competent staff. There were suitable numbers of staff to meet people’s needs and they were recruited safely. The registered manager and staff team had worked hard to improve areas of risk such as medicines management and falls and this had a positive impact on people. People lived in a safe environment that was clean and well maintained.

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

Staff received sufficient training to ensure they had the skills and knowledge to meet people’s individual needs. They told us that their induction was robust and regular supervision gave them opportunities to express concerns and feel motivated in their role. Staff were also encouraged to develop skills by completing additional qualifications in health and social care.

People’s nutritional needs were met and emphasis made not only to the quality of food but to the dining experience. Records showed that the provider sought guidance regularly from health and social care profess

Inspection carried out on 30 June 2017

During a routine inspection

We inspected Prideaux House on the 30 June and 03 July 2017. This was an unannounced inspection. Prideaux House provides accommodation, care and support for up to 20 people. On the day of our inspection 15 older people were living at the home. The service provided care and support to people living with dementia, at risk of falls and long term healthcare needs such as diabetes.

A manager was in post. They had completed their application to become the registered manager with CQC. An interview date had been confirmed. 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.

We last inspected Prideaux House in March 2016. Breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified and it was rated as requires improvement overall. We asked the provider to make improvements to ensure that care and treatment was provided in a safe way and that quality assurance systems improved. The provider sent us an action plan stating they would have addressed all of these concerns by March 2017.

This unannounced comprehensive inspection on the 30 June and 3 July 2017 found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made and that they had now met the breaches of regulation.

People spoke positively about living at Prideaux House. Comments included, “It’s my home” and, I’m very happy here.”

Robust systems had been introduced since the last inspection to assess quality and safety. These included audits for infection control, the environment and equipment used, medicines and daily notes. However, it was acknowledged that because the care plans had been rewritten with outside assistance, the manager had not audited the care plans and therefore had not identified the shortfalls we found during this inspection. These were amended immediately and appropriate action taken.

Since the last inspection people’s care plans had been rewritten, however further work was required to ensure that they reflected people’s changed needs. Records did not consistently reflect the care that was being provided by care staff. As the staff knew people very well this had not impacted on care delivery at this time.

The organisation had put systems in place to ensure staff followed good practice guidance in respect of infection control measures. People who relied on mechanical hoists for moving all had their own sling for everyday use. Staff told us that the slings were checked daily for wear and tear and soiling. All equipment used to assist people had been checked regularly to ensure that they were fit for use and in good repair. The mechanical sluice was operational and staff followed the organisational procedures that ensured that the risk of cross infection was mitigated as far as possible. Medicines were stored, administered, recorded and disposed of safely. Storage facilities throughout the service were appropriate and well managed. ‘As required’ (PRN) medicines had detailed protocols for staff to follow to ensure they were given appropriately and safely. Staffing numbers and the deployment of staff ensured that people received assistance in a timely, caring and respectful manner.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, some documentation to support specific decisions, such as continued bed rest, were not supported by a clear rationale and best interests meeting.

Inspection carried out on 4 March 2016

During a routine inspection

We inspected Prideaux House on the 4 and 7 March 2016. This was an unannounced inspection. Prideaux House provides accommodation, care and support for up to 20 people. On the day of our inspection 15 older people were living at the home. The service provided care and support to people living with dementia, risk of falls and long term healthcare needs such as diabetes.

A registered manager was 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 and associated Regulations about how the service is run.

We last inspected Prideaux House on 21 November 2013 where we found the provider was meeting all the regulations we inspected against.

Throughout our inspection, people spoke positively about living at Prideaux House. Comments included, “I like it here, a good place to live” and, I’m happy here.” However, we identified a number of areas that required improvement.

We found an identified risk with a fire exit had not been not been resolved. Parts of the environment and staff practice were seen to present a risk to the spread of infection. Specialist equipment used to keep people safe whilst in bed had not been set correctly. The administration of medicines was seen to be safe and people told us they received their medicines promptly and correctly. However staff who were providing people with ‘as required’ medicines were not consistently recording why they had been given it. This meant patterns may not have been identified by staff in a timely manner.

Assessments of people’s capacity to make decisions had not always been carried out in line with the requirements of the Mental Capacity Act 2005.

Although people spoke positively about food provided at Prideaux House we found staff deployment during meal times meant people did not always receive the support they required.

Although we saw many kind and caring interaction between people and staff we found occasions when peoples’ confidentially and dignity was not consistently respected.

People’s care plans were reviewed regularly however they did not consistently reflect the care that was being provided by care staff. Care plans did not provide detail on how people could be best supported for each identified need.

People felt the home was well run and were confident they could raise concerns if they had any. However, there were not robust systems in place to assess quality and safety. The registered provider had not adequately monitored the service to ensure it was safe and had not identified or acted upon areas where improvement was required.

The provider had established clear emergency contingency plans and evidence of routine maintenance and servicing of equipment such as the home’s boilers were seen to be regularly completed. There was a business plan in place which identified when areas of the premises would be improved.

People received medical assistance from healthcare professionals including district nurses, GPs, chiropodists and optician.

We found people had been supported by staff to maintain their personal appearance in accordance with their wishes.

All staff felt supported by senior staff and had confidence in the provider in running the service.

We found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 21 November 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service because people using the service had complex needs which meant that not all people were able to tell us their experiences. We spent time observing how support was provided and how staff interacted with people. We spoke with people using the service, staff and the homes acting manager. We looked at some of the homes records.

We found that care and support was person centred and was provided in a dignified and respectful manner. Care plans and risk assessments were detailed and personalised. We saw that people received a choice of healthy and nutritious meals. People were protected against the risk of an unsafe or unsuitable premises. We saw evidence of suitable quality assurance processes to gather information about the quality of service.

Inspection carried out on 21 January 2013

During a routine inspection

Some people using the service had complex needs, which meant they were not able to tell us their experiences. We used a number of different methods to help us understand the experiences of people using the service including SOFI.

Care plans were personalised, and documented the needs of people. Prideaux House had a complaints policy and procedure in place, people and/or their representatives received a copy of this when they moved into the home. Evidence was seen that comments and complaints were listened to, and resolved in a timely and appropriate manner.

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