Sussexdown

Sussexdown is a residential care home providing personal and nursing care to 53 people at the time of the inspection. The service is registered to support up to 77 people.

Care was provided across three units, one for residential care, one for people with nursing needs and a unit tailored to people living with dementia. The main building and grounds are a former convalescence home for people who had served in the armed forces which had been adapted whilst retaining its historical features. The area of the home for people living with dementia was purpose built.

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

We found the breaches of regulation identified at the previous inspections had been met, however, it was not yet clear how sustainable or embedded these improvements were. Shortfalls in relation to staff deployment remained an issue, however staffing numbers had improved since the last inspection and staffing numbers no longer impacted on the safety of people’s care. The provider relied heavily on agency staff, however there were times when agency staff were not available or cancelled at short notice. This had impacted on people’s quality of life as staff were able to spend less time with them. People spoke highly of the staff and said the care was good. They told us the staff were “kind,” “very nice” and, “caring”.

The service did not have a registered manager in post, however there were interim management arrangements in place. This included a clinical lead in day to day charge of the service with oversight by the regional support manager and the regional operations manager. The provider had recruited permanent staff to manage the service who were due to start their employment towards the end of October 2022. Staff told us the service had improved. They said they felt, “more settled with the management we have now that I did when the previous manager was here.”

People were supported to have 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. One person told us they had, “Choices within certain parameters, my best interests aren’t always what I want. I don’t want to be in a care home, but this is a lovely place, superb, really good. I’m free to come and go as I please, although it is not in my best interests to do so. The staff are kind and helpful.”

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 provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection improvement had been made and the provider was meeting regulations, however further improvements are required.

The last rating for this service was requires improvement (published 13 January 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

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.

We carried out an unannounced comprehensive inspection of this service on 13 February 2020 and a focused inspection on 19 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Good Governance and Staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We also inspected due to concerns we received in relation to staffing.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to continue to make improvements. Please see the safe and well led sections of this full report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Sussexdown is a residential care home providing personal and nursing care to 59 people at the time of the inspection. The service is registered to support up to 77 people.

Care was provided across three units with one for residential care, one for people with nursing needs and a unit tailored to people living with dementia. The main building and grounds are a former convalescence home for people who had served in the armed forces which had been adapted whilst retaining its historical features. The area of the home for people living with dementia was purpose built.

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

All people we spoke with told us there were not enough staff. The provider had not met the breach of regulation made at our last inspection regarding the number of staff. Staff said they were not able to provide the high-quality care people deserved due to the lack of staff. They said, “It’s difficult to spend time with residents, it’s quite hard going sometimes.” Staff raised concerns regarding their ability to manage risk when the service was understaffed. Staff indicated that morale was low, and care was task driven. People complained of being bored and not having anything to do. Staff and people told us there was no programme of activities. One person said they were not sure, “What they do to keep people entertained.”

There were continued shortfalls in relation to governance. The provider had not met the breaches of regulation made at our last two inspections regarding their oversight of the service. Staff told us they did not have faith that concerns raised with the registered manager would be dealt with. The registered manager's audits did not fully identify gaps in quality of care or areas for improvement. It was not always clear from the audits what action was required or if action had been taken. There was not a robust response to understand the risks low staffing numbers and the lack of stimulation posed to people’s quality of life. Staff spoke of being, “Frightened of repercussions” in relation to raising concerns or whistleblowing.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 24 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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.

We carried out an unannounced comprehensive inspection of this service on 13 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Good Governance and Staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We also inspected due to concerns we received in relation to staffing.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified continued breaches in relation to government and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with 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.

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

Sussexdown is a residential care home providing personal and nursing care to 66 people at the time of the inspection. The service is registered to support up to 77 people.

Care was provided across three units with one unit for residential care, one unit for people with nursing needs and a unit tailored to people living with dementia. The main building and grounds are a former convalescence home for people who had served in the armed forces which had been adapted whilst retaining its historical features. The area of the home for people living with dementia was purpose built.

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

People, relatives and staff told us consistently there were not enough staff to meet people’s needs. We identified times of day when the impact of this was heightened and there were times where staff had been absent and had not been replaced. Management had identified this issue and had a plan to address it, but this had not been implemented by the time of this inspection.

There were continued shortfalls in the governance of the service. Some records were incomplete and shortfalls we found had not been addressed, despite being picked up in audits. There was a new management team in place and they had started to identify and address issues, as well as working to improve the culture of the service. Feedback from staff about the culture was mixed, as improvements had not yet had a positive impact.

People felt safe when staff supported them and plans were in place to reduce risk. There had been recent improvements to medicines records which were completed after the inspection. People received their medicines safely and they were stored and managed securely. The home environment was clean and staff followed best practice in relation to infection control.

People gave us mixed feedback on the quality of the food they were served, but their dietary needs were met. Staff supported people to access healthcare professionals when required and people’s needs were assessed in line with best practice. There had been improvements to documentation relating to consent. 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 said they got on well with staff and we observed pleasant interactions between people and staff. Staff involved people in care and we saw people being encouraged to maintain their independence. There were a variety of activities for people to take part in and these were personalised. People knew how to complain and complaints had been responded to, improvements to the recording of complaints were made after the inspection.

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to governance and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with 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.

On the day of the inspection there were 75 people living at the home. The home is divided into three units; the Princess Alexandra unit can accommodate up to 20 people living with dementia, the Princess Alice unit can accommodate up to 34 people with residential care needs and the Douglas Bader unit provides nursing care for up to 23 people. The home caters for people with a range of needs including nursing, physical disability, dementia or mental health conditions. The home is surrounded by large landscaped gardens which was accessible for all people living at the home.

Our observations and feedback received about the care provided at the home demonstrated that people’s experience was variable, depending on which unit of the home people lived in.

The provider had a range of systems and processes in place which aimed to ensure good governance, however they were not consistently effective in identifying shortfalls in practice and the inconsistency in the quality of care people received across the home. For example, there was inconsistency in the person-centred approach people received, inconsistency in the embedding of the provider’s values in staff practice and inconsistent access to meaningful activity, depending on which area of the home people lived in. Records were not consistently completed which did not give assurance that people received the support they required in a timely manner.

There was an inconsistent approach in ensuring relevant people were included in making best interest decisions. For example, one person’s mental capacity assessment said their mother should be involved in all decisions about their care. However, there was no evidence that their mother had oversight of these decisions.

People did not consistently have their needs met in a person-centred way. Feedback and observations of people’s experiences were variable depending on which unit of the home people were living in. In the nursing unit, staff were task focussed and did not spend time to engage and chat with people.

People’s care plans did not consistently consider all their needs. Some care plans lacked information about the person, their likes and dislikes. This meant that some people may not have received care in line with their preferences. People’s access to meaningful activities was inconsistent depending on which unit of the home they lived in. There was a lack of vibrancy in the nursing unit and people were left for long periods of time with little interaction. One person said “I don’t do many activities. I can’t get there on my own. Sometimes they take me down, sometimes not.” People living in other areas of the home had access to meaningful activities which were driven by people’s interests.

People and their relatives did not consistently feel involved in discussions about their care. On the nursing unit of the home, one relative told us, “I come in everyday so my mum’s care should be a three-way process.” People’s care plans demonstrated variable evidence that people, or where appropriate, their relatives had been involved in the review of their care.

We have made a recommendation about involving people’s relatives, where appropriate, in decisions about their care.

People said they felt safe living at the home. One person told us, “I am very well looked after and feel very safe.” Another person told us, “Staff are very good to you and kind. I feel safe here and there are a sufficient number of staff.” Staff were knowledgeable about safeguarding and had received relevant training. The provider had robust recruitment procedures in place which ensured people were safe to work prior to them starting. Risks were well managed to ensure people were safe. People had access to medicines when needed and these were administered by trained and competent staff. The management, administration, storage and disposal of medicines was safe.

People spoke highly of the food, one person told us, “The food is very good and the cook will always cook something different if I don’t like what is on offer.” People who required specialist diets had their needs met appropriately. People’s needs in relation to hydration were met.

People were supported by staff with the appropriate skills and knowledge to do so. Staff had a good understanding of capacity and consent. Staff were suitably trained to care for people’s needs and were knowledgeable in their approach. People received access to health care in a timely manner and staff recognised changes in people’s needs in a timely way. For example, one person living with diabetes had good access to a multi-disciplinary team to support their needs, which included GP, chiropodist, district nurses and opticians.

We observed positive and respectful interaction between staff and people across the dementia and residential areas of the home and people were treated with kindness and respect on these units. One person said, “Staff are exceptionally kind, they respect my views.”

People and relatives were consistently involved in their care, in the units for people living with dementia and residential needs. For example, one care plan for a person living in the residential area of the home had extensive detail about their life history completed by their husband. This then informed the care they received.

People’s right to privacy was respected. Staff were observed asking for consent, and knocking before entering people’s rooms. People’s cultural and religious needs were met, there was an on-site chapel. This was open at any time for people to use and a priest delivered a monthly service for people of all faiths.

Concerns and complaints were responded to in a timely manner. People had access to the complaints policy and complaints received were responded to in a timely manner. One person said, “I am not afraid to let staff know if I am unhappy but I have not needed to.”

People were supported in a comfortable and dignified manner at the end of their life. Staff spoke compassionately about end of life care and had a good understanding of how to support people and their families.

At the time of inspection there was no registered manager in post. The previous registered manager had left on 8 May 2018. 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 provider had ensured interim management support was in place. People and staff spoke highly of their management. A member of staff said “they are so approachable, whenever I go to them I know they will listen. They are present, come over to the unit regularly and they are always happy to help.”

We found breaches 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 the report.

We spoke with five relatives on the day of our visit and four by telephone afterwards. They were generally very enthusiastic about the home. One said, 'They're always very cheery and very warm towards people'. Another told us, 'It gets ten out of ten as far as I'm concerned'. They told us that they felt involved and that the staff were skilled in their work. One explained, 'They have a knack of bringing things out of people like my Dad but without forcing him to do things'. Another said, 'We don't worry about Mum now. We know she is safe and that she is with people who care for her'.

We spoke with five members of staff and the manager. Staff told us that they had a good and stable team and that they enjoyed working at the home. One said, 'I think this place is brilliant'.

We found that the home was bright and that people looked well cared for. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. There was a wide range of activities on offer and people spoke with enthusiasm about the things that they were involved with. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss.

The provider told us people were assessed before they were admitted to the home. We reviewed the care records and found each person had an assessment prior to coming to the home. We noted that areas included in the assessment included people's thinking and orientation skills.

During the visit we observed staff engaged with people and their relatives in a warm and supportive manner. We observed staff treated people with dignity and respect. We noted information was displayed in different forms. For example we observed the time table of activities was pictorially displayed.

We found people were protected from the risk of abuse as staff were trained in safeguarding. Staff we spoke to were knowledgeable and knew how to raise a safeguarding alert if there were concerns about people's safety.

Staff told us they were supported to deliver care and treatment to people at an appropriate standard. We reviewed records and saw staff were regularly supervised and appraised.

The provider had a system in place to monitor and assess the quality of the service delivered.