Archived: Sussex Clinic

Updated 13 September 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was undertaken in line with our regulatory processes and time scales for service’s that were rated as ‘Inadequate’ at their last inspection. Sussex Clinic was rated Inadequate following inspections on 4 and 6 December 2018 and 10 January 2019.

Inspection team:

This comprehensive inspection took place on the 7 May 2019. The inspection was undertaken by two inspectors and one expert by experience [ExE] with experience in older people who use regulated services. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Sussex Clinic is a nursing home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had been without a manager registered with the Care Quality Commission since June 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. It is important for a manager to be registered with CQC, so they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

A manager had been appointed on the 12 February 2019. At the inspection they were undertaking the process of registering with CQC. Subsequent to this inspection this person became the registered manager for the service on 5 June 2019. They are referred to in this report as the ‘registered manager’.

Notice of inspection:

The inspection was unannounced.

What we did:

We reviewed information we had received about the service. This included details about incidents the provider must notify us about and we sought feedback from health professionals who worked with the service. We used information the provider sent us in the Provider Information Return [PIR]. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with nine people who used the service and seven staff including the registered manager, a registered nurse, three care staff and a cook. The nominated individual (NI) for Sussex Clinic spoke to us on behalf of the registered provider. We observed the residents and family meeting which was attended by people who lived at Sussex Clinic and 25 of their relatives and friends.

We looked at the relevant parts of six peoples care plans and personal care records and reviewed other records relating to the care people received and how the service was managed. These included risk assessments, quality assurance checks and governance systems, medicine administration records (MAR) and staff training. We asked the provider to send information on their actions plans to follow our last inspection on the 10 January 2019: these were received.

Updated 13 September 2019

About the service

Sussex Clinic is a residential care home that provides nursing and personal care for up to 40 people. At the time of inspection, 21 people were living at the service. People were aged 65 and over and lived with a range of health and physical health needs including degenerative conditions, diabetes and dementia.

People’s experience of using this service:

There had been some changes to the management of the service since the last inspection. A new manager had been appointed. Subsequent to the inspection they were registered with CQC as the registered manager for the service on 5 June 2019. People told us that this had had a positive impact on the culture and running of the service. People told us the service was a happier place to live and the registered manager was making positive changes.

The registered manager had made some improvements to keep people safe. Staff had undertaking training and had an improved knowledge of identifying and reporting concerns. The provider had engaged a safeguarding consultant who had reviewed accidents and incident records and provided an improvement plan. The registered manager had developed an action plan to address the CQC inspection reports of 4 & 6 December 2018 and 10 January 2019 and the subsequent the conditions placed upon the provider’s registration. Further improvements were required to ensure people were robustly and consistently protected from the risk of harm.

Safeguarding incidents were not always identified or reported. CQC were not always notified of events which the provider is required to notify us of by law.

Suitable process were not in place to identify and act on medicine errors quickly and seek medical assistance in a timely manner.

There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete. The providers action plans to improve the service were not always followed. Recently implemented systems to monitor accidents and incidents had not yet been fully embedded into daily practice.

People’s care plans did not always reflect a person centred approach to meeting their needs and preferences. People did not always feel involved in the review of their care. There was a process in place to review and update all care plans by 30 June 2019.

Safe recruitment checks were not always followed to ensure fit and proper persons were employed.

The environment was tired and in need of decorating and repairing in places. Some areas of the building would not be effective at preventing and controlling the spread of infection.

People were treated with kindness by a caring and dedicated care staff. Care staff demonstrated a compassionate approach towards people and worked well together as a team. People told us that they felt that the staff cared about them.

There was a complaints procedure and a process to respond to complaints received. Complaints had been investigated and responded to. People told us that since the registered manager had commenced they felt more confident to raise concerns and felt listened to.

A system was in place to monitor applications and authorisations to deprive people of their liberty and any conditions attached to them. Consent to care and treatment was sought and recorded in line with the principles of the Mental Capacity Act. Staff supported people in the least restrictive way possible.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people’s dietary needs and people told us they enjoyed the food available to them. People told us they could choose alternative meals if they did not like what was on the menu.

Rating at last inspection and update

At the last inspection the service was rated ‘Inadequate’ (report published 10 April 2019).

This service had been rated as Inadequate at the last two inspections and there were multiple breaches of regulation. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to Regulation.

Regulation 13 of the Health and social care Act 2008(Regulated activities) Regulations 2014. People were not always protected from abuse and improper treatment as the provider had failed to identify and report safeguarding incidents.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have a robust process to ensure the proper and safe management of medicines.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not an established process for assessing and monitoring the quality of services provided and that records were accurate and complete.

Regulation 19 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Safe recruitment checks were not always followed to ensure fit and proper persons were

Regulations 18 of Care Quality Commission (Registration) Regulations 2009. The provider had failed to notify CQC of relevant incidents that affected the health and safety and welfare of people using the service.

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 service to gain assurance that appropriate measures are put in place to address concerns. We will continue to monitor intelligence we receive about the service until we undertake a follow up inspection in line with CQC re-inspection schedule for service rated as ‘Requires Improvement’. If any concerning information is received, we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

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

Special measures

The overall rating for this service is requires improvement and the service remains in ‘special measures’. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.