Archived: Sussex Clinic

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.

We undertook an unannounced focused inspection of Sussex Clinic on 10 January 2019. This inspection was undertaken to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 4 and 6 December had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements.

We did not inspect the remaining Key Questions because this inspection focused on the immediate risks and urgent concerns identified at the inspection on the 4 and 6 December 2018. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Sussex Clinic is a nursing home in Worthing for up to 40 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. There were 24 people living at the service at the time of the inspection. This included older people, younger adults and those with a physical disability. Some people were living with dementia. By the nature of their complex health and social care support needs, people who live at Sussex Clinic are considered extremely vulnerable

We previously inspected Sussex Clinic on 4 and 6 December 2018 and the service was rated as Inadequate. We identified serious failings and shortfalls in the care and safety of people living at the service which either placed people at or exposed them to significant risk of harm. There were multiple breaches of the Health and Social Care Regulations 2014. After the inspection we asked the registered provider to act to address the urgent risks and concerns we had identified. The provider responded and said what action they had taken to address the urgent concerns and what they would do to improve and meet legal requirements.

In response to the level of serious concerns in relation to safeguarding urgent conditions were placed upon the providers registration. Initially there was a restriction on all new admissions into the service until 9 February 2019. After this date there is a phased approach until July 2019. The condition was made to give the provider time to make sufficient improvements to the care people receive and the safety of the service. The provider has supported this condition which will remain on their registration until 9 July 2019.

At this inspection we identified continuing failings and shortfalls in the care and safety of people living at the service which either placed people at or exposed them to significant harm. The service was rated Inadequate and remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service has been without a registered manager since June 2017. 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.

People were not always protected from abuse and improper treatment. Systems and processes to protect people from abuse were not operating effectively. There were three incidents that the provider failed to report to the local authority under safeguarding guidance. These included a grade four pressure wound, an unexplained injury and an allegation of physical assault by a person who lived at the service. This placed people at significant risk of harm as allegations and injuries were not being responded to appropriately.

People were exposed to the potential risk of harm as reasonable steps had not always been taken to assess and mitigate risks. There was a repeated incidence of a person cared for in bed not having access to a call bell. This placed the person at risk of not being able to receive the help they required. A person with a pressure wound was not receiving dressing changes in line with advice from the specialist health care professional and staff had not considered the risk of the wound deteriorating. This placed the person at risk of infection and further deterioration.

People were not always provided with safe care and treatment. The provider had failed to follow safety guidance and address the risk of harm from accidental ingestions or choking identified at the previous inspection. We observed a repeated incidence of fluid thickening powder being left easily accessible to a person with dementia. The provider had not made changes to the way fluid intake was documented to ensure people had sufficient amounts to drink.

The provider did not have an effective oversight of staff recruitment and had not ensured robust processes for ensuring people had suitable pre- employments checks undertaken, including a criminal records check (DBS). The provider had not taken measures to assures themselves of the suitability of employing a person with a criminal record. We had asked the provider to take immediate action to ensure peoples safety. The Provider wrote to us and gave assurances that they had applied for a DBS for this person which had been returned ‘clear’ of any criminal convictions. The person had returned to work. This information was incorrect and during the inspection the provider confirmed that this persons DBS was still in the application stage.

The provider had written to us to tell us about the measures they had put in place to address the concerns raised at our last inspection. Some of the actions the provided told us they had done had not been undertaken. Staff had not received supervision in line with the providers action plan, audits of accidents and incidents and safeguarding concerns had not yet been undertaken. The manager outlined their plans to address these on behalf of the provider, along with rewriting all care plans and risk assessments which they described as being out of date.

The service was not well-led. The provider had made steps to recruit a new manager and five had been employed since April 2018. An interim manager had commenced the week before the inspection. This person is a registered manager at another care home owned by the provider and will be providing 24 hours a week management support to Sussex Clinic whilst a new manager is recruited. The provider had not ensured good governance and management oversight whilst the service has been without a registered manager. The findings throughout this inspection showed that there was a significant failure to assess, monitor and mitigate risks relating to the health, safety and welfare of people

Some actions had been taken since our last inspection, these included additional training sessions relating to safeguarding and completing documents appropriately. In response to our request for the provider to act to address urgent concerns relating to safeguarding, the provider had engaged an independent safeguarding consultant. Rooms previously occupied by staff were vacant and the provider informed us that they were no longer allowing staff to live in empty bedrooms within the service.

We identified multiple breaches of the Health and Social Care Regulations 2014. You can see what action we told the provider to take at the back of the full version 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.

Sussex Clinic is a nursing home in Worthing for up to 40 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. There were 27 people living at the service at the time of the inspection. This included older people, younger adults and those with a physical disability. Some people were living with dementia. By the nature of their complex health and social care support needs, people who live at Sussex Clinic are considered extremely vulnerable.

We previously inspected Sussex Clinic on 28 November 2017 and the service was rated Requires Improvement. Breaches of the Health and Social Care Act 2008 ( Regulated Activities) Regulations 2014 were identified as the provider had failed to ensure that staff were sufficiently trained and that there were effective governance systems in place. After the inspection the registered provider wrote to us to say what they would do to improve and meet legal requirements.

The service has been without a registered manager since June 2017. 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.

At this inspection we identified serious failings and shortfalls in the care, and safety of people living at the service which either placed people at or exposed them to significant risk of harm. We raised multiple safeguarding alerts to the local authority for investigation. We also shared these concerns with the provider, manager and other statutory agencies. We took urgent enforcement action to address these concerns to improve people’s safety. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.

People were not always protected from abuse and improper treatment. Systems and processes to protect people from abuse were not operating effectively. There were 13 incidents that the provider had failed to report to the local authority under safeguarding guidance. These included eight people with unexplained injury’s and four allegations of physical assault by people who lived at the service. 12 of these had occurred in the 10 weeks prior to the inspection. Incident and accident records were not always accurate and some injuries had not been recorded. Staff did not know how to report an incident to safeguarding. This placed people at significant risk of harm as allegations and injuries were not being responded to appropriately. We asked the provider to take immediate actions to safeguard people.

People were not always provided with safe care and treatment. Risks were not always assessed and mitigated. We observed a situation where a person was at risk of harm from accidental ingestion or choking as the provider had failed to follow safety requirements. This is because thickening powder had been left easily accessible along with access to harmful cleaning chemicals to people who were assessed as living with dementia.

Some bedroom doors were closed and we saw people who were unable to get out of bed did not have access to call bells to summon help when needed. Some staff were staying in vacant bedrooms within close proximity to those occupied by people living at the service. The provider had not considered if an assessment of risk was required to assure themselves of people’s safety. We asked the provider to take immediate action to ensure the safety of people and mitigate risks from staff living in the service.

The provider did not have an effective oversight of staff recruitment and had not ensured robust processes for ensuring people were suitable for the job they were applying for. For some staff the provider had failed to undertake suitable pre- employment checks including those with a professional body and criminal records check. This meant that they had failed to identify and mitigate risks within the recruitment process and could not be assured that people were safe and being supported by suitable persons.

Care records were not always up to date, accurate or complete. For example, staff could not confirm that pressure mattresses were set to the correct setting for some people who were at risk from developing pressure ulcers. Fluid balance records for people who required their hydration needs to be monitored were inaccurate and recordings were inconsistent. Some staff were recording the fluid offered to the person whilst others were recording what had been consumed. Staff did not always provide adequate assistance where people required support to drink sufficient amounts, and some people who could drink independently had their drinks placed out of their reach. Staff did not always follow people’s communication needs and we observed people becoming frustrated with this.

People who were cared for, including people living with dementia and those who remained in bed did not have any meaningful stimulation and occupation. People were at risk of becoming isolated and some people told us that they were lonely. A person told us ‘I just wait until a person happens to come by, they don’t come by very often”. Another said, “it’s not easy living here”, “I don’t get out of bed much and there is very little to do and the conversation is not great’. The lack of engagement and stimulation meant that some people’s moods were low and they expressed boredom.

Relatives described the staff as caring, our observations showed that people were not always treated with dignity and respect. On two occasions staff moved a person’s bed whilst they were in it without any explanation. On both occasions the person was startled as they were unaware that this was going to happen. Some people who required support to dress had clothing that was inside out, soiled or had their name label visible. People were not always treated in a compassionate way. A person told us about how they had been sitting in the lounge since 6am, and that staff ‘never wave or look in when they go past’. They said, "I could be in here all day and no one speaks, sometimes they shut the door”.

People did not always receive consistency of support. We saw staff leaving people part way through assisting them to eat to assist someone else in another room and then returning to give the person another mouthful of food. People told us that they did not always have a choice of food and the food prepared was not always served of kept hot. A person told us ‘The meals are good, you don’t get a choice, sometimes they come around the day before and ask you but not often, they tell you what it is and I suppose you can say if you don’t like it, but I have never done that".

Records showed that staff had been provided with training since the last inspection, however records were not always accurate. Although records noted that a staff member had undertaken safeguarding training they said they had not. Staff did not always demonstrate the skills and knowledge in areas in which records said they had received training in. There was no system for monitoring the competency of staff following this training. Staff told us that they did not have regular supervision including clinical supervision.

The service was not well-led and had been without a registered manager since June 2017. The provider had made steps to recruit a new manager and four had been employed since April 2018. The most recent manager commenced two weeks before this inspection. The provider had not ensured good governance and management oversight whilst the service has been without a registered manager. The findings throughout this inspection showed that there was a failure to assess, monitor and mitigate risks relating to the health, safety and welfare of people.

The provider could not evidence that there was an accessible complaints process and whether complaints were investigated.

People lived in a clean environment which supported their privacy. We have made a recommendation for the provider to co

We previously carried out a comprehensive inspection at Sussex Clinic on 28 September 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the management of medicines and the provision of meaningful activities. The service received an overall rating of ‘requires improvement’. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for Sussex Clinic remains as ‘requires improvement’. We will review the overall rating of ‘requires improvement’ at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been made and sustained.

A registered manager was not in post and day to day management of the service was provided by an acting manager who was a registered manager of another service within the group. 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.

Some staff had received essential training and there had been opportunities for additional training specific to the needs of people. However, we saw that several members of staff had not received essential updated ‘refresher’ training in a timely manner. This is an area of practice that needs improvement.

There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met their individual needs.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, book reading, massage and manicures and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People were being supported to make decisions in their best interests. The acting manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

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.

Sussex Clinic is a nursing home providing accommodation and support for up to 40 people. At the time of our visit there were 28 people living at the home. The registered manager explained that although they are registered for up to 40 people the home can only accommodate a maximum of 31 people as some double rooms were being used for single occupation. The home was registered for adults with physical disabilities and older people. The majority of people living at Sussex Clinic at the time of the inspection were older people but there were also some younger people. The ages of people ranged from 37 to over 90 years old.

The home 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. Accommodation is arranged over two floors with a lift and stairs connecting all floors. The home is located in a residential area on Worthing.

Care provided was not always responsive to the needs of people living at the home. The social needs of some younger people were not always supported. Some people who were living with dementia did not have meaningful activities to occupy and stimulate them. We identified this as an area of practice that requires improvement.

People received their medicines safely however some poor practice in the administration and recording of medicines and inconsistencies in labelling of topical creams were identified as areas of practice that requires improvement.

Staff understood how to keep people safe from harm and abuse and risks to individuals were assessed and managed. People told us they felt safe. One person said, “I feel safe because there’s always someone around.” There were sufficient numbers of staff on duty to keep people safe. The provider had a robust recruitment system to ensure that staff were suitable to work with people.

People told us they had confidence in the staff. Their comments included, “They definitely know what to do,” and “I think they are well trained.” Staff told us that they had access to the training and support they needed and records confirmed this. Communication within the home was good and staff were clear about their responsibilities when on shift.

The registered manager had ensured that the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff understood their responsibilities with regard to seeking consent from people before providing care.

People told us they had access to health care services when they needed it. A visiting health care professional told us that staff were proactive in contacting them and seeking advice when needed.

People told us they enjoyed the food at Sussex Clinic. One person said, “It’s magic, I’ve only had one meal I didn’t like.” Risks associated with people’s nutritional and hydration needs were identified, monitored and managed. People who needed support to eat and drink were provided with help in a patient and sensitive way by the staff.

Staff had developed positive relationships with people and knew the people they cared for well. People told us that the staff were kind and caring. One person said, “I have nothing but praise for the staff here; they are all very kind and very nice.” For a number of staff English was not their first language. People told us, and we observed that, communication was sometimes difficult. The registered manager told us they were supporting these staff to improve their English skills and there were always experienced, familiar staff on duty to ensure the impact was minimised for people living at Sussex Clinic. People confirmed that this was the case.

People told us that their views were listened to and they felt respected by the staff. They said that staff protected their dignity and maintained their privacy and we observed examples of this throughout the inspection. One person said, “Staff always knock on the door,” another said, “They make sure my door is shut before attending to me.” People knew how to make a complaint and said they would feel comfortable to do so.

People and staff told us that they felt the home was well run and that the management team were approachable. There were robust systems in place to check the quality of the service and to provide effective governance. The registered manager used a range of audits and ensured that actions were taken to make improvements when issues were identified. There was a clear plan for developing the service going forward. This included improving the care plan format to become more person centred and to update the provider’s policy and procedures. The provider told us that a redecoration programme was underway to improve areas of the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We spoke with five residents, the owner, one registered nurse and two care staff. We reviewed five people's care records, including the notes made by staff on a daily basis.

We found that all compliance actions relating to care and welfare of people, safeguarding people from abuse and records had been met.

Our inspection was undertaken by one inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People's needs were assessed and care and treatment was usually planned and delivered in line with their individual care plan. However, whilst risks had been assessed within the care plans, these had not always been regularly reviewed. This meant that changes could not be made to the care plan to ensure that people's most up-to-date needs were being met.

We saw that Sussex Clinic had a safeguarding policy in place, but staff we spoke with were unclear how to contact the local authority safeguarding team. In one person's care record, we saw that they had been assessed as being at high risk of malnourishment, but that their food and fluid intake was not being monitored.

A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There were sufficient qualified, skilled and experienced staff to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications have needed to be submitted , proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

Many people who used the service had a diagnosis of dementia and different levels of capacity. However, people's capacity and their ability to make decisions were not routinely assessed as part of their care plans. For example, we saw that one person's capacity had been assessed at the time of their admission two years ago, but had not been assessed since.

People we spoke with thought they were well looked after by staff. One person said, "It's jolly good actually". A relative told us their family member liked it and another said, "I feel so pleased (X) is here".

Is the service caring?

We observed that staff were interacting well with people at lunchtime and encouraged them to eat a little more. A relative told us that they "Couldn't fault" the staff and another said that staff treated their relative well.

People's care records were not always reviewed and updated on a monthly basis in line with the service's own policy. This meant that potential changes to people's care were not identified and could not be implemented.

Is the service responsive?

People we spoke with told us they were well looked after by staff. One person said, 'It's jolly good actually' and another said, 'Very good actually, I've no complaints'. A relative told us that their family member liked it saying that they were 'happier here' than where they were before. Another relative said, 'I feel so pleased (X) is here'.

Is the service well-led?

We were told that relatives and people who used the service were asked for their views about the quality of care that was provided and the owner told us that a questionnaire had been circulated to relatives in April 2014. One relative said that they had enjoyed a cheese and wine evening that had been organised at Sussex Clinic.

When we asked to see copies of the questionnaire that had been sent to relatives, we were told that these were not available. The owner told us that some paper records had gone missing and had been removed from the premises. The owner told us that records had not been saved electronically as a back-up.

We saw that people's care records were not kept securely, but were on an open shelf in the manager's office. This meant that people's personal and confidential information was at risk of being misappropriated.

A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found two of the two issues identified at our last inspection in January 2013 had been attended to.

People told us that staff understood their needs and provided appropriate care and support. One person told us 'The carers are brilliant' and 'I love it here.' Another person said staff were 'Kind and caring.'

We saw there were systems in place to protect people from the risk of infection. For instance, staff told us that they had either recently completed their infection control training refresher course or were scheduled to take it. Additionally the sluices had been attended to and foot operated clinical and domestic waste bins were provided in all areas.

We saw that the provider had an effective system in place to monitor staff training. The training records were up to date.

The provider had systems in place to regularly assess and monitor the quality of service people receive by speaking to visitors and issuing questionnaires and staff were encouraged to raise any concerns.

People told us that they were happy in the home. They said staff were polite nice and friendly. One person said 'I cannot speak to highly of the staff they are very good.'

We saw that care workers were considerate in the way they provided care and support. People spoke highly of the care and treatment they received and told us their needs were adequately addressed. The people we spoke with told us they were very happy in the home and told us the staff were kind. One person told us 'I would recommend this home to anyone; they couldn't do anything any better.'

During our inspection we identified several potential infection control risks. These put people living in the home at risk of infection, contamination and cross infection.

The provider was not able to evidence that all staff working in the home were up to date with their mandatory training.