Crowborough Lodge Residential Care Home

Crowborough Lodge Residential Care Home is a care home registered to provide residential care and accommodation for 31 people with various health conditions, including diabetes and frailty. There were 28 people living at the service on the day of our inspection. Crowborough Lodge Residential Care Home is a large converted property located in Saltdean, East Sussex.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. One person told us, “I have no worries about living here, I just love it”.

People felt their healthcare needs were met and they had access to professionals should this be required. One person told us, “If I want to see a Doctor, the person in charge organises it for me”.

People enjoyed an independent lifestyle and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “Food is nice and plenty of choice”. Another person added, “We went on a trip to Pevensey Bay last week to a three-course meal and it was fantastic. We do exercises on a Monday to help us keep our joints from stiffening up”.

People felt the service was homely and welcoming to them and their visitors. One person told us, “We have a life of luxury here, it’s pretty good”. People told us they thought the service was well managed and they enjoyed living there. One person told us, “I came here for respite several times over the last seven years, and so I knew it was the place I wanted to come to when I needed to move out of my home, as I was safe and well looked after every time I came here”.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care from dedicated and enthusiastic staff that met their needs and improved their wellbeing. A member of staff said, “The manager 100% listens to us. The residents are happy, they live independently, it’s whatever they want to do”.

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

Rating at last inspection: The last rating for this service was requires improvement (published 13 February 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any concerning information we may inspect sooner.

Crowborough Lodge Residential Care Home 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 bedrooms are single occupancy and people have access to communal shower rooms and bathrooms. Two passenger lifts are available for access to parts of the accommodation. The service has an enclosed garden at the back of the premises.

At the time of our inspection, 25 people were living at the service and one person was in hospital.

This was a full comprehensive inspection to see what improvements the provider had made to ensure they met regulatory requirements.

At our last comprehensive inspection of 15 and 21 December 2016, we had found that risk assessments and management plans were not effective in ensuring that people lived in a safe environment. In addition, the provider had not always followed appropriate recruitment procedures. The provider did not ensure policies and procedures were current and updated to ensure delivery of safe care. The quality assurance systems failed to identify and address areas for improvement.

At this inspection, we found the improvements made were not sufficient to ensure people received consistently high standards of safe and effective care. Policies and procedures were not reviewed which put people at risk of receiving care that did not meet legislation and best practice guidance. Staff records were not well maintained. Quality assurance systems were not robust in identifying and resolving the concerns we found. People who spent time in their rooms did not always have support to undertake one to one activities.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 underwent an assessment of the risks to their health and well-being. Staff followed guidance to support people in a safe manner. Staff administered and managed people’s medicines safely. The registered manager ensured staff learnt lessons from incidents and developed plans to minimise the risk of the event happening again. There were enough staff deployed to meet people’s needs.

People took part in the assessing and identifying of their needs before they started to use the service. Staff delivered care in line with people’s needs and preferences. People received care from staff who were supported in their roles. Staff underwent induction and attended supervision and appraisal to develop their practice.

Staff treated people with respect and dignity. Staff were kind and caring. People received care in a manner which maintained their privacy and confidentiality. People were involved in making decisions about their care. Staff ensured people had access to information they required about services available to them. People enjoyed positive caring relationships with the staff who provided their care.

Staff delivered care as planned to meet people’s needs and preferences. Staff carried out regular reviews of people’s health and delivered care that took into account their changing needs.

People enjoyed the food provided and had their dietary needs and preferences met. People consented to care and treatment. Staff delivered care that met the requirements of the Mental Capacity Act 2005. Staff ensured people who were unable to make decisions about their care received appropriate support to do so.

People were happy to share their views about the service. The provider acted on people’s feedback to develop the service. People knew how to make a complaint and felt the registered manager took their concerns seriously.

People and staff said the registered manager was available and approachable. The registered manager had positive working relationships with other agencies to develop the quality of care.

We have made one recommendation in relation to activities and found one breach of regulation in relation to good governance. You can see what action we told the provider to take at the back of the full version of the report.

Although the service had a registered manager this person had not worked in the home since August 2016 when they resigned. A senior carer had been appointed as the acting manager and confirmed they were in the process of applying for their registration with the CQC. 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.

Crowborough Lodge Residential Home was inspected in August 2015. We found the provider was in breach of a Regulation. Improvements were required to make sure risks to people’s safety were properly assessed and action taken to mitigate any risks identified.

This inspection took place 15 and 21 December 2016 and was unannounced. At the time of this inspection, 27 people were living in the home. This was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. We found improvements had been made. However, the provider had not identified, assessed and responded to all risks in the service, or ensured all health and safety legislation had been adhered to.

Thorough environmental and individual risk assessments were not in place and the provider had not fully responded to health and safety legislation to ensure the health and safety of people using the service. Risks to people’s safety were found in the service that included hot electric radiators, hot blow heaters and a fall hazard. Hoists used in the service had not been checked in accordance with health and safety legislation.

The recruitment process followed did not ensure all staff working in the service unsupervised had their character and suitability to work checked. This did not protect people from the risk of unsuitable people working with them.

Systems for effective management had not been fully established. The quality monitoring did not ensure safe and best practice was followed in all areas. The provider had not ensured the service’s policies and procedures were followed and embedded into practice. For example, the recruitment procedure had not been followed to ensure all the required checks were completed before a staff member worked unsupervised. The provider had not established clear lines of accountability within the service. People and staff had not been provided with up to date information on the management of the service and staff were not always provided with job descriptions and terms and conditions of employment to clarify roles and responsibilities.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service, and the approach of the staff. Visiting professionals were positive about the care and support provided. They told us staff worked with them to improve people’s health.

People told us they felt they were safe and well cared for at Crowborough Lodge Residential Home. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff had been trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The acting manager and deputy manager had an understanding of both and followed correct procedures to protect people’s rights. People’s Medicines were stored, administered and disposed of safely by staff who were suitably trained. People had the opportunity to take part in a variety of activities in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported ton maintain their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the acting manager and provider. On call arrangements were in place to provide suitable management cover.

People were very complementary about the food and the choices available. People needed minimal support with eating and staff were positive in their approach to promoting people’s independence. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home and this was promoted by the pleasant staff and visible acting manager and provider. Staff enjoyed working at the home and felt supported. Systems for receiving feedback from people and staff were in place and were being used to improve the service. People were encouraged to share their views though ‘residents meetings’ and satisfaction surveys.

We found two 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 this report.

We looked a sample of records, including the homes scheduled audit cycles, staff rota, cleaning logs.

We found that the people who used the service were protected from the risk of acquiring a health related infection. We spoke to the registered manager who explanted the steps taken by the service to address the shortfalls identified at the last inspection.

We found that the people who use the service had their health and welfare needs met by sufficient numbers of appropriate staff.

We spoke to four people who use the service and they told us they were very happy living at Crowborough lodge.

People's care plans were informative and recorded people's preferences. The people who lived in the home that we spoke with were happy with the standard of care provided. One person told us the staff are 'Good as gold'. Another person said 'It's an old person's home whichever way you dress it up, but it' marvellous'. A third person commented that 'Staff are very good. I get on with all of them'.

The provider had not made sure that people were protected from the risk of infection. Cleaning schedules had not been based on an assessment of people's individual needs and did not include all areas of the home and the home's equipment. Infection control audits had not been completed. Staff had been suitably trained in the prevention and control of infection. They had access to the equipment they needed to minimise the risk of the spread of infection.

The provider had made sure there had been appropriate arrangements in place to manage medicines. Medication administration records were accurate. People we spoke with told us that they had received their medicines on time. One person said 'The manager is very strict about that. I get mine four times a day, always on time'.

The provider could not demonstrate they had systems in place to make sure sufficient number of suitably qualified staff had been employed to staff the home at all times.

The provider had made sure there were systems in place to receive comments and complaints and they were responded to appropriately.

It was clear that care workers and other staff had a good understanding of the needs of the people living there and noted that they showed patience and understanding when interacting with and supporting people.

The people that lived in the home and the visiting relatives that we spoke with were happy with the care delivered. We observed that people were relaxed and comfortable with each other and with staff. In the morning, people were engaged in a range of activities such as listening to the radio, reading the newspaper and chatting to one another. In the afternoon we observed a group discussion about a forthcoming outing.

Visitors told us that they were welcomed into the home and confirmed that the home kept them informed about any changes in their relatives condition. Care records detailed visits to and from health care professionals.

People we spoke with told us the food was good and that they had a choice of food at each mealtime. They also told us they enjoyed participating in the afternoon activity sessions.

Staff recruitment procedures were safe and care workers had the knowledge and experience they needed to meet the assessed needs of the people living there.

Equipment in the home was well maintained.