Sussex House Care Home

Sussex House is a residential care home providing personal care to up to 24 people. The service provides support to people who have mental health conditions. At the time of our inspection there were 22 people using the service. Sussex House accommodates people in one building over three floors.

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

Medicine practices were not always in line with best practice guidelines.

People received the care and support, however, staff did not always have time or were not always able to respond to people’s presenting or changing needs.

A system was in place to monitor the quality and safety of the service, however this was not always effective in identifying and addressing issues.

People had support from safely recruited staff. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. People and staff spoke positively about the management of the service. Staff continued to receive guidance and support from management when required.

Care plans included risk assessments for known risks and staff followed support plans to help keep people safe. Care plans were up to date, risk assessments were in place and regularly reviewed. People were regularly asked their views on the service provided and action had been taken when suggestions were made.

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.

The home was clean and tidy and additional cleaning processes had been implemented to prevent the risk of spread of infection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections

At the previous two inspections, we made recommendations the provider sought advice and improved their quality assurance systems. At this inspection, the provider had failed to take action and we continued to find concerns with the quality assurance systems. The auditing systems in place had failed to identify concerns with medicines, staffing and documentation.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, medicine management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also 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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sussex House is a residential care home providing personal care to 21 people who have mental health conditions. The service can support up to 24 people. The care home accommodates people in one building over three floors accessed by stairs and a lift.

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

At the last inspection, we made recommendations to improve the quality assurance processes, care planning and risk assessments. We found improvements had been made to care plans, risk assessments and most aspects of the quality assurance process.

However, there were no systems in place to monitor low level reporting to the local authority safeguarding team or when notifications required submitting to the Care Quality Commission. We have made a recommendation about continuing to improve systems to monitor this.

The provider had failed to notify us of some incidents they are required to by law. This is being addressed outside of the inspection process.

Local authority safeguarding procedures had not always been followed. Staff were aware of how to recognise safeguarding concerns. Steps had been taken to keep people safe and minimise risks to people’s safety. People received their medicines as prescribed, although there were some recording shortfalls.

Systems were in place to recruit staff safely. Further staff were being recruited to accommodate a need for an additional staff member in the evening. Staff felt supported in their role and received training to equip them with the necessary skills for their role. Staff supported people to access healthcare and maintain a nutritious diet.

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.

Staff treated people with respect and interacted with people positively. People were supported to maintain their independence and their privacy and dignity were respected.

People’s care plans were kept up to date and reflected their individual needs and circumstances. Staff recorded people’s care electronically, so this could be monitored in a timely manner. People were supported in line with their preferences and supported to engage in social and leisure activities. People told us they were able to raise complaints, and these would be addressed.

People and staff told us the registered manager was approachable. Staff felt there was an improved team morale and positive culture within the service.

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 21 May 2018). 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

Since the last inspection we recognised that the provider had failed to notify us of other incidents. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

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.

Sussex House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides support for adults who have mental health conditions and accommodates up to 24 adults. At the time of our inspection there were 21 people whose needs were predominately mental health, using the service. The service offers a range of ensuite rooms over three levels. There are also two communal lounge areas, a dining room, an activities room, a kitchen, bathroom and toilet facilities, independent skills kitchen area and outdoor courtyard.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some areas of the environment posed a potential risk to people. These included, a bottle of cleaning fluid left on the kitchen hatch and a box of disposable gloves left out in a bedroom, accessible to people who used the service, without any risk assessments in place to mitigate these risks. Individual risk assessments did not always identify the level of support people required. We have made a recommendation about risk assessment and management.

People who used the service had an assessment of their needs, risk assessments and a care plan. There was an inconsistency in the care files with some people having informative care plans for specific areas, whilst others contained less detailed information. The registered manager was in the process of transferring care plans to a new format which contained more detailed information. Similarly, we found that although risk assessments were completed, they did not always identify the level of support people required. We have made a recommendation about updating the information in care plans. The service was undergoing a refurbishment. The provider shared with us further plans to provide a kitchenette for people to practice their independence skills and refurbishment of the garden.

There was a quality monitoring system in place, which consisted of audits, checks, surveys and meetings. This was not fully effective in identifying the issues we found. We have made a recommendation about this.

Staff had completed training and knew how to safeguard people from the risk of harm and abuse. Medicines were managed safely and administered to people as prescribed.

Staff were recruited safely and in sufficient numbers to meet people’s needs. Staff had access to induction, a range of training, supervision and support. This provided staff with the necessary skills when providing support to people.

Staff had a kind and caring approach. They knew people’s needs very well and supported them to maintain independence, privacy and dignity. Staff supported people to make decisions in order to maintain their human rights. They ensured that when people lacked capacity, they included relevant people in best interest decision-making.

People’s health care needs were met and they had access to community health care professionals when required. The registered manager and staff team had developed good working relationships with health colleagues. This had resulted in planned discussions about treatment options. People’s nutritional needs were met. Menus provided them with choices and alternatives. Staff contacted dieticians and speech and language therapists when they had concerns.

There was a range of meaningful occupations and activities for people to participate in and planned visits to local facilities provided.

The provider had a complaints policy and procedure and staff knew how to manage complaints. Relatives told us they felt able to raise concerns if required. All of the people and relatives we spoke with described an open culture and accessible management.

The service provides support for adults who have mental health conditions. The service offers a range of en-suite rooms over three levels. There are also two communal lounge areas, a dining room, an activities room, a kitchen, bathroom and toilet facilities, independent skills kitchen area and outdoor courtyard space. The service was in the process of having a new passenger lift installed at the time of our inspection.

The inspection took place on 2 February 2016 and was unannounced. The service was last inspected on 20 December 2013 and the registered provider was meeting all of the regulations we assessed. At the time of our inspection the service had a registered manager in post.

A registered manager is a person who has registered with the 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.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to recognise and report potential abuse. Risk assessments were in place to guide staff in how to support people appropriately and minimise risks. People lived in a safe, clean environment where the equipment used was regularly checked and serviced.

The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) and we saw that applications, where required, had been submitted in respect of people being deprived of their liberty. During our inspection, we found that staff had been recruited safely and appropriate checks had been completed prior to them working with vulnerable people.

Staff had a good knowledge and understanding of the needs of the people they were supporting. Staffing levels were adequate and there was a training programme in place to ensure staff were equipped with the knowledge and skills required to carry out their role effectively. Not all staff had received mental health awareness training but the registered provider had measures in place to ensure all staff at the service would complete this by June 2016.

Medicines were managed, stored and administered in a safe way. People’s mental and physical health and nutritional needs were met and they accessed professional advice and treatment from community services when required. Positive interactions were observed between staff and the people they cared for.

People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. People and staff were relaxed throughout our inspection. There was a friendly environment and people told us they enjoyed living in the service. Positive relationships between people and the staff team had developed and staff demonstrated kindness and compassion towards people.

The service had a number of activity resources for people to use but we saw limited activities taking place during our inspection. There was no structure or activities programme in place at the service. We recommended the service reviewed this to encourage and increase activity participation.

People were supported to maintain relationships with their families and friends. The service was well managed and the registered provider undertook regular audits to ensure the service was safe. The registered manager and deputy care manager promoted an open-door culture and staff told us they felt well-supported working at the service. People who used the service and their relatives were encouraged to give feedback on the service to help make improvements or changes to practice.

One person's relative told us, 'I work in the care industry and I couldn't find better care for my mum.'

We noted people's care plans stated their food preferences. One person's care plan stated, 'The staff know my likes and dislikes and they offer me the food that I like.'

We were present whilst lunch was taken. People told us the food served was appetising. Comments from people who lived at the home included: 'The food is ever so nice; plenty of it' and 'I like the meals here, they are lovely.'

We looked around the home and observed a high overall standard of cleanliness. One relative told us, 'I think they do really well with the cleaning; it's very clean.'

We observed members of staff wearing personal protective equipment (PPE) when carrying out tasks around the home. One person who lived at the home told us, 'Yes, they always put fresh gloves on and wear aprons when they tend to me.'

People looked relaxed in the company of the staff. One person told us, 'The staff are really good, they go out of their way to help you out.' Another person commented, 'No problems with the staff; they're great with me.'

We asked people at the home if they were able to make complaints and how these were managed. One person said, 'Yes, I know how to complain but I wouldn't need to.'

We found there was information for staff to follow which ensured people received the care they required and their needs were appropriately met. People who used the service told us they were involved with their reviews and they attended meetings about their care.

We found that people's medication was administered and stored safely and staff had received medication training.

We found that recruitment procedures and practises ensured people were not exposed to any employees who should not be working with vulnerable adults.

We found there were systems in place which ensured people had a say about how the home was run and also considered the views of others who might have an interests in the care people received, for example health care professionals and relatives. People told us they were asked about the running of the home, comments included 'Yes we have meetings', 'We can talk to the manager if we have any concerns' and 'I feel I can talk to any of the staff they're all lovely.'