Alfriston Court Luxury Care Home is located in the village of Alfriston, it has large gardens and onsite parking. It provides care and support for up to 27 older people with nursing and personal care needs. The care needs of people varied, some people had minimal support needs whilst others had more complex health care needs, including end of life care. Some people had nursing needs associated with increasing physical fragility and medical conditions and needed close monitoring of their health, including palliative care. Some people had limited mobility and were assisted with moving, others had additional needs associated with dementia. The home provided respite care for people wanting short stays in a nursing home. At the time of this inspection 21 people were living at the home.

This inspection took place on 13 and 19 October 2016 and was unannounced.

The service had a registered manager in place. 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 the last inspection, undertaken on the 28 and 29 July 2015, we asked the provider to make improvements to ensure all medicines were administered in a consistent and safe way. Improvements were also needed to ensure when people lacked capacity, appropriate processes were followed to ensure staff took account of their individual rights and care was provided in their best interests' The provider sent us an action plan stating they had addressed all areas identified for improvement. At this inspection we found the provider had ensured staff had guidelines to follow when administering medicines. Staff had a good understanding of gaining consent from people and ensuring if people lacked capacity suitable people were involved in ensuring people’s rights were protected.

Management systems that included quality monitoring did not always ensure safe and best practice was followed in all areas. Some care records were not complete and some care plans did not include all relevant information. The management systems did not ensure all required notifications were sent to the CQC and verbal complaints and concerns had been recorded. All safety checks including those on hot water had not been fully completed.

Although staff took account of people’s rights when providing care and treatment, some records did not evidence appropriate processes to protect people had been followed in all cases. Agency staff had not undertaken an induction and there was no evidence that the provider had checked they had the appropriate skills, before they worked in the service.

Feedback received from people, their relatives and visiting health professionals were positive about the care, the approach of staff and atmosphere in the Alfriston Court Luxury Care Home. People told us they were happy living in the service and liked the staff. People were looked after by staff who knew them well and took an interest in them as people. People were treated with kindness and with a caring approach. Staff understood how to support people, taking into account their individuality and dignity.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff were trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and knew the correct procedures to follow in order to protect people’s rights.

Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in a care home. People were supported to receive the medicines they were prescribed.

Staff were provided with a

During our inspection we spoke with five people who used the service. We also spoke with seven staff members; these were the registered manager, a nurse, two care workers, the receptionist, the relief chef and the activities co-ordinator. We also took information from other sources to help us understand the views of people who used the service, which included resident and visitor surveys.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us, "The staff are very careful, very kind and treat me with dignity and respect.” Another person who used the service told us, "The staff are very nice, very thoughtful and very kind.” Staff we spoke with had a good understanding of the support needs of the people who used the service. One member of staff we spoke with told us, "The staff here love the residents. People are treated as we would want to be treated ourselves.”

The people who use the service were supported to have adequate nutrition and hydration. People were given choices of food and drink to meet their diverse needs.

We saw that people who used the service, people who worked in or visited the premises were in safe and accessible surroundings.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their job.

The service had a system in place to effectively deal with comments and complaints.

People described the home as ''a happy home'' and told us that it was a ''good place to live''. One person told us “I feel very safe and can speak with the manager at any time if I have any concerns”. Another said “I like my own company and privacy and staff respect that”.

We saw that people were able to personalise their own accommodation. They told us how comforting it was to be able to have their personal items and belongings around them when they came into the home. One resident told us “staff are so patient in explaining things to me all the time which is good because I cannot always remember”.

We spoke with residents and relatives and they all made it very clear that people’s needs were being met. They told us that independence and individuality were promoted within the home. People told us that they would speak to their families or the manager if they felt unsafe or scared. We took the opportunity of talking to relatives who were visiting at the time of our inspection. They told us that staff were ''very relaxed, caring and professional''. They said that in their opinion the staffing compliment was about right. One relative told us “my mother is safe, well looked after, happy and most importantly adored by all the wonderful staff here - what more could I ask for”.

People were able to comment on how their choices were respected and talked about how they liked their privacy and that they chose to spend much of their time in their own rooms.

People living in the home said that they were consulted with about the care and services provided to them. People spoken to were very happy with the care provided and felt that it met their needs and expectations.

People spoken with liked the food provided and all complimented the standard of this provision and how it was presented. One person said that ‘the food is very nice’ and another said ‘the food is always good. One individual however did raise the concern that the food ‘could be hotter’.

People felt that the rooms were cleaned regularly and felt that the home was clean although one person said that ‘the cleaning had been hit and miss in the past’.

Everyone spoken with were happy with the laundry service which they called ‘quick and efficient’ and how their personal clothing was washed and returned to them.

One person shared that they were able to have a bath whenever they wished. All people spoken with said how much they liked their bedrooms and commented on the lovely views.

People told us that that they thought the home was short of staff and although replacement staff were used this affected the continuity of the staffing and therefore the care provided. People have had the opportunity to raise this concern with the customer service manager who has reassured that more regular stable staff are hoped for in the future.

Everyone however complimented the staff working in the home one saying they are ‘lovely’ and also confirmed that they were available when needed.

People said that they have been asked regularly for feedback on the how the home is performing. They said that they felt comfortable to do this and to raise any concern or complaint

Alfriston Court Luxury Care Home is located in the village Alfriston has large gardens and onsite parking.

It provides care and support for up to 27 older people with nursing and personal care needs. The care needs of people varied, some people had minimal support needs whilst others had more complex health care needs including end of life care. Others had minimal nursing needs that were associated with increasing physical fragility and medical conditions that were managed with support and close monitoring of people’s health, including diabetes. Some people had limited mobility and were assisted with moving and others had additional needs associated with dementia. The home provided respite care for people wanting short stays in a nursing home. At the time of this inspection 22 people were living at the home.

This inspection took place on 28 and 29 July 2015 and was unannounced.

The service had a registered manager in place. 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.

We found people’s safety was not always promoted. Some medicines were not administered in a consistent way. Guidelines to assist staff in the safe and consistent administration of medicines were not complete.

The staffing provision was flexible and responded to people’s changing needs, live in staff were available to respond to emergency situations at night. .

There was little evidence that people who lacked capacity had suitable processes followed to ensure staff took account of their individual rights and best interest.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Relevant guidelines were available within the service for all staff to reference. Staff at all levels had an understanding of consent and caring for people without imposing any restrictions.

All feedback received from people and their representatives through the inspection process was positive about the care, the approach of the staff and atmosphere in the home.

Recruitment records showed there were systems in place to ensure staff were suitable to work at the home. Staff had a clear understanding of the procedures in place to safeguard people from abuse.

Staff were provided with an induction and training programme which supported them to meet the needs of people. The registered nurses attended additional training to update and ensure their nursing competency.

People were looked after by staff who knew and understood them well. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. Care plans were personalised and reflected people’s individual needs and preferences. These were regularly reviewed. Risk assessments were in place to keep people safe. People had access to health care professionals when needed.

There was a variety of activity and opportunity for interaction taking place in the service. This took account of people’s physical and mental limitations and were based on what people enjoyed. Visitors told us they were warmly welcomed and people were in maintaining their own friendships and relationships.

People had their nutritional needs assessed and monitored and were supported to enjoy a range of food and drink throughout the day. Mealtimes were pleasant and relaxed occasions.

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be. A complaints procedure was available for people to use along with feedback forms.

There was an open culture at the home and this was promoted by the registered manager who was visible and approachable. Staff enjoyed working at the home and felt supported. Systems for quality monitoring were in place and were being used to improve the service. People were encouraged to share their views on a daily basis and satisfaction surveys were being used.

We found a breach 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.