We inspected Arundel Park Lodge on 29 November 2016. The inspection was unannounced.

The home provides residential care for up to 30 people. People required support with their personal care and had additional nursing needs including frailty associated with old age and poor mobility. Some people were living with dementia.

Arundel Park Lodge is a detached art deco style property situated in Saltdean. There are two communal lounges and dining room and well-maintained gardens. The home is one of two locations owned and run by Whytecliffe Limited.

As part of this inspection, we checked what action had been taken to address the breach of legal requirements we had identified at our last inspection on 8 September 2015. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection we found improvements had been made and sustained and the breach previously identified was addressed.

There was a registered manager in post. 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.

We saw that regular meetings with residents and their relatives had not taken place. This was a missed opportunity to ask questions, discuss suggestions and address problems or concerns with management. Feedback had been sought from people and their relatives in the 2016 questionnaire. However, residents and relatives meetings had not been held on a regular basis to provide a forum for people to raise concerns and discuss ideas. One person said, “My views have not been asked of before but I think the home is well managed.” We have identified this as an area of practice that needs improvement.

Care plans reflected people’s assessed level of care needs and care delivery was person specific. For people with specific health problems, there was guidance in place for staff to deliver safe care and treatment. We were told, “[My relative] has dementia and now needs nursing care. They are safe and well looked after here. The home have smoothed the way in the whole process. Mum is safe and happy.” There were sufficient suitably qualified and experienced staff to deliver care.

People’s medicines were stored safely and in line with legal regulations and people received their medicines as prescribed.

The provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Staff were following the principles of the MCA. Consideration was made of people’s ability to make individual decisions for themselves, as required under the MCA Code of Practice.

People and visitors we spoke with were complimentary about the caring nature of staff. The delivery of care was tailored to individual choice. Care plans had sufficient information on people’s likes and dislikes and information about people’s lifestyle choices was available for staff. The provision of meaningful activities positively influenced people’s well-being. A relative told us, “[Named relative] never wants to come out of their room but they still offer the opportunity and encourage participation. There’s a lot going on for those that want it.”

People and their relatives were complimentary about the meal service at the home. One person said, “The food and drink I get here is perfect. It’s cooked well, tastes nice and a good variety. I do need support to eat and drink as I am unable to hold anything,” The dining experience for people was social and enjoyable. People were supported to eat and drink enough to sustain their health and well-being.

Quality assurance systems were in place. Incidents

We spoke with a range of staff including the registered manager, care workers and head of housekeeping. We talked with four residents and three visitors to the service, we used a structured observation tool to help us better understand the experience of people who could not speak with us and looked at records to help us understand the experience of people who used the service.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One care worker told us "We have some residents who have struggled to make choices. We still ask them and as far as possible give them choices."

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Staff told us that they knew people well and were aware of their needs. One care worker we spoke with told us "I can’t imagine or would want to work anywhere else. I can see just how important it is to care for people." People were registered with a GP and had access to a range of healthcare professionals.

We saw that they had appropriate systems and policies in place in respect of cleanliness and infection control. The home appeared clean and well maintained.

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

Staff records and other records relevant to the management of the service contained relevant information and were fit for purpose.

During our visit, we found that people living in the home appeared settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

We were told that, in accordance with their identified wishes and individual support plans, people were encouraged and enabled, as far as practicable, to make choices about their daily lives.

The inspection took place on 8 and 9 September 2015.

Arundel Park Lodge is a care home with nursing for up to 30 older people that require support and personal care. People maybe living with conditions associated with advancing age, including dementia. The home is located in Saltdean and is one of two provided by Whytecliffe Limited.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

Not everyone could tell us of their experiences, but those that could spoke positively of the home and commented they felt safe. People had confidence in the staff to support them and we observed positive interactions throughout our inspection. Our own observations and the records we looked at found some concerns. A person was not supported to eat and drink in a safe manner following the guidelines set out by a health care professional. We also found cross infection risks identified in two areas. Staff did not have the opportunity to wash their hands before leaving the staff bathroom because it lacked a hand basin. We looked at equipment used by people and saw that a commode was rusted and corroded.

Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

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

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) that applies to care homes. The registered manager had identified that applications were outstanding but had not made the appropriate applications as people’s needs changed. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People enjoyed the facilities that the home offered such as the lounges and garden. We saw the newly erected summerhouse provided with the help of a dementia funded grant. However, the environment had not made other reasonable adjustment for the many people living with dementia. The premises did not meet the needs of people living with dementia. There was a lack of signage to help people find their way around the building. There were no signs to identify bathrooms and other rooms in the home which may add to orientation for people with cognitive impairment. Corridors, walls, doors and rails were all well maintained but were painted in similar shades, when colour contrast is known to be helpful for people with dementia and others to help to distinguish borders.

People were not always listened to or provided with care that was suited to individual people’s preferences and needs. A radio played music during lunchtime, we asked people what they thought about the choice and were told, “It’s dreadful but it’s what the girls want.”

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.

Accidents and incidents were recorded appropriately and steps were taken by the home to minimise the risk of similar events happening in the future. Emergency procedures were in place in the event of fire.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. All staff received one to one meetings with their manager. Nurses received clinical supervision and formal personal development plans. Three monthly appraisals were in place for nursing and care staff.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals. People were able to give feedback and have choice in what they ate and drank and special dietary requirements were met.

People felt well looked after and supported and were encouraged to be as independent as possible. Health care was accessible for people and appointments were made with GP’s and therapists to maintain people’s health and welfare.

We observed friendly relationships between people and staff. One person told us, “One of the best things is the caring attitude of the staff’.” People told us the staff supported them to maintain their independence as it was important to them.

People could choose how to spend their day and they took part in activities in the home when they wanted to. Activities and opportunities for social engagement were offered throughout the week. One person told us, “We spend our time in the lounge, the [activities coordinator] comes in and does activities, quizzes and all that. She’s very good.”

People were encouraged to express their views. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, I tell the staff.” Another said, “The manager is approachable and makes time to talk.”

Staff were asked for their opinions on the service and whether they were happy in their work. Staff enjoyed their work. They felt supported within their roles and described a caring and ‘open door’ management approach. They described how management were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

We have identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.