We inspected Ash Grove Care Home on 5 and 6 February 2018. The inspection was unannounced. The home has been inspected four times since 2014. At the inspections of December 2014 and July 2015, it was rated as inadequate and a range of breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. Following these inspections the CQC took enforcement action in accordance with its procedures. An inspection took place in April 2016 where we found improvements had been made and the home was rated as requires improvement. However despite these improvements, we continued to find three breaches in Regulations.

At a further inspection, which took place in May 2017, we found there were still breaches of three regulations. Risks to people were not always safely managed in relation to pressure damage and their health needs. Protocols for people who had been prescribed ‘as required’ medicines were not always in place. There were not always enough staff working to support people safely. Concerns had been identified through the quality assurance system, however, these had not all been addressed. People’s records were not always up to date and did not reflect their current needs. We also identified areas of practice that required improvement to ensure people were consistently supported in a dignified manner, and that people had enough to do during the day. The home was rated Requires Improvement and CQC took enforcement action in accordance with its procedures. The home was also placed in ‘special measures.’

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, and confirm that the service now met legal requirements. We found there were no breaches of regulation and improvements had been made in the required areas. The overall rating for Ash Grove Care Home has been changed to ‘Good’. We will review the overall rating of ‘Good’ at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

Ash Grove Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ash Grove Care Home provides accommodation and personal care for up to 30 people in one adapted building. At the time of the inspection there were 14 people living there. People living at the home were older people, some of who were living with dementia. They had a range of needs associated with old age and their health.

There was no registered manager at the service at the time of the inspection. However, there was a manager working at the home and responsible for the day to day running of the service. They had commenced the registration process with the Care Quality Commission and their registration was confirmed the week following this inspection. 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 found significant improvements had been made and the provider is now meeting the regulations. However, time is needed to fully embed these improvements into everyday practice and ensu

This inspection took place on 23 and 30 May 2017. It was unannounced. The home is registered to provide care and accommodation for 30 people. There were 13 people living there when we inspected. People cared for were all older people who were living with dementia, some of whom could show behaviours which may challenge others. People were living with a range of care needs, including arthritis, diabetes and heart conditions. Most people needed some support with their personal care, eating, drinking and mobility

Ash Grove Care Home had changed its name since the last inspection; it was called Woodville Rest Home. The home is a large domestic-style house which has been extended. People's bedrooms are provided over three floors, with a passenger lift in-between. Single story accommodation is provided in an extension to the rear. There is a sitting/dining room on the ground floor.

There was a registered manager in post. They worked part-time at Ash Grove Care Home and were also the registered manager of another care home which is owned by the provider. 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. The provider for Ash Grove Care Home is Pages Homes Limited. They own one other care home, also in Bexhill on Sea.

The home has been inspected three times since 2014. At the inspections of 30 December 2014 and 2 January 2015, and 21 and 24 July 2015, it was rated as inadequate and a range of breaches in regulations of the HSCA 2008 (Regulated Activities) Regulations 2010 and 2014 were identified. Following these inspections the CQC took enforcement action in accordance with its procedures. The last inspection took place on 5 and 6 April 2016. At that inspection the home was rated as requires improvement, and the provider had made considerable progress to address the breaches identified at previous inspections. However despite these improvements, we continued to find three breaches in Regulations. Following the last inspection, the provider and registered manager have been in regular contact with the CQC to advise us of progress towards meeting the requirements of Regulations.

At this inspection, we found the provider and registered manager had not been successful in making all relevant improvements.

At the last inspection, people’s safety was not always ensured. By this inspection, some areas relating to people’s safety and risk, including risk of infection, had not been ensured for all people. Other areas had been addressed, including appropriately supporting people who were at risk of falling.

Audits continued to be developed at this inspection, however some areas relating to people’s health and well-being had not been identified and some records continued not to be completed. Although the provider aimed to ensure adequate staffing levels to meet people’s needs, they had not identified they were regularly not achieving these staffing levels. This could have put some people at risk to their safety and welfare.

Training and supervision systems were being developed at the last inspection, but not all areas had been fully actioned by this inspection, including training staff in certain key areas to meet individual people’s healthcare needs. Training and supervision had been further developed in other areas.

At the last inspection, management of medicines had much improved and only one area needed to be addressed. By this inspection, this one area relating to ‘as required’ (PRN) medicines still had not been addressed.

Improvements had been made to support people with nutrition from the last inspection but people still did not consistently have the support they needed at mealtimes because there were not enough staff deployed at some meals.

A

This inspection took place on 5 and 6 April 2016. It was unannounced. There were 10 people living at Woodville Rest Home when we inspected. People cared for were all older people who were living with dementia, some of whom could show behaviours which may challenge others. People were living with a range of care needs, including arthritis, stroke and heart conditions. Some people needed support with all of their personal care, eating and drinking and mobility needs. The service also provided end of life care.

Woodville Rest Home is a large domestic-style house which had been extended. People’s bedrooms were provided over three floors, with a passenger lift in-between. Single story accommodation was provided in an extension to the rear. There were sitting/dining rooms on the ground and third floors. The sitting/dining room on the third floor was not being used because only 10 people were living at the home. There was a wheelchair accessible enclosed patio/garden area to the rear.

A new manager had been in post for four weeks at the time of the inspection. The previous registered manager left during the autumn 2015. A prospective manager had been appointed after the previous registered manager left, but they had not remained 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 2008 and associated Regulations about how the service is run.

Woodville Rest Home was last inspected on 21 and 24 July 2015. It was rated as inadequate after that inspection and the CQC took enforcement action. Following the inspection, the provider sent in an action plan. In this plan they outlined how they would address breaches in regulations and stated that all areas would be addressed by 31 March 2016.

The provider had made considerable progress to address the breaches identified at the previous inspection.

At the last inspection, people were not always treated with dignity and respect. Some matters still needed to be addressed. Some care workers did not support people in an individual way, including not taking appropriate action when a person may have been in discomfort, and not consistently interacting with people in an approachable way. Other care workers showed a respectful, kindly approach towards people. The new manager reported they were aware of the variance in approach between different care workers and they were taking action to address matters.

At the last inspection people’s care was not provided in an appropriate way to reflect their needs and preferences. Appropriate assessment of people’s needs were not carried out and care was not designed to meet their needs. This included planning people’s care with relevant healthcare professionals and having regard to their nutritional and hydration needs. The provider had taken action, and only some areas still needed to be addressed. The new manager had introduced a new system for assessment and care planning, they were about half way through this process of re-writing people’s care plans. The older systems were not always effective, for example in relation to people’s continence needs. The new systems showed improvements, with person-centred assessments and care plans, for example where people had dementia care needs. People’s dietary needs were now fully assessed and where risks were identified, care plans which care workers followed, were in place. Effective systems had been developed to ensure people were supported by external healthcare professionals.

At the last inspection, staff did not have appropriate training and support to meet people’s needs. Action had been taken but the new manager had not been in post long enough to ensure all areas had been addressed. This included ensuring all staff were trained in supporting people who were living with dementia

An adult social care inspector carried out this inspection. At the time of our inspection the service provided care and support to 25 people.

We spoke with people who used the service and three visiting relatives. We spoke with five staff members this included the registered manager and deputy manager.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led.

At the time of our inspection the service provided care and support to 23 people. We spoke with a number of people who used the service. Many were not able to tell us about their experiences of living at the home because of their complex needs. However, three people were able to provide feedback to us on the care and treatment they received.

We also spoke with two visiting relatives and four staff members, this included the registered manager. Following the inspection we contacted a health care professional who visited the home on a regular basis.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was clean and well maintained. We saw that services had the necessary checks carried out. Risk assessments were in place to provide information to staff to help minimise the risk of any harm to people.

Staff told us that there was enough staff and they felt well trained in the work they undertook. We noted that the recruitment practice followed by the home was not always robust.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were able to describe when a DoLS had been put in place in the past and why this had been used. Staff had been trained to understand when an application should be made, and the manager knew how to submit and review one.

Is the service effective?

We saw individual plans of care were in place. There was evidence to confirm that each person had their needs re-assessed on a monthly basis.

People and their relatives told us that the care provided was appropriate and met people’s needs. Discussion with staff confirmed that staff knew and understood people’s individual care and social support needs.

Training records seen confirmed staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and caring staff. We saw that staff were very kind and polite and gave people time when supporting them.

Our observations confirmed that people were encouraged to be independent but were helped when they needed any support.

Is the service responsive?

Individual care plans were developed for each person following admission. People were given choices. People had access to activities and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw that a number of quality assurance processes were in place. These included feedback from people who used the service and their representatives.

The home had a registered manager who had returned from maternity leave the month prior to this inspection. There was a deputy manager and a team of senior care staff. Staff told us they were clear about their roles and responsibilities. Senior care staff worked in the home alongside more junior staff to lead and guide. Staff said they were kept up to date with any changes as required and felt the home had a supporting team.

We carried out this inspection at Woodville Rest Home to follow up on information that we had received about the care and support provided at the home.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs, which meant they were not able to tell us their experiences.

We examined five care plans. We found that there were inconsistencies in the information recorded, and the way records were kept.

We reviewed the home’s recruitment procedures and found that they were not effective.

We looked at the staffing rota and found that there were not enough staff, with the appropriate skills and experience, to meet the needs of people living at the home.

We spoke with three people during our inspection. One person told us, “It’s very nice here.” Another person said, “I like it here, but don’t like jigsaws.” We spoke with staff, one staff member told us, “The home is great to work in, the new lounge is ideal for people.” Another said, “The staffing levels are good, we have a good team and don’t use agency staff.”

We found at this inspection that the management team had reviewed staffing levels against the environment and people’s dependency levels. There were enough qualified, skilled and experienced staff to meet people’s needs.

We spoke with two people during our inspection. One person told us, “It’s so comfortable here.” Another person said, “I’m very happy.”

We observed four people and reviewed the records of their care to help us understand their experiences. We saw that staff were attentive and reassuring when caring for people. There was a calm and relaxed atmosphere at the home.

We saw that there were processes in place to ensure that people’s consent was sought and respected. We saw that people were offered choices and their preferences acted upon.

We observed the administration of medicines and found that safe practices were in place.

We saw that people were protected by effective recruitment and selection processes. There was a consistent level of staffing in the home. However, there were insufficient staff available at night due to the new layout of the home and the increased number of people living there. There were training programmes in place and staff felt supported to meet people’s needs.

There was an effective complaints system in place which showed that the home improved its practice based on the feedback received.

We spoke with the manager and one member of staff during our inspection.

We looked around the home to see the ways that people who used the service were being kept safe during the building works that were taking place.

We found that there were appropriate risk assessments and daily checks in place. Arrangements were in place to ensure that people had freedom of mobility in the home and that their safety was maintained.

We spoke with staff who told us how they ensured that people were looked after during the changes that were taking place. We observed that staff were keeping people entertained in the lounge area.

We spoke to three of the 15 people who use the service they all told us they were happy living in the home. One person told us, "It's like being at home." Another person told us, "I like it here." One person said the home was "Fantastic." We also spoke to one carer who told us they had "Every confidence" in the way the staff looked after their relative.

People told us they were given choices about their care and treatment and were looked after in a respectful way. They told us they had the freedom to choose what they wanted to do and when they wanted to do it. We observed that staff were respectful and caring when assisting people with their needs. We saw that staff responded promptly and sensitively to requests for help. People told us they felt safe living in the home and were well looked after by staff who had the skills to do their job.

We looked at the systems and processes the home had in place to ensure that standards of quality were reviewed and maintained. These processes helped to keep people safe and ensured that a quality service was provided. We also looked at the arrangements in place to ensure people's safety during the building works taking place in the home and identified some areas for improvement.

This inspection took place on 21 and 24 July 2015. It was unannounced. There were 20 people living at Woodville Rest Home when we inspected. People cared for were all older people who were living with dementia, some of whom could show behaviours which may challenge others. People were living with a range of care needs, including arthritis, stroke and heart conditions. Many people needed support with all of their personal care, eating and drinking and mobility needs. The registered manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.

Woodville Rest Home is a large domestic-style house which has been extended. People’s bedrooms were provided over three floors, with a passenger lift in-between. Single story accommodation was provided in an extension to the rear. There were sitting/dining rooms on the ground and third floors. The sitting/dining room on the third floor was not being used because the home was not up to capacity. There was a wheelchair accessible enclosed patio/garden area to the rear. Woodville was situated in a residential street in Bexhill on Sea. The provider for the service was Pages Homes Limited who also owned another care home in the vicinity.

Woodville Rest Home had a recently appointed a registered manager. The previous registered manager left Woodville Rest Home in the Spring of 2015. The new registered manager had previously been the registered manager for Pages Homes Limited’s sister home. 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.

Woodville Rest Home was last inspected on 30 December 2014 and 2 January 2015. They were rated as inadequate at that inspection. The Care Quality Commission (CQC) issued two Warning Notices after the inspection in respect of care and welfare of people and assessing and monitoring of the quality of the services. The provider sent us an action plan which detailed when different areas would be addressed. This stated all matters would be addressed by 27 May 2015.

We found the provider had not met the Warning Notices or addressed their action plans by their due dates.

As at the last inspection, the provider was not consistently ensuring people’s care needs were assessed or met, including supporting people who were living with dementia, people who were at risk of pressure wounds and people who had continence needs. The provision of activities had increased but activities provided did not take account people’s individual diverse care and support needs.

We continued to find some people showed weight loss and were at risk of dehydration, but relevant care plans were not in place or relevant external professionals contacted. Also where people had seating and mobility needs, relevant healthcare professionals were again not contacted so people received the support and equipment they needed.

People’s privacy and dignity was not consistently respected to ensure their basic needs were met, in an appropriate way. Communal use of certain clothes continued.

As at the last inspection the provider did not have safe systems to ensure a hygienic environment to prevent risk of spread of infection. There continued to be a lack of hand washing and drying facilities in some areas. Some equipment and furnishings were not clean, including people’s easy chairs and shower seats.

People were still not protected by the provider’s systems for administration of medicines. There were unsafe systems for the storage of prescribed skin creams and a lack of information about their use. There continued to be administration of some prescribed medicines which were out of date.

At the last inspection we saw staff had not been trained in a range of areas, including the safe moving and handling of people and principals of infection control. At this inspection staff were not all trained in infection control and although staff had been trained in the safe moving and handling of people, this had not been embedded and again we observed unsafe ways of supporting people to move.

Although we had issued a Warning Notice after the last inspection about assessing and monitoring the quality of services, the provider had not identified a range of areas to ensure people were safe and areas for action were not identified and acted on. This included where people may be at risk from others or from the home environment. Differences between what people’s care plans stated and how care workers carried out care had not been identified. There was a lack of auditing of the systems for monitoring of the external cleaning contractors.

The provider did not have systems for the monitoring of informal concerns raised by people, so was not aware of some issues. However there were effective systems for formal complaints, which were being followed.

Some of the past recruitment systems had not ensured all relevant checks on prospective staff were undertaken to verify they were safe to provide care to people. The registered manager reported they would take action to ensure these matters were addressed.

However, the provider had taken action since the last inspection in a range of areas. They had invested in more equipment to support people with moving, which care workers were positive about. Plans were being developed to make the home environment more supportive for people who were living with dementia. The provider had identified many of their policies and procedures needed up-dating and development, they had contracted with an external company to do the necessary work.

The new registered manager had reviewed staff training needs and was working to ensure all staff were appropriately trained. This included making sure all staff were trained in awareness of how to support people who may be at risk of abuse, and their responsibilities under the Mental Capacity Act (MCA). Staff knew about actions to take if they thought a person was at risk of abuse and were aware of the plans to ensure they were trained in the MCA.

People and staff felt staffing levels had improved. This was partly because the provider had kept staffing at the same levels for when the home was full.

Some people were supported in the way they needed in their daily lives, including during mealtimes and when involving them in activities. Staff were consistently polite and friendly to people when they supported them.

Staff reported on the improvements in the service. They said the training provided had supported them more in their role. They felt the new registered manager was involving them more and providing an open atmosphere in which they could work to support people.

We found a number of 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

CQC are taking enforcement action to ensure that Pages Homes Limited provide safe and effective care.