Clifden House Dementia Care Service provides care and support for up to 59 older people most of who are living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with old age, mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. At the time of this inspection there were 53 people living at the home.

We carried out an unannounced inspection 16 and 17 June 2016 where we identified a breach in relation to Regulation 12 because people’s support needs in relation to fire safety had not been assessed. Following the inspection, we received an action plan that told us people’s individual needs had been assessed. At this unannounced inspection on 05 and 09 May 2017 we confirmed this and that people’s needs had been reviewed and updated as and when their needs had changed. The provider had therefore met this Regulation.

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 2008 and associated Regulations about how the service is run.

Record keeping in some areas of care planning was not accurate or up to date. Before our inspection the registered manager had identified some areas where this was the case, for example in relation to Deprivation of Liberty care plans. However, we recommended the registered provider continued to monitor that care plan documentation was continually reviewed and updated to ensure accuracy.

Each person had a personal emergency evacuation plan to be followed in the event of a fire or emergency. The home’s policy had been updated based on this and a detailed fire risk assessment had been carried out to ensure people’s safety.

A wide range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. External entertainers were provided on both days of our inspection with music to suit a range of tastes and interests. Throughout our inspection we observed people being offered a variety of activities, actively participating and showing that they enjoyed them. For those who liked a quieter life the gardens offered a secure and safe environment to take a stroll. The home kept hens and those who chose to, could assist in their upkeep.

There were safe procedures for the management of medicines. People had access to healthcare professionals when they needed it. This included GP’s, dentists, community nurses and opticians.

Staff had a good understanding of the Deprivation of Liberty Safeguards (DoLS) and knew that people either had or that applications had been made to have a DoLS. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

Staff had the skills and knowledge necessary to provide people with safe and effective care. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home. Staff received regular support from management which made them feel supported and valued. They were encouraged to develop their skills and take on additional responsibilities. For example, to be a ‘Champion’ in a particular area such as infection control, or the management of medicines.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. They supported people to enable them to remain as independent as possible. Staff showed that they understood how to assist people living with dementia through the use of good moving and handling tec

Clifden House Dementia Care Centre provides care and support for up to 59 older people living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. The care home provides some day and respite care for people living locally. On occasions staff can meet more complex care needs with community health care support including end of life care when required. At the time of this inspection 52 people were living at the home.

We carried out an unannounced inspection on 14 and 16 January 2015 where we found improvements were required in relation to the management of medicines, the documentation of complaints and in relation to the supervision and appraisal of staff. The provider sent us an action plan that told us how they would address these issues. We carried out this unannounced inspection 16 and 17 June 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that the provider had addressed the breaches found at the last inspection. However, we identified a breach in terms of fire safety.

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 2008 and associated Regulations about how the service is run.

There was no advice in care plans about how to evacuate people in an emergency or in the event of a fire. Fire drills were not recorded and whilst alarms were sounded regularly, and staff had regular fire safety training, the provider had not tested that staff knew what to do in an emergency situation.

There were mixed views about the culture of the home. Some staff, visitors and professionals said that there was an open culture and that they could raise any issues of concern. Others said communication with some of the management staff could be difficult. Most of the staff told us they were supported well and had regular opportunities to share their views on the running of the home. All complaints were documented and actions had been taken to address them.

There were safe procedures in place for the management of medicines. There were enough staff employed to ensure that people's needs were met. Staff received ongoing training and support, which included a mixture of online training and attendance at external training courses. They had access to health qualification training and specific training on caring for people living with dementia. There were safe recruitment systems to ensure that new staff were checked before starting to work in the home.

People told us they liked the food served and they could have an alternative if they did not want what was offered. Nutritional assessments were carried out to ensure that no one was at risk of malnutrition or dehydration. People were supported to attend health care appointments as needed. All visiting professionals told us the home was in touch with them if there was a concern about people’s needs. One professional told us, “We have regular contact with the home, and they contact us about residents who they are concerned about and the staff have been caring.”

Staff understood the principles of consent and the Mental Capacity Act (2005). Mental capacity assessments were in place and Deprivation of Liberty Safeguards (DoLS) had been submitted when required. Best interests meetings had been held if there was a concern that someone did not have capacity to make a decision. Staff had a good understanding of safeguarding; they were able to recognise different types of abuse and told us what actions they would take

Two adult social care inspectors 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 49 people.

We spoke with a number of people who used the service. Many were not able to express verbally their experiences of living in the home, but we observed people for interaction and signs of wellbeing.

We spoke with three visiting relatives and six staff members, this included the registered manager and activities co-ordinator. We also spoke with 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. However, we noted that some of the care documentation was not accurate or up to date.

Staff told us that there was enough staff and they felt well trained in the work they undertook.

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 care plans reviewed 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. However, this did not include feedback from people who used the service and their representatives.

The home had a registered manager who had been in post a number of years. There were allocated team leaders to manage each of the three zones in the home. The team leader was supported by senior carers. 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 them. Staff said they were kept up to date with any changes as required and felt the home had a supporting team.

We spoke with people who used the service, their relatives, and a range of care and nursing staff.

The improvements required to comply with the regulations in relation to records have been made.

We looked at a range of records within Clifden House and found they were kept securely and could be located promptly when needed. We saw people’s personal records including medical records, were generally accurate and fit for purpose. One relative of a resident said, “Their care plan is written down and I have been consulted about it. It looks at every aspect of their care.”

We spoke with relatives of people who lived at the home who told us that they were happy with the care their relatives had received. They told us that their relatives had been provided with the opportunity to socialise and participate in a range of activities that they enjoyed.

Care workers had a good understanding of the care needs of the people living in the home. We observed they attended to people's needs in a timely manner and showed patience and understanding when supporting people.

The improvements required to comply with the regulations in relation to the storage and administration of medicines had been made.

People were aware of how to raise concerns and make comments on the services provided. Complaints made had been responded to and investigated appropriately.

There were sufficient numbers of staff on duty to meet the needs of the people living in the home. However, the care workers were not allocated time to complete care records and the manager had no administrative support. The shortfalls in relation to records identified at the last inspection had not been addressed. We noted that not all the records maintained by the home were accurate, complete or fit for purpose. This meant that there was a risk that people had not been protected from the risk of unsafe or inappropriate care and treatment. Not all records containing personal information had been stored securely or kept confidential.

The Care Quality Commission received information of concern in relation to the level of care. We carried out this inspection to review the level of care in the home.

We spoke to 11 people using the service, five relatives, and one professional health worker. Some people had complex needs and were not always able to verbalise their experiences, so we observed the interaction between staff and other people closely.

Feedback from relatives and the visiting health professional was positive about the care and support provided at Clifden House. People who used the service made some positive comments about the care and staff working in the home. One person said, ‘’I am happy here they look after you really well. ’’One visitor said, ‘’The care here is very good and the food is exceptional.’’

We looked at the systems and processes in place for the safe management of medicines. We found that people were happy with how their medicines were given to them. We saw that care plans had information on the use of medicines. We found that there were some procedures in the service which did not follow safe practices with regard to medicine management.

We looked at records held in the home and how these were stored. Not all care records were up to date or reflected all the current needs of people using the service. We found that records were not always stored securely, or able to be located promptly.

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

Three regular visitors spoken with felt that they were involved and consulted about care provided as necessary and as appropriate. One person using the service said that they were treated well and that staff were respectful.

A visiting health care professional told us that staff were kind and respectful and that they promoted people’s privacy and dignity. They confirmed that the home worked with them to promote people’s health.

People spoken with said that they liked their own rooms and that the home was clean.

Four visitors spoken with were positive about the care and support provided by the home. People using the service told us that they were happy living in the home comments included ‘’I am well looked after’’ ‘’I like it here’’.

Visitors spoken with complimented the staff. One said that the staff were ‘’incredible’’.

Staff told us that they felt well supported by the management team. One staff member told us how much she enjoyed working at the home.

Residents spoken with were happy to talk and commented on the care saying ‘I like it here’ ‘everything is fine’ ‘the care is lovely’.

Residents spoken with said that they liked the food and that it was always good. One resident said that she was never given seconds.

Clifden House Dementia Care Centre is a detached property in Seaford a seaside town between Eastbourne and Brighton. It provides care and support for up to 59 older people living with a dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people’s needs were less complex and required care and support associated with mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. The care home provides some day and respite care for people living locally. On occasions staff can meet more complex care needs with community health care support including end of life care when required. At the time of this inspection 51 people were living at the home.

This inspection took place 14 and 16 January 2015 and was unannounced.

At the last inspection we found the service non-compliant with regulation 10 (2) and regulation 20 (1)(2) of the HSCA 2008 (Regulated Activities) Regulations 2010. Concerns were about the lack of systems to regularly assess and monitor the quality of service that people received and risks associated with a lack of accurate record keeping. At this inspection some improvements were noted but further improvements were required.

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.

Medicines were not always managed safely. Records were not always accurate and systems did not ensure that variable dosage medicines were given as required. Some prescribed medicines were not available as required. This meant that medicines were not always given in accordance with prescriptions.

Staff did not receive regular supervision and appraisal, therefore, there was no system to review and monitor staff performance and development of skills.

Written and verbal complaints were not always responded to in a timely and proactive way. This meant information of concern was not always used to improve the service and some complainants did not have their concerns addressed.

Whilst, observations indicated that the staffing arrangements ensured staff were available in such numbers and skills to respond to people’s needs in a timely fashion. There was no system used to assess the number of staff required to ensure adequate staffing throughout the day and night. We were therefore not assured that the staffing numbers were reflective of people’s needs at all times. .

The home’s recruitment procedure ensured relevant checks were completed on staff prior to employment. One reference was sourced along with a verbal contact was made with another reference. All staff had a disclosure and barring check (DBS) completed by the provider before working in the home unsupervised.

The registered manager used a number of audits to review the quality of the service and these were reported on during staff meetings to improve care. People’s views were obtained through a variety of sources and systems were in place to encourage feedback from people. This included annual satisfaction surveys and on-going feedback system through the services website. Formalised analysis from these systems had not been established.

People were cared for by staff that knew them well and responded to their individual care needs and preferences. Staff were kind, friendly and patient with people. Staff were mindful to people’s privacy and dignity taking account of their individuality

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. Some general comments included, ”As soon as I saw it I thought this was the place – it’s alive,” and “It’s better than I ever dreamt it could be.”

Staff were trained on safeguarding and understood their responsibilities to keep people safe from abuse and were clear what action they would take if they had any suspicion of abuse occurring.

The service was clean and well maintained with safety issues taken into account and responded to. Individual risk assessments were undertaken and reflected those associated with people living with dementia and reflected a person centred response to individual risk. Health and safety checks were undertaken and procedures were in place to ensure emergency situations were responded to.

People had a variety of food available at mealtimes and snacks through the day. Mealtimes were unrushed and people were encouraged and supported to eat a nutritional diet. There were systems to monitor people’s diet ensuring everyone had something to eat wherever they were and whatever they were doing.

Systems for sharing information between staff were established. Staff had regular contact with other health and social care professionals. This included the GPs and community mental health team along with the district nursing team who visited the home most days. Health care professionals told us that staff always, ‘did their best’ and sourced help and advice when they needed it.

People were able to move around the home and garden freely. People had their choices and preferences responded to by staff who understood their responsibilities in ensuring they gained consent to care. Staff had training and an awareness of the Mental Capacity Act 2005. The senior staff were more skilled and had applied for Deprivation of Liberty Safeguards (DoLS) as necessary to ensure people had their rights taken into consideration if any restriction was considered.

Activity, entertainment and staff interaction was tailored to individual need. There was a variety of arranged activity including group and one to one interaction. Staff responded to what people wanted to do on a daily basis.

The registered manager and registered provider had a high profile in the home. There was a staffing structure that allowed staff to report to senior staff who managed areas of the home. On call arrangements were in place and staff knew who to contact when they needed any advice or guidance.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.