This inspection took place on the 5 and 7 November 2018 and the first day was unannounced.

Crest House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide personal care and accommodation for up to 25 older people. At the time of the inspection there were 14 people living there. Most people were independent, while others needed some assistance to move around the home safely and support with personal care.

At the last inspection in August 2017 the overall rating for Crest House was Requires Improvement as more work was needed to ensure the quality assurance system identified areas for improvement. For example, accident and incidents were not consistently reported to the local authority. Recruitment procedures were also not robust and records did not consistently demonstrate that suitable people were employed. At this inspection we found these areas had been addressed and the overall rating had improved to Good.

The registered manager was present during the 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.

The quality assurance system had been reviewed and areas for change had been identified and prioritised to drive improvement. The recruitment process was robust and staff had completed relevant training, including medication, infection control, equality and diversity and safeguarding people. Staff understood people’s needs and how to protect people from abuse. They explained what action they would take if they had any concerns and followed current guidelines.

People were involved in writing and reviewing their care plans and staff offered support based on each person’s individual preferences. Risk had been assessed and people were supported to be independent in a safe way, using walking aids or with staff assistance. There was a varied programme of group and one to one activities, that were discussed and agreed with people living in Crest House. The provider and staff asked for feedback from people and visitors about all aspects of the services provided, through day to day discussions and regular residents meetings. People said they were comfortable talking to staff about the support and care they received and the activities they chose to do.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard (AIS). The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff said people could communicate their needs and the registered manager had arranged AIS training.

People said the food was very good. They were offered choices for each meal and drink and snacks were available at any time. Visitors to the home were made to feel very welcome and people were supported to keep in touch with relatives and friends.

People, their relatives, staff and professionals spoke highly about the registered manager and felt the service was well-led. The provider sought feedback to improve the quality of the service and involved people and relatives in planning any changes.

Further information is in the detailed findings below.

Crest House is a care home in St Leonards-on-Sea, registered to provide residential and respite care for up to 25 older people. There were 16 people living at the home at the time of the inspection.

People required a range of help and support in relation to living with memory loss, dementia and personal care needs. The home provides individual rooms for people with communal areas including a lounge and dining room. The home has a passenger lift and wide staircases with handrails to assist people to access all areas of the building. This was an unannounced inspection which took place on 12 October 2017.

Crest House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

Systems were in place to assess and monitor the service, however, these had not identified all shortfalls found during the inspection. Accident and incident reporting needed to improve. Although staff understood how to recognise safeguarding concerns and risks were identified to help ensure people remained safe, notifications had not always been completed to the local authority as required. However, the impact of this was minimised as systems were in place to ensure that health care was sought and regular checks completed to assess and monitor people’s condition after an accident or incident occurred.

Recruitment processes needed to be reviewed, not all information had been documented to give a clear audit trail and to ensure that recruitment systems were robust.

The training programme needed to be improved to ensure staff training was completed and recorded in a timely manner. We were informed immediately after the inspection that adequate steps had been taken to address this. The impact of some training being out of date was reduced as the majority of staff had worked at Crest House for many years and knew people and well and had received training in the past. However, for new staff and to ensure skills and knowledge were maintained and current a robust training schedule was needed.

People were actively involved in day to day choices and decisions. The registered manager had an understanding of Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) although documentation around how decisions were made and who was involved needed to be improved.

A complaints procedure was available for people to access if needed. And people told us they would be happy to raise and discuss any issues with staff or management if they arose.

People had detailed care documentation which was person centred and based on their individual preferences and support needs. The registered manager had ensured that care documentation was detailed to inform staff and reviewed regularly.

Medicines policies and procedures were in place to ensure people received their medicines safely.

People had access to healthcare services to maintain good health.

Staffing levels were appropriate to meet people’s needs. Staff felt supported and had meetings and supervision. Staff felt the registered manager was open and supportive.

People gave positive feedback regarding the food and meals at Crest House. People were supported to eat and drink well, with choices provided. Staff provided support for people who needed it and ensured that mealtimes were relaxed and sociable.

Staff knew people well and spoke kindly to people, taking the time to stop to chat and support people. People’s privacy and dignity was supported and respected. Staff spoke positively about people, and showed concern for people’s wellbeing. People were actively encouraged to maintain relationships with family and friends and relatives or next of kin were involved in decisions when appropriate.

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