We undertook an unannounced inspection of this service on 13 February 2018.

Crowborough Lodge Residential Care Home 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 bedrooms are single occupancy and people have access to communal shower rooms and bathrooms. Two passenger lifts are available for access to parts of the accommodation. The service has an enclosed garden at the back of the premises.

At the time of our inspection, 25 people were living at the service and one person was in hospital.

This was a full comprehensive inspection to see what improvements the provider had made to ensure they met regulatory requirements.

At our last comprehensive inspection of 15 and 21 December 2016, we had found that risk assessments and management plans were not effective in ensuring that people lived in a safe environment. In addition, the provider had not always followed appropriate recruitment procedures. The provider did not ensure policies and procedures were current and updated to ensure delivery of safe care. The quality assurance systems failed to identify and address areas for improvement.

At this inspection, we found the improvements made were not sufficient to ensure people received consistently high standards of safe and effective care. Policies and procedures were not reviewed which put people at risk of receiving care that did not meet legislation and best practice guidance. Staff records were not well maintained. Quality assurance systems were not robust in identifying and resolving the concerns we found. People who spent time in their rooms did not always have support to undertake one to one activities.

There was a registered manager in post. 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.

People underwent an assessment of the risks to their health and well-being. Staff followed guidance to support people in a safe manner. Staff administered and managed people’s medicines safely. The registered manager ensured staff learnt lessons from incidents and developed plans to minimise the risk of the event happening again. There were enough staff deployed to meet people’s needs.

People took part in the assessing and identifying of their needs before they started to use the service. Staff delivered care in line with people’s needs and preferences. People received care from staff who were supported in their roles. Staff underwent induction and attended supervision and appraisal to develop their practice.

Staff treated people with respect and dignity. Staff were kind and caring. People received care in a manner which maintained their privacy and confidentiality. People were involved in making decisions about their care. Staff ensured people had access to information they required about services available to them. People enjoyed positive caring relationships with the staff who provided their care.

Staff delivered care as planned to meet people’s needs and preferences. Staff carried out regular reviews of people’s health and delivered care that took into account their changing needs.

People enjoyed the food provided and had their dietary needs and preferences met. People consented to care and treatment. Staff delivered care that met the requirements of the Mental Capacity Act 2005. Staff ensured people who were unable to make decisions about their care received appropriate support to do so.

People were happy to share their views about the service. The provider acted on people’s feedback to develop the service. People knew how to make

Crowborough Lodge Residential Home provides care and support for up to 31 older people with care needs associated with age. The needs of people varied, some people were mainly independent, others had low physical and health needs and others had mild dementia and memory loss. The care home provided some respite care and could meet more complex care needs with the support of community nurses, which had included end of life care.

Although the service had a registered manager this person had not worked in the home since August 2016 when they resigned. A senior carer had been appointed as the acting manager and confirmed they were in the process of applying for their registration with the CQC. 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.

Crowborough Lodge Residential Home was inspected in August 2015. We found the provider was in breach of a Regulation. Improvements were required to make sure risks to people’s safety were properly assessed and action taken to mitigate any risks identified.

This inspection took place 15 and 21 December 2016 and was unannounced. At the time of this inspection, 27 people were living in the home. This was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. We found improvements had been made. However, the provider had not identified, assessed and responded to all risks in the service, or ensured all health and safety legislation had been adhered to.

Thorough environmental and individual risk assessments were not in place and the provider had not fully responded to health and safety legislation to ensure the health and safety of people using the service. Risks to people’s safety were found in the service that included hot electric radiators, hot blow heaters and a fall hazard. Hoists used in the service had not been checked in accordance with health and safety legislation.

The recruitment process followed did not ensure all staff working in the service unsupervised had their character and suitability to work checked. This did not protect people from the risk of unsuitable people working with them.

Systems for effective management had not been fully established. The quality monitoring did not ensure safe and best practice was followed in all areas. The provider had not ensured the service’s policies and procedures were followed and embedded into practice. For example, the recruitment procedure had not been followed to ensure all the required checks were completed before a staff member worked unsupervised. The provider had not established clear lines of accountability within the service. People and staff had not been provided with up to date information on the management of the service and staff were not always provided with job descriptions and terms and conditions of employment to clarify roles and responsibilities.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service, and the approach of the staff. Visiting professionals were positive about the care and support provided. They told us staff worked with them to improve people’s health.

People told us they felt they were safe and well cared for at Crowborough Lodge Residential Home. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff had been

This inspection was a follow up inspection at Crowborough lodge as we found it to be non-compliant with outcomes 08 (Infection Control) and 13 (Staffing) at the last inspection.

We looked a sample of records, including the homes scheduled audit cycles, staff rota, cleaning logs.

We found that the people who used the service were protected from the risk of acquiring a health related infection. We spoke to the registered manager who explanted the steps taken by the service to address the shortfalls identified at the last inspection.

We found that the people who use the service had their health and welfare needs met by sufficient numbers of appropriate staff.

We spoke to four people who use the service and they told us they were very happy living at Crowborough lodge.

As part of our inspection we spoke with five people living in the home, visiting relatives of two people, the manager, three care workers and the chef. We also observed care workers and other staff interacting with people throughout the visit.

It was clear that care workers and other staff had a good understanding of the needs of the people living there and noted that they showed patience and understanding when interacting with and supporting people.

The people that lived in the home and the visiting relatives that we spoke with were happy with the care delivered. We observed that people were relaxed and comfortable with each other and with staff. In the morning, people were engaged in a range of activities such as listening to the radio, reading the newspaper and chatting to one another. In the afternoon we observed a group discussion about a forthcoming outing.

Visitors told us that they were welcomed into the home and confirmed that the home kept them informed about any changes in their relatives condition. Care records detailed visits to and from health care professionals.

People we spoke with told us the food was good and that they had a choice of food at each mealtime. They also told us they enjoyed participating in the afternoon activity sessions.

Staff recruitment procedures were safe and care workers had the knowledge and experience they needed to meet the assessed needs of the people living there.

Equipment in the home was well maintained.

Crowborough Lodge Residential Care Home is registered to accommodate up to 31 people who need support with personal care.

The home is located in a residential area of Saltdean on the outskirts of Brighton. It is within walking distance of local amenities and bus services along the coast to Brighton and Eastbourne.

We spoke with seven people who lived there and three people’s relatives. People confirmed that they were able to choose how they spent their time, what time they got up and went to bed and that there was always a choice of food at mealtimes.

Visitors told us that they were very pleased with the care and support their relative’s were receiving. They said that the registered manager and staff were approachable and that they had been consulted about their relatives care and support needs. They told us they were kept informed of their relative’s condition and were always welcomed into the home.

People told us they felt safe and that they would speak to the registered manager or the care staff if they had a problem.

Care records confirmed that people had been consulted about the care and support that they received. It was evident through speaking to people that a range of activities were on offer in the home on a daily basis and that day trips out were organised by the home every few months.

During our visit we saw that people were being spoken with and supported in a sensitive, respectful and professional manner. Staff we spoke with knew the people living at the home well and had a good understanding of their support needs.

Crowborough Lodge Residential Home is located in a residential area close to the seafront. It provides care and support for up to 31 older people with care needs associated with age. The needs of people varied, some people were mainly independent others had low physical and health needs and others had a mild dementia and memory loss. The care home provided some respite care and can meet more complex care needs with the support of community nurses which has included end of life care. At the time of this inspection 26 people were living at the home.

This inspection took place on 29 August and 2 September 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.

The provider had not ensured the home had been suitably risk assessed with suitable measures being put in place to ensure people’s health and safety. Individual and environmental risk assessments to maintain people’s health, safety were not full or effective and therefore could place people at risk. For example, windows above ground floor had not been fitted with restrictors risk assessments had not been undertaken to mitigate any risk to people using these rooms.

Systems for effective management had not been fully established. The registered manager had limited time for management duties that included quality audit. The provider did not undertake supervision of the registered manager to review appropriate resources for the management of the home were in place. Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow. Systems for planning the future of the home including the ongoing maintenance planning were not established.

Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of the staff and atmosphere in the home.

People told us they felt they were safe and well cared for at Crowborough Lodge Residential Home. Medicines were stored, administered and disposed of safely by staff who were suitably trained.

Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. 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 preferences and choice. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager. On call arrangements were in place to provide suitable management cover.

People were very complementary about the food and the choices available. One person said the food was, “Marvellous.” People needed minimal support with eating and staff were positive in their approach to promoting people’s independence.

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home and this was promoted by the pleasant staff and visible registered manager and provider. 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 though ‘residents meetings’ and satisfaction surveys.

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.