We inspected Dean Wood Care Home on the 16 and 18 October 2017 and the inspection was unannounced. Dean Wood Care Home is registered to provide accommodation and care, including nursing care for up to 80 people, with a range of medical and age related and chronic conditions, including arthritis, frailty, mobility issues and dementia. The service is divided into three floors. The ground floor provided care and support for people living with dementia. The first floor provided care and support to people with nursing care needs and the second floor provided to care and support to people with lower level care needs.

Dean Wood Care Home belongs to the large corporate organisation called Bupa Care Homes (CFChomes) Limited. Bupa provide nursing care services across England and have several nursing homes within the local area.

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.

At the last inspection undertaken on the 13 and 14 September 2016 areas of improvements were found in relation to staff morale, lack of staff supervisions and further work required to embed the provider’s audits and action plans. Recommendations were made and at this inspection, we found improvements had been made. However, we identified new areas of care that needed improvement.

Systems and processes were in place for the provider to monitor compliance with the Health and Social Care Act 2008 (Regulated Activities) 2014. Audits were undertaken on a regular basis and the provider was able to demonstrate how audits were utilised to drive improvement. However, the provider’s internal quality assurance framework was not consistently robust and further work was required to strengthen the provider’s internal quality assurance checks. For example, shortfalls and omissions with documentation had not consistently been identified as part of the provider’s internal quality assurance framework. We have identified this as an area of practice that needs improvement.

Positive relationships had been developed between people as well as between people and staff. There was a friendly, caring, warm and relaxed atmosphere within the service and people were encouraged to maintain relationships with family and friends. One person told us, “I’m very happy, I’m having a ball.”

People were protected, as far as possible, by a safe recruitment system. Staffing levels were based on an assessment of people’s individual care needs. Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application to restrict people's freedom had been submitted. Staff had received training on the Mental Capacity Act 2005 (MCA) and worked in line with the principles of the Act.

People spoke highly of the food and said that they were able to make choices about what they had to eat. People received enough to eat and drink and risks associated with nutrition and hydration were managed effectively. People were supported to access the health care services that they needed.

The management of diabetes and catheter care was effective. Staff felt supported within their roles and staff morale had improved. The management team were dedicated to ensure staff’s and people’s voice was heard and acted on. Forums were in place for people and their relatives to give feedback on the running of the service.

People received care and support that was responsive to their needs. Care plans provided i

We inspected Dean Wood Care Home on the 13 and 14 September 2016. We previously carried out a comprehensive inspection on 24 and 25 February 2015. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to people not being moved and transferred safely. We also identified areas of improvement required in relation to the management of medicines, staff not receiving regular supervision and the culture and morale of staff. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these concerns.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas, however we identified further areas of practice that needed improvement.

Dean Wood Care Home is registered to provide accommodation and care, including nursing care for up to 80 people, with a range of medical and age related and chronic conditions, including arthritis, frailty, mobility issues and dementia. The service is located in Woodingdean, East Sussex in a residential area. There were 77 people living at the service on the days of our inspections.

A registered manager was in post, however at the time of our inspection they were on planned leave. 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. Day to day charge of the home was taken by a support manager and the deputy manager, to provide consistent management cover until the registered manager returned to post. They are referred to as the manager in this report.

A formal supervision strategy for staff was yet to be fully established, as was a clear structure of one to one supervisions, as to who provides them and is accountable for them to be implemented. This issue had been identified through the providers own quality monitoring processes and systems have started to be put in place. However, this needs to be embedded, to ensure that the provider’s policies and good practice guidelines are being implemented.

The culture and values of the provider were not embedded into every day care practice. We received mixed feedback from staff in relation to whether they felt supported within their roles, and being able to approach management with issues and concerns. Mixed feedback was also received in relation to staff morale and feeling valued in their role.

Daily records used to monitor the assessed levels of air mattresses to help prevent pressure damage contained gaps in their recording, or were missing. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, the provider was unable to identify the specific actions from these audits and could not demonstrate improvement or impact for people over time.

The above issues have all been identified as areas of practice that need improvement.

People told us they were happy living at Dean Wood Care Home. One person told us, “The staff are helpful and kind”. A visiting relative said, “It’s brilliant care, they’ve really picked up on [my relative’s] personality”. People’s privacy and dignity was respected. Staff had a good understanding of people’s needs. They treated people with respect and protected their dignity when supporting them with personal care. One person said, “Staff are kind and considerate, they ask what I want to do”.

Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provide

During our inspection we spoke with six people who used the service and one visiting relative. We also spoke with 14 staff members; these included the registered manager, a senior nurse, a unit manager, a customer advisor and several care workers. The people we spoke with told us that on the whole they were happy with the care they had received and with the staff team. One person who used the service told us “I’m very happy here and I think the staff are great”.

Staff we observed had an understanding of the support needs of people who used the service. A member of staff we spoke with told us “We get to know the residents and build relationships with them. I think we give care in a way that I would be happy for my own family to receive”. We found that the documentation used for care planning had been reviewed recently, was detailed and person centred.

Sound arrangements were in place for the safe ordering, storage, administration and disposal of medicines at the service. Staff had a good understanding of their responsibilities in relation to the safe administration of medicines.

We inspected Dean Wood Nursing and Residential Care Home on the 24 and 25 February 2015. Dean Wood Nursing and Residential Care Home provides care and support to people with personal care and nursing needs, many of whom were living with dementia.

The home is arranged over three floors, offering residential and nursing care based on people’s particular needs and requirements. One area is a specifically designed unit which provides an environment that supports people living with dementia. The environment was dementia friendly and assisted people with orientation around the home. The home can provide care and support for up to 80 people. There were 76 people living at the home on the days of our inspections.

Dean Wood Nursing and Residential Care Home belongs to a large corporate organisation called BUPA. BUPA provide residential and nursing care across England.

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.

Dean Wood Nursing and Residential Care Home was last inspected on 9 January 2014 and no concerns were identified. However, at this inspection we found areas of improvement required in respect to moving and handling practices, the management of medicines, staff supervision meetings and the culture of the service in relation to staff satisfaction.

Despite staff receiving appropriate training in the moving and handling of people, we saw unsafe moving and handling practices taking place which placed people at risk of harm. We have identified this as an area of practice that requires improvement.

Medicines were stored appropriately, but documentation used to show people had received their medicine contained errors and omissions. We have identified this as an area of practice that requires improvement.

Staff had formal personal development plans, which included regular supervision meetings with their manager. However, these one to one meetings had not routinely been taking place. We have identified this as an area of practice that requires improvement.

The culture and values of the provider were not embedded into every day care practice. Staff we spoke with did not have a strong understanding of the vision of the home. Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of cohesion and a negative culture in the home. We have identified this as an area of practice that requires improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work with adults at risk. Staff were knowledgeable and had received training on safeguarding adults. Staff understood what action they should take if they suspected abuse was taking place.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that staff understood the principles of DoLS, when an application should be made and how to submit one.

Where people lacked the mental capacity to make a specific decision 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.

Accidents and incidents were recorded appropriately and steps taken by the service to minimise the risk of similar events happening. Risks associated with the environment and equipment had been identified and managed.

People were encouraged and supported to eat and drink well. One relative said, “My mother has eaten more in the few days she has been here than in her last residential home”. There was a varied choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People could choose how to spend their day and they took part in activities in the home and the community. People told us they enjoyed the activities, which included coffee mornings, singing, exercises, films, bingo, quizzes and a social club.

Staff had received essential training and there were opportunities for additional training specific to the needs of people. Care plans gave information on how people wished to be supported and daily records showed what care had been delivered.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “I trust them and they know what they are doing”. A relative said, “I’m confident my relative is being well cared for”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to stay in touch with their families and receive visitors. Relatives were asked for their views about the service and the care delivered to their family members. Completed surveys showed families were happy overall and felt staff were friendly, welcoming and approachable. Residents’ and relatives meetings were held and people said they felt listened to and any concerns or issues they raised were addressed.

People were involved in the development of the service and were encouraged to express their views. The provider undertook quality assurance reviews to measure and monitor the standard of the service.

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.