This inspection took place on the 29 March 2018 and was unannounced.

At the previous inspection of this service in August 2016 the overall rating was requires improvement because we found improvements were needed in relation to the safe management of medicines, the quality assurance system was not robust and the provider had not informed the Care Quality Commission (CQC) about notifiable incidents and accidents.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm that the service now met legal requirements. We found improvements had been made, the provider had met the legal requirements and the overall rating had improved to Good.

Eridge House Rest 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 home is registered to provide personal care and accommodation for up to 43 older people. At the time of the inspection there were 34 people living there. Most people were independent and had capacity to make decisions about the support and care provided; they went out into town and for meals with relatives and friends. Others due to frailty and health care needs such as diabetes and following a stroke were supported with personal care and mobilising around the home.

Eridge House Rest Home has a registered manager. They were on leave at the time of the inspection and the deputy manager was available to assist 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 management had carried out regular audits, including medicines, care plans, health and safety and infection control. The registered manager had sent notifications to CQC with regard to incidents that may affect the provision of care and support.

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. People at Eridge Rest Home can all communicate effectively. However, where people had specific needs, such as slight confusion or limited eyesight, a ‘passport’ had been developed and included in their care plans for people to take with them if they had appointments outside the home.

Staff had received relevant training and were supported to develop their knowledge and professional practice through regular supervision and yearly appraisals.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been requested when needed to ensure people were safe.

Risk had been assessed and people were encouraged to be independent in a safe way, with the provision of walking aids and assistance from staff as required. Safeguarding training had been provided; staff understood how to protect people from harm and what action they should take if they had any concerns. Emergency procedures had been developed to support people if they had to leave the building; there were regular checks of the environment and staff followed the providers inf

Eridge House Rest Home is registered with CQC to provide residential care for up to 43 older people. At the time of the inspection there were 39 people living at the home.

People’s level of care and support needs varied. Some people were independent and required guidance and prompting from staff, many went out alone regularly or with friends and family, whilst others required assistance with all care needs and remained in bed or in their rooms.

This was an unannounced inspection which took place on 26 and 30 August 2016.

At the last inspection undertaken on the 22 and 23 June 2015 we asked the provider to make improvements in relation to the safe administration of medicines, and clearer documentation around people’s care and support needs.

The provider sent us an action plan stating they would have addressed all of these concerns immediately after the inspection. At this inspection we found the provider was meeting these regulations, however some further areas were identified that were required to be improved.

Eridge House Rest Home 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.

The manager was in day to day charge of the home. People spoke highly of the home and the way it was run. And staff told us that they felt supported.

Medicine administration, documentation and policies were in place, medicines were stored safely. However, we have made a recommendation about the management of some medicines.

Notifications had not been completed for all notifiable incidents and accidents. These were reported to the local authority before the end of the inspection. We have made a recommendation to ensure all notifiable incidents are reported correctly.

There was no designated domestic staff to carry out cleaning at the home. This was currently being done day to day by care staff. We identified some areas of the home needed attention to ensure cleaning was thorough and complete.

Staff felt that training meant that they were able to meet the needs of people living at Eridge House. Staff received regular supervision and some had worked at the home for many years. Staff were able to tell us about people’s needs. People told us they liked living at Eridge House as it was a homely environment.

Staff demonstrated an understanding around safeguarding and were able to tell us how they would report any suspected abuse. People were involved in day-to-day choices. All staff and management had an understanding of Mental Capacity Assessments (MCA) and Deprivation of Liberty Safeguards (DoLS). Although no DoLS were currently required.

Recruitment systems were in place and staff told us staffing levels were appropriate to meet people’s needs. A training programme was on going to ensure staff were appropriately trained to support people appropriately.

Risk assessments had been completed, this included fire safety and evacuations plans. There were systems in place to assess and monitor the service. This included auditing and feedback from people. Findings were analysed and used to make improvements to the day to day running of the home.

People’s nutritional needs were met. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food and the registered manager had introduced new meals when this had been requested in feedback questionnaires.

A single 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?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and were well treated by staff. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. One person who used the service told us “This is my home the staff are so nice and caring”. People spoken to said they felt safe.

Systems were in place to make sure that both managers and staff learnt from events such as accidents and incidents and responded to complaints and concerns.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Policies and procedures were in place to make sure that unsafe practices were identified and the people were protected. We spoke with the manager and four members of staff on duty. They knew the different forms of abuse, how to recognise the signs of abuse and how to report any concerns.

Is the service effective?

People we spoke with told us they were happy with the care they received and felt their needs had been met. People who lived in the home told us the manager and staff were effective in meeting their care and support needs. From our observations and also speaking with the staff it was clear that staff understood people’s care and support needs and they knew them well. One person told us “I have everything I could wish for, staff are so supportive”. Another person told us that they “Always check to make sure I am ok”. People were supported in all aspects of daily living with an emphasis of maintaining independence. We spoke with three people who lived in the home who had taken the bus to have coffee in the town centre; this gave us evidence that people are supported to maintain community involvement.

Staff had received training and ongoing development to meet the needs of the people living at the home.

Is the service caring?

Staff were attentive and kind to the people who needed support. Staff told us they encouraged people to maintain their independence. From our observations and from what people told us staff understood people’s care and support needs. We observed staff speaking to people in a meaningful and respectful way. We observed that staff knocked on people’s doors and asked for permission before entering their rooms.

People’s preferences, interests and diverse needs had been recorded in the care plans we viewed.

People who used the service had been offered a quality assurance survey to complete. We saw feedback from surveys where most people living in the home rated it as being either good or excellent. Where shortfalls or concerns were raised they had been addressed and discussed with the person.

Is the service responsive?

People who lived in the home told us the manager and staff were always responsive to their needs and preferences. People we spoke to living in the home told us they were able to make their own daily living choices such as meal choices and activities

People’s needs had been assessed before they moved into the home. Information had been recorded on detailed care and support plans. People told us they regularly discuss their needs with their support worker. Care plans we viewed detailed people’s preferences regarding personal care routines, food likes and dislikes, interests and social activities. People who lived at the home had an activities programme based on their individual needs

People knew how to make a complaint if they were unhappy. The complaint’s policy was displayed on a notice board to remind people.

Is the service well-led?

The service was managed by the home’s owner. We were told a senior member of staff had been working towards the qualification to become the registered manager.

The service worked with other agencies and services to make sure people received care in a joined up way. Staff received regular supervision and appraisal.

A quality assurance system was in place and records we viewed showed regular audits on the service and that any shortfalls had been addressed by the manager. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home, and the quality assurance systems that were in place. There was a clear staffing structure in place with clear lines of reporting and accountability. Members of staff spoken to said they always received excellent support and appropriate advice from the manager. This helped to ensure that people received a good quality service at all times.

Staff received a full training programme which included protection of vulnerable adults. First aid, fire safety, administration of medicines, and infection control. The home had procedures in place to ensure that all training was completed by all staff. This was evidenced in the staff training matrix.

There were 37 people living at the home on the day of our inspection. We spoke with six people and six staff. One person told us, “I enjoy living here, home from home.”

We found that people were shown respect and dignity. There was a range of activities for people to engage with.

We looked at seven care plans and their associated documentation. We saw that they reflected the care that was provided to people. The home had systems in place to ensure people’s individual needs were met.

We found the home to be clean and tidy and free from malodours. One person told us, “My room is often given a good clean.”

The home had effective systems in place for staff recruitment.

The home had a complaints procedure. People we spoke to were aware of how to make a complaint.

During our visit we spoke with four people who were using the service, five members of staff one visiting relative and one visiting professional. People who used the service and their relatives told us that they liked living at the home and that the service met their needs. People told us that staff were very helpful and that there was always someone around to provide help and support. Comments included the following: "the home is very good and my mother receives excellent care", and, "There is nothing I can find fault with."

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner by staff. We looked at peoples individual care plans and saw that they were person centred and the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitored the quality of care that people received. We saw that there were arrangements in place to ensure that medication was stored and dispensed correctly.

Staff told us that they had received regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

Eridge House Rest Home is a residential home providing care for older people in Bexhill-on-Sea. People living at Eridge House required varying levels of care and support. Many were highly independent and just required some assistance with washing and dressing and others required assistance with all care needs.

Eridge House provides local authority and privately funded long and short term (respite) periods of care.

The service is registered to provide care for up to 43 people. At the time of the inspection there were 36 people living at the service.

This was an unannounced inspection which took place on 22 and 23 June 2015.

Everyone we spoke with during the inspection was able to tell us about their thoughts and feelings about living at Eridge House, what they enjoyed and how they chose to spend their time.

Eridge 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.

Care plans had been written and reviewed regularly by the manager. However, changes to care plans were not clear, or whether people had been involved in changes to the way their care was provided.

The provider could not demonstrate that people had received all medicines and topical cream applications in accordance with prescriptions by their GPs. A number of inconsistencies were seen in medicine documentation, including temperature checks and medicine administration records (MAR) charts.

Evacuation information for night time was not clear in the fire documentation.

Quality assurance checks were completed regularly by the manager and provider to ensure that the service provided good care and continued to improve. However some areas of auditing including medicines and care records needed to be improved.

Activities were provided regularly for people when they wished to access them with regular organised activities and people told us they accessed these when they wanted to. Many people spent their time going out independently and continued hobbies and activities they had prior to moving in to the service. A number of people were seen to go out independently or with visitors, and those who chose to stay in their rooms told us this was their choice.

People’s weights were reviewed when needed, with referrals made to outside agencies when people had poor nutrition or had lost weight. People who required any help or assistance at meal times had this provided in a dignified manner.

People living in the service told us they felt safe at Eridge House and staff felt supported working at the service. The manager was a visual presence at the service on a daily basis and had an ‘open door’ policy for staff, people living in the service and visitors.

Staff and people living at Eridge House felt staffing levels were appropriate. Staffing levels had been regularly reviewed and extra staff provided when needed. Staff told us that they had a clear chain of management to report any concerns to as "the door was always open” and it was a positive open working environment. Staff told us the manager or owner was always around and available if they had any concerns.

A training schedule was in place. With a different training scheduled each month, which would be attended by all available staff. Staff had received appropriate training and were able to demonstrate a good knowledge around recognising and reporting safeguarding concerns. Staff told us that if they identified any new training which they felt would improve their knowledge to meet people’s individual needs and his was supported and encouraged by the registered manager.

Environmental and individual risk assessments had been completed. There was an organisational recruitment policy and procedure to follow when recruiting new staff. This included an in house induction for new staff.

Equipment maintenance and servicing had taken place. With environmental and maintenance audits completed to ensure the building and equipment were maintained appropriately.

Staff felt supported by the manager and work colleagues .There was a programme for supervision and appraisals to take place, this included further ‘ad hoc’ meetings when required and policies and procedures were in place to support staff.

Staff involved people in daily decisions and gained consent from people before providing any care or assistance. Staff demonstrated an awareness around mental capacity, choice and restraint. The manager told us that they were aware how to make an application regarding Deprivations of Liberty Safeguards (DoLS) but had not needed to do this.

People we spoke with told us the meals were lovely and without exception we received positive feedback around food and drink provided. Meals seen were well presented, with three courses at lunch time. People had a choice of meal with alternatives available when people changed their minds.

People were seen to spend their time how they wished. During the inspection we saw many examples of positive communication and interaction between staff and people. Staff responded politely and positively when they sat with people for a chat or popped into their rooms. Staff showed a clear fondness for people and cared about their care and welfare. If people appeared upset or anxious staff responded in a calm manner. People knew staff and it was apparent in their body language they felt comfortable and trusted staff to look after them.

Staff told us they were part of a team, and felt that they all shared the same values to ensure people received the best care. Staff spoke positively about the manager, the culture within the service and told us they enjoyed being part of the team.

There were no current complaints investigations in progress. Past complaints had been dealt with following the organisations complaints procedure. People told us they knew how to raise concerns if they needed to.

We found some breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.