About the service: Fabee Nursing Home is a residential care home that was providing personal and nursing care for up to 17 older people. People living at the home had a range of needs. Some were associated with old age and frailties associated with old age. Other people had more complex health needs which included diabetes and stroke. Some people were living with a dementia type illness.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿ We found some improvements were needed to people’s records to ensure they contained all the information about people and fully reflected their care and support needs.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, information about how decisions had been made had not been recorded. We identified this to the provider as an area that needs to be improved.

¿ Improvements were needed to some aspects of the audit and monitoring system. As improvements to people’s records and information about people’s capacity had not been identified by the provider.

¿ Other aspects of the audit system identified areas for improvement and these were addressed in a timely way.

¿ People and their relatives told us they felt safe at the home. Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff about individual and environmental risks. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout.

¿ People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

¿ People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. Staff received training that enabled them to deliver the support that people needed. Staff received support from the provider and their colleagues. People's dietary needs were assessed and people received the support they needed with their meals.

¿ Nurses completed clinical training which reflected the needs of people in the home. Nurses also completed revalidation with the Nursing and Midwifery Council (NMC) to help demonstrate they maintained their knowledge and skills.

¿ People were supported by staff who treated them with kindness, respect and compassion. Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to make their own decisions and choices about what they did each day.

¿ People received support that was person-centred and met their individual needs, choices and preferences. People’s engaged in a range of activities that they enjoyed and were meaningful. Complaints had been recorded, investigated and responded to appropriately.

Rating at last inspection:

¿ Requires improvement. (Report published 20 March 2018). At our last inspection, there were four breaches of the regulations. The provider sent us an action plan and told us how they would address these issues.

¿ At this inspection we found these regulations had been met. However, improvements were needed in the key question well-led. The overall rating for the service is now good.

Why we inspected:

¿ This was a planned inspection based on the rating at the last inspection.

Follow up:

¿ We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This comprehensive inspection took place on 6 and 7 February 2018. The first day of the inspection was unannounced. The service was previously inspected in March 2015 and was rated Good.

At this inspection we found four breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 15 (Premises and Equipment); regulation 12 (safe care and treatment); regulation 19 (Fit and proper persons employed) and regulation 17 (Good governance) We have also made a recommendation to ensure good practice is maintained in relation to the provision of suitable activities for people living with dementia.

Fabee Nursing Home is a care home with nursing located in Hastings, East Sussex. It is registered to support a maximum of 17 people. The service provides personal care and support to people with nursing needs and increasing physical frailty, such as Parkinson’s disease and strokes. Some people were also living with a dementia type illness. There were 14 people living at Fabee Nursing

Home during our inspection.

Fabee Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post, who was also the registered provider. 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.

We identified the provider had not ensured all aspects of the environment were safe. For example, a fire risk assessment had not been completed to assess the premises for fire safety and risk. Following the inspection the provider sent us a full fire safety risk assessment. The provider was taking action to address the recommendations within the report. We shared this information with the local fire service who confirmed they would contact the provider.

The laundry room required refurbishment to reduce the risk of cross contamination. Some soft furnishings, such as chairs, would benefit from a deep clean.

Recruitment practices were not carried out robustly to ensure potential employees were suitable to work at the service. Some aspects of medicines management were not safe. Not all prescribed preparations were stored securely. Other aspects of medicines management were safe. People had received their medicines as prescribed.

The premises were in need of some refurbishment to ensure it met people’s diverse care and support needs, especially those living with dementia.

There was a lack of social opportunity and engagement for people, especially people living with

dementia. We have recommended the provider implements best practice guidance and resources to support meaningful engagement for people living at the service.

There were a range of audits and systems in place to enable the provider to monitor the quality of the service provided. However, these had not identified the areas of improvement and breaches of the regulations found at the inspection.

People said the service was safe. Comments included, “I am safe here. Staff are here to help me. They are quick to come when I need them...”; “Yes, I think it is safe…the support staff are very good” and “I don’t have to worry about (person) here. People and their relatives said staff were caring, kind, friendly and respectful.

Arrangements were in place to protect people from abuse. The registered manager and staff were aware of their responsibility to report any concerns. Staffing levels were supportive of people’s needs. Risks to people’s health and safety had been identified and actions had been taken to reduce the risk of harm. Accide

People at the home had complex needs and were not all able to tell us about their experiences at the home. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with the provider/ manager, deputy manager and two members of staff.

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had not needed to make any applications but there were policies and procedures in place and the senior staff had been trained to understand when an application should be made and, how to submit one. We were told that arrangements had been made for the staff team to receive regular training on this subject.

Systems were in place to make sure that all staff learnt from events such as accidents and incidents, complaints, concerns and adverse inspection findings. Feedback was sought from people and their relatives and acted upon. This helped reduce risks to people and enabled the service to improve.

People were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained. We found that wound care records were not clear and fully completed. There were gaps found in people’s documentation and body maps. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People told us they were happy living at Fabee and that their individual needs had been met. Staff had a good understanding of people’s needs and it was evident that they knew people well. If people had complex needs, specialist advice and support had been sought to assist staff. Staff had received training to meet the needs of the people living at the home.

Where people needed specialist equipment, such as walking aids and hoists, to support their mobility or to assist in transferring them form one position to another, we saw that it was available, serviceable and being used.

Is the service caring?

People were treated with respect and staff were courteous. They explained to people what they were doing and offered them a choice of food and drinks.

People told us that the staff were kind and attentive. Care records contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that staff showed patience, compassion and understood how to support people as individuals. One person told us “I’m happy that I live here”. Our observation found that staff knew how to communicate effectively with people and we saw how this helped to reduce one person's anxiety and meet their needs.

We saw that staff supported people to achieve their wishes. For example, one person wanted to stay in their room because it was comfortable, “I like to stay here and eat my meals in my room.”

Is the service responsive?

Records confirmed that people’s preferences, interests and diverse needs had been recorded and that care and support had been provided that met their wishes.

People’s needs had been assessed before they moved to Fabee. This meant that the service had the skills and facilities to meet their identified needs. Regular monitoring of people’s health, associated risks and their social needs identified when particular measures were required to help keep people safe. We saw that, when identified, such measures were put in place. This meant that the service was responsive to people’s individual needs. Records confirmed people’s preferences and care and support had been provided in accordance with their wishes.

Is the service well led?

The provider had worked hard with addressing shortfalls identified at the last year’s inspections. It was evident that progress had been made and was on-going. The service had a quality assurance system that was effective. Records showed that identified shortfalls were usually addressed promptly and the quality of the service had improved. Discussion with staff found that they had a good understanding of their responsibilities and of the values of the service.

When we inspected this service on 11th June 2013 we found that people were not adequately supported at meal times and the premises were not suitably maintained. The provider told us that they would ensure these shortfalls were addressed. This inspection was carried out to follow up on the progress made by the home in relation to these essential standards.

We spoke with six people who lived at the home, one relative and four staff.

We found that meals were balanced and nutritious and people were appropriately supported at meal times. One person told us, “I get the help I need with my meals.”

We saw that refurbishment within the home was on-going. However, work had progressed in several parts of the home. We saw evidence that further improvements were planned.

We found that staff had been supported by being provided with an appropriate range of scheduled training. We found that staff had regular supervision.

We spoke with eight people who lived at the home, one relative and four staff.

We found that the home had a consent folder that recorded peoples consent. We saw that staff verbally sought consent from people. One person told us, “I am looked after well."

We found that the meals were varied, balanced and nutritious. However not all people were supported effectively at meal times.

We found that the home had made improvements to cleanliness and infection control and the cleaning audit tool since our visit in March 2013. The home was clean and tidy. However we found infection control was sometimes compromised by the outstanding building refurbishments.

We found that parts of the premises did not provide safe and suitable facilities for the people that lived in the home. We saw that refurbishment works had begun in several parts of the home but further areas required attention.

We saw there had been improvements to the way staff had been recruited since our visit in March 2013. We found there were effective systems in place to recruit staff.

The home had effective systems in place to monitor the quality of the service they provided. There was evidence that residents and visitors had been consulted for their views.

We spoke with four people who used the service, three relatives, and four staff members, one of whom was the manager.

We observed the interaction between people in the home and this was seen to be positive and constructive at all times. People told us that they and the people they represented were treated with dignity and respect, and received the care they required. One person told us, ‘’The staff look after us all so well.’’

We looked at arrangements in place to maintain a clean environment and to reduce the risk of cross infection. We found that systems to maintain and monitor good standards of cleanliness and infection control were not established.

We reviewed the recruitment practice and found the home did not follow robust recruitment processes.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction. A relative told us, ‘’I would talk directly to the manager, if I had a complaint, but I have never had a reason to do this.’’

One individual said how happy she was in the home and said ‘I really like the fact that if I ask a question I get an answer’. Another described how she was involved in the admission to the home and that she had chosen this home.

All people who were spoken with during the visit to the home expressed a satisfaction with the care provided. Comments included ‘staff are very kind,’ ‘I am well looked after’.

Overall, everyone spoken with was happy with the home and facilities and care provided by the home, with people expressing a high level of satisfaction with the staff in the home with comments including how kind the staff are and that they are always polite and helpful.

The inspection took place on 06 & 09 March 2015.

Fabee Nursing Home is a care home with nursing located in Hastings, East Sussex. It is registered to support a maximum of 17 people. The service provides personal care and support to people with nursing needs and increasing physical frailty, such as Parkinson’s disease, multiple sclerosis and strokes. We were told that some people were also now living with a mild dementia type illness. There were 16 people living at Fabee Nursing Home during our inspection.

At the last inspection in May 2014, we identified concerns in relation to care records and audits, which were a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. An action plan was received from the provider and at this inspection we found that the required improvements had been made by the provider.

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 and shares the legal responsibility for meeting the requirements of the law with the provider. The registered manager is also the provider of the service.

People spoke positively of the service and commented they felt safe. Our own observations and the records we looked at reflected the comments people had made.

Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from a registered nurse.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they had a good understanding of the legal requirements of the Act and the implications for their practice.

Care plans contained information on people’s likes, dislikes and individual choice. Information was readily available on people’s life history and there was evidence that people and families were involved in the development and review of their care plans. Activities were available but were not always participated in by individual choice.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutritional and hydration needs. The communal dining experience was usually available, however it was being refurnished and decorated during our inspection. People told us they ate their meals where they wanted to.

Staff felt supported by management, said they were well trained and understood what was expected of them. There was sufficient day to day management cover to supervise care staff and care delivery. The current management structure at the service provided consistent leadership and direction for staff.

The registered manager carried out regular audits and monitored activity to assess the quality of the service and make improvements. For example, in the area of training and supervision of staff.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated they had built a good rapport with people.

Staff told us the people were important and they took their responsibility of caring very seriously. They had developed a culture within the service of a desire for all staff at all levels to continually improve. Areas of concern had been identified and changes made so that quality of care was not compromised.

Feedback was regularly sought from people, relatives and staff. Staff meetings were being held on a regular basis which enabled staff to be involved in decisions relating to the home. Resident meetings were held and people were also encouraged to share their views on a daily basis.

Incidents and accidents were recorded and acted upon which had then prevented a reoccurrence.

People were protected, as far as possible, by a comprehensive recruitment system.