About the service:

Filsham Lodge is situated on the outskirts of Hailsham. The service provides nursing care and support for up to 53 older people, some of whom are living with dementia. The manager told us that the service accommodated a maximum of 51 people as double bedrooms were no longer used. There were 38 people using the service at the time of our inspection, all of whom were in receipt of nursing care and a majority of whom were living with dementia.

People’s experience of using this service:

A registered manager was not in post. However the manager had submitted an application that was in progress. Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included ensuring all equipment used by people was clean and hygienic and that care delivery was consistently delivered in a way that ensured people had a choice. Recruitment processes needed improvement and these were attended to immediately during the inspection process.

The service had made improvements to the safety of people's care. People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Risk assessments included falls, skin damage, behaviours that challenge or cause distress, swallowing problems and risk of choking, and mobility. The care plans also highlighted health risks such as diabetes. People said they felt comfortable and at ease with staff and relatives felt people were safe. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns.

The service had made improvements that ensured people were consistently treated with respect and dignity. Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner. We received positive feedback from relatives and visiting professionals about the care provided. One visitor told us, “I have no complaints at all, the staff are all kind and very good,” and “The staff keep us informed and my relative is content here.”

The service had started to improve communication with allied health professionals and were working alongside them to consistently drive improvement. A number of audits had been developed, including those for accidents and incidents, care plans, medicines and cleaning schedules. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Staff said they were encouraged to suggest improvements to the service.

The organisation had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

More information is in Detailed Findings below.

Rating at last inspection:

The rating of this service at our last inspection was "Requires Improvement.” (Report published 14 September 2018).

At our last inspection, there were three breaches of the regulations. We also took enforcement action at that time.

Why we inspected:

This was a planned focussed inspection to follow up on our enforcement action.

Follow up:

The overall rating of the service remains Requires Improvement. The service had met the breaches of Regulation and the Safe and Caring questions had improved to Good. However further time was needed to ensure the

We inspected Filsham Lodge on 19 and 21 June 2018. This was an unannounced inspection.

Filsham Lodge 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.

Filsham Lodge is situated on the outskirts of Hailsham. The service provides nursing care and support for up to 53 older people, some of whom are living with dementia. The registered manager told us that the service accommodated a maximum of 51 people as double bedrooms were no longer used. There were 48 people using the service at the time of our inspection, all of whom were in receipt of nursing care and a majority of whom were living with dementia.

A registered manager was not in post. A registered manager is a person who has registered with the 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 took up their post in January 2018 and has not yet submitted their application to register.

This is the second time the home has been rated requires improvement. At a comprehensive inspection in May 2017 the overall rating for this service was Requires Improvement with two breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 identified. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key question in safe to at least good. The provider sent us an action plan stating they would have addressed the breaches by December 2017.

This unannounced inspection took place on 19 and 21 June 2018 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that the breach of regulation 11 had been met however we identified there were new breaches of Regulation 10 and 12 and a continued breach of regulation 17. This was because we could not be sure people always received care that was safe, risks to people’s care were not always addressed, for example in relation to moving people safely and people were not consistently treated with dignity and respect. Further improvements were also needed to develop the quality assurance systems.

People told us that they felt safe and visitors were complimentary about the care people received. One person told us, “I feel safe, good care and no problems.” A visitor said, “I can’t praise the staff, it’s a real home here.” However, we found people’s safety was not consistently managed safely. There were not enough suitably qualified or experienced staff at all times to move people safely. Not all areas of the building were clean and some bathroom equipment was not fit for use, which had not ensured that people were protected from the risk of cross infection.

The principles of the Mental Capacity Act (MCA) 2005 were still not consistently applied in practice. Documentation referred to people’s best interests and decisions being made in their best interests, but care tasks were often undertaken without clear consent and discussion.

Whilst the building had been upgraded and met the physical needs of people, there was a lack of visual signage to assist in enabling people to be orientated to time, day and season.

People told us that the staff were caring, however not everyone was treated with dignity and respect. Whilst we saw some caring interactions between staff and the people who lived in Filsham Lodge, there was a lack of interaction when undertaking care tasks. People were assisted by staff with eating but practices were poor as staff did not communicate with them and sat in a position which meant the person could not see the staff assisting them. People’s dignity was not prot

We inspected Filsham Lodge on 8 May 2017. This was an unannounced inspection. Filsham Lodge is situated on the outskirts of Hailsham. The service provides nursing care and support for up to 53 older people, some of whom are living with dementia. The registered manager told us that the service accommodated a maximum of 51 people as double bedrooms were no longer used. There were 48 people using the service at the time of our inspection, all of whom were in receipt of nursing care and a majority of whom were living with dementia.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

At the last inspection undertaken on the 2 December 2016, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the principles of the Mental Capacity Act 2005 not being adhered to. The management and storage of medicines was not safe. Infection control procedures had not been followed, people’s right to privacy was not consistently respected and the provider’s quality assurance framework was not robust. Recommendations were also made in relation to staffing levels, safeguarding and staff’s interaction with people. The provider sent us an action plan stating they would have addressed all of these concerns by February 2017. At this inspection we found the provider had made improvements to the management of medicines, staffing levels, safeguarding, privacy and dignity and staff interaction with people. However, improvements were not yet fully embedded and the provider continued to breach the regulations relating to the other areas.

The principles of the Mental Capacity Act (MCA) 2005 were still not consistently applied in practice. Documentation made reference to people’s best interests and decisions being made in their best interests. For example, the use of bed rails or remaining in bed. However, underpinning mental capacity assessments were not in place to demonstrate that people lacked capacity to make these specific decisions.

People, staff and relatives spoke highly of the registered manager and their leadership style. However, despite people’s praise, we found areas of care which were not consistently well-led. The provider’s quality assurance framework had not consistently identified shortfalls and the audit of incidents and accidents was not consistently robust.

Accurate, complete and contemporaneous records had not consistently been maintained. Documentation failed to reflect the support people received to manage and meet their continence needs. Arrangements were in place to provide social activities and reduce the risk of social isolation. However, these arrangements were not yet consistently embedded into practice. We have identified this as an area of practice that needs improvement.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted.

People told us they felt safe living at Filsham Lodge. One person told us, “There are no complaints here.” Another person told us, “The carers look after me well.” Staff worked in accordance with people's wishes and people were treated with respect and dignity. It was apparent that staff knew people's needs and preferences well. Positive relationships had developed amongst people living at the service as well as with staff.

Systems were in place to ensure people were supported to receive their medicines on time by qualified and competent staff. Medicines were ordered and disposed of safely. People were supported to access health services and their health care n

Filsham Lodge is situated on the outskirts of Hailsham. The care home provides nursing care and support for up to 53 older people, some of whom are living with dementia. The registered manager told us that the service accommodated a maximum of 51 people as double bedrooms were no longer used. There were 49 people using the service at the time of our inspection and the registered manager told us that most people were living with dementia and 48 people were receiving nursing care.

We last inspected Filsham Lodge in May 2015 when the service was rated ‘Good’. After that inspection we received concerns in relation to the safeguarding of people’s belongings in the service. This was a focussed inspection in response to these concerns. The inspection was carried out on 2 December 2016 and was unannounced. We looked at the three key questions ‘Is the service safe’, ‘Is the service caring’ and ‘Is the service well led’. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Filsham Lodge on our website at www.cqc.org.uk.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Staff understood how to recognise the signs of abuse, but appropriate action had not always been taken by the registered manager to assess whether alleged abuse required reporting to the local authority safeguarding team under the multi agency safeguarding policy.

People’s medicines were not always stored in a safe way. There were not effective systems in place for ensuring that opened medicines were disposed of within an appropriate timeframe.

The registered provider had not ensured that the premises were clean and hygienic to ensure the risk of the spread of infection was reduced.

People’s right to privacy was not consistently maintained as some bathroom doors did not close properly and did not have a lock. Staff generally sought and obtained people’s consent before they provided care. However we found that people’s mental capacity had not always been assessed before a decision was made in their best interests, following the requirements of the Mental Capacity Act 2005.

There was not an effective system in operation for monitoring the quality and safety of the service to make improvements to the care provided. Where shortfalls in the service were identified appropriate action had not always been taken to make improvements.

There were sufficient numbers of care staff to meet people’s care needs, but the registered provider had not demonstrated that sufficient numbers of nursing staff were deployed in the service to meet people’s nursing needs. We have made a recommendation about this.

The registered provider had not ensured that the service was organised in a way that provided personalised care. Some people had to wait a long time for their meals to be served and staff did not always meet the people’s social needs. We have made a recommendation about this.

Risks to people’s wellbeing were assessed and staff knew what action they needed to take to keep people safe. People had individual evacuation plans outlining the support and equipment they would need to safely evacuate the building.

Staff treated people with kindness and respect. People told us they liked the staff and that they were caring. Staff knew people well, understood what care they needed and responded to their physical needs. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. People were involved in making decisions about their care.

You can see what action we told the provider to take at the back of the full version of the report.

One Adult Care 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. We spoke with five people who lived at the home, one relative and four members of staff, including the registered manager.

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us, "It's a real comfort to know that mum is safe and well cared for."

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always safely met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs.

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. The staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with conditions such as dementia and mental health illnesses. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People were supported by kind and attentive staff. We saw that all staff that had contact with the people who used the service showed patience and empathy.

We spoke with relatives who said they were always made to feel very welcome. They told us “Whenever I visit there are always staff around and they are kind, friendly and provide good quality care.” We saw that the staff took time with people over lunch and when they were moving about within the home. We observed high levels of respect and people were treated sensitively with consideration and dignity.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to take part in a range of activities, reflecting their interests and preferences, both in and outside the service. A care worker told us "We spend time with people and get to know them individually, so we can find out what their interests are and how they like to spend their day.”

People’s needs were assessed before they moved into the home and detailed care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people’s individual care needs. We saw that the staff monitored weight, nutrition and hydration and handover sessions were helpful and informative. However we did find that the care documentation did not reflect the care delivery in respect of monitoring fluid and food intake, safe moving and handling and continence needs. This could impact negatively on people’s needs if staff do not respond to poor intake of food and fluids and move people safely.

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people who used the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the deputy manager told us they operated an 'open door policy' so people who used the service and visitors to the home could discuss any issues they may have.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up and consistent way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. 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 quality assurance processes were in. They also told us that they felt valued and supported by the management team and were happy and confident in their individual roles.

There were 46 people living at Filsham Lodge Care Home at the time of this inspection visit. Some people had complex needs and were not always able to verbalise their experiences, so we observed the interaction between staff and other people closely. We spoke to five people who used the service, three relatives and five staff members.

People who used the service made some positive comments about the care and staff working in the home. A relative told us that they were ‘’Happy’’with the care and support provided within the home. One person told us, “I like it here.” Another person told us, "The staff are kind and the food tasty."

Care plans and delivery of care for some people was more task orientated than person centred. Not all care plans had been reviewed regularly to reflect people’s health and well-being changes.

We examined the home’s policy, practice and records in relation to medication. We found that staff were appropriately trained, medication was stored appropriately and administered correctly. We saw that record keeping in relation to medication was accurate and up to date.

We found that the skill mix and experience of staff had impacted on positive outcomes for people who used the service. The provider could not evidence that there were enough qualified, skilled and experienced staff to meet people’s needs.

We spoke to seven people during our inspection visit. We also used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people who used the service.

People we were able to speak with who lived in the service told us they liked living at Filsham Lodge care Home. We were told "It's my home, sometimes I grumble but the staff are very good,” "Caring and kind staff,” and "I know I'm safe, staff look after us very well.” We also spoke with relatives/visitors. One visitor told us “Wonderful place, the staff are very committed.” Both family, visitors and the people who used the service were enjoying an Easter party on the day of the inspection. One visitor said, "This is so lovely for them, they are really enjoying themselves, singing along with the entertainer."

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found that care and treatment was planned and delivered in a way that ensured people’s safety and welfare. There were effective recruitment and selection processes in place and staff records and other records relevant to the management of the service were accurate and fit for purpose.

Due to people’s complex needs, many people were not able to tell us about their experiences. We used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people using the service.

People we were able to speak with who lived in the home told us they were happy there. Comments included, “this is my home now” and “tasty food and lots of it”.

Relatives and visitors spoken with told us they were happy with the care provided in the home. One relative told us, “They keep me informed and are very kind”.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of three people and a visiting health professional who were able to contribute their views on outcomes for the people who used the service.

We were told,” we are being involved more, which helps us”, “staff are kind” “I want to go home, but it is nice here”.

Not all of the people living in the service were able to tell us whether they were satisfied with the care they received. However two people were able to tell us that able to tell us that the staff were kind and looked after them well.

Not all of the people using the service were able to tell us about their experiences in the home, however for those who were they told us that the staff were caring and looked after them well. One person also told us that the food was hot and tasty. We were also told, “Very nice dear”, “Pretty good thank you”.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 29 May and 1 June 2015 and was unannounced. At our last inspection in June 2014 no concerns were found.

Filsham Lodge is situated on the outskirts of Hailsham and provides nursing care and support for up to 53 people that have a dementia type illness. There was a manager in post who was also a registered nurse. 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.

Staff demonstrated a clear understanding of how to protect people from abuse and harm. They were aware of the procedures to follow in case of abuse or suspicion of abuse. People told us, “I feel safe, and very well looked after.”

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs and ensured continuity of support. The provider used robust recruitment procedures to ensure staff were suitable for their role and people were kept safe.

Risk assessments were in place which were specific to people’s needs and challenges. These included guidance on how to minimise risks and make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

Staff were trained in the safe administration of medicines. Records relevant to the administration of medicines were audited. This ensured they were accurately kept and medicines were administered to people and taken by people safely according to their individual needs.

Staff had completed the training they needed to support people effectively and were able to access additional training if required. All members of care staff received regular one to one supervision sessions to ensure they were supported while they carried out their role. All staff received an annual appraisal of their performance and training needs.

People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their support was delivered. One person told us, “I am given a choice on what to wear, and the carers maintain my privacy and dignity.”

All care staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). They were knowledgeable about the requirements of the legislation.

Staff sought and obtained people’s consent before they provided support. When people declined or changed their mind, their wishes were respected. People’s dietary preferences and restrictions were recorded, familiar to staff and complied with.

People were referred to a variety of health care professionals whenever necessary in a timely manner. Care plans included people’s likes and dislikes, their individual care support plans, preferred activities and end of life wishes.

People’s privacy was respected and people were supported in a way that respected their dignity and individuality. Staff took time to speak with people and were kind and patient when supporting them with personal care.

People’s needs and personal preferences had been assessed before care was provided and were continually reviewed. Staff knew people well and understood how to meet their support needs

People’s individual assessments and care plans were reviewed regularly with their participation or their relative’s involvement. Care plans were reviewed regularly and updated when their needs changed to make sure people received the support they needed.

The provider took account of people’s views and these were acted upon. The provider carried out service user surveys and sent questionnaires regularly to people’s relatives. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued and supported under the registered manager’s leadership. The Care Quality Commission had been notified of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and action was taken to implement improvements.