The inspection took place on 15 January 2019, the inspection was unannounced.

Fort Horsted Care Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People received nursing and personal care.

Fort Horsted Care Home Ltd accommodates up to 30 people in one single storey building. There were 26 people living at the service when we inspected. A number of people received their care in bed. Some people lived with dementia.

At the last inspection on 09 November 2017 we rated the service Requires Improvement overall. The provider had failed to adequately assess and mitigate risks to people and staff. The provider had also failed to manage medicines safely. The provider also failed to plan care and treatment to meet people’s needs and follow the principles of the Mental Capacity Act 2005. The provider had failed to operate effective quality monitoring systems and failure to make accurate, complete and contemporaneous records.

At the last inspection on 09 November 2017 we also made a number of recommendations relating to: reviewing systems and processes to evidence that staffing levels met people's assessed needs, reviewing and amending safeguarding policies, reviewing and amending people's care plans with them as their needs change. We also recommended that registered persons reviewed the catering arrangements for people with different diet needs and training requirements for staff to ensure that staff had the right skills and knowledge to work with people who had specialist health conditions and arrangements for clinical supervision. We also recommended that the provider reviewed their policy and procedures to ensure people and their relatives had clear information about how to raise and escalate complaints should they need to and seeking advice and following good practice guidance to support people with dementia to orientate themselves in the service to enable them to live well.

The provider submitted an action plan on 05 March 2018. This showed that all breaches had been complied with and they planned to monitor this on an ongoing basis.

At this inspection we found the provider had met some of their actions. However, there continued to be three breaches. The service has been rated Requires Improvement overall. This is the second consecutive time the service has been rated Requires Improvement.

There was 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.

Improvements had been made to medicines management. However, further improvements were required. People were prescribed a variety of pain relieving tablets as and when required (PRN). PRN protocols were not always in place to detail how they communicated pain, why they needed the medicine and what the maximum dosages were.

Improvements had been made to management of risks. However, further improvements were required. Risks to people's individual health and wellbeing had been assessed. Risk assessments did not provide staff with clear guidance and information about the size and type of equipment required to support the person to move safely.

The management team had a good oversight of the quality and safety of the service. They had undertaken quality audits but these had not been robust enough to capture the action required to improve the service. Further improvements were required to ensure records were accurate and complete. Registered persons had not notified CQC of incidents such as serious injuries or Deprivation of Liberty Safeguards (DoLS) authorisations that h

This inspection was carried out on 09 and 13 November 2017. The first day of the inspection was unannounced.

Fort Horsted Care Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People received nursing and personal care

Fort Horsted Care Home Ltd accommodates up to 30 people in one single storey building. There were 29 people living at the service when we inspected, one of whom was in hospital. A number of people received their care in bed. Some people lived with dementia.

There was 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 this inspection people told us they enjoyed living at the service. They got on well with staff and we saw that people were comfortable and relaxed.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always complete, accurate or securely stored.

People's care plans detailed most of their care and support needs. However, care plans did not all reflect each person's current needs or specific healthcare needs.

The provider followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. Appropriate numbers of staff had been deployed to meet people's needs. It was not clear how staffing levels had been determined as people’s dependency information was not used to calculate the staffing required. We made a recommendation about this.

People’s care records and assessments did not follow the principles of the Mental Capacity Act 2005. Staff supported people to make everyday choices about their care.

Staff had attended basic training but had not always attended training relevant to people's needs.

Staff had received effective supervision from the registered manager. There was no formal process in place for the registered manager (as a trained nurse) to receive planned and regular clinical supervision. We made a recommendation about this.

Risk assessments were in place to mitigate the risk of harm to people and staff. These had not always been updated when people’s needs had changed.

Medicines had not always been well-managed or stored securely. Prescribed thickening powder which was a choking risk was found unattended in the dining room and in some people’s bedrooms.

People and their relatives gave us mixed feedback about the activities. Activities took place during the inspection. Some people were enabled to access their local community both with their relatives and with the staff. We made a recommendation about this.

People had choices of food at each meal time which met their likes, needs and expectations. Food was not always prepared to meet people’s dietary requirements. People with diabetes were provided with the same meals as others. We made a recommendation about this.

There was a lack of signage around the home to direct people to communal areas such as the lounge and dining room. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had systems in place to track and monitor applications and authorisations.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The service did not have a copy of the local authorities safeguarding adults policy and procedure. We made a recommendation about this.

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