The inspection took place on 27 November 2018 and was unannounced.

Ingham House 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.

Ingham House is registered to accommodate 37 older people, some of whom may be living with dementia. There were 33 people living at the home at the time of the inspection.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

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. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks, including swallowing problems and risk of choking, and moving and handling. For example, to reduce risk of falls there was clear guidance of checking foot wear and mobility aids. A relative told us “They have worked out the risks, not many stay alone in their rooms and staff are ever present in the lounges, they are never unsupervised.”

There were safe systems for the management of medicines and people received their medicines in a safe way. Staff and relatives felt there were enough staff and people said staff were available to support them when they needed assistance. All staff demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. Agency staff were used when required and the registered manager ensured the agency staff used had the necessary skills to work at Ingham House. People said they felt comfortable and at ease with staff and relatives felt people were safe.

People were supported to eat healthy and nutritious diets. People told us that “food was excellent” and ”always lots of choices.” Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were “kind” and “Patient and compassionate” and “They come in often to see if everything is alright-they listen to

Ingham House provides long term and respite care for older people including those with a dementia diagnosis. People's care needs varied, some people required care and assistance with all areas of daily living, whilst others required support and guidance as their needs were less complex. Some people were independently mobile and able to walk unaided or with the use of walking frames others required full assistance with their mobility.

The service is registered to provide care for up to 37 people. At the time of the inspection there were 33 people living at the service.

We carried out a comprehensive inspection of Ingham house on 7 and 8 February 2017. After that inspection we received new information of concerns in relation to people’s safety and the leadership of the service. As a result we undertook a focused inspection on 13 July 2017 to look at these concerns. The last inspection identified a breach of legal requirement in relation to records and quality assurance systems. After the inspection, the registered manager wrote to us as required. At this inspection we found improvements had been made and the provider was now meeting all legal requirements. This report only covers our findings in relation to the breach of regulation and concerns raised regarding safety and the leadership of the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ingham House on our website at www.cqc.org.uk

Ingham House has 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.

Feedback from people and relatives was positive about the care people received at Ingham House. People felt safe and lived in a safe and clean environment. People’s individual needs were risk assessed and responded to. Medicines were stored and given safely and in accordance with people’s individual prescriptions. The recruitment procedures followed ensured staff and volunteers had required checks completed before they worked unsupervised in the service. Staffing numbers ensured people had their care and support needs attended to.

Staff knew people well and had a good understanding of their care, support and emotional needs. Staff enjoyed working at the home and felt fully supported by the management team. The registered manager and deputy manager had a high profile in the service worked alongside the staff and was available to people and their relatives. Feedback was regularly sought from people, relatives and staff and was responded to in order to improve the service. People were encouraged to share their views on a daily basis, through meetings and satisfaction surveys. Systems to monitor the quality of the service and to receive feedback from people and their relatives were established and responded to.

Full details of our findings can be found in the main body of the report under safe and well-led.

Ingham House is a residential home in Eastbourne, providing long term and respite care for older people including those with a dementia diagnosis. People’s care needs varied, some people required care and assistance with all areas of daily living, whilst others required support and guidance as their needs were less complex. Some people were independently mobile and able to walk unaided or with the use of walking frames others required full assistance with their mobility.

The service is registered to provide care for up to 37 people. At the time of the inspection there were 36 people living at the service.

This inspection took place on 7 and 8 February 2017 and was unannounced.

Ingham House has 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.

At the last inspection in January 2015 we asked the provider to make improvements in relation to the safe management of medicines. The provider sent us an action plan saying this would be in place by January 2015. At this inspection we found that although improvements had been implemented with regards to medication practice, including MAR charts and documentation of medicines, including the rationale behind why PRN or ‘as required’ medicines had been given had not been maintained.

When changes had occurred to people’s health needs this information had not been updated promptly in appropriate care plans to ensure staff were aware of that persons specific needs in relation to the new health need. Improvements were needed to documentation to ensure it was clear up to date and contemporaneous.

Although a quality assurance system was in place this had not identified the areas in relation to lack of PRN protocols and care documentation. By talking to staff and management it was clear that information was shared in handover and by word of mouth regarding changes to people’s needs however appropriate documentation was not in place.

People felt involved in decisions and choices about how they spent their time. Staff told us how they supported people’s choices and preferences. Management and staff had an understanding of mental capacity (MCA) and Deprivation of Liberty Safeguards (DoLS). People felt safe living at Ingham House and felt that there were enough staff to meet their needs. Staff had an understanding about how to recognise and report safeguarding concerns and people told us they would raise concerns with staff if they felt they needed to.

Maintenance of equipment and services took place. On-going redecoration of the communal areas was in progress. People told us Ingham House was a homely environment to live in.

We received positive feedback regarding the meals provided. Meal choices were available and people were supported to eat a healthy balanced diet. The registered manager had implemented a split mealtime for people to ensure that those who liked a quiet environment at meal times had this provided. Relatives spoke highly of the quality of food provided and were able to stay for a meal with their loved one if they wished.

Staff received appropriate training and many had completed or were working towards further qualifications. Staff felt supported and received regular supervision and appraisals. When people became unwell or needed referrals to other health professionals this had taken place. People were supported to attend appointments and encouraged to maintain relationships with people that were important to them.

Staff responded to people with kindness and patience. We saw staff stopped to speak to people offering support and guidance when required. Relatives and visitors were greeted warmly and told us they felt encouraged to visit at any time.

People’s r

At the time of our inspection there were 34 people living at Ingham House. We used a number of different methods to help us understand the experiences of people using the service. We spoke to people living in the home who told us “the girls are lovely” and “I have nothing to grumble about, it’s all very nice.” Another person told us “I love my room, it’s got all my own things in it, they keep things lovely clean and tidy. It is a nice place to live, the staff are like a family.”

During our inspection we found that people had been involved in decisions about their care, and chose how they spent their time. Care plans documented the needs of people living in the home.

The provider had systems in place to ensure staff recruitment measures were followed. Peoples care needs were reviewed weekly, this meant that staffing levels could be assessed regularly to ensure that there were sufficient staff to meet the needs of people living in the home.

Staff received regular supervision, and were encouraged to attend further training appropriate to the work they perform.

A copy of the complaints procedure was available and included in the service user contract when people moved into the home. A complaints policy was available for people to access if required.

Evidence was seen that comments and complaints were documented, and responded to in accordance with the organisations complaints policy and procedure.

At the time of our inspection there was no registered manager employed at Ingham House. The organisation had informed us that the previous manager had left. However, the previous manager had not deregistered with CQC at the time of the inspection, therefore their name still remains on any reports until such time that this information is received.

We used a number of different methods to help us understand the experiences of people using the service. Some people using the service had complex needs, which meant they were not able to tell us their experiences. Those who could told us “I have been here a long time, I like it here, I go out more than I would if I lived at home on my own, there is always something going on." And “I have lived here a few months, I chose this home as it is family run and I liked the look of it. I like the trips out. Sometimes you can’t get out, but I get out quite often." Everyone we spoke with told us they were happy with the level of care provided.

During our inspection we found that care and treatment was being provided to meet people’s needs. People’s bedrooms and communal areas were clean and tidy, and the provider had appropriate systems in place to monitor and improve the service.

Ingham House is a residential care home providing permanent residential and respite care for 37 older people and people with dementia. At the time of the inspection there were 35 people living at the service. People’s care needs at Ingham House were varied. Some people required care and assistance due to their mental health needs, dementia or memory loss; others lived independent lives but required support with mobilising and personal care. Ingham House also provides a day centre from the service. People living in the service attended activities provided for people attending the day centre. This gave people the opportunity to mix with people who did not live at the service.

This inspection took place on 13 and 14 January and was unannounced.

Ingham House has a registered manager. 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.

Medicine policies were in place to support the administration of medicines, however, staff did not always follow these. This could leave people at risk of harm from inappropriate treatment.

Safeguarding adults training was on-going and staff understood their responsibilities to report any concerns if they suspected abuse. Safeguarding and accident/incident forms had been completed and the local authority and CQC had been notified appropriately and in a timely manner when required.

Fire safety assessments had been completed by an external organisation. However, personal emergency evacuation procedures (PEEPS) did not give instructions to staff on how to commence evacuation of the premises. Care plans had been written with risk assessments written for any identified risks.

The provider followed thorough recruitment processes that ensured staff employed were suitable to work and had the appropriate skills and qualifications to undertake their allocated role. An induction was provided for new staff and competencies checked to ensure staff were providing care appropriately. Staffing numbers were reviewed and amended if needed.

Staff told us they felt that they had all the training they needed provided. Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training was in progress and mental capacity assessments were competed for people.

People told us the meals were good. The cook knew people’s likes, dislikes and special requirements. People were offered choice, and the chef was able to provide alternative meals if requested.

Systems were in place to liaise and refer people to other health professionals when needed and to support people to access services, this included GP’s, chiropody and district nursing services. People were able to access health care services when they wished. One person told us they asked to see the nurse and staff arranged this for them.

There was a comprehensive activities schedule, with activity co-ordinator providing group and one to one activities. Staff communicated well with people, when people became distressed or upset staff responded promptly and with support and encouragement. Staff spoke positively about people during staff handover, and showed concern for people’s wellbeing. Staff told us that they felt that they were working well as a team.

People were involved in care decisions when this was appropriate. Some people were unable to consent fully to all decisions about their care due to their dementia. However, we saw that people were involved in day to day decisions, people’s dignity was maintained and doors were closed when care took place. Staff understood their role and responsibilities and were clear how their decisions, actions, behaviours and performance affected the running of the service and the care people received.

There was a complaints policy and information regarding the complaints procedure was available. Previous complaints had been investigated in accordance with the service policy and procedures.

There was a comprehensive format for meetings and auditing within the service. Audits had been completed. Issues raised in meetings had been acted on and addressed appropriately.

The registered manager had a comprehensive overview of the service. Meetings took place weekly to review people’s care needs.

Certificates were in place to show that regular servicing and maintenance had taken place. Policies and procedures were available for all staff, relatives and visitors to access if required. The service had recently amended its registration to include dementia. Staff had received the appropriate training and told us they felt supported to provide good care for people with dementia.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.