We inspected Lydfords Care Home on the 30 October 2017 and the inspection was a focused inspection. Lydfords Care Home provides accommodation and nursing care for up to 43 people who have nursing needs, including poor mobility or diabetes, as well as those living with dementia. On the day of our inspection, there were 41 people living at the service. The home is a large property, spread over three floors, with a communal lounge, dining room and large gardens. It is situated in East Hoathly, East Sussex. Lydfords Care Home belongs to the large corporate organisation called Four Seasons. Four Seasons provide nursing care services across England and have several nursing homes within the local area.

The service had 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 the last comprehensive inspection on the 15 and 16 September 2016, the service was rated as 'Good' overall and Requires Improvement in the 'effective' domain. This focused inspection was prompted in part, by a notification of a serious injury involving a person who lived at the service. The incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident, indicated potential concerns about the management of risk in relation to fire safety and falls. This inspection examined those risks. We therefore looked at two key questions, is the service safe and well-led? This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lydfords Care Home on our website at www.cqc.org.uk

At this inspection the management of medicines was not consistently safe. Guidelines were not always in place for the use of ‘as required’ medicines. Documentation failed to reliably record the reason for administration for the use of ‘as required’ medicines. This meant the provider was unable to monitor whether the medicine was being administered for its intended usage. People received their medicines on time, however, the provider had not ensured that medicines were stored or managed safely at all times. Staff left the medicine trolley unattended during inspection. We have identified this as an area of practice that needs improvement.

Staffing levels were based on an assessment of people’s individual care needs. People and staff felt staffing levels were sufficient. However, observations throughout the inspection noted that the call bell system was constantly ringing. People raised concerns that they felt they had to wait for assistance. An audit of the call bell system found it failed to consistently record when people’s call bells were answered and when a number of people had pressed their call bells, the system did not record who pressed their call bell first. Steps were in the process of being taken to replace the call bell system. However, we have identified this as an area of practice that needs improvement.

Steps had been taken to ensure the building complied with fire regulation standards. A fire risk assessment dated May 2017 identified a number of shortfalls. Appropriate action had been taken to address the shortfalls. Training had been provided for staff to become fire wardens and fire drills were now taking place.

People were protected from harm and abuse. There were appropriate, skilled and experienced, permanent staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. Risk assessments ensured that risks were managed and people were able to maintain their independence.

Staff were chec

We inspected Lydfords Care Home on the 15 and 16 September 2016. Lydfords Care Home provides accommodation and nursing care for up to 46 people who have nursing needs, including poor mobility or diabetes, as well as those living with dementia. On the days of our inspection, there were 46 people living at the home. The home is a large property, spread over three floors, with a communal lounge, dining room and large gardens. It is situated in East Hoathly, East Sussex. Lydfords Care Home belongs to the large corporate organisation called Four Seasons. Four Seasons provide nursing care services across England and have several nursing homes within the local area.

The service had 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.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications to restrict people's freedom had been submitted to the appropriate DoLS office and checklists were in place to determine whether people’s rights were being restricted. Staff had received training; however, staff were not consistently aware who was subject to a DoLS and what that meant for that individual. Conditions attached to DoLS were not consistently being met. We have made a recommendation for improvement.

People's nutritional needs were met. They were provided with a wide range of food options and individual dietary requirements were catered for. People’s choking risk had been assessed and measures implemented to mitigate the risk of choking. However, improvements are required to enhance people’s dining experience. Further work was required to ensure food and fluid charts were completed correctly. We have made a recommendation for improvement.

Appropriate recruitment checks took place before staff started work. Staffing levels were based on the individual needs of people and staff and people felt staffing levels were sufficient. Observations throughout the inspection found that the call bell constantly rang. An audit of call bell response times found that people had occasionally had to wait in excess of twenty minutes for staff to respond. The management team were responsive to this feedback and took action immediately. We have made a recommendation for improvement.

People's privacy respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this. Care plan reviews, as well as residents' meetings, enabled people to make their thoughts and suggestions known. People's right to make a complaint or comment was welcomed and acknowledged and action had been taken in response to people's concerns.

People, staff and relatives were complimentary about the leadership and management of the home and of the approachable nature of the management team. One relative told us, “The manager is very bright and fair but will not let anything go. She is also a good nurse, if there is a gap she wears her nurse’s uniform and works the shift.” There were quality assurance processes in place to ensure that the systems and processes were effective and people's needs were being met.

Positive relationships had been developed between people as well as between people and staff. There was a friendly, caring, warm and relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. People and their relatives were complimentary about the caring nature of staff, one relative told us, “The most important thing is they are very nice to her, they treat her like a human being and do not talk down to her.”

People's safety was maintained as they were cared for by staff that

During our inspection we spoke with nine people who used the service. We also spoke with seven members of staff including the manager, a registered nurse, the activities co-ordinator, the chef and three care workers. We looked at care documentation, records, audits and minutes of meetings.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us "Yes they certainly know how to look after people here and I’m very happy thank you”.

Staff we spoke with said that they had undertaken safeguarding vulnerable adults training and people living at the home told us that they felt safe and knew who to talk to if they had any concerns.

At a previous inspection it had been identified that staffing levels had not been appropriate to meet the needs of people at the home. In response to this we reviewed the current staffing levels and found that the provider had taken steps that ensured sufficient staff were employed with the right skills to meet the needs of people who were using the service.

Staff were told us that they felt valued and supported and that their training needs had been met. However, we found that during the absence of the manager on maternity leave only a few members of staff had participated in regular supervision. There was no evidence to support that any staff had received an annual appraisal.

The provider had assurance systems in place to continually manage risk and monitor the quality of the service provided.

We found that people were asked for their consent to care and treatment and their decisions were respected. Where people were unable to give consent, arrangements were in place to discuss care and treatment with their representative. A relative of a person who could not communicate their needs told us "I talk on their behalf - and they (staff) are very happy to do as I ask them".

We found that people's needs were assessed and their care plans included their individual preferences. Risks to people's health and wellbeing were identified and managed. We found that care plans were regularly updated and reviewed. A visiting doctor told us "staff provide good care, and the manager has a good knowledge of people's needs".

People's medicines were handled safely and appropriately. Medicines were administered by qualified nursing staff who were assessed as competent to do so.

We found that the staffing levels were not based on a risk assessment and analysis of people's needs and this meant that people were not always supported by enough staff. We have asked the provider to ensure that there are always sufficient number of staff to ensure the health, safety and welfare of people who used the service.

The provider had an effective system in place to respond to the complaints and comments made by people or those acting on their behalf. We found that improvements were made to the service where concerns had been raised.

People living in the home told us that they could make choices about everyday life and these were respected and responded to.

People told us they were happy with the care and the food was good.

All feedback from visitors and people living in the home apart from one comment was positive about the staff in the home.

People told us that they were listened to and that surveys had been used to gather their views. They felt able to discuss any matters about the service with staff and particularly with the appointee manager.