This inspection took place on the 27 September and 2 October 2018 and was unannounced.

Normanhurst Care Home 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.

The home is registered to provide personal care and accommodation for up to 75 older people. At the time of the inspection there were 59 people living there. Most people were independent and had capacity to make decisions about the support and care provided; they went out into town and for meals with relatives and friends. Other people, due to frailty and health care needs, were assisted with personal care and mobilising around the home.

At the last inspection in August 2017 the overall rating for Normanhurst Care Home was Requires Improvement as more work was needed to ensure their quality assurance system identified areas where improvements were needed. at this inspection we found this had been addressed and the overall rating had improved to Good.

The registered manager was present during the inspection. 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 providers for the service are Mr David Lewis and Mr Robert Hebbes. They also own Normanhurst Nursing Home and Normanhurst EMI Home.

The quality assurance system had been reviewed and areas for change had been identified and prioritised to drive improvement. The care planning process had been changed and an electronic system had been introduced, which was audited as part of their monitoring process. People were involved in writing and reviewing their care plans and decided with staff how much support they needed, based on their preferences. Regular resident’s meetings offered people opportunities to discuss the services provided at the home and put forward suggestions to develop them.

Activities had been developed and planned with people living in the home, which resulted in a range of group and one to one activities that people could participate in if they wished. People, visitors and staff clearly enjoyed these and they were comfortable in each others company.

Risk had been assessed and people were encouraged to be independent in a safe way, with the provision of walking aids and assistance from staff as required. Staff had completed relevant training, including infection control, medicines and safeguarding. They understood people’s needs; how to protect people from abuse and what action they could take if they had any concerns. Supervision and staff meetings ensured staff were up to date with current best practice and they had a good understanding of their and their colleague’s roles and responsibilities. Robust recruitment procedures meant only suitable staff were employed and there were enough staff working to provide the care people needed.

Staff understood the Mental Capacity Act 2005 and consistently asked if people needed support or assistance. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS applications had been requested when required to ensure people were safe.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were aware that people had different communication needs and could explain how they supported people to communicate.

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This inspection took place on 21 and 24 August 2017 and was unannounced. There were 55 people living at Normanhurst Care Home when we inspected. People cared for were all older people. They were living with a range of care needs, including arthritis, breathing difficulties and heart conditions. Some people were also living with dementia. While some people lived largely independent lives, others needed support with their personal care and mobility needs. The registered manager told us they also provided end of life care at times. No one was receiving end of life care when we inspected.

Normanhurst Care Home was a large building. Accommodation was provided over four upper floors, ground floor and a semi-basement. Two passenger lifts were available to support people in getting between each floor. Lounges and a separate dining room were provided on the ground floor. The home was situated on the sea-front in Bexhill on Sea.

Normanhurst Care Home had a registered manager. 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 registered manager was also the registered manager for Normanhurst EMI Home, which was next door to Normanhurst Care Home. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They also owned Normanhurst Nursing Home and Normanhurst EMI Home.

Normanhurst Care Home was last inspected in June 2016. At this comprehensive inspection the overall rating for this service was Requires Improvement. Four breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. This was because audits of service provision had not identified a range of areas that needed to be improved. The provider had not always ensured care was provided in a safe way to people. This was because they did not consistently assess risks to people and do all they could to mitigate such risks. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by August 2017.

This inspection on 21and 24 August 2017 was to see if improvements had been made and embedded into practice. We found that many improvements had been made and the breaches of regulation met.

Since the last inspection systems and processes to assess and monitor the quality of the service to drive improvement had been developed. However further development was required in certain areas to ensure that risk was mitigated to ensure people’s health and well-being was protected. This was in respect of infection control measures and the information documented in care plans.

The provider had not correctly displayed their CQC rating on their website and the information on the website was misleading. This was identified and rectified during the inspection process.

We recommend the provider ensures they understand all legislation in respect of providing care and treatment.

This inspection found the provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Deprivation of Liberty Safeguards had been requested for those that required them. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the MCA 2005 and DoLS.

People received care that reflected both their health and social care needs. Care plans had been reviewed and there was acknowledgement from the management team that there was still work to be done to ensure documentation reflected peoples personal preferences and health needs. A

This inspection took place on 28 and 29 June and 4 and 5 July 2016. It was unannounced. We inspected Normanhurst Care Home at the same time as we inspected the service’s sister homes, which were next door. There were 58 people living at Normanhurst Care Home when we inspected. People cared for were all older people. They were living with a range of care needs, including arthritis, breathing difficulties and heart conditions. Some people were also living with dementia. While some people lived largely independent lives, others needed support with their personal care and mobility needs. The registered manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.

Normanhurst Care Home was a large building. Accommodation was provided over four upper floors, ground floor and a semi-basement. Two passenger lifts were available to support people in getting between each floor. Lounges and a separate dining room were provided on the ground floor. The home was situated on the sea-front in Bexhill on Sea.

Normanhurst Care Home had a registered manager. 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 registered manager was also the registered manager for Normanhurst EMI Home, which was next door to Normanhurst Care Home. The providers for the service were Mr David Lewis and Mr Robert Hebbes. They also owned Normanhurst Nursing Home and Normanhurst EMI Home.

Normanhurst Care Home was last inspected on 9 September 2014. No issues were identified at that inspection.

During their audits of service provision, the provider had not identified a range of areas. This included some assessments of risk for people. For example where people had an accident, their individual accident reports were not used to assess and reduce their risk. The provider’s audits had not identified that people did not consistently have care plans developed, including where people lived with dementia or had specific care needs. Some documentation about people was not completed, to ensure people received consistent care. The provider had also not identified that parts of the home environment did not follow guidelines on supporting people who were living with a disability or dementia. There was a lack of audit of staff supervisions, to ensure relevant areas were identified. Recruitment systems were not audited to ensure that all staff folders included all required information and the provider’s policies were consistently followed.

Some staff had not been trained in their responsibilities under the Mental Capacity Act 2005 (MCA). People’s assessments in relation to the MCA were not decision specific and did not ensure the requirements of the Act were followed. Deprivation of Liberties (DoLS) applications were made, however there was a lack of best interest decisions documentation where people needed to have their liberties restricted, for example by the use of bed rails.

Some staff did not fully engage with people who were frail and living with dementia, this included in the dining room, lounges and where people remained in their own room all the time. Other staff were responsive and consistently supported people in the way they needed.

Certain areas for supporting people with medicines relating to individual assessments and protocols, required improvement. In other areas, staff supported people in taking their medicines safely and ensured appropriate systems for storage of medicine. Staff had effective systems for liaison with external healthcare professionals where people needed support.

There were a wide range of meals offered to people. People commented favourably on the meals service. Where people required support with their

A single 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 who used the service, their relatives and the staff told us, what we observed and the records we looked at.

To see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained.

There were policies in place that ensured people were protected against the risks associated with falls.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While there were no applications that needed submission, proper policies and procedures were in place.

Is the service effective?

People told us that they were happy living in the home and the care they received. It was clear from our observations and from speaking to staff that they understood people's care and support needs well.

We saw from training records that staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were cared for by kind and attentive staff. We saw that staff were patient with people giving them enough time and encouragement to carry out tasks of daily living. One person told us " The staff are very attentive and caring."

People who lived at the home told us that they were happy living there. They told us that staff were caring and attentive. One person told us " I love it here." Another told us that "This is one of the best homes in the area." Another said " I have no complaints."

We saw that care delivered was good and met individuals assessed needs. People were cared for in a clean environment by staff who received appropriate training and professional development and support.

Is the service responsive?

People's needs were assessed and care delivered according to individual needs. Records outlined people's needs, interests and preferences. People had access to a wide range of activities and were given choices on how they wished to spend their time.

Is the service well-led?

Staff were well informed about the quality assurance processes in the home. People were asked their views and we examined surveys and audits carried out in the home. Staff told us that any concerns were dealt with by management promptly and that they were clear about their roles and responsibilities. There was an 'open door policy' and staff could discuss their views and concerns openly with the manager who would take them into account.

People who lived at the home told us they were happy living there. They told us they were well looked after. One person told us, “I have a good group of friends here.” Another person told us, “it was a good decision to move in here”. Someone else said, “I have no worries and no responsibilities”.

We saw that care delivered was good and met the individuals assessed need. People were cared for in a clean environment by staff who received appropriate training and support.

People were listened to and any complaints were addressed appropriately.

People told us what it was like to live at Normanhurst Care Home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a second inspector, for part of the inspection, and a practising professional.

During the day we spoke with eight of the 56 people accommodated. People said that staff treated them well and that they were kind and caring. They said that there was a good range of activities provided.

Everyone spoken with said that the food was ”very good” or ”excellent” and that there was an extensive choice available.

People said that staff were “kind and caring” and that care was ”not hurried”. Two people said that if they wanted anything done differently they “tell reception”.