We inspected Patcham Nursing Home on 31 July 2018. Patcham Nursing Home 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. Patcham Nursing Home is registered to accommodate up to 30 people, some of whom were living with dementia and other health conditions. Patcham Nursing Home is comprised over two floors, with two lounges and a dining area. There were 27 people living at the service during our inspection. We previously inspected Patcham Nursing Home on 27 June 2017 and found areas of practice that needed improvement. Some improvements had been made, however, we found further areas of practice that needed improvement.

A registered manager was 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 and associated Regulations about how the service is run.

The culture and values of the provider were not embedded into every day care practice. Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of cohesion and a negative culture in the service. Some staff did not have a good understanding of equality, diversity and human rights. We have identified this as an area of practice that requires improvement.

On the day of our inspection, staffing levels were appropriate. However, we received mixed feedback from people and staff in relation to staffing levels. Documentation showed that on several occasions, shifts had gone ahead with less staff than had been assessed needed. We have identified this as an area of practice that needs improvement.

We have made a recommendation in respect to equality, diversity and human rights.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people at the end of their life. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. The service was clean and procedures in relation to infection control were robust.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people, massage and manicures, and themed events, such as reminiscence sessions and visits from external entertainers People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

People were en

The inspection took place on 27 June 2017. Patcham Nursing Home was previously inspected in 14 April 2015, where we identified areas of practice that needed improvement.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found improvements had been made. However, we identified further areas that needed improvement. The overall rating for Patcham Nursing Home has changed from ‘Good’ to ‘Requires improvement’.

Patcham Nursing Home provides personal care, accommodation and nursing care for up to 30 people. On the day of our inspection there were 25 older people at the service, some of whom were living with dementia and chronic health conditions. The service is spread over two floors with a communal lounge/dining room, a further sun lounge and a garden.

There was a manager in post, who had applied to become the registered manager. However, at the time of our inspection, they were not registered with the CQC. 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’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, safe procedures for the administration of the medication were not routinely being followed, which placed people at potential risk of receiving their medicines incorrectly. We have identified this as an area of practice that needs improvement.

We have made a recommendation about the management of medicines.

Staff had received essential training and there had been opportunities for additional training specific to the needs of people. However, we saw that several members of staff had not received essential updated ‘refresher’ training in a timely manner. This is an area of practice that needs improvement.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People and relatives told us they felt the service was safe. They remained protected from the risk of abuse because staff understood how to identify and report it.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. They supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs continued to be met and people reported that they had a good choice of food and drink.

People remained encouraged to express their views. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People and relatives also said they felt listened to and any concerns or issues they raised were addressed. They enjoyed taking part in meaningful activities both in the service and the community.

Staff felt fully supported by management to undertake their roles. People, staff and relatives found the management team approachable and professional.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team and this was observed

The inspection took place on 14 April 2015. Patcham Nursing Home was last inspected on 26 August 2013 and no concerns were identified.

Patcham Nursing Home is located in Patcham, Brighton. It is registered to support a maximum of 30 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia, and many who had complex health needs and required end of life care. The home is set over two floors. On the day of our inspection, there were 29 people living at the home.

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.

Care plans gave detailed information on how people were to be supported and the care they required. This information was reviewed and updated regularly. However, the care plans did not routinely contain people’s life histories, their likes and dislikes, goals, aspirations and fears. The home had recognised this, and was in the process of reviewing and changing all care plans to a more person centred format to reflect people’s individual needs. This process had not yet been completed, and we have identified this as an area of practice that requires improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here. I was living on my own and I am glad I’m in here”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as palliative (end of life) care. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “I like the food and I can choose what I want”. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People could choose how to spend their day and they took part in activities in the home and the community. People told us they enjoyed the activities, which included singing, exercises, films, and themed events, such as celebrations for St George’s Day. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported, and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. One person told us, “They treat you well here”. A relative said, “We find the staff caring and considerate”.

People were encouraged to express their views and completed surveys, and feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, they sort it out quickly”.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where management were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

During our inspection we spoke with six people who used the service and two relatives. We also spoke with four members of staff including the manager, a nurse and two care workers. We looked at care documentation, records, audits and minutes of meetings.

People who used the service told us they liked living at the home, they were happy with the care and treatment they received and the service met their needs. They told us that staff were “Kind and caring” and there was always someone around to provide help and support. One person who used the service told us, "I'm very happy here and have no complaints".

Individual care plans provided structure and guidance for care workers, to ensure that the assessed care and support needs of people using the service could be met consistently and safely.

People were protected against risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

The service had effective systems in place to deal with people's concerns and complaints.

Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

We found that nurses and care workers had developed awareness and a sound understanding of each person's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

In this report the names of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a Registered Manager on our register at the time.

During our visit we spoke with five people who were using the service, five members of staff and one visiting relative. People who used the service and their relatives told us that they liked the home and that the service met their needs. People told us that staff were kind and caring and that everyone was very nice. One person told us " it is an extra special home, the food is amazing."

People were offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitored the quality of care that people received. People said they would speak to the staff or the manager if they had any concerns.

Staff had received regular and varied training and felt supported to carry out their roles and meet the needs of people who used the service.

During our visit, we found that people living in the home appeared settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

We were told that, in accordance with their identified wishes and individual support plans, people are encouraged and enabled, as far as practicable, to make choices about their daily lives.