Pentlow 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. Pentlow Nursing Home provides accommodation for up to 60 older people. It spreads over two neighbouring buildings called Pentlow and Summerdown. People's nursing and support needs varied, some were living with complex nursing needs, including end of life care, diabetes, stroke, heart conditions and Parkinson's disease. People needed support with their personal care, eating and drinking and mobility. Some were living with a dementia and memory loss and required support with this, along with their physical care needs.

This inspection took place on 18 and 23 October 2018 and was unannounced. At the time of this inspection 34 people were living at the service, 11 in Summerdown and 23 in Pentlow. The first day of the inspection was unannounced, this meant staff did not know we were coming.

We had previously carried out an inspection in December 2014 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in June 2016 where we found improvements had been made and regulations had been met. However, further improvements were needed. We inspected the home again in August 2017 where we found some improvements but we found further and ongoing areas that required improvement, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the management of medicines did not always provide clear records to ensure medicines were given safely and in a consistent way. Agency staff were relied on as part of the regular staff provision. They had not received training on specific care and practice related to the service they were working in. The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. The quality monitoring systems did not always establish best practice or identify all areas for improvement.

The provider sent us an action plan and the registered manager provided monthly updates on the progress being made to ensure the regulations were being met. At this inspection we found a number of improvements had been made. However further improvements were required. This the fourth time this service has been rated Requires Improvement.

The service 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 management of medicines still did not always ensure medicines were handled safely and in a consistent way. Medicine records and care documentation were not always completed to ensure GP prescriptions were appropriately recorded and followed. When people were prescribed 'as required' medicines guidelines were not provided to ensure staff gave these in a consistent way.

Infection control measures had not ensured the sluice rooms were hygienically clean. This meant there was a possible risk of cross infection.

The quality monitoring systems did not always establish best practice or identify all areas for improvement. The quality monitoring audits had not addressed ongoing problems with the safe handling of medicines, inconsistent records, and the risk of cross infection in the sluice rooms. Care records were not complete and were not always accurate for each person.

There was a structured management team with identified roles and responsibilities. However, staff gave mixed feedback on how the management team supported them, some were positive and others we

Pentlow Nursing Home provides facilities and services for up to 60 older people who require personal or nursing care, for long term and for short periods to cover family holidays or times of ill health. People's nursing and support needs varied, some were living with complex nursing needs, including end of life care, diabetes, stroke, heart conditions and Parkinson's disease.

Many people needed support with their personal care, eating and drinking and mobility. Some were living with a dementia and memory loss and required support with this, along with their physical care needs. Pentlow Nursing Home is based over two neighbouring buildings called Pentlow and Summerdown.

This inspection took place on 30 August and 7 September 2017 and was unannounced. At the time of this inspection 40 people were living at the service, 12 in Summerdown and 32 in Pentlow.

The service did not have a registered manager. However, the appointed manager was working in the service and their application for registration was being processed by the Care Quality Commission. 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 inspection undertaken on the 8 and 9 June 2016 the home was rated ‘Requires Improvement’ overall. This was because we found some areas of practice that needed to improve. At this inspection some areas had improved, including the safety of the premises, however we found further and ongoing areas that require improvement.

The management of medicines did not always provide clear records to ensure medicines were given safely and in a consistent way. There were no records to identify when and how prescribed topical creams were administered and medicines given ‘as required’ did not always have clear guidelines for staff to follow. When ‘as required’ medicines were administered the amount and time was not always recorded.

Agency staff were relied on as part of the regular staff provision. Although there was a basic induction sheet completed, staff had not received training on specific care and practice related to the service they were working in. The operations manager and appointed manager advised that further induction training was to be provided, which would be tailored to the agency staff’s needs.

The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. Care plans did not cover specific health care needs and therefore did not ensure these needs were responded to in a consistent and appropriate way. Other records were not completed consistently to ensure responsive care. For example, the handover sheets used to share key information between staff were not accurate.

The quality monitoring systems did not always establish best practice or identify all areas for improvement. The provider had not established systems that identified and responded to poor record keeping, the management of reported incidents, the submission of required notifications, and a lack of person centred care planning.

People were happy with the care they received and they appreciated and told us they liked the regular staff that cared for them. Staff were kind and attentive and demonstrated a caring approach to people.

Staff employed by the service had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a

Pentlow Nursing Home provides nursing and personal care for up 60 people both long term and for short periods to cover family holidays or times of ill health. People’s nursing and support needs varied, some were living with complex nursing needs, including end of life care, diabetes, stroke, heart conditions and Parkinson’s disease. Many people needed support with their personal care, eating and drinking and mobility. Some were living with a dementia and memory loss and required support with this along with their physical care needs. Pentlow Nursing Home is based over two neighbouring buildings called Pentlow and Summerdown. There were 45 people living at the service at the time of the inspection including both privately and local authority funded.

This inspection took place on 8 and 9 June 2016 and was unannounced.

At the last inspection undertaken on the 22 and 23 December 2014 we asked the provider to make improvements in relation the safe management of medicines, appropriate provision and support for people to eat and drink. The provider was asked to ensure the care and support provided was person centred and records were complete accurate and informed the care needed and provided. The provider sent us an action plan stating they would have addressed all of these concerns by September 2015. At this inspection we found the provider was meeting these regulations although further work was needed to embed and ensure safe and good practice in all areas.

The service did not have a registered manager in post however there was an acting manager and we were told a new manager had been appointed and was taking up post in August 2016. 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 and associated Regulations about how the service is run.

The quality monitoring systems needed further development to ensure they were used to ensure best practice and to identify shortfalls and demonstrate effective responses. This included the provision of suitable guidelines and records for medicine administration and management of accidents. Guidelines to assist staff in the administration of medicines were not always complete and records of when topical creams were administered were not always accurate. In addition systems for safety in all areas of the home and garden had not been fully established. These areas were raised with the acting manager for improvement. Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of staff and atmosphere in the home. People said they would recommend the service and one said “I can’t think of a better place to end my days.” People were looked after by staff attentive staff who treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

There was a variety of activity and opportunity for interaction taking place in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with senior staff and the acting manager. People were complementary about the food and the

We used a number of different methods to help us understand the experiences of people using the service. We spoke to people living in both of the buildings. We were told “I am very content here.” And “I am very pleased to be here.”

During our inspection we found that people were involved in decisions about their care and treatment. Care plans were personalised and documented the needs of people.

Safeguarding measures were in place to protect people living in the home. Staffing levels had been assessed and reviewed to ensure adequate staffing levels in accordance with the organisations requirements. Complaints procedures were displayed around the home and a complaints policy was in place. Evidence was seen that comments and complaints were listened and responded to in a timely and appropriate manner.

People spoken with told us they were very happy living at Pentlow Nursing Home. One person told us “I like to spend time in my room, staff are very nice here”

Pentlow Nursing Home is a nursing home in Eastbourne, providing care for people who require nursing care both long term and for a period of respite, they also provide end of life and palliative care. People’s nursing needs varied, some had complex nursing and care needs, others required support with dementia and memory loss. Pentlow Nursing Home is based over two neighbouring buildings called Pentlow and Summerdown. There were 48 people living at the service at the time of the inspection including both privately and local authority funded.

The inspection took place on the 22 and 23 December 2014 and was an unannounced inspection.

Pentlow Nursing Home 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.

We were able to enter the premises without challenge and had to make ourselves known to staff, Security at the service had not been maintained and this could leave people at risk with regards to their personal safety and belongings.

Individual risk assessments were in place for people’s identified needs. However not all information in care plans had been followed, this included mouth care and the repositioning of people. Daily records and charts did not correspond; this meant it was difficult to assess how frequently care had been provided.

Medicine policies were in place to support the administration of medicines. We found not all medicines with a limited shelf life had been dated on opening to ensure that they were used within the required timescale.

MAR folders were used frequently throughout the day, with some pages falling out due to rips in the paperwork. Not all guidance was in place with regards to ‘as required’ medicines.

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

Personal evacuation plans had been written for people, these included specific information regarding equipment, support measures and assistance required. Plans were in place to deal with an emergency or evacuation of the premises.

Staffing numbers were calculated by hours of care required for each person. This was worked out across the two buildings by the use of a dependency tool completed by the nurses. This was reviewed weekly as people’s needs changed. Staff told us that they were very busy and there were times when they felt that there should be more staff, especially at meal times.

Recruitment processes ensured staff employed were suitable to work and had the appropriate skills and qualifications to undertake their allocated role. Further training opportunities were available for staff to ensure on going development. Staffing numbers were reviewed and people’s needs assessed by the use of a dependency tool. This was reviewed and amended weekly.

People were satisfied with the way care was provided. Staff told us they felt that training opportunities were good and they were encouraged to undertake further training. Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training was in progress and mental capacity assessments were competed for people.

People who required support or encouragement to eat were not adequately supported at meal times. We received positive feedback regarding the standard of meals provided. Although there seemed to be confusion regarding how menu choices were collated and how many days in advance menu choices were completed. People’s likes, dislikes and special requirements were catered for, and the chef was able to provide alternative meal choices if requested.

Pentlow and Summerdown buildings were adapted neighbouring domestic properties which had restricted storage areas for equipment and laundry. This meant that communal bathroom and shower rooms had been used to store items used for moving people, spare equipment, rubbish bags and laundry. This meant that access to these areas could be restricted. On-site maintenance was available throughout the week, with on-call maintenance workers available out of hours. Both buildings had communal areas which were nicely decorated with access to a rear garden in good weather.

We asked people if they felt staff were caring, some people indicated that whilst the majority of the staff were caring and kind, this was not universal. However, overall people were happy with their care. Staff were seen to speak to people in a kind caring manner. People’s dignity was maintained and doors were closed when care took place. Signs were placed on doors informing people not to enter as care was in progress.

People’s religious and spiritual needs were documented in their care files. Staff told us how they met people’s religious needs, this included end of life needs. To facilitate the provision of end of life and palliative care the service had close links with the local hospice and palliative care team.

There was a comprehensive activities schedule, with activity co-ordinators working seven days a week providing group and one to one activities.

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.

People told us they felt involved in the on-going development of the service. There was a comprehensive format for meetings and auditing within the service. Audits included actions and had been signed to show when these had been completed. Some audits including care documentation and medicines had not identified some areas which required improvement.

Issues raised and discussed in meetings had been acted on and addressed appropriately. For example requests for specific meals to be included on the menu, or for certain activities or trips to be organised.

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.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which now correspond with the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.