We inspected Rottingdean Nursing and Care Home on 11 January 2018. Rottingdean Nursing and Care 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. Rottingdean Nursing and Care Home is registered to accommodate up to 35 people, some of whom were living with dementia and other chronic conditions. Rottingdean Nursing and Care Home is comprised over three floors, with a lounge and dining areas. There were 31 people living at the service during our inspection.

Following the last inspection on 6 October 2015, we saw that not all staff had received training in safeguarding adults from abuse. We asked the provider to take action to make improvements and this action has been completed.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

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.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

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.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. 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.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both 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. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

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’s end of life care was discussed and planned and their wishes had been respected.

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 in their rooms, bingo, exercise, quizzes, 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 recei

The inspection took place on 6 October 2015. Rottingdean Nursing and Care Home was last inspected on 4 June 2014 and no concerns were identified. Rottingdean Nursing and Care Home is located in the village of Rottingdean near to Brighton and provides accommodation for up to 35 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia, and some who had complex health needs and required end of life care. The service is across three floors. On the day of our inspection, there were 33 people living at the service.

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 staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. However, after reviewing training records, we saw that twelve ancillary staff had not received training around safeguarding and recognising abuse. We identified this as an area of practice that needs 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 always feel safe and looked after, I have no worries about that”. 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.

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.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken 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 caring for people with dementia, wound management, and palliative (end of life) care. People felt the staff were well trained and responded to their needs. A relative told, “I am never concerned about the staff or the nursing aspect of [my relative’s] care. They are all really on the ball regarding [my relative’s] needs”. Staff had received both one to one and group supervision meetings with their managers, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “There’s always a choice of two meals. It’s good”. 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. A relative told us, “They will always let us know if they have to call the doctor or [my relative’s] medication has changed, they really keep in touch with us, we never have to worry, as they are good at picking up on things”.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included singing, exercises, films, arts and crafts, church visits and trips to the shops. People were encouraged to stay in touch with their families and receive visitors. A relative told us, “I was concerned that [my relative] was isolating themselves as they spent so much time in their room. I know now that the activities co-ordinator visits people in their rooms and I was pleased when I visited recently and they were sitting with [my relative]”.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. A relative told us, “We are often here and I think the staff just forget we are in the room. I’ve always been impressed with how caring they are”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

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. A relative said, “They encourage me to speak directly with the managers’ about and concerns or niggles I might have”.

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 managers and senior staff were always available to discuss suggestions and address problems or concerns. A member of staff said, “I’m really proud of what we’ve achieved. The staff are a fantastic team who make the place feel really homely for the residents”.

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

Our inspection team was made up of an Adult Social Care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with two people who used the service, two visiting relatives, the registered manager, a registered nurse, a cook, a domestic worker and two care workers.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

If you want 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 were treated with respect and dignity by the staff. People who used the service told us they felt safe. A person told us "I feel comfortable and safe here".

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs. One relative told us “We’ve been involved since day one with planning the care. We been told about the nursing care and have given information about [my relatives] likes and dislikes and life history”.

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service told us "The staff are lovely and all really kind". A relative told us “I think this is a caring and very welcoming home”.

We spoke with relatives who said they were able to visit at any time and they were always made to feel welcome. We saw that the staff took time interacting patiently and sensitively with people throughout the home. We observed that people were treated with consideration, dignity and respect.

People who used the service, their relatives, friends and other professionals involved with the service had completed a recent satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service. The home had a dedicated activity co-ordinator, and people told us that they had regular activities planned and occasional trips out of the home, which helped to keep them involved with their local community.

People’s needs were assessed before they moved into the service and detailed and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people’s individual needs.

We were told by the registered manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people who used the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they carried out a range of internal audits, including care planning, medication and environmental health and safety.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

During our inspection we spoke with three people who used the service and four visiting relatives. We also spoke with four staff members; these were the manager and three care workers.

The people we spoke with told us they were generally happy with the care they had received and with the staff team. One person who used the service told us “They are nice and kind here and I’m listened to. I’ve nothing to grumble about”. Another person who used the service told us “I’m happy here to be honest. The staff are all kind to me”. Staff we spoke with had a good understanding of the support needs of the people who used the service. One member of staff we spoke with told us “We are always trying our best. We make sure everyone is safe and well treated”.

During our visit we saw that the service had an effective recruitment and selection procedure in place and that the appropriate pre-employment checks had been completed on staff. The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

We also saw that the service had quality assurance systems in place to monitor the quality of the service provided, and to gain the views of the people who used the service.

During our visit we spoke with one person who used the service and with six staff members, these were the manager, two registered nurses and three care workers.

The person we spoke with told us they were generally happy with the care they had received and with the staff team. They told us “I like it here, I think it’s good”, they also told us “The staff are good, I’m definitely happy here”.

Staff we spoke with knew the people living at the home well and had a good understanding of their support needs. One member of staff we spoke with told us “I feel we offer nice care, there is always somebody there for them [the people who used the service]”.

We found that not all of the care plans we saw contained signed consent to care and treatment. We raised this with the manager, who told us that the current care files were in the process of being updated and that signed consent would be sought again from all people who used the service, or their relatives or representatives as part of this course of action.

Despite the overall appearance of the home being clean and having appropriate systems and policies in place, we evidenced areas of non-compliance in respect to cleanliness and infection control.

We spoke with three care workers during our visit and were told that they felt valued and supported and that their training needs had been met. We also evidenced that staff records and other records relevant to the management of the home were accurate and fit for purpose.

People told us that they felt safe and were well cared for by the staff. Everyone spoken with said that they liked living at the home.

People were happy with the level of support that they received and felt comfortable with the staff and management of the home.

People told us that if they were unhappy about anything they would report it to the manager or another member of staff.