The inspection took place on 20 and 21 February 2018, the first day of the inspection was unannounced.

At the last inspection in June 2015 the home was rated Good.

St Clare’s 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.

St Clare’s Care Home provides nursing or personal care for up to 60 adults over 65 years of age, some of who are living with dementia. At the time of our inspection there were 59 people living at the home. Accommodation is provided in a purpose built, two story building set in large grounds in a rural area of East Sussex.

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.

People told us they felt safe, staff knew how to recognise and report abuse. However, staff told us at times they were using unplanned restraint. We found when allegations against staff had been made, the Care Quality Commission and local authority had not always been notified.

Where risks to people were identified, some of the risk assessments lacked information and guidance for staff to follow to reduce the risks.

Medicines were stored and administered safely, where people required staff to support them to apply topical creams, consistent application records were not always kept.

People’s rights were not fully protected because consent to care and treatment was not always sought in line with current legislation.

People’s care records were not consistently accurate. There was a system in place for people and their relatives to be involved in reviewing the care people received.

The systems and processes in place to monitor and drive improvement were not fully effective at identifying shortfalls in the service.

There were enough staff available to meet people’s needs, the service was using agency staff to cover vacant shifts and they endeavoured to use the same staff where possible to aid consistency. The provider followed safe recruitment procedures.

People were protected from the risk of infection and the provider ensured people lived in a safe environment because regular checks on the environment were carried out.

Staff felt they received enough training to meet people’s needs, they commented positively about the training and support they received.

People received adequate nutrition and hydration and they commented positively about the dining experience. Consistent records were not always kept where people had their fluid intake monitored.

People were supported to see health professionals when required and staff acted upon their guidance.

The provider had plans in place to improve the environment to meet the needs of people who were living with dementia.

People and their relatives spoke positively about the staff supporting them. Our observation of staff interactions were positive. Staff described how they supported people in a way that promoted their privacy and dignity. Staff spoke positively about the people they supported.

There were a range of activities on offer for people to take part in. Our observation of people’s engagement in activities was mixed.

People, their relatives and staff had the opportunity to provide feedback on the service and where feedback was given, the provider had acted upon it.

People and their relatives knew who the registered manager was, and they felt able to approach them with any concerns. People, their relatives and the staff spoke positively about the registered manager.

We found one breach of the Health and Social Care Act 2008 (Regulated A

Some people were not able to tell us about their experiences. Therefore we used a number of different methods to help us to understand the experiences of people, including observing care being delivered.

We spoke with twenty people and one visitor. Everyone told us they were satisfied with the care they or their relative received. We saw records that showed people were involved in developing their care plans. People said they understood their care plans and that staff had explained things to them and what they could expect whilst staying at St Clare's. We saw how staff worked with people, at their own pace, to make sure they knew what support was needed and how best they could meet that need.

We found that all of the records we reviewed were accurate, up to date and had been regularly reviewed and evaluated.

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

We looked at staff records and found staff were recruited using a robust system and saw there were good systems in place to ensure staff were well supported in their work. Staff said they made every effort to provide a person centred service.

People said they were treated very well and their experiences in the home were positive and that they felt valued. People told us that if they had a complaint they would talk to the manager and they were confident any issues would be dealt with properly.

This inspection was undertaken by a pharmacist inspector following concerns that had been raised with us about the way medicines were being handled at the home.

People told us that the nurses gave their medicines to them regularly when they were due. One person said that although they looked after their own medicines when they were in their own home, they were happy for the nurses to look after their medicines and liked ‘being waited on’. Another person said that the staff trusted them and left medicines for them to take in their own time. This meant that people were given their medicines to them in their preferred way.

We found gaps in the way the home was recording information about medicines which meant that the home had not taken the appropriate steps to ensure that people received the right medication at the right time.

The inspection was carried out on 30 June 2015 and was unannounced. St Clare’s Care Home is a nursing home that provides accommodation for people who require nursing or personal care for up to 60 adults over 65 years of age, some of who are living with dementia. At the time of our inspection the home was full.

Accommodation was provided in a purpose built, two story building and was set in large grounds in a rural area of East Sussex. The home had communal lounges, cinema, library, activities and therapy room, a large dining area and an attractive and fully accessible garden.

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.

There was guidance for staff on actions to take to minimise risks to people and provide appropriate and individualised care to people. Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and outcomes to be achieved. People’s medicines were stored safely and in line with regulations. People received their medicines on time and safely.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People were happy and relaxed with staff. We heard different views about whether there were sufficient staff to care for them. Overall, there were sufficient numbers of suitable staff to keep people safe. One person told us, “Do you know, I have a great feeling of safety here. I couldn’t be in better hands”.

People felt well looked after and cared for 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; it’s a home from home.” A visitor told us, “Fantastic, we know [our relative] is safe and happy.”

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work with people who required care. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered 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. Emergency procedures were in place in the event of fire.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as dementia and end of life care. Staff had received both one to one supervision meetings with the registered manager and annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “The food is home-made and good. I went off my food before I came here but I’ve picked up now and I’ve had two sweets today so I feel much better”. There was a daily choice of meals and people were able to give feedback and have choice in what they ate and drank. 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 were encouraged to express their views and completed surveys, and feedback received showed people were satisfied with the care they received. People and their relatives said 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 home and whether they were happy in their work. They felt supported within their roles and described an ‘open door’ approach from the registered manager. The management were always available to discuss suggestions and address problems or concerns.