St Nectans Residential Care Home is a care home for up to 35 older people that require support and personal care. The people living at St Nectans Residential Care home all lived with a degree of physical frailty. There were also people who were living with early stages of a dementia type illness, diabetes, Parkinson’s disease and heart disease.

The home is owned by St. Nectans Residential Care Home Limited and is located in the centre of Bexhill on Sea, East Sussex.

At a comprehensive inspection in June 2015 the overall rating was requires improvement. Breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found there were risks to people due to unsafe management of medicines and care plans that were not accurate and up to date. There were also some environmental issues that had had the potential to place people at risk. People in the service had not been protected against unsafe treatment by the quality assurance systems in place.

During our unannounced inspection 21, 24 and 26 October 2016, we looked to see if improvements had been made. We found that many improvements had taken place and the breaches of regulations had been met. There was still some embedding to do in respect of peoples care plans and the planned introduction of a new style care plan will assist this process.

At the time of the inspection there were 29 people living in the home with a further two people due to arrive for a short stay before returning home.

There was no registered manager in post. The registered manager resigned in August 2016. A new manager has been in post for four weeks and is in the process of submitting her application to 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 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 had confidence in the staff to support them and we observed positive interactions throughout our inspection.

This inspection found that people were safe. Care plans and risk assessments were person specific and reflected peoples current needs. 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. Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. The environment was clean, well maintained and safe. 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.

Since the last inspection, the provider had introduced robust systems for quality assurance reviews to measure and monitor the standard of the service and drive improvement. This included the employment of a quality assurance manager.

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. It’s nice here.” A visitor said, “Lovely staff and it’s a real home 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. Staff retention was good and most staff we spoke with had worked at St Nectans for many years.

The Care Quality Commission (CQC) monitors the

We spoke to seven people who used the service in depth, one relative and six staff members.

People told us that they were treated with kindness and respect and that they had given consent to the care that was given.

We examined four care plans and saw evidence that delivery of care was person centred. Care plans and activities were designed and carried out to give people new experiences and independence while keeping them safe.

We found good management processes in place in relation to obtaining, storing, administering and disposing of medicines. Staff administering medication were appropriately trained and gave support to people where required.

We found there were robust recruitment processes that ensured there were sufficient experienced and qualified staff employed to meet people’s needs.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints raised were resolved to people's satisfaction with information used to change practice where necessary.

We spoke to 10 people during our inspection. We also used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people using the service.

People we spoke with who lived in the service told us they liked living at St Nectan’s. We were told "nice staff and a clean house", " caring and kind staff", and "I walk on the seafront and they help me keep independent". We were also told that the menu changes every week and the food is good.

Some people we spoke to were able to tell us that they enjoyed living at St Nectans Care Home, and were happy. We were told by one person “everyone is very nice” “I am really happy here” “wonderful” and “the food is always very good”.

The inspection took place on 5 and 12 June 2015. St Nectans Residential Care Home was last inspected on 6 September 2013 and no concerns were identified.

St Nectans Residential Care Home is a care home for up to 28 older people that require support and personal care. At the time of the inspection there were 23 people living in the home. The home is owned by St. Nectans Residential Care Home Limited and is located in the centre of Bexhill on Sea, East Sussex.

The people living at St Nectans Residential Care home all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, diabetes, Parkinson’s disease and heart disease.

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 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. However we also found that there were some shortfalls that could potentially impact on people’s safety and well-being.

People were not consistently safe. Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. However not all were up to date. This meant that staff were not fully informed of people’s changed needs in respect of end of life care, diabetes, visual impairment and mobility. Whilst people’s medicines were stored safely and in line with legal regulations, medicine administration records (MAR) were not consistently completed.

Accidents and incidents were not all recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been not been identified and managed effectively. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff, however the evacuation plans did not reflect the decrease in staff in the afternoon and night. People’s mobility and cognitive abilities were changing and there had not been the environmental changes necessary to ensure their safety. This pertains to window restrictors, stairs and open stairwells.

Where people’s health had changed considerably, care plans did not reflect the changes and therefore staff were potentially uninformed of important changes to care delivery. The lack of opportunity for outings and walks for people at this time impacted negatively on people’s social well-being.

A quality monitoring system was in place but was not effective to enable the service to highlight the kind of issues raised within this inspection, such as high number of unwitnessed incidents and accidents and medication administration shortfalls.

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 live 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 home. 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. The management team 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.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes and administrating insulin. 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 told us they enjoyed the activities, which included singing, films, and visiting entertainers. 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 us well, we are looked after very well, plenty to eat and my room is kept clean and tidy.” A visitor told us, “Kind and helpful, we know our relative is safe and happy.”

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”.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.