This inspection took place on 15 March 2018 and was unannounced. At the last inspection in February 2016, the provider was rated Good overall and a recommendation was made in relation to developing the activity programme.

Sussex House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides support for adults who have mental health conditions and accommodates up to 24 adults. At the time of our inspection there were 21 people whose needs were predominately mental health, using the service. The service offers a range of ensuite rooms over three levels. There are also two communal lounge areas, a dining room, an activities room, a kitchen, bathroom and toilet facilities, independent skills kitchen area and outdoor courtyard.

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.

Some areas of the environment posed a potential risk to people. These included, a bottle of cleaning fluid left on the kitchen hatch and a box of disposable gloves left out in a bedroom, accessible to people who used the service, without any risk assessments in place to mitigate these risks. Individual risk assessments did not always identify the level of support people required. We have made a recommendation about risk assessment and management.

People who used the service had an assessment of their needs, risk assessments and a care plan. There was an inconsistency in the care files with some people having informative care plans for specific areas, whilst others contained less detailed information. The registered manager was in the process of transferring care plans to a new format which contained more detailed information. Similarly, we found that although risk assessments were completed, they did not always identify the level of support people required. We have made a recommendation about updating the information in care plans. The service was undergoing a refurbishment. The provider shared with us further plans to provide a kitchenette for people to practice their independence skills and refurbishment of the garden.

There was a quality monitoring system in place, which consisted of audits, checks, surveys and meetings. This was not fully effective in identifying the issues we found. We have made a recommendation about this.

Staff had completed training and knew how to safeguard people from the risk of harm and abuse. Medicines were managed safely and administered to people as prescribed.

Staff were recruited safely and in sufficient numbers to meet people’s needs. Staff had access to induction, a range of training, supervision and support. This provided staff with the necessary skills when providing support to people.

Staff had a kind and caring approach. They knew people’s needs very well and supported them to maintain independence, privacy and dignity. Staff supported people to make decisions in order to maintain their human rights. They ensured that when people lacked capacity, they included relevant people in best interest decision-making.

People’s health care needs were met and they had access to community health care professionals when required. The registered manager and staff team had developed good working relationships with health colleagues. This had resulted in planned discussions about treatment options. People’s nutritional needs were met. Menus provided them with choices and alternatives. Staff contacted dieticians and speech and language therapists when they had concerns.

Sussex House care home is centrally located near to local attractions, restaurants and shops in the seaside town of Cleethorpes in North East Lincolnshire. The service is registered with the Care Quality Commission (CQC) to provide residential care and accommodation for up to 24 people. At the time of our inspection 16 people were living permanently at the service and two people were being supported on short term respite.

The service provides support for adults who have mental health conditions. The service offers a range of en-suite rooms over three levels. There are also two communal lounge areas, a dining room, an activities room, a kitchen, bathroom and toilet facilities, independent skills kitchen area and outdoor courtyard space. The service was in the process of having a new passenger lift installed at the time of our inspection.

The inspection took place on 2 February 2016 and was unannounced. The service was last inspected on 20 December 2013 and the registered provider was meeting all of the regulations we assessed. At the time of our inspection the service had a registered manager in post.

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 found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to recognise and report potential abuse. Risk assessments were in place to guide staff in how to support people appropriately and minimise risks. People lived in a safe, clean environment where the equipment used was regularly checked and serviced.

The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) and we saw that applications, where required, had been submitted in respect of people being deprived of their liberty. During our inspection, we found that staff had been recruited safely and appropriate checks had been completed prior to them working with vulnerable people.

Staff had a good knowledge and understanding of the needs of the people they were supporting. Staffing levels were adequate and there was a training programme in place to ensure staff were equipped with the knowledge and skills required to carry out their role effectively. Not all staff had received mental health awareness training but the registered provider had measures in place to ensure all staff at the service would complete this by June 2016.

Medicines were managed, stored and administered in a safe way. People’s mental and physical health and nutritional needs were met and they accessed professional advice and treatment from community services when required. Positive interactions were observed between staff and the people they cared for.

People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. People and staff were relaxed throughout our inspection. There was a friendly environment and people told us they enjoyed living in the service. Positive relationships between people and the staff team had developed and staff demonstrated kindness and compassion towards people.

The service had a number of activity resources for people to use but we saw limited activities taking place during our inspection. There was no structure or activities programme in place at the service. We recommended the service reviewed this to encourage and increase activity participation.

People were supported to maintain relationships with their families and friends. The service was well managed and the registered provider undertook regular audits to ensure the service was safe. The registered manager and deputy care manager promoted an open-door culture and staff told us they felt w

We looked at four care plans for people who used the service. These were personalised and provided detailed guidance about how people’s needs should be met.

One person’s relative told us, “I work in the care industry and I couldn’t find better care for my mum.”

We noted people’s care plans stated their food preferences. One person’s care plan stated, “The staff know my likes and dislikes and they offer me the food that I like.”

We were present whilst lunch was taken. People told us the food served was appetising. Comments from people who lived at the home included: “The food is ever so nice; plenty of it” and “I like the meals here, they are lovely.”

We looked around the home and observed a high overall standard of cleanliness. One relative told us, “I think they do really well with the cleaning; it’s very clean.”

We observed members of staff wearing personal protective equipment (PPE) when carrying out tasks around the home. One person who lived at the home told us, “Yes, they always put fresh gloves on and wear aprons when they tend to me.”

People looked relaxed in the company of the staff. One person told us, “The staff are really good, they go out of their way to help you out.” Another person commented, “No problems with the staff; they’re great with me.”

We asked people at the home if they were able to make complaints and how these were managed. One person said, “Yes, I know how to complain but I wouldn’t need to.”

We found that people were consulted about their care and appropriate arrangements were in place to ensure decisions made were in people’s best interest if they found this difficult. A family member told us they were kept informed about their relative’s needs. They said “The manager always rings me and lets me know how (name of person withheld) is getting on” and “They keep me well informed.”

We found there was information for staff to follow which ensured people received the care they required and their needs were appropriately met. People who used the service told us they were involved with their reviews and they attended meetings about their care.

We found that people’s medication was administered and stored safely and staff had received medication training.

We found that recruitment procedures and practises ensured people were not exposed to any employees who should not be working with vulnerable adults.

We found there were systems in place which ensured people had a say about how the home was run and also considered the views of others who might have an interests in the care people received, for example health care professionals and relatives. People told us they were asked about the running of the home, comments included “Yes we have meetings”, “We can talk to the manager if we have any concerns” and “I feel I can talk to any of the staff they’re all lovely.”

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about the care they received. We received comments such as: “I can't think of anywhere else I would like to be", "Quality of care is excellent" and "I like it here, good care."

People living in the home, confirmed they felt safe and said they liked the staff. One person told us: "Everyone is good, staff sort out any concerns I have" and "If I have any problems I can turn to the staff and they support me."

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the staff and care provided. They told us that staff treated them with respect. We received comments such as: “Good care”, “Staff are good” and “Staff look after you very well.”

People living in the home, confirmed they felt safe and said they liked the staff. One person told us: “I feel safe here” and another person said “I can talk to the staff, and they will sort it out for you.”

Everyone told us that the food was good and a varied menu was available. They told us staff came quickly when they required assistance at any time of the day or night. Other comments we received were: “I like it here” and “Meals are very good.”