Barons Down Nursing Home is located on the outskirts of Lewes, with some parking on site. The building has been extended and there is a large communal lounge/dining room on the ground floor with a conservatory at the side which overlooks the garden. People can access all parts of the home using the passenger lift and the gardens are wheelchair assessable.

The home provides support and care for up to 30 people with nursing and personal care needs. There were 25 people living at the home during the inspection. Some people required continual nursing care due to complex health care needs; including end of life care. Other people needed support with personal care and assistance to move around the home safely due to frailty or medical conditions and some people were living with dementia.

A registered manager was responsible for the day to day management of the home. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and is part of the Mental Capacity Act 2005 (MCA). We last inspected this home on 25 November 2015 and found additional training was needed to ensure staff had a clear understanding of DoLS. Training in record keeping was required to ensure records reflected the care and support provided and evidence the involvement of people and their relatives in developing and review their care plans.

This inspection took place on 15 February 2017. Additional training had been provided for staff with regard to DoLS and they had a clear understanding of current guidance and their responsibilities. We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in place supported this practice and the provider was up to date with current guidance to ensure people were protected. This was reflected in the care plans, which were up to date and had been reviewed with each person and their relatives where appropriate.

People said the staff were very good and provided the support they wanted and needed. New staff were required to complete the Care Certificate and ongoing training; including protecting vulnerable people and health and safety, ensured staff had appropriate skills and an understanding of how to meet people’s needs. Staff encouraged people to be independent and make choices and individualised risk assessments provided guidance for staff to assist people to ensure their safety.

There was an effective system in place for the management of medicines and staff competency was assessed to ensure they were up to date with current guidelines. People had access to health professionals as and when they required and visits were recorded in their care plans; with relevant guidance for staff if any changes to support had been identified.

People said the food was very good, choices were provided and the menu was based on people’s likes and dislikes. Group and one to one activities were available for people to participate in if they wished and people chose how and where they spent their time.

Feedback was sought from people, relatives, staff and health professionals through satisfaction surveys for the services overall as well as specific ones, such as a nutritional survey. People, relatives and staff said the management was approachable and the registered manager had an open door policy to encourage them to be involved in developing the services.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when

Barons Down Nursing Home is located on the outskirts of Lewes, with some parking on site. The original building has been extended and there are communal rooms on the ground floor, including a conservatory area to the side of the lounge. A lift enables people to access all parts of the home and there are accessible gardens to the rear and side of the building.

The home provides support and care for up to 30 people with nursing and personal care needs. There were 19 people living at the home during the inspection. No new admissions had been accepted while repair work had been carried out on the lift. Some people had complex needs and required continual nursing care and support, including end of life care. Other people needed support with personal care and assistance moving around the home, due to physical frailty or medical conditions, and some people were living with dementia.

A registered manager was responsible for the day to day management of the home. 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.

This inspection took place on the 25 November 2015 and was unannounced.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, but they were not up to date with current guidance to ensure people were protected. Additional training had been arranged and advice was being sought from healthcare professionals.

People were assessed before they moved into the home to ensure staff could meet their needs, and care plans, including risk assessments to ensure their safety, were developed from this information. However, there was no evidence to show that people, or their representatives if appropriate, were involved in developing the care plans and people’s daily records did not reflect the support and care we observed.

People said there were enough staff working in the home and that staff provided the support and care they needed. New staff were required to complete an induction programme in line with the Care Certificate, and the on-going training programme supported staff to meet people’s needs. The registered nurses attended fundamental training and additional training to ensure their nursing competencies were up to date.

Systems were in place to ensure people were protected and support was provided safely. This included safeguarding training, staff had a good understanding of abuse and how to raise concerns if they had any. Staff were trained in the safe administration of medicines. Staff followed relevant policies, they gave out medicines safely and signed the administration records after they had been taken.

People, relatives and staff said the management were very approachable, and were involved in decisions about how the service developed with on-going discussion on a day by day basis and during residents meetings. In addition feedback was sought from people, their relatives, healthcare professionals and other visitors to the home, through satisfaction questionnaires.

People told us the food was very good. Staff asked people what they wanted to eat, choices were available for each meal, and people enjoyed the food provided. People told us they decided what they wanted to do, some joined in activities while others chose to sit quietly in their room or communal areas. One person said, “There is a programme of activities, but I don’t go down every time. I went to the Halloween party and that was very good, I have photos of my family with me.”

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them.

During our inspection we spoke with six people who used the service and a visiting relative. We also spoke with five staff members; these were the registered manager, a registered nurse, a senior care worker, the activities co-ordinator and a care worker.

We also took information from other sources to help us understand the views of people who used the service, which included resident and relative meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, “I receive very good care here. The staff are nice and they help me as much as they can.” A relative of a person who used the service told us, “I don’t think I’ve ever had to complain and my relative feels safe here.”

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service.

The provider had arrangements in place for the safe ordering, storage, administration and disposal of medicines at the service. Staff had a good understanding of their responsibilities in relation to the safe administration of medicines.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their job.

We also found that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.

During our visit we spoke with 12 people who lived at the home, six staff members and three visitors.

The people we spoke with told us they enjoyed living at Barons Down Nursing Home. One person said “I like the staff and the food is good,” “Great food and my bedroom is warm and comfortable,” and “really looking forward to the new lounge and dining area.”

One visitor said “I can not praise the staff enough, kind and caring.”

The staff we spoke with were knowledgeable about people’s needs and what support they required.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.

People told us that they enjoyed living at the home and that staff were patient, caring and kind. They told us they were never rushed and that there was usually enough staff on duty to support them when needed.

People told us the food was good and that they could choose and alternative if they did not want the food on offer at meal times. One person told us they preferred not to eat at the dining table and that the home accommodated this. People and their relatives told us they enjoyed the entertainment and activities on offer at the home.

We spoke with three people’s relatives who spoke highly of the home. Thy told us that visitors are always welcomed and that their relatives were happy and well cared for.

Staff members we spoke to told us that they were happy working in the home, that the team worked well together and that they had received the training they needed to meet individual’s care needs.