A comprehensive inspection took place on 6 and 7 November 2018. The inspection was unannounced.

Bon Accord is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bon Accord is a nursing home providing accommodation for people who are living with dementia and who may require support with their nursing and personal care needs. Bon Accord is registered to accommodate 41 people. Some of the rooms were designed as shared rooms; however, rooms had been converted and were now single occupancy. This meant that the home could accommodate a maximum of 33 people. There were 26 people living at the home at the time of the inspection. The home is a large detached property situated in Hove, East Sussex. It has three communal lounges, two dining rooms and communal gardens.

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.

At our last inspection in November 2017, the service was rated requires improvement. This was because the service was not at full occupancy and the provider could not demonstrate that existing staffing levels could be maintained if occupancy increased. We found that the provider was not always working in accordance with legislative requirements in relation to gaining consent. We also found that the provider had not always considered and recorded peoples end of life wishes. At this inspection on 6 and 7 November 2018 we found that the management team had taken steps to improve these areas. The overall rating for the service has improved to Good.

People, their relatives and staff spoke positively of the improvements made to the governance of the service. Quality assurance and information governance systems were in place to monitor the quality and safety of the service. Staff worked well together and were aware of their roles and responsibilities.

People and their relatives told us they had trust in the staff and felt safe and secure living at Bon Accord. Staff showed a good awareness of safeguarding procedures and knew who to inform if they saw or had an allegation of abuse reported to them. The registered manager was also aware of their responsibility to liaise with the local authority if safeguarding concerns were raised.

Staff remained kind and caring and had developed good relationships with people. People's privacy was respected and staff supported people to be as independent as possible. People were involved in making decisions about their care.

Risks relating to people's care were reduced as the provider assessed and managed risks effectively. People were encouraged to be as independent as possible. There were effective infection prevention and control measures in place.

People's medicines were managed safely by staff. People were supported by staff who had been assessed as suitable to work with them. Staff had been trained effectively to have the right skills and knowledge to be able to meet people's assessed needs. Staff were supported through observations, supervisions and appraisals to help them understand their role. The provider had ensured that there were enough staff to care for people.

People continued to receive care in line with the Mental Capacity Act 2005 and staff received training on the Act to help them understand their responsibilities in relation to it. People’s capacity to make decisions had been carefully assessed. 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

The inspection took place on 27 November 2017 and was unannounced. Bon Accord is a nursing home providing accommodation for people who are living with dementia and who may require support with their nursing and personal care needs. Many of the people, due to their cognitive abilities, had difficulty communicating their needs. This meant that they were vulnerable as they were not able to raise concerns or make basic decisions about their care and welfare needs. Bon Accord is registered to accommodate 41 people. Some of the rooms were designed as shared rooms; however, rooms had been converted and were now single occupancy. This meant that the home could accommodate a maximum of 33 people. There were 23 people living at the home at the time of the inspection. The home is a large detached property situated in Hove, East Sussex. It has three communal lounges, two dining rooms and communal gardens.

The home is owned by Four Seasons (No9) Limited, which is part of a large, national corporate provider called Four Seasons. Four Seasons (No9) Limited own a further three care homes in England. At the previous inspection on 31 May and 7 June 2017, a manager and a deputy manager from one of the providers’ other services had been in day-to-day management of the home. The manager was going to apply to become the registered manager. However, at this inspection, the manager had left employment and the deputy manager was in day-to-day management of the home. In addition, the regional manager and a member of the providers’ quality team visited the home twice a week to ensure that there was appropriate support and governance in place until a new registered manager was found. The provider was in the process of trying to recruit to the post of registered manager. However, the home had been without a registered manager for nine months. A registered manager is a ‘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 home is run.

At the previous inspection on 31 May and 7 June 2017 the home received a rating of ‘Inadequate’. This home has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this home is now out of Special Measures.

At this inspection the provider was found to have met the previous breaches of regulations, however, continued improvements were needed to sustain and embed the improvements that had been made. Although the management of risk had improved and people were receiving appropriate support to maintain their health and well-being, further improvements need to be made to ensure that all risks, specific to peoples’ lifestyles, are managed effectively. People were asked their consent and were able to make decisions about their care. When people had a condition that affected their ability to give their consent, mental capacity assessments had been completed and Deprivation of Liberty Safeguards (DoLS) applications had been made. Conditions associated to peoples’ DoLS had mostly been met. One person had a condition associated to their DoLS which informed staff that they needed to support the person to regularly access the community. Records showed that the person had been supported to access the community and had enjoyed car rides and visits to local cafes and shops. However, this had not happened frequently as outlined within the DoLS. These are areas of practice in need of improvement.

Records demonstrated that people had received appropriate support from staff and external healthcare professionals at the end of their lives. However, records did not always plan for or document peoples’ prefer

This inspection took place over two days on 31 May 2017 and 7 June 2017. Bon Accord is a nursing home providing accommodation for people who are living with dementia and who require support with their nursing and personal care needs. Many of the people had difficulties in communicating their needs. This meant that they were at risk as they were unable to raise concerns or make basic decisions about their care and welfare needs. Bon Accord is registered to accommodate a maximum of 41 people, as some of the rooms are large enough for dual occupancy. However, rooms had been converted and were single occupancy; therefore a maximum of 33 people can be accommodated. There were 27 people living in the home at the time of the inspection. The home is a large property situated in Hove, East Sussex; It has three communal lounges, two dining rooms and a garden.

The home is owned by Four Seasons (No9) Limited, which is part of a large national corporate provider called Four Seasons. Four Seasons (No9) Limited own a further three care homes in England. A registered manager is a ‘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 home is run. The home did not have a registered manager in post at the time of the inspection. An acting manager was in post and they were present on the first day of the inspection.

At the last inspection on 6, 7 and 15 February 2017, we found multiple breaches of the regulations. The service was rated as inadequate overall and was placed in special measures. We undertook a comprehensive inspection on 31 May and 7 June 2017 to check whether the required actions had been taken to address the breaches we previously identified. This report covers our findings in relation to these requirements.

Although there had been some improvements we found continued breaches of the Regulations. The overall rating for the service remains as Inadequate and the service therefore continues to be in 'Special measures.' Services in special measures will be kept under review and, if we have not taken immediate actions to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. You can see what actions we have taken at the end of the full version of this report. The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection on 6, 7 and 15 February 2017 medicine management was inadequate, there was unsafe moving and handling practice, failures in following health care professional’s advice and the lack of effective risk management placed people at serious risk of harm. At the inspection of 31 May a

The inspection took place on 6, 7 and 15 February 2017. The inspection was brought forward due to information of concern that we had received from relatives, the local authority and the Clinical Commissioning group (CCG) due to information of concern. The first and third days of inspection were unannounced which meant that the provider, registered manager and staff were not expecting us.

Bon Accord is a nursing home providing accommodation for people who are living with dementia and who require support with their nursing and personal care needs. It is registered to accommodate a maximum of 41 people, as some of the rooms are large enough for dual occupancy. However, rooms had been converted and were single occupancy; therefore the provider only accommodated a maximum of 33 people. On the first day of our inspection there were 31 people living in the home. On the second day of our inspection there were 30 and on the third day of our inspection there were 29 people living in the home. This was due to deaths that had occurred. The home is a large property situated in Hove, East Sussex; It has three communal lounges, two dining rooms and a garden.

The home is owned by Four Seasons (No9) Limited, which is part of a large, privately owned, national corporate provider called Four Seasons. Four Seasons (No9) Limited own a further three care homes in England. The management team consisted of a registered manager and senior care assistants. A registered manager is a ‘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 home is run. On the second day of inspection the registered manager resigned with immediate effect.

The overall rating for Bon Accord is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the providers’ registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There were systematic failings, poor leadership and management and ineffective governance that meant that people did not always receive good quality, safe care. Quality assurance processes, whilst sometimes recognising that there had been inadequate care, were not robust and had failed to adequately improve the care that people received. There had been on-going, long-standing issues with regard to peoples’ access to medicines that had not been suitably managed or improved. The registered manager, who was new in post, was not suitably supported to ensure that they were able to assess, monito

During our visit we consulted the service's policies and procedures, eight sets of care plans, training records, and spent time observing how care was delivered. We spoke with the manager, five care workers, two nurses, the chef, five residents and five relatives.

Three of the residents we spoke with communicated with us and told us that they were treated with kindness and respect. One person said, "The staff are kind. I am happy here". We spoke with five relatives and one described the home as "A place where good care is provided and where the staff understands the needs of people with dementia". Another relative said, "I cannot recommend the home enough, they are simply superb and caring". We saw care and treatment was delivered in line with updated care plans which reflected individual needs.

We saw the food provided was of a high standard. Meals were hot, nutritious and well presented with attention to detail. A relative told us, "The food is always really tasty and the portions are generous".

We found Bon Accord and all its facilities were cleaned regularly and hygienic. The staff were vigilant and observed guidelines to minimise risks of infection for people who used the service. A relative said, "The place always smells really nice and clean".

There was an effective complaints policy and procedures in place, and we saw that the service learned from complaints and incidents in order to improve the service.

During our visit it we only spoke with a few residents due to the nature of their physical condition and limited communication. We spent time observing how care was delivered and we spoke with several residents who told us that they were treated kindly and with respect and dignity. We spent time with relatives and were told that in their experience people were given choices about their daily life and how they wanted their care needs to be met. Residents, staff and relatives described the home as ''a happy home'' and told us that it was a ''good place to live'' and that they “felt very safe in the home and could speak with the manager at any time if they had any concerns”.

A relative told us that the care provided was “excellent” and said “I now don’t worry about my family member’s care anymore as she is in safe hands. There is a real feeling that this is a family home not just for her but for me too”.

We inspected Bon Accord on the 14 and 15 April 2015. Bon Accord is a nursing care home located in Hove. It provides care and treatment for up to 41 older people, the majority of whom require specialised dementia care. At the time of the inspection the home was full. The age range of people varied between 52 – 96 years old.

Accommodation was provided in a residential area of Hove. It was arranged over three floors. The upper floors were accessible by lift. It had developed the environment to support the needs of older people and those with dementia. The home had communal lounges, dining areas, conservatory 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.

People and their relatives spoke positively of the service and commented they felt safe. They were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. We were told, “I don’t remember ever having to wait, they make sure I am totally safe and happy before leaving me.”

Staff interactions demonstrated they had built a good rapport with people. Care plans and risk assessments included people’s assessed level of care needs and actions for staff to follow. Staff explained how they kept people safe. People told us that their room was kept clean and safe for them. One person said, “Someone comes and cleans and checks my room for any problems. It’s homely, comfortable and safe. What more could I want?”

People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from registered nurses.

As well as nurses on duty in the home, health and social care professionals from a range of disciplines visited the home on a regular basis. Staff regularly liaised with GPs, physiotherapists and speech and language therapists.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had a good understanding of the legal requirements of the Act and followed it in their practice.

Care plans contained information on people’s likes, dislikes and individual choice. Information was available on people’s life history and people and families were involved in the development and review of their care plans.

A range of group activities were available but were not always participated in by individual choice. One person said, “I like to be left to my own devices and this is respected”. As well as group activities, people were supported to maintain their hobbies and interests. People received 1:1 support in activities as part of their day.

There was a varied menu, which was planned and changed on a regular basis and reflected the season. Everyone we spoke with was happy with the food provided. Their dietary needs and preferences were recorded. People told us that their favourite foods were always available, “They know what I like and don’t like.” People were supported to eat and drink enough to meet their nutritional and hydration needs. Staff used their knowledge of people’s likes and dislikes where they were unable to make a choice.

Staff felt supported by management and understood what was expected of them. There was sufficient day to day management cover to supervise care staff and care delivery. The management structure at the service provided consistent leadership and direction for staff. The registered manager carried out regular audits and monitored the quality of the service.

Management and staff were committed to a culture of continuous improvement. A healthcare professional told us, “I am impressed by the manager’s openness. They have a clear vision about the direction they want to take the home.” Feedback was regularly sought from people, relatives and staff. Staff, resident and relatives meetings were held in which decisions relating to the home were discussed.