The inspection took place on 23 and 24 February 2017 and was unannounced.

Caer Gwent provides nursing care and accommodation for up to 61 older people with a variety of health needs. At the time of our inspection, 59 people were living at the home. Caer Gwent is a large home, situated away from the road and close to Worthing town centre. The home is divided into several units or suites comprising: Amberley, Goodwood, Arundel, Petworh and Parham. Each suite contains bathrooms, communal sitting and dining areas. A library room on the ground floor has a range of books for people to borrow. All bedrooms have en-suite facilities. There is a separate two bedroomed apartment serviced by a separate lift. The home has gardens at the rear which are accessible to residents and off-road parking.

A registered manager was 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 felt that Caer Gwent provided a safe environment. Staff had been trained to recognise any signs of potential abuse and knew what action to take. People’s risks were identified, assessed and managed appropriately, with clear guidance for staff on how to support people safely. Staffing levels were sufficient to meet people’s needs and safe recruitment practices were in place. Medicines were ordered, administered, stored and disposed of safely. The home was clean and hygienic.

Staff had been trained in a range of areas and new staff following the Care Certificate, a nationally recognised qualification. Registered nurses completed specialised training. Not all staff had received regular supervision in line with the provider’s policy, that is, three supervisions per year and an annual appraisal if required. The registered manager was aware of this and that this was an area that required improvement. Staff felt supported and attended team meetings and some group supervision meetings were held. Staff had a good understanding of the legislation relating to mental capacity and Deprivation of Liberty Safeguards and put this into practice. People were supported to have sufficient to eat and drink and the lunchtime experience we observed was a relaxed affair. People were supported to have good health and had access to a range of healthcare professionals and services. Rooms were personalised and people commented on the comfort of their rooms.

Positive, warm and caring relationships had been developed between people and staff. There were several instances that were observed when staff responded to people’s needs in a sensitive and compassionate way. People and their relatives were involved in decisions relating to their care. People were treated with dignity and respect.

Care plans provided detailed information and guidance to staff on how to support people in a person-centred way. People’s personal histories were recorded. A range of activities was organised by the activities co-ordinator and some external visitors provided musical entertainment. Complaints were managed in line with the provider’s policy.

People and their relatives were encouraged to feedback about the quality of the care delivered and residents/relatives’ meetings were organised. A newsletter was published to update people on what was happening. Staff felt supported by the registered manager and enjoyed working at Caer Gwent. High quality care was delivered and a range of audits was in place to measure and monitor the service overall. However, the registered manager had not notified the Commission of three significant events and these were discussed at the time of our inspection.

The inspection took place on 30 December 2015 and was unannounced.

Caer Gwent provides nursing care and accommodation for up to 61 older people with a variety of health needs. At the time of our inspection, 45 people were living at the home. The home was under capacity due to extensive refurbishment and redevelopment taking place. It is estimated that full occupancy will be achieved by February 2016. Caer Gwent is a large home, situated away from the road and close to Worthing town centre. The home is divided into several units or suites comprising: Amberley, Goodwood, Arundel, Petworh and Parham. Each suite contains bathrooms, communal sitting and dining areas. All bedrooms have en-suite facilities. The home has gardens at the rear which are accessible to residents and off-road parking.

A registered manager was 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.

Not all staff had a thorough understanding of the Mental Capacity Act 2005 and the requirements of this and associated legislation. A minority of staff had completed training on this topic. The registered manager was aware of their responsibility under the Deprivation of Liberty Safeguards legislation and had applied to the local authority for authorisations where people were deprived of their liberty. Staff followed an induction programme and completed all essential training and there were additional training opportunities available to some staff. All staff had received regular supervision or annual appraisals. People were supported to have sufficient to eat, drink and maintain a healthy lifestyle; they had access to a range of healthcare professionals and services. The home was in the process of being updated and a refurbishment programme was due to be completed in early 2016.

People felt safe living at the home and staff were trained to recognise the signs of potential abuse; they knew what action to take and who to contact if they suspected abuse was taking place. Risks to people were identified, assessed and managed safely. Risk assessments provided detailed information and guidance to staff about how to support people. The service followed safe recruitment practices and appropriate checks were in place. People and staff had mixed views about staffing levels at the home. Some people felt that staff did not always have time to stop and chat. Staffing levels were not always consistent. The provider was in the process of recruiting additional staff. People’s medicines were managed safely.

People were looked after by kind and caring staff and positive, friendly relationships had been developed. Staff knew how to support people in line with their personal preferences and there was information about people’s lives contained within care records. People were treated with dignity and respect and were supported to express their views and to be involved as much as possible in decisions about their care.

In the main, people received personalised care that met their needs. Care plans provided detailed information to staff about people’s needs and the support they required. However, two care plans contained conflicting information which could have been confusing and was inaccurate. The home employed the services of an activities co-ordinator who organised a programme of events and activities took place every day. The majority of people did not or chose not to participate in these activities. The provider managed complaints appropriately. Complaints were responded to in line with the provider’s policy and to the satisfaction of the complainant.

People, their relatives and staff felt the service was well led and that the registered manager was approachable. Residents’ meetings were organised and people were asked for their views of the service through a survey from the provider. The registered manager also met with people to obtain their feedback. Staff felt supported by the registered manager, that they could raise any issues and that these would be dealt with appropriately. There were systems in place to measure the quality of the service provided overall. The provider was in the process of developing a robust, consistent quality audit system which would be rolled out across the provider’s other homes.

The inspection began at 10.10 and was concluded at 16.40. There was no manager registered for the service at the time of the inspection. There were 59 people living at the service on the day of our visit. We spoke with six people who used the service, two of the management team and three members of staff. One person said “I’m cared for well.” Another person who used the service said “The care is very good.”

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People had the opportunity to say how they preferred their care to be undertaken, and guidance was provided for staff on meeting their needs accordingly.

People told us they were happy with the care and support they received. One person told us “Staff are always helpful. Staff treat you well.” People’s needs were assessed and support and treatment were planned and delivered in line with their individual needs. Records showed that where needed people had been assisted to access medical support, such as General Practitioners (G.P.s) and physiotherapists.

There were arrangements in place to ensure that the risk of cross infection was minimised. We found that the service had acted quickly when a risk of cross infection had been identified.

Records showed that a programme of training for staff had been regularly provided. A member of staff told us “there has been a lot of training.” Another member of staff said “Managers keep an eye on when training is due and tell you. Managers are good at providing support.”

We found that the provider had regularly reviewed the quality of service at the home and obtained people’s views on the service. Action taken by the service had led changes in the meals provided. Measures put in place had also reduced the number of falls recorded at the service.

We inspected Caer Gwent on 25 November 2012 and found that people were not protected against the risks associated with medicines. This was because the provider did not have consistent arrangements in place for people who self-medicated and for people who had as needed (PRN) medicines. The provider wrote to us and said they would be compliant with the management of medicines by the end of January 2013. We inspected the service to determine if they were compliant.

We found that there were arrangements and safeguards in place for people who wished to self-medicate. We also found that there was clear guidance for people who needed PRN medicines.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People told us they were happy living there and that staff treated them with kindness and respect. People told us "the staff are friendly." People told us that staff understood their needs and provided appropriate support. We found that people were involved in their care planning.

People told us that the home's environment was maintained and cleaned to a high standard. One person said, "the cleansing business here is wonderful."

People gave mixed responses about the staffing levels in the home. While some people commented that staff were quick to respond and "there's always someone there to help," other people commented that there wasn't enough staff and they had to wait for assistance. One person said that staff responsiveness "depends on how busy they are and how short staffed they are." We found that staffing levels had tended to fluctuate but had stabilised in recent weeks.

We found that the provider did not have appropriate or consistent procedures in place for people who managed their own medicines and for people with as needed (PRN) medicines. This meant that people were not always protected from the risk of unsafe or unsuitable medicine administration.

People told us that they really enjoyed living at Caer Gwent and that they received good care and support from the staff team.

We talked to many people who were living at Caer Gwent and some of the relatives of people who were less able to communicate with us. They all said it was a good home and that they had no complaints about any aspect of the service they received. They said the food was plentiful, varied and of a good quality with plenty of choices. Some people told us about how they could have some input into what sort of food was served.

We spoke to people about how well the premises were looked after and they said the home always looked lovely. Several visitors told us the home always smelt pleasant and looked more like a hotel than a care home.

We also spoke to staff who told us Caer Gwent was a good place to work and that they felt they could care for people properly here. They told us they felt supported and that the manager was very approachable.

We spoke with several visitors about the care that they observed being provided by staff at Caer Gwent. All of them told us they were impressed with the caring attitude and facilities at the home. We asked specifically about any concerns or poor practice they may have noticed and they all said they had no concerns at all. One person described it as a “luxury cruise liner without the sea!”