This inspection took place on 2 and 3 October 2018 and was unannounced.

Creedy House 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. Creedy House can accommodate 44 people. At the time of our inspection there were 36 people living at the service.

Creedy House is a large, detached premises situated in a residential area in Littlestone-On-Sea. The service was divided into two areas: The House, which accommodated people requiring nursing as their primary need and The Lodge, where people living with dementia had their bedrooms.

There was a registered manager at the service. 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.

Creedy House was last inspected 21 March 2018. At that inspection it was rated as 'Requires Improvement' overall. Five breaches of Regulation were found during that inspection.

At this inspection we found improvements had been made, however we found one new breach, and two continued breaches of the regulations and two areas for improvement. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Quality auditing had improved and action taken to address some shortfalls we identified at the last inspection. However, there were still areas that had not improved and these had not been picked up through the monitoring process. This included shortfalls in robust recruitment processes; the provider had not ensured staff had complete work histories.

People were being kept safe from abuse. Staff had received training in safeguarding and had an improved understanding of how to report concerns. People were supported safely around risks, however some risk assessments lacked guidance on action to take if someone’s needs changed. Risks to the environment had been assessed.

Staffing had been reviewed and assessed using a dependency tool. There were sufficient staff to meet people’s needs and keep them safe. Medicines were stored, administered and disposed of safely. The service was clean and well kept, and staff used personal protective equipment to reduce the risk of the spread of infection. Accidents and incidents were logged and actions taken to reduce the risk of the incident reoccurring were documented.

People’s needs were assessed prior to them receiving a service. Staff received the training and supervision required to complete their roles effectively. Staff made appropriate referrals when necessary, for example to the falls clinic, dietician and speech and language therapist (SaLT). People’s needs were met by the design of the building and suitable adaptations had been made. People enjoyed the food and were supported to eat sufficient amounts. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Staff treated people with kindness and compassion and people and their relatives told us they liked the staff. Staff knew people’s needs well and people told us they valued their staff. People and their relatives were consulted around their care and support. People’s dignity and privacy was respected and promoted and staff encouraged people to be independent as safely possible.

Care records had not all been maintained to provide an up to date reflection of people’s needs. However, this was rectified on the day by staff. People told us the activities had improved, and the service had employed an additional activities coordinator. People’s concerns and complaints had been logged and responded t

This inspection was completed on 21 March 2018 and was unannounced.

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

Creedy House is a large, detached premises situated in a residential area in Littlestone-On-Sea. The service was divided into two areas: The House which accommodated people requiring nursing as their primary need and The Lodge where people living with dementia had their bedrooms.

There was a manager at the service, who was in the process of applying to be 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.

At our last inspection we recommended that the provider ensured that quality and safety checks included observation of staff practice to see that it reflects care plan guidance and consistently minimises risks to people. At this inspection we found that these had not been implemented. Risks had been identified, however, action had not always been taken to minimise the risk from occurring. People had fallen and displayed behaviour that challenged. Although the manager had identified these as risks, there was a lack of guidance for staff regarding how to support people to prevent these from occurring. Incidents had not always been appropriately documented or analysed to look at the reason why they occurred.

One person had displayed behaviour that challenged and an identified reason for this was a possible urine infection. Staff had not tested the person’s urine to see if this was the reason for their behaviour and if they required antibiotics. Some people had Deprivation of Liberty Safeguards (DoLS) in place, and conditions on these DoLS, had not always been complied with. Staff did not always work consistently across organisations, meaning necessary referrals to healthcare professionals were not always made. Other health care needs such as pressure areas, support with catheter care and diabetes were managed well.

At our previous inspection we recommended that the provider introduced a dependency tool to calculate the number of staff required to support people. Although this had been introduced the manager was unable to show us how the number of staff required had been calculated. People and their relatives told us they sometimes had to wait to receive support. Staff were busy and although we observed some kind and caring interactions, staff were task focused. Some staff did not treat people respectfully and we observed staff moving people in wheelchairs abruptly, without telling them what was about to happen.

At our last two inspections we identified that recruitment checks were not always completed and staff had not been recruited safely. At our last inspection we made a recommendation for the provider to consider using a recruitment checklist to ensure that all areas were addressed for every applicant. This had been introduced and staff were recruited safely.

At our last inspection we highlighted that there were no pictorial menus available for people living with dementia. Pictorial menus could assist people with dementia to make meaningful choices about what they wanted to eat. These were not seen to be in place during the inspection. People had enough to eat and drink and when they required specialist diets, were supported to eat and drink safely.

At our previous inspection we recommended that the provider increased oversight of the service’s complaints process to ensure it was suitably robust. Although improvements had been made the manager did not record all actions taken as a result of a com

This inspection took place on 8 and 9 February 2017 and was unannounced.

Creedy House is registered to provide personal and nursing care for up to 44 people. There were 31 people using the service during our inspection. People were living with a range of nursing and care needs. These included: diabetes, catheter and continence management, pressure wounds, mobility support; and many people were living with different types and stages of dementia.

Creedy House is a large, detached premises situated in a residential area in Littlestone-On-Sea. The service was divided into two areas: The House which accommodated people requiring nursing as their primary need and The Lodge where people living with dementia had their bedrooms.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 manager had applied to the Commission to become registered and the application was being processed at the time of this inspection.

This service was last inspected in August 2016 when it was rated as inadequate overall and placed into special measures. Eight warning notices were issued to the provider following that inspection and the provider sent us regular action and improvement plans to document positive changes.

At this inspection we found significant improvement in most areas, with a small number of issues which still required further attention.

Assessments had been made about different risks to people; and in most cases staff acted consistently to minimise those risks. However, there were two occasions when actions to reduce known risks did not happen all the time.

The management of medicines had improved overall but the storage and recording of prescribed creams needed addressing to ensure people received them safely and consistently.

There were enough staff on duty and they had received relevant training and supervision to help them carry out their roles effectively. Staff were observed putting their training into practice in a safe way. Most recruitment files contained all the required information about staff, but the minority needed further detail about past employments.

Staff knew how to keep people safe from abuse and neglect and the manager referred any incidents to the local safeguarding authority as appropriate. Incidents and accidents had been properly recorded and preventative actions taken. The safety of the premises was assured by regular and routine checks on utilities and equipment.

People received a choice of nutritious meals and were supported to eat and drink. Some recording of people’s intake needed improvement to ensure it was clear and consistent.

A range of professionals were involved in people’s health care and individual plans of care were in place if people had catheters or pressure wounds. Care plans about diabetes were updated during our inspection as they did not properly reflect people’s needs.

Staff and managers worked within the principles of the Mental Capacity Act 2005 (MCA) which ensured people’s rights and wishes were protected.

Staff were caring, supportive and kind. People’s dignity was protected by considerate acts to make sure people had privacy when they needed it.

Complaints had not all been logged, creating a risk that they could be overlooked. However, the provider’s complaints policy was publicised and people and relatives knew how to raise any concerns.

Care planning was person-centred, reflected people’s individual personalities and highlighted their past achievements. A range of activities were on offer with specific sessions and groups designed for people living with dementia.

Provider and management oversight of the service had increased significantly since our last inspection. Most audits and checks had been effective i

This inspection took place on 1, 2, 3, 6 and 7 August 2016 and was unannounced.

Creedy House is registered to provide personal and nursing care for up to 44 people. There were 41 people using the service during our inspection with a further two people being treated in hospital. People were living with a range of complex nursing, mental health and care needs. These included: Schizophrenia, learning disability, diabetes, catheter and continence management, pressure wounds and mobility support; and many people were living with different types and stages of dementia.

Creedy House is a large, detached premises situated in a residential area in Littlestone-On-Sea. The service was divided into two areas: The House which accommodated people requiring nursing as their primary need and The Lodge where people living with dementia had their bedrooms.

The service was not well-led. Leadership and oversight of the service was poor meaning that people did not receive a good standard of care. People had experienced harm and neglect as a result of this. Audits designed to identify shortfalls in the quality and safety of the service had not been effective and records were not always accurate or complete. Feedback about people’s experiences had not been sought and staff concerns had not been addressed.

There was not a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. 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. There was however, a new manager who started work at the service on the first day of our inspection; and who intends to apply to the CQC for registration.

Creedy House was last inspected in October 2014, when it was rated as good.

At this inspection, people had not been kept safe from abuse or improper treatment. Some people showed violent or aggressive behaviour and this had not been properly managed. Staff had not received effective training which left people and staff exposed to risk of harm.

Other risks, including those associated with the environment and medicines had not been minimise to ensure people were kept safe. Recruitment checks had not been sufficiently robust so that only suitable applicants were employed.

There were not enough trained and competent staff on duty and as a result people’s needs were sometimes overlooked. Staff training had been ineffective in equipping staff to carry out their roles.

People’s healthcare including what they ate and drank had not been monitored or managed effectively; meaning people did not receive appropriate care and support to keep them well.

The principles of the Mental Capacity Act had not been followed, so people’s rights were not always protected.

Most staff were kind and gentle but they were constantly rushed; which led to people’s needs being disregarded at times. Care plans were presented in a person-centred way but people’s preferences and choices were not consistently respected. Activities were available but there was limited meaningful stimulation for people living with dementia.

Complaints had been not been managed in line with the provider’s policy and people and relatives were unclear about how to complain.

The service was not well-led and had been without a registered manager for about a year. Leadership and oversight had been lacking meaning that people did not receive a good standard of care. Audits designed to identify shortfalls in the quality and safety of the service had not been effective and records were not always accurate or complete. Feedback about people’s experiences had not been sought and staff concern had not been addressed.

We identified a number of breaches of Regulation. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special me

The inspection visit was carried out on 15 October 2014 and was unannounced. The previous inspection was carried out in December 2013, and there were no concerns noted.

The premises are an old detached building with a newer purpose-built extension. The service provides general nursing care and accommodation for up to 44 older people, some of whom may also have dementia. The extension provides a separate unit to care for people with more complex dementia needs. On the day of our inspection there were 41 people living in the home. Two people were in hospital, and the home had one vacancy.

The service is run by a manager, who had been in post for six months, and who was present on the day of the inspection visit. The manager had commenced the process of going through formal registration processes with the Care Quality Commission. (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 and associated Regulations about how the service is run).

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some of the people in the home had been assessed as lacking mental capacity to make complex decisions about their care and welfare. There were clear records to show who their representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

All staff had been trained in safeguarding adults, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the manager or outside agencies if indicated.

The home had suitable arrangements in place to protect people from risks. There were annual building risk assessments and other regular risk assessments for the premises to promote people’s safety. Each person living in the home had individual risk assessments in regards to their personal care and treatment. There were reliable processes in place for the servicing and maintenance of equipment.

The manager carried out on-going assessments to ensure there were appropriate numbers of suitably trained and experienced staff to care for people living in the home. There were robust

recruitment practices in place to help ensure that staff were suitable for their work. Staff responded to people with kindness and empathy, and showed compassionate care. They were supported through individual supervision, staff meetings, yearly appraisals and on-going training sessions. All of the staff were trained in dementia care.

Medicines were administered by trained nurses and were stored and managed in accordance with current guidance.

People thought that the food was “excellent”. The chef was enthusiastic about ensuring that people had food to eat that they enjoyed, and that was suitable for them. Menus reflected people’s current choices, and included a good variety of foods for meeting people’s nutritional needs. Staff supported people to eat and drink, and were familiar with people’s different diets.

Nursing staff oversaw the monitoring of people’s health care needs. They made referrals to GPs and other healthcare professionals to support people with routine health checks and specialist care. They were knowledgeable about people’s specific care needs and kept their own skills and development up to date.

During the inspection we saw staff from different job roles responding to people in a caring and gentle manner. They quickly noticed when people were agitated or upset and knew how to distract them, comfort them, or assist them. People were able to carry their call bells with them to different areas in the home, and staff were quick to respond when people called them. People said that the staff explained things to them and were helpful. People’s relatives said that the staff “always” informed them if there were any significant changes with the person’s health or care needs, and spoke highly of the staff’s dedication.

People’s care plans contained comprehensive details about their individual care needs. The staff said they were committed to giving person-centred care, making sure that each person was treated and cared for as an individual. This was reflected in social activities, and staff were familiar with people’s likes and dislikes, such as if they liked to be in company or on their own, if they liked to take part in group activities, and if they had specific hobbies and interests. The home provided a wide range of different activities throughout the week for people to enjoy, and supported people to go out of the home.

The manager had made innovative changes since commencing her post, and had carried these out after discussion and agreement with the staff. People living in the home, their relatives and staff said that her appointment had brought about “Significant improvements” in the home. Staff had a greater understanding and awareness of how to care for people with dementia; and there was a greater emphasis on meeting people’s individual needs. Staff said the manager had brought fresh vision to the home, and had clearly communicated this to the staff. We obtained feedback from visiting health and social care professionals who said that the home was running more smoothly since a new manager was in post; and that she had been very supportive in caring for people with complex needs. The manager was increasing the home’s liaison with the local community and with other home managers. This broadened the staff’s perspective and promoted learning from good practice in other care services.

There were suitable systems in place to obtain people’s views and ensure that their views were listened to and brought about change. There was a culture of learning from incidents and listening to people to provide on-going improvements. People said the home had “Taken huge strides forwards” since the new manager had been appointed.

There were 43 people using the service at the time of our inspection. We used a number of methods to find out what people’s experiences of the service were. This included talking with people and their relatives and observing some of the care they received.

We found that people were involved in planning their care and had been asked to give their consent before any care or treatment was carried out. Where people did not consent to care their decision was respected and alternative ways to meet their needs were discussed with them. People that used the service told us they were happy with the care they were receiving and that it met their needs. Comments included “I have no complaints” and “The staff are accommodating and kind”.

We found that the premises were suitable for the needs of the people using the service and there was a programme of refurbishment in place to upgrade some areas of the building. People using the service and their visitors told us that the service was always kept very clean. There were enough staff employed, who had the necessary skills and qualifications, to meet people’s needs. We found that people did not have to wait long for support and that staff were responsive to people’s needs and requests.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector, who was joined by an “Expert by Experience” (people who have experience of using services and who can provide that perspective), and a practising professional nurse.

During the visit we carried out a “Short Observational Framework Inspection” (SOFI). SOFI is a specific way of observing people’s care to help us to understand the experience of people who are unable to talk with us.

The registered manager and the regional manager were available during the inspection, and the inspector and the practising professional gave feedback to them at the end of the inspection.

We spoke with staff and relatives during the visit; and we talked with people living in the home, in communal areas, and in their own rooms. People who were able to express their feelings spoke positively about the home. We gathered evidence of people’s experiences of the service by reviewing questionnaire responses and comments in other documentation, as many people were unable to talk clearly with us due to dementia.

Some of people’s comments included:

“I have only been here for a short while and this home was chosen with help from my family. I am not sorry I came here, I am so happy here. I lived alone since my husband died and it is so lovely to have company and the staff are especially nice and kind."

“My daughter found this Home for me – she did a good job there. It really is like “home” – you can do what you want, when you want."

“This is a lovely home with wonderful staff. I would not tolerate a second rate service. I am happy here."

A relative said:

"My mother has settled in fine and although she only came for a trial period, after three weeks she says she wants to stay. As a family we have only seen good things here and I can thoroughly recommend it."

People, relatives and friends told us they were happy and satisfied with the care and support received. Comments included ‘I like it here very much’, ‘I don’t have to worry about anything here’ and ‘it’s very nice’. People told us they were not involved in care plan reviews but one said they had 'requested changes to their personal care routine and this was changed without question'. They said ‘they are very good like that’. When asked about her privacy and dignity, one lady told us 'yes respected but since a lot of the dear souls have dementia, at meal times they help themselves to my food or leftovers and I have complained about that but they can’t help it'. She also told us that whilst the home has resident's meetings, she doesn’t attend because she can’t hear. She felt she wasn't involved in care reviews.

Two people told us they feel safe at the home. One lady said everyone is very kind and she would 'feel okay to complain' if she needed to. Another person told us 'the staff are very nice and they treat you nice'.

The people we spoke to all made positive comments about the staff. We saw staff communicating effectively with people who use the service and we saw no evidence of staff behaviour compromising the care and treatment of people.