This inspection took place on 18 October 2017 and was unannounced.

The last inspection took place on 5 September 2016. As a result of this inspection, we found the provider in breach of four regulations, in relation to person-centred care, need for consent, nutrition and hydration needs and good governance. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection on 18 October 2017, we found the provider and registered manager had taken appropriate action and these regulations had been met. As a result, the overall rating for this service has improved from 'Requires Improvement’ to ‘Good’.

Dean House is a residential care home registered to provide accommodation and care for up to 27 older people, some of whom are living with the early stages of dementia. At the time of the inspection, 23 people were living at the home. Dean House is situated close to the seafront in a residential area. Communal areas include a living room, dining room, conservatory and accessible gardens. A lift and two staircases provide access to the first floor.

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 told us they felt safe living at the home and that staff supported them well. Staff had been trained to recognise signs of potential abuse and knew what action to take in relation to any safeguarding issues. Risks to people were identified, assessed and managed appropriately. Risk assessments provided detailed advice and guidance to staff on how to mitigate risks. Staffing levels were within safe limits. Robust recruitment systems ensured new staff were vetted as needed before they came to work at the home. Medicines were managed safely.

Staff had a good understanding of the legislation in relation to mental capacity and protecting people’s liberty and put this into practice. Capacity assessments for people had been completed as needed and applications made to the local authority where it was felt people were deprived of their liberty. People received a choice in what they wanted to eat and drink. Nutritious meals were provided and people told us they enjoyed the food on offer. People had access to a range of healthcare professionals and services and spoke positively about the home. Staff had completed a range of training that enabled them to carry out their roles and responsibilities. They had regular supervision meetings and staff meetings also took place.

People were looked after by kind and caring staff and positive, friendly relationships had been developed. Staff engaged with people appropriately and had time to spend with them. People spoke highly of the staff who looked after them. People were encouraged to be involved in decisions relating to their care and were treated with dignity and respect.

People were asked for their views in the organisation of activities and a range of activities was on offer. Some people felt there was a lack of outings into the community and told us they would like to go out more. This is an area that needs improvement. Care provided was responsive to people’s needs and delivered in a person-centred way. Care plans were detailed and contained information for staff on people’s personal histories, care and support needs. Complaints were managed in line with the provider’s policy.

People and their relatives felt the home was well run. People were asked for their views about the home through residents’ meetings and questionnaires. People felt involved in developing the service. The registered manager was popular with s

The inspection took place on 5 September 2016 and was unannounced.

Dean House is a residential care home providing accommodation, including respite care, for up to 27 people, some of whom are living with dementia or diabetes and who may require support with their personal care needs. On the day of our inspection there were 21 people living at the home. The home is a large property situated in East Preston, West Sussex. It has a communal lounge, dining room, conservatory and garden.

The home was the only home owned by the two providers and the management team consisted of a registered manager, an operations manager and a team leader. 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.

People had variable experiences and we found several areas of practice that required improvement.

There were concerns with regards to people’s emotional and social needs being met. People told us that staff did not have time to spend with them and our observations confirmed this. Observations showed staff were very busy and task orientated and did not appear to make time to meet people’s social and emotional needs. One person told us, “There are enough of them but they are very busy, sometimes when you ask them something they are a little abrupt but it is just because they’re busy”. Another person told us, “The staff don’t have time to be friendly”.

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People provided mixed feedback with regards to the provision of activities. Some people told us that they enjoyed the external activities that were sometimes provided, however, felt that there wasn’t much to do to occupy their time and our observations confirmed this. People who spent time in their rooms were at risk of social isolation. Observations showed people spending extended periods of time alone in their rooms, only seeing staff when they were providing personal care or food and drink. One person told us, “There is not much to do here”. Another person told us, “I don’t get visitors’, I have no family, I get incredibly lonely, the only criticism I have is the boredom”. A relative told us, “There is not enough to occupy them, I feel a bit more one to one time with my relative could be an improvement”.

People’s health and physical needs were assessed when they moved into the home, these were reviewed on a monthly basis by care staff. However, there were concerns regarding the involvement of people and their relatives’ in the care plan reviews. One person told us, “I know I have a care plan but I’ve not had a review”. A relative told us, “I’ve not experienced a review in the last twelve months and I’ve never been informed of the outcome of an assessment my relative had some time ago, communication from the home is somewhat lacking”. Care plans did not contain sufficient information about people’s life history, background or social and emotional needs. The management team had recognised this and were in the process of developing a new care planning system, which was yet to be implemented, to address this. Reviews that did take place did not always reflect the good practice carried out by staff. For example, one person’s review failed to recognise that the person had been referred by the registered manager to a healthcare professional and that their support needs had changed. Observations showed that staff had implemented the necessary changes but this had not been sufficiently documented to ensure that the person’s care was consistent.

The lack of interaction and stimulation for people, as well the lack of involvement of people and their relatives’ to ensure person-centred care was provided are areas of concern.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their day to day care. The registered manager was aware of the legal requirements with regards to ensuring people

We met with five of the 25 people who lived at Dean House. Although we met with them, four people had conditions which had affected their ability to communicate with us. We were, therefore, unable to discuss the care they received with them. However, we spoke with one person and two of other people’s relatives.Comments made about the care provided were positive. One person told us, "I am happy here. I am learning to accept I need help at my age." A relative commented, "I would say it is adequate. The staff are very caring. They never have agency staff, which means the staff know the residents and their needs."

We observed a group of people in the lounge who were taking part in a game of bingo. We noted that there were positive interactions between people and staff who were on duty.

We spoke with three members of care staff, who were on duty. We found that they had a good understanding of their roles and responsibilities. They also demonstrated they knew what was expected of them to ensure people's needs had been met.

We also gathered evidence of people's experiences of the service by looking at a selection of records. We looked at care records. They did not demonstrate that people or their relatives had been involved with the planning or reviews of their care. We also found that care records did not always provided care staff with appropriate information to follow with regard to the delivery of care.

We also looked at a selection of records including staff recruitment and complaints that had been received. We found that the provider's recruitment practices were sufficiently robust to ensure care staff employed at Dean House were safe to work with vulnerable people. Complaint records demonstrated that they had been fully investigated and to the satisfaction of the person who made the complaint.

Due to the nature of our visit, we did not speak with people living at the home or their relatives on this occasion.

Some of the people that lived at Dean House had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

We spent time watching people in the lounges and found that people had positive experiences. The staff supporting them spoke clearly to people and explained what they were doing. Staff were seen to respect their wishes if they wanted to manage on their own.

We also observed the lunch time meal and saw that the food was presented in an appetising manner and the portions seen were appropriate. Staff were seen to support people appropriately and the meal was not rushed.

We also spoke with four people who lived at the home and all those spoken with said they were happy at the home. One person said “The staff are very nice and always treat me well”.

Another person said “I am well looked after”.

We also spoke to two visitors who were at the home during our inspection visit. They told us that their relatives were supported by staff to receive the care they needed.

Staff said that they would always respect people’s wishes and when asked what they would do if they felt there may be a conflict between a person’s wishes and their care needs they told us that they would speak with the manager.

People said that they are treated with respect and dignity and that their care needs are met. Staff were said to be responsive when people ask for help by using the call points in their rooms. People were not aware that they have a care plan although they said that they have a main carer or key worker and that they are asked about the support they would like to have. Comments made by people included’ ‘You can have a wash and shower when you want.’ People confirmed that they are able to exercise choice in how they spend their time, including where to have meals and at what times they get up as well as choices at each meal.

People said that they like the meals and that there are ample portions with plenty of fresh fruit and vegetables.

People reported that they feel safe at the home and that they are treated well by the staff. One person commented that there have been frequent changes of care staff, which can interrupt consistency in care.

We were told by people that there is a range of activities including outings and entertainment in the home including visiting theatre groups and singers. People also said that they are able to go out independently. One person said that there isn’t enough to do and that more activities involving mental stimulation would be helpful.

People said that the home is kept clean and that they like the environment.