The inspection took place on 17 July 2018 and was unannounced. Deerswood Lodge 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.

Deerswood Lodge is situated in Crawley, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Deerswood Lodge is registered to accommodate up to 90 people across separate units, each of which have separate bedrooms with ensuite shower facilities, a communal dining room and lounge. There are also gardens for people to access and a hairdressing room. The home provides accommodation for older people and for those living with dementia. At the time of the inspection there were 80 people living at the home. The home had a 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.

Prior to the previous inspection on 26 and 28 July 2017, the registered manager had notified CQC about a death that had occurred. An incident that had occurred prior to the death indicated potential concerns about the management of risk in relation to falls. While we did not look at the specific circumstances of the incident at this inspection, we did look at associated risks. Whilst all other parties have completed their investigations, the CQC investigation remains at this stage, ongoing.

At the last inspection the home was rated as Requires Improvement. The provider was found to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive and Well-led to at least good. A recommendation was made to improve the access to meaningful activities. There were concerns with regards to the sufficiency of staff, the maintenance of records and people’s care records not always being reviewed to reflect their current needs. At this inspection people’s access to meaningful activities and stimulation had improved. People and staff provided mixed feedback with regards to the staffing levels. Although no longer a breach of Regulation in relation to staffing, staffing levels were identified as an area in need of improvement. There is a continued concern regarding the maintenance of records and the reviewing of people’s care. The provider and registered manager had failed to improve the service people received. This is the third consecutive time that the home has been rated as Requires Improvement.

At this inspection, we found medicines were not always stored safely. People were not always provided with dignified care when receiving their medicines. Some people had specific healthcare conditions and required their medicines at specific times. Records for one person showed that they had not been given their medicines in a timely manner to maintain their health or to support them to manage their condition. This was an area of concern.

Records to document people’s care such as topical cream charts, fluid charts and repositioning charts were not always completed in their entirety. Reviews of people’s care records had not always taken place following incidents. Staff were not always provided with the most up-to-date and current guidance to inform their practice. This was an area of concern.

People were asked their consent for day-to-day decisions that affected their care. Staff supported them in the least restrictive way possible and policies and procedures supported this practice. However, people were not always supported

The inspection took place on 26 and 28 July. The first day of the inspection was unannounced, however the second day of the inspection was announced and the registered manager, staff and people knew to expect us.

Deerswood Lodge is a residential care home providing accommodation and personal care for up to 90 older people, some of whom have physical disabilities or are living with conditions such as diabetes and dementia and who may require support with their personal care needs. On the day of the inspection there were 82 people living at the home.

Deerswood Lodge is situated in Crawley, West Sussex and is one of a group of services owned by a National provider, Shaw Healthcare Limited. It is a purpose built building with accommodation provided over two floors which are divided into smaller units of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are well-maintained communal gardens. The home also contains a day service facility where people can attend if they wish, however this did not form part of our inspection.

The home had a registered manager. 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 management team consisted of the registered manager, two unit managers and team leaders.

We previously carried out an unannounced comprehensive inspection on 8 June 2016. A breach of a legal requirement was found in relation to safe care and treatment, as risks to each person’s individual needs were not always identified or minimised and risk assessments and care plans were not always sufficient. Due to this, staff were not provided with sufficient guidance to inform their role and ensure the person’s safety. It was also identified that the recording of conditions associated with peoples’ Deprivation of Liberty Safeguards (DoLS) authorisations and staffs’ awareness of these was an area in need of improvement. The home was rated as ‘Requires Improvement’.

At this inspection it was evident that improvements had been made within these areas. The registered manager and staff had a good awareness of the Mental Capacity Act 2005 (MCA) and had assessed peoples’ capacity and made the necessary applications to the local authority when people needed to be deprived of their liberty. There was an awareness of the conditions associated to authorisations of DoLS and these were clearly documented in peoples’ care plans to inform staff and guide their practice. Risk assessments had been completed that identified the hazards and the measures that had been put into place so that staff were provided with guidance to inform their practice and ensure peoples’ safety.

The inspection was prompted in part, by a notification of a death of a person who lived at the home. The incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the death and the incident prior to it, indicated potential concerns about the management of risk in relation to falls. This inspection examined those risks.

There was mixed feedback with regard to the sufficiency, deployment and abilities of staff. People told us and records confirmed that people sometimes had to wait unacceptable amounts of time to received support. One person told us, “It’s not nice when you have to wait about ten or fifteen minutes to use the commode”. The registered manager was in the process of recruiting staff, however, in the interim period had ensured that agency care staff were available to meet peoples’ needs. People told us and our observations confirmed that some agency staff lacked the knowledge, abilities or understanding of peoples’ needs and sometimes failed to engage or interact with people. A comment from one person echoed this, they told us, “Sometimes the agency s

The inspection took place on 8 June 2016 and was unannounced. Deerswood Lodge is a residential service providing accommodation and personal care for up to 90 older people including those living with dementia. The service is one of a group of 54 services owned by Shaw Healthcare Limited. The service was last inspected on 8 April 2013 and no concerns were identified.

Deerswood Lodge is a purpose built service with accommodation provided over two floors divided into smaller units of ten single bedrooms with ensuite bathrooms. Each unit has an open plan lounge and kitchen/dining area and all rooms on the first floor can be accessed by a passenger lift. There are additional communal areas throughout the building and accessible, secure gardens and grounds. On the day of inspection there were 82 older people living at Deerswood Lodge with a range of physical disabilities including people living with dementia, requiring varying levels of support to manage their daily activities and maintain good health.

The service had 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. The registered manager was present throughout the inspection.

Individual risks were not always identified and plans in place did not contain sufficient guidance for staff to reduce known risks. For example, one person was a smoker but there was no risk assessment or plan in place to manage the risk to themselves or the environment. Another person had a catheter in place but there was no clear guidance for staff on how to recognise if the catheter was blocked and what to do in the event of a blockage. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was meeting the requirements of the Mental Capacity Act (MCA) 2008 and the Deprivation of Liberty Safeguards (DoLS). Conditions attached to stafndard DoLs applications were met however they were not detailed in people’s individual care plans to ensure that staff consistently upheld people’s rights and this is an area that needs improvement.

Feedback regarding the quality of food was varied. People told us and we observed that people had sufficient to eat and drink. However, risks and nutritional preferences were not always clearly identified and guidance for staff lacked detail. For example, one person’s care plan stated they should have a modified diet. However the reason for the modified diet was not given and not all of the recommendations made by the Speech and Language Therapist had been incorporated into the care plan. This meant that there was insufficient guidance for staff on how to support the person to minimise the risk of choking. This was identified as an area of practice that needs improvement.

Staff had received training in safeguarding adults and had a good understanding of their role in keeping people safe, how to recognise abuse and report any concerns. One person told us they felt, “Safe and comfortable.” There were safeguarding and whistleblowing policies in place and a robust recruitment process to ensure that any staff employed were safe to work with people.

Environmental risks were well managed. There were health and safety and equipment checks in place and any repairs were attended to promptly by maintenance staff. Accidents and incidents were recorded and monitored for trends with actions plans in place to reduce the risk of recurrence.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. Staffing levels were calculated according to people’s needs. Any gaps in the rota due to staff vacancies were managed effectively through the deployment of regular agency staff. Staff we

There were 86 people living at the home at the time of inspection. During our visit we spoke with seven people and observed care being delivered. One of the people that we spoke to said, “It’s a really nice place”.

People told us that staff were kind and understood their individual needs. We observed people being spoken to in a friendly and polite manner. Staff acknowledged peoples request for help and support. We saw daily menu choices displayed in each communal area and that drinks were always available. One person told us, “Food is good here”. During our visit we observed a staff member ask a person about their meal preferences. We also observed staff providing gentle encouragement to eat and drink.

We looked at people's individual care plans and observed that each plan had information to confirm that an assessment of needs had been carried out. We spoke with care staff that were on duty. They demonstrated that they knew how care was to be delivered to ensure that peoples wishes and preferences were respected.

We viewed information about available activities displayed around the home. We observed photographic displays of recent activities featuring the people who live at the home. One of the people that we spoke with said, “It’s a lovely place, I am very happy here”.

We looked at records relating to staff recruitment. The records showed us that the provider had effective recruitment and selection processes in place.

Due to their disabilities many of the people who had dementia were not able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. This tool allows us to spend time watching what was going on in a service and helps us to record how people spent their time, the type of support they get and whether they have positive experiences.

We spent 25 minutes watching care and support provided to five people before lunch. This was in a unit that had been set up to accommodate up to ten people. We found that people generally had positive experiences and good interactions with care staff.

We also spoke briefly with four people and a relative who was visiting. They told us they were very happy with the care afforded to them. They also told us about activities and entertainments that had been provided.

We spoke with three members of care staff who were on duty. They demonstrated they knew about how care was to be delivered to each person to ensure their wishes and preferences had been respected. They told us that they felt well supported by the manager.

During our visit we spoke with a number of staff and service users in different communal areas of the home and we spoke with relatives who were visiting service users at the time.

People living at the home told us they felt safe living at Deerswood Lodge and that staff were usually available when they needed them. They felt the staff knew what they needed and knew how they liked things done.

People we spoke with told us they felt able to say what they wanted and that staff would accommodate their needs.

Staff we spoke with knew the people living at the home well and had a good understanding of their care needs.