We inspected Fitzroy Lodge on 8 May 2018. Fitzroy Lodge 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. Fitzroy Lodge is registered to provide care for up to 24 people, with a range of health conditions and some who were living with dementia. On the day of our inspection there were 18 people living at the service, who required varying levels of support. We previously inspected Fitzroy Lodge on 4 and 5 July 2017 and found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and further areas of improvement were required. We asked the provider to take action to make improvements and these actions have been completed.

Risks associated with people’s care, the environment and equipment had been identified and managed. A planned schedule of maintenance, improvement and additional work was carried out as necessary. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People’s care was enhanced by adaptations made to the service. People were cared for in a clean and hygienic environment and appropriate procedures for infection control were in place.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. Notifiable events and actions had been reported to the CQC in a timely manner.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, bingo, arts and crafts, trips into town and themed events, such as karaoke, massage therapy and visits from external entertainers. However, feedback from people was not routinely positive in relation to the activities on offer. We have made recommendations about the provider seeking guidance in relation to the provision of meaningful and person centered activities, and about systems being implemented to comply with the Accessible Information Standards (AIS).

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 and associated Regulations about how the service is run.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as the treatment of specific infections and palliative care (end of life).

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of

This inspection took place on 4 July 2017 and was unannounced. We also returned on the 5 July 2017. The manager was given notice of the second date, as we needed to spend specific time with her and the provider to discuss aspects of the inspection and to gather further information.

Fitzroy Lodge is registered to provide residential care for up to 24 older people who may be living with dementia. At the time of our inspection, there were 19 people living at the home. The home is located in a residential area of Worthing close to the seafront. There was one lounge, another small sitting area and a separate dining room. A passenger lift provided access between the floors. On the ground floor was a private room, which was used when the hairdresser visited on a weekly basis. We also observed another seating area along the hallway on the first floor where people could rest and where dementia friendly activities were placed for people to engage in. People had their own rooms and had access to a large garden at the rear of the property, which had a summer building, named the ‘café’. The manager told us this is where people could relax, look out over the garden and have their drinks. The home was previously inspected on 24 February 2015 and no concerns were identified.

A new manager was appointed in April 2017. They had submitted an application form to the Care Quality Commission to be registered as a manager. Since our visit, they have been successfully registered with the 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 2008 and associated Regulations about how the service is run.

We found that the systems in place to reduce risks associated with the environment were not always suitable for purpose or properly maintained and this exposed people to the risk of harm. Some rooms did not have working fire detectors; there was inadequate compartmentation between rooms that would result in a fire spreading. We contacted the West Sussex Fire and Rescue Service to report our concerns. A Fire and Rescue Inspector carried out an inspection on 28 July 2017, following this inspection a representative from West Sussex Fire and Rescue told us, the provider was in the process of working on recommendations made to make the building safe. These included ensuring areas of the building were made more fire resistant. The provider was informed a further visit from West Sussex Fire and Rescue would occur during or after November 2017 to ensure that the deficiencies found had been acted on and resolved. People told us and the staff confirmed that the majority of people preferred to use a shower, rather than a bath. However, out of the three showers available, the manager told us only one was in working order. We found that the one in working order was not suitable for purpose. This meant there were not a sufficient amount of bathrooms for the number of people using the service. We also found that radiator coverings were not fixed to the walls as intended, which could result in a person being injured. The bathroom and toilet facilities were not clean or properly maintained. People told us and staff confirmed they were unpleasant to use. Since the inspection the provider submitted sufficient evidence that demonstrated the bathroom, shower and toilet facilities had been refurbished and were in working order. The door from the laundry room was also unable to lock which meant the building was not secure. This meant people’s personal safety was not protected. Since the inspection the provider offered assurances that the laundry room door has been repaired.

Risk assessments and management plans were not always sufficiently well developed to mitigate or manage risk. We found the fire risk assessment was out of date and arrangeme

This inspection took place on the 24 February 2015 and was unannounced. The home was previously inspected on 18 February 2014 and no concerns were identified.

The home provides accommodation and care for up to 24 adults. The home specialises in the care of people living with dementia and people who have mental health needs. There were 21 people living at the home at the time of our visit. The home is located in a residential area of Worthing close to the seafront.

The home has 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.

People told us they liked living at the home and no one had any negative comments about it. One person told us, “It’s a nice place to live” and another person said, “I can’t think of anything I’d change”. The home had a lively atmosphere and people’s relatives and friends visited them during our visit.

There were sufficient staff to keep people safe. People were supported by kind and considerate staff who responded to their needs quickly. People were treated with dignity and respect and were involved in making decisions in relation to how their care was provided. Staff received training to meet the needs of the people in the home. Staff understood and followed the requirements of the Mental Capacity Act (MCA) 2005. Staff observed the key principles of the MCA in their day to day work checking with people they were happy for them to undertake care tasks before they proceeded.

Staff were positive about their roles and the support they received from management. Staff knew the people they supported well and the choices they made about their care and their lives. The needs and choices of people had been clearly documented in their care records. People were supported to maintain independence and control over their lives and to undertake activities in line with their interests.

People felt safe living at the home. There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. When the provider employed new staff at the home they followed safe recruitment practices.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed. People had sufficient to eat and drink throughout the day.

The provider sought feedback on the care and support provided and took steps to ensure that care and treatment was provided in a safe and effective way, and where necessary improvements were made. People were involved in developing the service as were their relatives. Regular meetings were held and satisfaction surveys sent out and action taken in response to feedback received.

When we visited the location, we found that the registered manager, Mrs Anne Marie Lovejoy, was no longer managing the regulated activities at this location. We discussed this with the provider and have advised that they will need to de-register before a new manager can be registered for this location. Mr Pravin Bhanudasrao was the interim manager at the time of our inspection.

On the day of our inspection, we were told that there were fourteen people who lived at the service. The manager told us that some bedrooms were being refurbished after recent storm damage. They also told us that no-one was cared for in bed, however, we observed one person who received support to eat their lunch in bed.

Care plans showed that comprehensive risk assessments had been completed and that these had been reviewed on a regular basis. One person told us that they had a relative who had lived there and, “Although bedridden at the end”, had “generally good care”.

We spoke with staff who described the training they had received which enabled them to care for people at the service safely and effectively. One member of staff told us, “I get all the training I need.”

The provider had arrangements in place to monitor the quality and safety of the service provided.

One person who used the service told us that, “It’s very good here” and that, “They wouldn’t change anything”.

When we inspected the home on 5 June 2013 we found that the home did not have effective systems in place to monitor infection control or cleanliness. As a result, several areas in the home were unclean and posed an infection control risk to people who lived and worked at the service. We also found that medicines were not safely stored according to legislative requirements and best practice. We inspected the service to check whether improvements had been made in these areas.

We found that the home and grounds were clean and tidy. Areas which had previously posed infection control risks had been cleaned appropriately. In addition the home had implemented new checks and records related to cleaning and infection control which evidenced their compliance.

We saw that medicines were stored safely and in accordance with legislative requirements and best practices.

We conducted this inspection to follow up on concerns identified at a previous inspection relating to the care and wellbeing of the people in the home.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people who used the service had complex needs which meant they were not able to tell us their experiences.

This included Short Observational Framework Investigations (SOFI) which involves observing the interactions between people who live in the home and the staff caring for them. This is a useful tool to assess the quality of care and interactions that occur in the home. We undertook SOFI observations during lunch time. The majority of people appeared to enjoy their meal however there was little interaction between the staff and the people who lived in the home. For example we observed one member of staff assisted a person with their meal quietly at a relaxed pace, smiling and encouraging them; whist another member of staff ed spoke over the person and did not engage or interact with them at all. We found that staff skills in caring for people with dementia varied and not all staff provided positive support to the people with minimal eye contact and little conversation.

We found that since our last inspection a new manager had been appointed. Many of the issues identified at the previous inspection were either in the process of being addressed or had been actioned. For example the care plans and records had all been updated, more staff had been employed and a programme of training was underway to ensure they had the skills to provide care and support to elderly people with Dementia.

However we identified further concerns relating to the safe administration of medicines and poor infection control practices.

We conducted this inspection out of hours because we had received information of concern relating to the care and wellbeing of the people in the home. During this inspection we used a number of different methods to help us understand the experiences of people using the service, because many of the people who used the service had complex needs which meant they were not able to tell us their experiences.

We found that although people praised the kindness and dedication of the staff, their care and treatment did not always meet their needs. One person told us “The staff are usually quite nice; they are willing to help you most times”. There was no evidence to support that staff were trained and supported to look after the people in the home. The home did not support people to engage in meaningful activities. We found that the quality of records and record keeping was poor.

During our tour of the home we noted the worn furniture and fixtures which presented a health and safety risk and did not provide a therapeutic environment for the people living in the home. The lift was broken and we were told had out of action for several weeks. We found there was a lack of hot water in many areas of the home meaning that people were unable to bath and have their hygiene needs met.

There was no evidence that the home had a robust Quality Assurance system in place to monitor, evaluate and improve the care and service provided.

We spoke with three of the 21 people who lived at Fitzroy Lodge. They told us they were very happy with the care afforded to them. One person told us, “I’m quite happy here. I don’t want to go anywhere else.”

We spoke to the relatives of two people who were visiting the service. They confirmed they were very happy with the care provided to their relatives. One relative told us they visited most days and told us they observed people were well cared for. The second relative told us, “I’m relieved to have found a place like this. The staff are really nice and kind. I have no worries; I know my relative is fine and has settled in really well.”

We spoke with three members of care staff who were on duty. They demonstrated they knew about the level of care that each person required. They also confirmed they were well supported by the manager.