The inspection at Freshford Cottage Nursing Home took place on 30 January and 1 February 2018 and was unannounced.

Freshford Cottage Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide nursing, personal care and accommodation for up to 20 older people, over 65 years of age, who have chronic physical health care needs, such as diabetes, and who also may be living with dementia. At the time of the inspection there were 17 people living at the home. The premises is a converted older building, with an extension to one side, on two floors. Lifts enable people to access their rooms and there are communal rooms on the ground floor, with access to the garden for people using walking aids and wheelchairs. Freshford Cottage Nursing Home is one of three care homes within the registered organisation.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 24 October 2016 the service was rated as Requires Improvement overall. We found that improvements were needed under key questions of safe and well led. We asked the provider to take action to make improvements to guidance for ‘as required’ medicines, the medicine administration records, daily records and quality monitoring of the care and services provided. This action has been completed and the rating for each key question and the overall rating for Freshford Cottage Nursing Home is ‘Good’.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. At this inspection we have made a recommendation that the provider seeks advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

Staff managed medicines safely. Staff responsible for giving out medicines had attended training and their competency was assessed to ensure they understood ‘as required’ medicines and completed the medicine administration records. The provider had identified where improvements were needed in record keeping through the quality assurance system. Staff had been allocated to review care plans to ensure they were up to date. People, and their relatives if appropriate, had discussed their needs with staff; they were involved in writing their care plan and had signed them to show their agreement

The care plans were person-centred. They included people’s individual support and care needs and assessment of risk; with clear guidance for staff to follow to ensure safe and appropriate care was provided. For example, if people were at risk of falls or unable to move around the home independently, the most appropriate aid, such as a hoist or wheelchair, was recorded. Staff asked people how and where they wanted to spend their time and used the aids to assist people to and from the lounge or to sit comfortably in their own room. People took part in one to one and/or group activities of their choice. These included bingo, manicures, quizzes, trips into town shopping and the seafront and, there were with regular visits from external entertainers.

Staff were knowledgeable about people’s individual needs. Staff had attended essential training as well as

Freshford Cottage is located in Seaford with parking on site. The original building has been extended, there are communal rooms on the ground floor; a lift enables people to access all parts of the home, and there are accessible gardens to the front and side of the building.

The home provides support and care for up to 18 people with nursing and personal care needs. There were 17 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions such as diabetes, and some people were living with dementia.

The registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.’ A manager had been appointed prior to the inspection. They told us they

would be applying to register as the manager of the home with CQC.

The inspection took place on 24 October 2016 and was unannounced.

At the comprehensive inspection on 28 September and 2 October 2015 the overall rating for this service was requires improvement. The inspection found improvements were required in relation to providing safe care and treatment for people at risk, record keeping and assessing and monitoring the service provided and, there was no registered manager in place.

The provider sent us an action plan and told us they would address the issues by 14 January 2016.

During our inspection on 24 October we looked to see if improvements had been made and a manager had been appointed. We found improvements had been made, the provider was now meeting the regulations, and a registered manager was in place although further work was needed to ensure systems were embedded into practice.

A quality monitoring and assessing system had been developed and had identified some areas where improvements were needed. However, further work was required to ensure the system picked up the areas we found in the inspection; including the gaps in medicine records, limited information in the daily records and signage in people’s rooms. The provider had a monitoring system in place that had identified areas where improvements were needed and, offered on going support to develop a robust system.

Risk assessments had been completed as part of the care planning process and staff demonstrated how they guided them to support people safely to move around the home and reduce the risk of pressure damage and falls. Staff had attended safeguarding training and demonstrated an understanding of what action to take if they had any concerns.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People said the food was good, they were offered choices and staff were observant and took action if people lost weight. Activities were provided each weekday afternoon and people enjoyed participating in these.

Relatives and visitors were welcome at any time and felt involved in decisions about the support and care provided.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them.

During our inspection we spoke with six people who used the service and a relative of someone who used the service. We also spoke with five staff members; these were the registered manager, a senior care worker, a care worker, a nurse and the administrator.

We also took information from other sources to help us understand the views of people who used the service, which included resident meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, “The care here is very good. I can’t fault it. They look after me well.” Another person commented, “The staff are good. If you want anything they will get it for you. It’s first class.”

The people who used the service were in safe and secure premises that promoted their wellbeing.

We saw that the equipment used to meet the needs of the people who used the service was suitable for its purpose, well maintained and used correctly and safely.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their jobs.

The provider had also ensured that sufficient numbers of staff with the right skills and abilities were employed to meet the needs of the people who used the service.

We also saw that care plans, staff records and other records relevant to the management of the home were accurate, fit for purpose and held securely.

On the day we visited the home we spoke to five of the people who lived there, the relatives of four other people who were visiting, three members of staff, the registered manager, area manager and a visiting health care professional. Feedback from everyone we spoke with was positive.

People were happy with the delivery of care and felt that staff cared for them well. They told us that they had received the support they needed when they needed and were able to make their own decisions about daily living. They told us they could get up and go to bed when they wanted and had a choice of food at meal times and received their medicines safely. They told us that the home contacted the GP and other health care professionals on their behalf when needed and that their health care needs had been met. People were also happy with the level of entertainment and activities provided.

People told us they felt safe living in the home and that staff never raised their voices treated them with respect. They said staff knocked on the door before entering their rooms, showed patience and understanding and never rushed them.

Staff told us that they felt supported. They told us they had received the training they needed to fulfil their roles, that management were approachable and that they listened to their views.

Freshford Cottage is located in Seaford with parking on site. The original building has been extended, there are communal rooms on the ground floor; a lift enables people to access all parts of the home, and there are accessible gardens to the front and side of the building.

The home provides support and care for up to 18 people with nursing and personal care needs. There were 17 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions such as Parkinson’s disease, and some people were living with dementia.

The home has been without a registered manager since August 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.’ A manager had been appointed prior to the inspection. They told us they would be applying to register as the manager of the home with CQC.

The inspection took place on 28 September and 2 October and was unannounced.

The quality monitoring and assessing system used by the provider to review the support provided at the home was not effective. It had not identified issues found during this inspection, including that staff did not follow relevant guidelines when giving out medicines, care plans did not reflect people’s specific needs and there was no system in place to ensure people’s diet was nutritious and varied.

Risk assessments had been completed as part of the care planning process. However, staff did not demonstrate a clear understanding of how to use this information to prevent harm, this meant people may be at risk and a preventable accident occurred during the inspection.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, but had not followed current guidance to ensure people were protected.

New staff were required to complete an induction programme in line with Skills for Care and fundamental training had been provided for all staff, but staff had not attended training specific to people’s health care needs, for example dementia awareness.

Staff said the manager was approachable and they felt they could be involved in developing the service to ensure people had the support they needed and wanted. Relatives said the manager seemed very nice, but they were concerned that there had been four managers in a year and a considerable turnover of staff.

People’s opinions of the food varied and the chef planned to make changes to the menu, depending on the feedback from people and their relatives, if appropriate. Staff asked people what they wanted to eat and choices were available for each meal. People told us they decided what they wanted to do, some joined in activities while others sat quietly in their room or communal areas.

A safeguarding policy was in place and staff had attended safeguarding training. They had an understanding of recognising risks of abuse to people and how to raise concerns if they had any.

A number of staff had left and new staff were being appointed with ongoing recruitment to ensure there were sufficient staff working in the home. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them. One person had made a complaint and said the manager had investigated it and they were satisfied.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.