The inspection took place on 14, 15 November 2017 and 29 March 2018. It was unannounced.

Glen Arun Care Home was last inspected in December 2016. We found that there were insufficient numbers of suitably qualified, skilled and experienced staff deployed to peoples' needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. At this inspection we found that improvements had been made and the provider had taken the action required to meet this regulation.

Glen Arun Care Home is registered to provide accommodation, nursing care and support for up to 36 older people. At the time of our visit there were 34 people at the service. The service has a wide range of communal areas and well maintained accessible gardens.

The service had a registered manager in place. 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 were protected from risks to their health and wellbeing. Up to date plans were in place to manage risks, without unduly restricting people’s independence.

People said they felt safe at the service and knew who they would speak to if they had concerns. The service followed the West Sussex safeguarding procedure, which was available to staff. Staff knew what their responsibilities were in reporting any suspicion of abuse.

People were treated with respect and their privacy was promoted. Staff were caring and responsive to the needs of the people they supported. People's health and well-being was assessed and measures put in place to ensure people's needs were met in an individualised way.

People’s medicines were managed safely. People had enough to eat and drink throughout the day and night. The mealtime was an inclusive experience.

There was an open and friendly culture combined with a dedication to providing the best possible care to people. Staff at all levels were approachable and keen to talk about their work and committed to the on-going development of the service. The atmosphere in the service was happy and calm. People were engaged and occupied; they interacted and chatted with each other. Every person we spoke to was complimentary about the caring nature of the management and staff.

Staff received training to enable them to do their jobs safely and to a good standard. They felt the support received helped them to do their jobs well.

There were enough staff on duty to support people with their assessed needs. The registered manager considered people’s support needs when completing the staffing rota and staffing levels were calculated appropriately. The registered manager followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

People benefited from receiving a service from staff who worked well together as a team. The registered manager and the staff team took pride in their work. Staff were confident they could take any concerns to the management and these would be taken seriously. People were aware of how to raise a concern and were confident appropriate action would be taken.

The premises and gardens were well maintained. All maintenance and servicing checks were carried out, keeping people safe. People were empowered to contribute to improve the service. People had opportunities to feedback their views about the service and quality of the care they received.

Glen Arun Care Home provides accommodation for up to 35 older people, some of whom are living with dementia and diabetes and who need support with their nursing and personal care needs. On the day of our inspection there were 34 people living at the home. The home is a large property, spread over two floors, situated in Horsham, West Sussex. There is a communal lounge, a dining room and gardens.

We carried out an unannounced comprehensive inspection on 5 November 2014. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. On 23 June 2015 we carried out a focused inspection to check that they had followed their plan and to confirm that they were meeting legal requirements. At that inspection we found that significant improvements had been made and all previous areas of concern had been addressed.

This inspection took place on 19 December 2016 and was unannounced. It was brought forward following concerns that had been raised with us in relation to staffing levels and timely access to care to meet peoples’ needs. At the inspection we spoke to people, relatives and staff. Following the inspection we spoke to a healthcare professional. All of whom told us that there was sometimes insufficient staffing to meet peoples’ care needs and some of our observations confirmed this. Comments from people included, “Well you have to accept that with so many people to be seen you have to wait your turn”, “They do tell you that if two of them are doing something for someone else you have to wait” and “ I have to wait to get up in the morning, you have to fit into their rota”.

People received their medicines from registered nurses and were happy with the support they received, one person told us, “They asked me if I wanted to be in charge of my own medication but I was happy for them to do all that for me so I don’t have to worry about forgetting it and yes I get my tablets regularly”. There were good systems in place to inform staff of when to offer people medicines on an ‘as and when required’ basis and systems ensured that the storage, administration and disposal of medicines were safe. However, there were concerns regarding peoples’ access to prescribed medicines. A healthcare professional told us about several occasions when medicines had been prescribed but people had not received their medicines for several days. Measures had been taken to ensure that this was less likely to occur in the future as the manager had changed the pharmacy that delivered the medicines, however, there were still concerns regarding staffs’ intervention to ensure medicines were provided to people in a timely manner.

Staff had demonstrated good practice by identifying and acting on concerns in relation to a pressure wound for one person. However, there were a lack of notifications to CQC about the deterioration of this and in relation to safeguarding investigations that had been conducted by the local authority. Notifications enable us to have oversight and to ensure that appropriate actions had been taken to ensure peoples' safety and well-being. Although this had improved since the new manager had been in post, this needed to be fully embedded in practice. Quality assurance audits were in place, however these were not always sufficient and although there were plans to improve these, the current provision did not ensure that the systems and processes used within the home were effective to ensure people received safe and effective care at all times. Records, to document peoples’ care and nursing needs, as well as the monitoring of the care they received on a day-to-day basis, were not always in place or completed sufficiently. When this was fed back to the manager immediate action was taken to address this, however this needs to be fully embedded in practice.

The home had been without a registered manager for over a year, however, there had been a numbe

We carried out an unannounced comprehensive inspection at Glen Arun Care Home on 5 November 2014. During this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, relating to risk assessments and the principles of the Mental Capacity Act (MCA) 2005. As a result we undertook a focused inspection on 23 June 2015 to look specifically at whether the service was safe and effective. The purpose of the inspection was to follow up on whether the required actions had been taken to address the previous breaches and to see if the required improvements had been made.

You can read a summary of our findings from both inspections below.

Comprehensive inspection on 5 November 2014

This inspection was unannounced and it took place on the 5 November 2014. Glen Arun Care Home is a nursing home which can accommodate up to 35 older people with a variety of long term conditions and physical disabilities. On the day of our inspection 32 people were being accommodated.

Where people lacked the mental capacity to make decisions the home was not guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. Risk assessments were not complete and had not been reviewed on a regular basis.

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. In this home the registered manager is also the registered person.

People felt safe with the home’s staff .Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm. Care records contained risk assessments to protect people from any identified risks and help keep them safe. We found risk assessments regarding aspects of people’s care were not always kept up to date or reviewed on a regular basis.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained to meet people’s needs safely. People and staff told us there were always enough nursing and care staff on duty.

People told us the food at the home was good and there was always a choice. Staff need to ensure they plan who is taking responsibility to support people at meal times as individual people were supported by numerous staff.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely.

Each person had a plan of care which provided the information staff needed to provide effective support to people. Staff received training to help them meet people’s needs. Staff received an induction and there was regular supervision including monitoring of staff performance. People said they were well supported and relatives said staff were knowledgeable.

People’s privacy and dignity was respected and staff had a caring attitude towards people. People knew the manager and staff by name. People were given appropriate support and had their independence promoted. Each person was allocated a key worker. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff. There was a range of activities people could take part in if they wanted to.

The manager operated an open door policy and welcomed feedback on any aspect of the service. Staff

confirmed management were open and approachable. A health care professional told us the manager and staff were very approachable and could follow their professional advice.

There were policies and procedures for quality assurance The manager and provider completed weekly and monthly checks to monitor the quality of the service provided to ensure the delivery of high quality care.

People and staff were able to influence the running of the service and make comments and suggestions about any changes. Regular meetings with staff and people took place. These meetings enabled the manager and provider to monitor if people’s needs were being met.

Focused inspection on 23 June 2015.

We inspected Glen Arun Care Home on 23 June 2015. This was an unannounced inspection. The service was registered to provide accommodation and care for up to 35 older people with a variety of long term conditions, including frailty, diabetes, dementia and physical disabilities. On the day of our inspection there were 34 people living at the home, with one person currently in hospital.

During the previous inspection, on 5 November 2014, we found breaches of Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 (Corresponding to Regulation 9 HSCA (RA) Regulations 2014) in relation to inconsistencies in the recording and reviewing of risk assessments and Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 (corresponding to Regulation 11 HSCA (RA) Regulations 2014 ) in relation to the service not meeting the requirements of the Mental Capacity Act 2005 (MCA). Where people lacked the mental capacity to make decisions, the service was not applying the principles of the MCA to ensure any decisions were made in the person’s best interests. Following that inspection, the provider had sent us an action plan detailing how they intended to address the shortfalls.

On the day of our inspection, it was clear that the manager and staff had worked hard to make improvements, they had thoroughly addressed all the previous issues and shortfalls and no concerns were identified. People were being supported to make decisions in their best interests. The registered manager and staff had received updated training on the MCA and the Deprivation of Liberty Safeguards (DoLS). The deputy manager, a Registered Mental Nurse (RMN) had provided all staff with updated and comprehensive training in the principles of the MCA. All personal and environmental risk assessments had been reviewed and were now closely monitored to ensure they accurately reflected an individual’s changing needs and condition.

People said they felt safe at Glen Arun and were happy, comfortable and relaxed with staff. They told us “The staff are wonderful; I could speak to any of them. I’ve got no complaints.” People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff had also received both one-to-one supervision meetings with their manager, and formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans we looked at were person centred and contained appropriate updated risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

This inspection was unannounced and it took place on the 5 November 2014. Glen Arun Care Home is a nursing home which can accommodate up to 35 older people with a variety of long term conditions and physical disabilities. On the day of our inspection 32 people were being accommodated.

Where people lacked the mental capacity to make decisions the home was not guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. Risk assessments were not complete and had not been reviewed on a regular basis.

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 felt safe with the home’s staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Care records contained risk assessments to protect people from any identified risks and help keep them safe. We found risk assessments regarding aspects of people’s care were not always kept up to date or reviewed on a regular basis.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained to meet people’s needs safely. People and staff told us there were always enough nursing and care staff on duty.

People told us the food at the home was good and there was always a choice. Staff need to ensure they plan who is taking responsibility to support people at meal times as individual people were supported by numerous staff.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely.

Each person had a plan of care which provided the information staff needed to provide effective support to people. Staff received training to help them meet people’s needs. Staff received an induction and there was regular supervision including monitoring of staff performance. People said they were well supported and relatives said staff were knowledgeable.

People’s privacy and dignity was respected and staff had a caring attitude towards people. People knew the manager and staff by name. People were given appropriate support and had their independence promoted. Each person was allocated a key worker. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff. There was a range of activities people could take part in if they wanted to.

The manager operated an open door policy and welcomed feedback on any aspect of the service. Staff confirmed management were open and approachable. A health care professional told us the manager and staff were very approachable and could follow their professional advice.

There were policies and procedures for quality assurance. The manager and provider completed weekly and monthly checks to monitor the quality of the service provided to ensure the delivery of high quality care.

People and staff were able to influence the running of the service and make comments and suggestions about any changes. Regular meetings with staff and people took place. These meetings enabled the manager and provider to monitor if people’s needs were being met.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with four people living at the home. All were complimentary about the care and support they received and were happy living at Glen Arun. One person told us, "Really, the staff are so kind and caring". Another told us, "It's a home from home here. It's so warm and friendly". A visitor said,"We tried other homes before this and Glen Arun is the best by far. There's more than just care given here". We noted that the home employed an activities co-ordinator; the people we spoke with were happy with the number and range of activities on offer.

We saw that people's consent was sought, wherever possible, before care and support was provided. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We saw that medicines were properly handled and administered in line with the providers policy. We noted that there were enough skilled and experienced staff to do this and to deliver effective care. We also found that systems were in place to make a complaint about the service if people needed to and that complaints were managed in an effective and timely manner.

During our visit we spoke with two people and made observations. We also spoke with one relative and one visiting healthcare professional.

People who used the service were positive about the care they receive. Each person commented that they were treated with respect and that they could exercise individual choices in their care and treatment. One person told us that they found the manager very approachable and they could talk to them about any suggestions or concerns. People told us that they found the care good and had no complaints.

We observed that the staff were respectful and caring and demonstrated an understanding of individual needs in the planning of care and treatment.

People we spoke with told us that they felt safe at the home and that their needs were met. One person told us that they were regularly checked by staff to ensure that they were comfortable and safe.

We saw that people were involved in regular meetings about the home and services provided and that they were informed and consulted about activities and changes.

We spoke to three staff. They said they felt supported by the manager and that they listened to their views on the service. One told us that "this is the best place I've ever worked in" and another said that the manager's "door is always open" for them to talk to.

We found that there was a good system of quality control in place, with people, visitors and staff being surveyed for their opinions on the care provided.