This inspection took place on 8 and 10 January 2019 and was unannounced. Hilgay Care Home 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. The care home can provide accommodation and personal care for 35 people in one detached building that is adapted for the current use. The home provides support for people living with a range of complex needs, including people living with dementia. There were 18 people living at the home at the time of our inspection.

The service 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. The provider of Hilgay Care Home was also the registered manager and they were present throughout the first day of the inspection and part of the second day.

At the last inspection on 23 April 2018 we rated the home as Requires Improvement. This was the third occasion that the home had been rated Requires Improvement. Following the last inspection, we met with the provider to confirm what they would do, and by when, to improve the key questions of is the service safe and well led to at least Good. The provider submitted an action plan which detailed how they planned to make the required improvements.

We received information from the local authority about a number of safeguarding concerns at the home. This indicated potential issues with the management of risks of people falling. We examined these risks as part of this inspection.

At this inspection the registered manager had not maintained improvements seen at the last inspection and standards at the service had deteriorated. We identified serious concerns which put people’s health and well-being at risk.

There were not enough staff to care for people safely. Staff did not all have the training that they needed to be effective in their roles. Some staff had been deployed to work with people during their induction period without having received the training they needed to assist people to move safely.

Risks to some people were not being effectively managed. When people had falls, systems for reviewing their needs were not robust and adjustments were not always made to mitigate risks. Some people needed support to move using equipment. Assessments and care plans did not provide clear guidance for staff in how to support people safely. Some assessments were completed by staff who did not have the necessary training and experience. We raised a safeguarding alert with the local authority following the inspection.

Incidents and accidents were recorded. The registered manager had oversight of these records but had failed to identify patterns and trends. They had not taken all reasonable steps to prevent further occurrences or to mitigate risks to people.

Systems and processes for management at the home were not effective and there was an over reliance on the registered manager. There were not sufficient trained staff willing to administer medicines to people. This had resulted in the registered manager working an unsustainable number of hours over an extended period. Suitable contingency plans were not in place which put people at risk of not receiving their prescribed medicines when the registered manager was unexpectedly away from the service. A safeguarding alert was raised by the deputy manager during the inspection.

The system for managing complaints showed that two complaints had been received since the last inspection. However, people, their relatives and staff told us about a number of other complaints that had been raised but were not recorded. P

This inspection took place on 23 April 2018 and was unannounced. Hilgay Care Home 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. The care home can provide accommodation and personal care for 35 people in one detached building that is adapted for the current use. The home provides support for people living with a range of complex needs, including people living with dementia. There were 25 people living at the home at the time of our inspection.

The service 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. The provider of Hilgay Care Home was also the registered manager and they were present throughout the inspection.

At the last inspection on 26 September 2017 we found a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because there were not sufficient numbers of suitable staff employed. We also identified other areas of practice that needed to improve. We issued a warning notice requiring the provider to become compliant with the legal requirements by 31 January 2018. The provider sent us an action plan on 21 February 2018 to tell us what they had done to meet the legal requirements in relation to staffing. At this inspection, on 23 April 2018, we found that the improvements set out in the warning notice had been made and the previous breach had been addressed. However, we identified further areas of practice that required improvement.

Policies and procedures were in place to guide staff, however some policies were not being followed. The registered manager used a number of management tools to monitor standards and quality and to provide oversight. However, these systems were not always effective in identifying shortfalls in practice. Governance is an area of practice that requires improvement.

Staff understood how to recognise abuse and how to report concerns. However, processes to safeguard people from harm and abuse were not consistently followed in line with local safeguarding arrangements. This is an area of practice that needs to improve to ensure that people are consistently protected.

People told us they felt safe living at Hilgay, one person said, “There are always staff around to help us.” Risks to people were assessed and managed and there were plans in place to guide staff in how to support people safely. People were receiving their medicines from staff who were trained to administer medicines safely. Incidents and accidents were recorded and monitored so that lessons were learned when things went wrong. There were systems in place to ensure that people were protected by the prevention and control of infection.

Staff were receiving training and support relevant to their roles. Communication between staff was effective. One staff member said, “We have very good team work here.” People’s consent to care and treatment was sought and staff understood the principles of the Mental Capacity Act 2005.

People’s needs were assessed, monitored and managed. People were supported to have enough to eat and drink and staff supported them to access health care services when they needed to. One person told us, “They look after me very well.”

People and their relatives told us that they were happy with the care provided. One relative said, “The staff are so caring, kind, friendly and attentive. It’s a home from home.” People were encouraged to express their views and to be involved in planning their care. Relatives also described being involved and

This inspection took place on 26 September 2017 and was unannounced. Hilgay Care Home provides residential care for up to 35 older people. There were 28 people living at Hilgay Care Home when this inspection took place, some people were living with dementia. The house is situated in a residential area of Burgess Hill in West Sussex. Accommodation is arranged over three floors with a passenger lift connecting each floor.

The registered manager had left in June 2017 and at the time of the inspection there was no 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. The provider was in the process of applying to become the registered manager.

At the last inspection on 19 and 20 July 2016 we found breaches of four regulations relating to inadequate levels of staffing, lack of support at meal times, lack of person centred care and poor management oversight. The provider sent us an action plan on 4 October 2016 explaining what they would do to ensure that they were meeting the regulations by the end of November 2016. At this inspection on 26 September 2017 we found that some improvements had been made but there continued to be a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because there were not sufficient numbers of suitable staff employed. We also identified other areas of practice that needed to improve.

People, their relatives and staff all told us that there were not enough staff on duty. People were having to wait for their care needs to be met. One person said, “I always have to wait a long time for my call bell to be answered.” During the inspection we observed that people’s call bells were not always answered promptly and one person waited for 30 minutes. One person said, “Sometimes I wait so long for staff to come I wet myself.” A relation told us, “They (staff) try their best, but they are always short staffed.” Staff members we spoke with were all clear that there were not enough staff on duty. One staff member said, “The care gets done but people have to wait for it.” The provider was using high numbers of agency staff to cover for vacant posts over a sustained period of time. Staff told us that agency staff were not always available. Records showed that staff numbers had not remained consistent with the provider’s dependency tool which identified how many staff were needed to care for people’s needs safely. This meant that the provider had not fulfilled their plan to improve staffing levels following the previous inspection in July 2016 and it remained that there were not always enough staff on duty to care for people. Following this inspection, we received further information about staff working at night who were not trained to administer medicines. This showed that the provider had not ensured that the skill mix of staff was always suitable to meet the needs of people. This was a continued breach of the regulations.

The provider had put an action plan in place following the last inspection on 19 and 20 July 2016 to address the breaches that were identified. Whilst they had followed their plan in most respects and met the previous breaches, there had been a failure in management oversight to ensure that improvements needed were effectively identified and sustained. This was identified as an area of practice that needed to improve.

People’s social needs were not always being met. The number of organised group activities had improved since the last inspection and people told us that they enjoyed the organised activities provided. However at other times people did not have enough to do. One person said, “There is nothing for me to do here, what can I

The inspection took place on 19 and 20 July 2016 and was unannounced. Hilgay Care Home provides residential care for up to 35 older people. There were 28 people living at Hilgay when this inspection took place, some people were living with dementia. The house is situated in a residential area of Burgess Hill in West Sussex. Accommodation is arranged over three floors with a passenger lift connecting each floor. There is a large conservatory attached to the lounge /dining room and a smaller sitting room on the ground floor. A spacious and attractive garden is accessed from the conservatory or from the main front door of the building.

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.

This was the first inspection since the new provider was registered in July 2015. The registered manager had been in post for five months at the time of the inspection. They told us that a number of changes had already been made and plans were in progress as part of an ongoing development programme. We identified a number of areas of practice that needed to improve and four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to inadequate levels of staffing, lack of support at meal times, lack of person centred care and poor management oversight. You can see what action we asked the provider to take at the back of the full version of this report.

There were not always enough staff on duty to ensure that people’s needs were met. People, their relatives and staff told us that there were not enough staff and our observations confirmed this. Staff were rushing between tasks and they had little time to spend with people. People often had to wait for support with their care needs and some people did not receive the support they needed. We identified this as an area of practice that requires improvement.

People told us they enjoyed the food at Hilgay and that they could choose what they liked to eat. One person said “It’s usually nice, tasty food.” However some people were not supported effectively at meal time because staff were not always available to help them. One staff member said “We need more hands, especially at lunchtime.” We identified this as an area of practice that requires improvement.

Care plans and risk assessments did not reflect people’s individual needs and lacked detail and information to guide staff in how to care for people safely. Risks to people were not consistently managed. Some people had been identified as being at high risk of falls however there was no clear guidance for staff in how to provide care safely or how to manage the risks. This was identified as an area of practice that needs improvement.

Care plans were not updated when people’s needs changed. Staff told us that they did not often refer to the care plans as they were “Not very useful.” Care plans were written in a generic way and did not always provide personalised detail such as people’s interests, preferences or specific wishes. The registered manager planned to introduce a new format but these were not yet in place. People were not supported to follow their interests and many people told us they were bored and did not have enough to do. A staff member said, “We haven’t got the staff to do activities with people, we have no time to spend one to one with people, and people don’t get to go out.” This was identified as an area of practice that requires improvement.

People and staff expressed mixed views about the management of the home. One person said “They aim to provide a good service.” One staff member said, “It’s hard for them coming into a new team but I have found them to be supportive. I