We inspected Holm Lodge on the 16 November 2016 and the inspection was unannounced. Holm Lodge provides accommodation for up to 23 older people. On the day of our inspection there were 20 people living at the home. Holm Lodge is a residential care home that provides support for older people. Some people had illnesses or disabilities associated with old age such as limited mobility, physical frailty or lived with health problems such as diabetes. Some people lived with dementia and sensory impairment. Accommodation was arranged over two floors with stairs and a stair lift connecting each level.

There was 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.

Building work was taking place at Holm Lodge at the time of our inspection. The provider had failed to fully mitigate the associated risks to people whilst the work was taking place. We have identified this as an area of practice that needs improvement and made a recommendation about robust risk assessments.

People commented they felt safe living at Holm Lodge. One person told us, “Very happy, definitely very safe here.” A wide range of risk assessments were in place and people were supported to take positive risks. People could freely move around the service and spend their days as they wished. However, risk assessments did not always include the measures required to fully mitigate the risk. We have made a recommendation about the oversight of risk assessments.

Care and support was provided to people living with dementia, however, improvements were required to make the environment dementia friendly. We have made a recommendation about sourcing input from a national source on dementia friendly environments.

Staff had received essential training on the Mental Capacity Act (MCA 2005) however, their understanding and knowledge of the Act was varied. Mental capacity assessments had not consistently been completed. We have made a recommendation about MCA training and the implementation of the Code of Practice into care planning process.

Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the service. The registered manager had a range of tools that supported them to ensure the quality of the service being provided. Despite this system in place, the provider and registered manager had failed to recognise that policies and procedures had not been updated to reflect current legislation and guidance. We have made a recommendation about internal review of policies and procedures.

People were supported to maintain relationships with people that mattered to them. Relatives were made to feel welcome and visiting was not restricted. A relative told us, “Always seem to be plenty of staff, who always greet me with a welcome and a cup of tea after my long journey.”

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's privacy and dignity was respected and upheld. One person told us, “I can do what I want, come and go within reason and I am treated with the greatest respect.” Another person told us, “Staff are very committed in what they do, very sincere. Staff respect you for what you are.”

Staff were caring and built friendships with people. One staff member told us, “We all adore the residents here.” People told us they enjoyed the food at Holm Lodge. One person told us, “Food is very good, enough choice and amount.” Risks of malnutrition and dehydration were identified and managed effectively and people were supported to have enough to

The purpose of this visit was to follow up areas of non-compliance identified during the previous inspection. At that time we had concerns regarding staffing levels in the home, inconsistent recruitment procedures and unsatisfactory staff support, supervision and training.

During this inspection we spoke with two people who used the service. We also spoke with the providers, the new manager, two care workers and the office administrator. We looked at staff files, recruitment documentation and other records and minutes of meetings.

Following a very unsettled period at Holm Lodge during which six managers came and went, we were told that the provider had now appointed a manager, with many years’ experience of the care sector. The manager told us that they had experience and knowledge of the client group and a sound understanding of the requirements of the regulations. In addition to staff recruitment, training and supervision, they told us that they have extensive experience of assessing, meeting and reviewing people’s care and support needs.

A care worker we spoke with told us, “It’s early days but people seem very happy with how things are now and morale is pretty good. We all just need some stability here but the new manager seems really good. She’s very supportive and very approachable and has settled in really well.”

We found that recruitment procedures had improved and all necessary checks had been carried out before new staff started work in the home.

The manager told us that staffing levels were being closely monitored to ensure that they reflected the assessed dependency levels of people who used the service.

We saw that staff training and formal supervision was being provided and staff told us that they were supported in their work.

During our inspection we spoke with six people who used the service and two of their relatives. We also spoke with the provider and four members of staff including the manager and three care workers. We looked at care documentation, records, audits and minutes of meetings.

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, "I'm very happy here and have no complaints”. Another person told us, “The staff are very kind here, they know what I like and the food is excellent". Relatives told us that they had noticed general improvements since the new manager had been in place. One relative told us, “Socks needed to be pulled up and hopefully they have been”.

We saw that individual care plans were in the process of being reviewed. This ensured that the assessed current and on-going support needs of people using the service could be met consistently and safely.

Recruitment procedures were inconsistent. Shortfalls that were identified included incomplete application forms, missing dates and employment history and inadequate or unsatisfactory references.

Staff training and formal supervision had “slipped” over recent months. The manager told us they were reinstating regular supervision and were also currently researching external training providers.

During our inspection we were accompanied by two Quality Monitoring Officers from East Sussex County Council.

We found that the premises were clean and well maintained and the atmosphere was relaxed and homely.

We found that comprehensive and well maintained person centred support plans enabled care workers to meet people's assessed needs in a structured and consistent manner. In accordance with their individual care plans, people were supported to make choices about their daily lives. They had input into how the home was run and were able to influence decision making processes.

Care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

Positive comments from people using the service and their relatives indicated a high level of satisfaction with the home and the services provided:

“I’m very happy here. It’s very comfortable and everyone is so friendly”.

“The staff here are so kind and caring – I’ve got no complaints”.

Appropriate arrangements were in place in relation to storing, administering handling and recording medicines.

We found improvements in the recruitment procedures. Appropriate staff training, risk assessments and safeguarding policies and procedures ensured that people using the service were safe.

At our last inspection on 10 August 2012 we found shortfalls in relation to the recruitment of staff and staffing levels. This meant the provider was non compliant in these outcome areas. The provider wrote to us and told us they were compliant. We undertook this follow up inspection to check what the provider had told us.

As part of this inspection we spoke with the provider the newly recruited manager, the deputy manager, three care workers workers, the home's administrator, five people who lived there and one visitor. We looked at records relating to the running of the home and the personnel files of the manager and seven care workers.

Recruitment practices adopted by the home were unsafe. Relevant identity and security checks had not been completed for all staff or checked for authenticity. Staff personnel and recruitment files did not contain all the required information.

There were enough qualified, skilled and experienced staff to meet people’s needs. The care workers we spoke with told us that they felt there had been sufficient number of care workers on duty to meet the needs of the people who lived there, people we spoke with confirmed this. One person told us "They answer the call bell quickly". Another person told us "There's always plenty of girls around to help us".

People living in the home spoken with during the inspection expressed satisfaction with the home, the staff and the service provided. People told us that they were encouraged and enabled, as far as practicable, to make choices about their daily lives. One person told us:

“I like living here and I’m very content, they spoil me.”

A visitor told us that they were welcomed into the home and had noted a lot of improvements over recent months. They told us the person they were visiting was very happy living at Holm Lodge and that staff “couldn’t do more”.

During our visit, we found that people living in the home were settled and content and they were clearly well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of people being supported in a professional, sensitive and respectful manner.

Feedback from the local authority and information received anonymously by the CQC raised concerns that the home’s staff duty rota did not always accurately reflect the number of care workers on duty. Our findings corroborated this.

We found that records that the home is required to maintain in relation to the recruitment of staff, the care delivered at the home and the management of the home were not all complete, readily accessible or accurate.