We inspected Homelea Residential Care Home on 23 and 24 April 2018. The first day of the inspection was unannounced. The home has been inspected twice under the current provider. At the inspection of January 2017 we found the provider was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks to people’s safety were not always well managed, people did not always receive care that was person-centred and people’s privacy and dignity was not always upheld. The provider sent us an action plan and told us they would address these issues. We inspected again in September 2017 in response to concerns raised and found improvements were still required. The provider remained in breach of the regulations because risks to people’s safety were not always well-managed, care and treatment was not always provided with the consent and involvement of relevant persons. People’s care was not always person centred. We also found the home was not well led. The provider had not ensured systems and processes were in place to assess, monitor and improve the quality and safety of the service provided. People’s records were not complete and the provider had not notified us of significant events which they are required to tell us about by law. The home was rated ‘requires improvement’ and the well-led question was rated inadequate. CQC took enforcement action in accordance with its procedures and issued a warning notice and four requirement notices.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, we also wanted to check that the service now met legal requirements. We found some improvements had been made, however not all breaches of regulation had been met.

Homelea Residential Care Home 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. Homelea Residential Care Home provides accommodation and personal care for up to 27 people in one adapted building. At the time of the inspection there were 20 people living there. People living at the home were older people, some of whom were living with dementia. They had a range of needs associated with old age and their health.

There was a registered manager at the service who was also the provider. 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 inspection found improvements had been made across the service. However, these improvements were not, as yet all fully embedded in practice and need further time to be fully established in to everyday care delivery. The breaches of Regulations 9 and 17 had not been met.

Improvements had been made to the activities and there was now an activity session each day. However, there were periods of time where people did not have anything to do. Activities were not person-centred or meaningful.

People’s records did not fully reflect the care they required and received. Although staff could tell us about the care and support people needed and received and how people made choices, this had not always been recorded.

There was a quality assurance system in place. However, this had not identified all the shortfalls we found in relation to people’s records and what they done throughout the day. There had been no audit of the daily records to determine shortfalls within the recording.

There had been a lack of stability within the management team. Although staff told us recent changes meant they now felt supported, this lack of stability

Homelea is a residential home in Eastbourne, providing care for people with dementia. Homelea provides long term care and periods of respite. People’s care needs varied, some had complex dementia care needs and required full support with all activities of daily living. Other people’s needs were less complex and required care and support associated with mild dementia and memory loss. Some people were able to walk unaided or with the use of walking frames, others required full assistance with their mobility. The service is registered to provide care for up to 27 people. At the time of the inspection there were 23 people living at the service including two people staying at Homelea for a period of respite care.

Homelea Residential Care Home was taken over by a new provider in August 2016. We carried out an inspection in January 2017. Were we identified three breech of regulation and we told the provider improvements were needed. The service was rated as requires improvement. This inspection which took place on 12 and 13 September and was unannounced. The inspection was carried out by two inspectors.

At the time of the inspection the registered manager had been absent for a period of sickness and this was due to continue. Since the inspection we have been notified that the registered manager has now left the organisation. 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 deputy manager had been employed and had started the day the registered manager had gone off sick, so had received a minimal handover. Since the inspection we have been informed by the registered provider that the deputy manager has now left the organisation.

We found there was a lack of consistent and strong leadership or provider oversight. Quality assurance systems had not identified issues found during the inspection. Governance systems were not robust.

Accidents/ incidents and falls were not being responded to appropriately or reported to the local authority in accordance with safeguarding protocols. The registered provider and deputy manager did not have an understanding of the expectations in relation to safeguarding people. This included reporting accidents, incidents and falls to other external professionals. People’s safety had not been monitored and responded to appropriately.

People did not receive person centred care. Documentation had not been updated or maintained to ensure it was accurate, up to date and contemporaneous. Documentation did not support care that was individualised or person centred.

There had been a high number of unwitnessed falls and incidents. Staffing levels had not been reviewed in response to this. The provider had not ensured that staff had the appropriate, skills, knowledge or experience to meet people’s needs. Individual and environmental risk assessments were not in place when risks to people’s safety had been identified. Changes to peoples care needs had not been updated in care plans.

Information regarding Deprivation of Liberty Safeguard (DoLS), capacity and who was legally entitled to be involved in decisions had not been completed in care files. There was no information to show how decisions had been made regarding peoples care needs or who was legally entitled to be involved in decisions. Decisions regarding people’s dignity and choices were not always supported.

Activities were provided, however these were limited to set times with minimal access to activities or items to keep people occupied at other times.

Although work had taken place to ensure medicine procedures were in place, further improvement was needed to ensure medicines were consistently safe.

There was on-going improvement to the environment, maintenan

Homelea is a residential home in Eastbourne, providing care for people with dementia. Homelea provides long term care and periods of respite. People’s care needs varied, some had complex dementia care needs and required full support with all activities of daily living. Other people’s needs were less complex and required care and support associated with mild dementia and memory loss. Some people were independently mobile and able to walk unaided or with the use of walking frames others required full assistance with their mobility. The service is registered to provide care for up to 27 people. At the time of the inspection there were 25 people living at the service.

This inspection which took place on 16 and 17 January 2017 and was unannounced.

Homelea Residential Care Home was taken over by a new provider in August 2016. The previous registered manager had stayed in post at the home and had registered as manager under the new provider. 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.

At the time of the inspection the registered manager was absent for a planned period of time. During this period acting managers had been employed but currently the day to day running of the home was being overseen by the provider who told us they would remain in day to day charge until the registered manager returned.

Since taking over the service the new provider had carried out audits and identified a number of areas which needed to be improved. Although some new systems and documentation had been started this had not become fully embedded into practice. New documentation to record people’s daily care and support had not been fully completed by staff; this meant it was difficult to get a clear picture of how people were receiving care each day. Daily records were task orientated and did not consistently include details of people’s mood and behaviours or how they had spent their day. Some just stated ‘Fine’ or ‘Well.’ Other information was completed using tick charts to show care tasks carried out. Information was not person centred and it was difficult to follow the rationale behind some decisions that had been made.

Medication systems needed to be improved. We found topical creams which had prescription labels removed and creams which had been prescribed to a named person were found in other people’s ensuite bathroom and bedrooms.

Infection control best practice was not being adhered to by care staff. Staff did not wash or disinfect their hands in accordance with infection control guidelines to prevent the spread of infection.

We saw examples that demonstrated that staff had not considered people’s privacy and dignity. Staff spoke across communal areas regarding peoples care needs. Staff were not seen to respond in a timely manner when people requested assistance.

There was a four week menu displayed. There was one main meal choice but if people did not like this, alternatives would be provided. Mealtimes were chaotic and people did not receive appropriate support to ensure they ate and drank their meals. Staff did not speak to people to inform them what they were eating and when alternatives were requested staff did not ensure that this was responded to effectively.

Systems to record accidents and incidents were not being followed to give accurate details of incidents, injuries and actions taken. Body maps were not consistently completed. No information was in place regarding wound sizes and some documentation was not dated or signed.

Activities were taking place; however at times when visiting professional were not at the home, staff were responsible for providing this. A new staff member was due to have further training to assist in this rol