This inspection took place on 30 August 2017 and was unannounced. The last inspection took place on 22 August 2016. At the previous inspection, we found the provider in beach of regulation relating to safe care and treatment as medicines were not managed safely. Risk assessments were not completed when people managed their own medicines. Records were not kept on what medicine people who self-managed their medicine had taken and what stocks they had of each medicine. At this inspection we saw improvements had been made in this area and medicines were now managed safely. We saw that people who managed their own medicines now had records which confirmed their medicines had been taken. There were also concerns about the lack of guidance for medicines which were prescribed on an “as and when required” basis. We saw that there was now clear guidance for staff on how to ensure these medicines were administered as prescribed. At the previous inspection limited shelf life medicines such as liquid medicines did not have the opening date recorded when they were opened. We saw at this inspection that medicines were now dated on opening.

We also identified concerns around consent; consent had not always been gain for the use of equipment by people who may lack capacity. We also saw that capacity assessments had not always been completed. At this inspection we saw that when there were concerns about people’s capacity assessments were completed and when needed people had assessments for the use of equipment such as bedrails.

Concerns were raised about a DNACPR form not being in place for someone who did not have capacity as the forms had not been received from their power of attorney. We spoke with the registered manger and they told us that following the previous inspection this had been rectified in a timely way to ensure that the person’s wishes would be respected. We saw that a DNACPR form had been stored in the persons file.

Another area which required improvement was the provision on activities. There was a lack of meaningful activities for people to take part in, people described the activities as “childish”. We asked the provider to submit an action plan on how they would address these breaches. At this inspection we saw that people’s social needs were assessed and planned for. People spoke positively about the activities with where provided.

At the previous inspection quality assurance within the home also required improvement as they were not sufficient to ensure that the registered manager had oversight and ensure that a high quality care was delivered. At this inspection we saw that a robust quality assurance system was in place which was used to identify and resolved any concerns. At this inspection, we found the provider and registered manager had taken appropriate action and these regulations had been met. As a result, the overall rating for this service has improved from ‘Requires Improvement’ to ‘Good’.

Scotch Dyke Residential Home provides care and support for up to 25 older people with a variety of long term conditions and physical health needs. It is situated in a residential area of Ferring, West Sussex. At the time of our inspection there were 23 people living at the home. People had their own room and rooms were en-suite. There was a dining and lounge area and a garden area that people could access.

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.

People were protected by staff who knew how to recognise and report the signs of abuse. Staff had received regular safeguarding training. Safe recruitment practices were followed. Disclosure and Barring Service checks (DBS) had been requested

The inspection took place on 22 August 2016 and was unannounced.

Scotch Dyke is a residential care home providing accommodation, including respite care, for up to 25 people, a small minority of whom are living with dementia or diabetes and who may require support with their personal care needs. On the day of our inspection there were 23 people living at the home. The home is a large property situated in Ferring, West Sussex. It has a communal lounge and conservatory, dining room and well maintained gardens.

The management team consisted of a registered manager, a deputy manager and team leaders. A registered manager is a ‘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 home is run.

There were effective systems in place for the storage and disposal of medicines and people told us that they were happy with the support they received. One person told us “If I take tablets the staff give them, I don’t remember, they do”. Another person told us “I can’t remember things so it is important that they do it for me, they keep it in a locked cabinet in the hall, and they are trained”. However, there were concerns regarding the administration and management of medicines. Observations raised concerns regarding staff’s practice when dispensing and administering medicines. Staff did not adhere to the correct procedures when dispensing and administering medication, particularly controlled drugs. Some people had medicines that were prescribed on an ‘as and when required’ basis. There was insufficient guidance available for staff to ensure that people received their medicines consistently and when they were needed. Some medicines, such as liquid medicines and creams, have a limited shelf life. Observations showed that several medicines, which had a limited shelf life, had been opened and no dates had been recorded on the containers to inform staff of how long the medicines had been in use. Therefore people were at risk of receiving out of date medicines that may be less effective or cause them harm. The registered manager demonstrated good practice and enabled people, who were able, to administer their own medicines. However, there was a lack of risk assessments to ensure that the people, as well as others, were safe when people administered their own medicines. These was an area that required improvement.

The registered manager had demonstrated good practice by ensuring that people’s end of life care wishes were discussed and documented. End of life care records for one person showed that the person had made the decision to not be resuscitated. However, the registered manager had not taken timely action to ensure that there was legal documentation in place to ensure the person’s wishes could be respected. This was an area in need of improvement.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. The registered manager was aware of the legal requirements with regards to ensuring people who lacked capacity had mental capacity assessments and that they were not deprived of their liberty unlawfully. However, had not ensured that these were in place for all people who lacked capacity. For example, one person, who used bed rails and who lacked capacity to consent to their use, had not had their capacity assessed, nor had their legal representatives been involved in the decision making process to consent to their use. This is an area of practice in need of improvement.

People provided mixed feedback with regards to the provision of activities. Some people told us that they enjoyed talking with other people, reading and resting, whereas other people told us that they were unhappy with some of the activities that were provided as they were too child-like, and chose instead to not partake in them. One person told us “The activities are for little kids, who wa

At the time of our inspection there were 24 people who lived in the home. We spoke with people, their relatives and to staff. People told us that they were involved in decision making regarding their care and treatment. They were encouraged to express their opinions, preferences and views.

We found that care was person centred, planned and delivered safely with regular reviews. One person's relative told us that they lived in Switzerland and felt that ' this was a home from home. Nothing was too much trouble and that the staff were wonderful and friendly. They felt confident to have their relative looked after here with them being so far away".

People told us that they felt safe in the home and we found that staff understood their roles and were committed to providing a high quality of care. People said that there were always enough staff available to meet their needs.

We found that the provider had effective systems in place to monitor and assess the quality of the service, which took into account the views of the people, relatives and staff. We saw that the provider used this feedback to make service improvements.

At the time of our inspection there were 23 people who lived in the home. We spoke with people, their relatives , staff and healthcare professionals. People told us they were involved in making decisions about their care and treatment and were encouraged to express their views and preferences.

We found that care was planned and delivered safely in line with people's individual needs. A person told us "they understand my needs and they meet them". A person's relative said "we are confident enough to go away on holiday - we are very happy with the way our relative is looked after".

People told us they felt safe in the home, and we found that staff understood their responsibilities to safeguard people from the risk of abuse. People said they were satisfied with the provider's staff and there were enough staff available to meet their needs. The manager told us "this is the residents home, their needs and wellbeing are our priority and we fit around them and do our upmost to help them".

We found that the provider had effective systems in place to monitor and assess the quality of the service, which took into account the views of people, their relatives and representatives. We saw that the provider used this information to make improvements.

We spoke to three people who live at Scotch Dyke. They told us what they thought about the quality of care they receive.

We also spoke to four members of staff who were on duty. They told us about the level of care they provide to people at Scotch Dyke. They also told us about the support and training they have received to enable them to provide good quality care.

We also spoke to a District Nurse who was visiting to provide treatment to some people. They told us about the care provided.

We spoke to the manager about the systems that were in place to assess and review the needs of each person. We also spoke to the manager about how the quality of service provision is assessed and monitored