We undertook an unannounced focused inspection of Sussex Clinic on 10 January 2019. This inspection was undertaken to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 4 and 6 December had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements.

We did not inspect the remaining Key Questions because this inspection focused on the immediate risks and urgent concerns identified at the inspection on the 4 and 6 December 2018. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Sussex Clinic is a nursing home in Worthing for up to 40 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. There were 24 people living at the service at the time of the inspection. This included older people, younger adults and those with a physical disability. Some people were living with dementia. By the nature of their complex health and social care support needs, people who live at Sussex Clinic are considered extremely vulnerable

We previously inspected Sussex Clinic on 4 and 6 December 2018 and the service was rated as Inadequate. We identified serious failings and shortfalls in the care and safety of people living at the service which either placed people at or exposed them to significant risk of harm. There were multiple breaches of the Health and Social Care Regulations 2014. After the inspection we asked the registered provider to act to address the urgent risks and concerns we had identified. The provider responded and said what action they had taken to address the urgent concerns and what they would do to improve and meet legal requirements.

In response to the level of serious concerns in relation to safeguarding urgent conditions were placed upon the providers registration. Initially there was a restriction on all new admissions into the service until 9 February 2019. After this date there is a phased approach until July 2019. The condition was made to give the provider time to make sufficient improvements to the care people receive and the safety of the service. The provider has supported this condition which will remain on their registration until 9 July 2019.

At this inspection we identified continuing failings and shortfalls in the care and safety of people living at the service which either placed people at or exposed them to significant harm. The service was rated Inadequate and remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This w

The inspection took place on the 4 and 6 December 2018 and was unannounced. The inspection was brought forward because of concerns raised to CQC from health and social care professionals. We had been told that a large number of staff had recently left the service, there were poor clinical skills, inconsistent management and lack of clinical oversight.

Sussex Clinic is a nursing home in Worthing for up to 40 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. There were 27 people living at the service at the time of the inspection. This included older people, younger adults and those with a physical disability. Some people were living with dementia. By the nature of their complex health and social care support needs, people who live at Sussex Clinic are considered extremely vulnerable.

We previously inspected Sussex Clinic on 28 November 2017 and the service was rated Requires Improvement. Breaches of the Health and Social Care Act 2008 ( Regulated Activities) Regulations 2014 were identified as the provider had failed to ensure that staff were sufficiently trained and that there were effective governance systems in place. After the inspection the registered provider wrote to us to say what they would do to improve and meet legal requirements.

The service has been without a registered manager since June 2017. 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.

At this inspection we identified serious failings and shortfalls in the care, and safety of people living at the service which either placed people at or exposed them to significant risk of harm. We raised multiple safeguarding alerts to the local authority for investigation. We also shared these concerns with the provider, manager and other statutory agencies. We took urgent enforcement action to address these concerns to improve people’s safety. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People were not always protected from abuse and improper treatment. Systems and processes to protect people from abuse were not operating effectively. There were 13 incidents that the provider had failed to report to the local

We inspected Sussex Clinic on 28 November 2017. Sussex Clinic is registered to provide nursing care to up to 40 people, some of whom were living with dementia and other chronic conditions. The service comprises of three converted houses, with a lounge and dining areas. There were 30 people living at the service during our inspection.

We previously carried out a comprehensive inspection at Sussex Clinic on 28 September 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the management of medicines and the provision of meaningful activities. The service received an overall rating of ‘requires improvement’. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for Sussex Clinic remains as ‘requires improvement’. We will review the overall rating of ‘requires improvement’ at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been made and sustained.

A registered manager was not in post and day to day management of the service was provided by an acting manager who was a registered manager of another service within the group. 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 and associated Regulations about how the service is run.

Some staff had received essential training and there had been opportunities for additional training specific to the needs of people. However, we saw that several members of staff had not received essential updated ‘refresher’ training in a timely manner. This is an area of practice that needs improvement.

There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met their individual needs.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

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 chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, book reading, massage and manicures and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People were being supported to make decisions in their best interests. The acting manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their

The inspection took place on 28 September 2016 and was unannounced.

Sussex Clinic is a nursing home providing accommodation and support for up to 40 people. At the time of our visit there were 28 people living at the home. The registered manager explained that although they are registered for up to 40 people the home can only accommodate a maximum of 31 people as some double rooms were being used for single occupation. The home was registered for adults with physical disabilities and older people. The majority of people living at Sussex Clinic at the time of the inspection were older people but there were also some younger people. The ages of people ranged from 37 to over 90 years old.

The home 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. Accommodation is arranged over two floors with a lift and stairs connecting all floors. The home is located in a residential area on Worthing.

Care provided was not always responsive to the needs of people living at the home. The social needs of some younger people were not always supported. Some people who were living with dementia did not have meaningful activities to occupy and stimulate them. We identified this as an area of practice that requires improvement.

People received their medicines safely however some poor practice in the administration and recording of medicines and inconsistencies in labelling of topical creams were identified as areas of practice that requires improvement.

Staff understood how to keep people safe from harm and abuse and risks to individuals were assessed and managed. People told us they felt safe. One person said, “I feel safe because there’s always someone around.” There were sufficient numbers of staff on duty to keep people safe. The provider had a robust recruitment system to ensure that staff were suitable to work with people.

People told us they had confidence in the staff. Their comments included, “They definitely know what to do,” and “I think they are well trained.” Staff told us that they had access to the training and support they needed and records confirmed this. Communication within the home was good and staff were clear about their responsibilities when on shift.

The registered manager had ensured that the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff understood their responsibilities with regard to seeking consent from people before providing care.

People told us they had access to health care services when they needed it. A visiting health care professional told us that staff were proactive in contacting them and seeking advice when needed.

People told us they enjoyed the food at Sussex Clinic. One person said, “It’s magic, I’ve only had one meal I didn’t like.” Risks associated with people’s nutritional and hydration needs were identified, monitored and managed. People who needed support to eat and drink were provided with help in a patient and sensitive way by the staff.

Staff had developed positive relationships with people and knew the people they cared for well. People told us that the staff were kind and caring. One person said, “I have nothing but praise for the staff here; they are all very kind and very nice.” For a number of staff English was not their first language. People told us, and we observed that, communication was sometimes difficult. The registered manager told us they were supporting these staff to improve their English skills and there were always experienced, familiar staff on duty to ensure the impact was minimised for people living at Sussex Clinic. People confirmed that this was the case.

People told us that their views were listened to and they felt r

An inspection manager and an inspector carried out this inspection. The focus of the inspection was to check if the provider had taken sufficient steps to meet compliance actions that were set at our previous inspection in May 2014.

We spoke with five residents, the owner, one registered nurse and two care staff. We reviewed five people’s care records, including the notes made by staff on a daily basis.

We found that all compliance actions relating to care and welfare of people, safeguarding people from abuse and records had been met.

Sussex Clinic is a care home registered to provide nursing or personal care for up to 40 people. At the time of our visit there were 25 people who used the service.

Our inspection was undertaken by one inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People's needs were assessed and care and treatment was usually planned and delivered in line with their individual care plan. However, whilst risks had been assessed within the care plans, these had not always been regularly reviewed. This meant that changes could not be made to the care plan to ensure that people's most up-to-date needs were being met.

We saw that Sussex Clinic had a safeguarding policy in place, but staff we spoke with were unclear how to contact the local authority safeguarding team. In one person's care record, we saw that they had been assessed as being at high risk of malnourishment, but that their food and fluid intake was not being monitored.

A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There were sufficient qualified, skilled and experienced staff to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications have needed to be submitted , proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

Many people who used the service had a diagnosis of dementia and different levels of capacity. However, people's capacity and their ability to make decisions were not routinely assessed as part of their care plans. For example, we saw that one person's capacity had been assessed at the time of their admission two years ago, but had not been assessed since.

People we spoke with thought they were well looked after by staff. One person said, "It's jolly good actually". A relative told us their family member liked it and another said, "I feel so pleased (X) is here".

Is the service caring?

We observed that staff were interacting well with people at lunchtime and encouraged them to eat a little more. A relative told us that they "Couldn't fault" the staff and another said that staff treated their relative well.

People's care records were not always reviewed and updated on a monthly basis in line with the service's own policy. This meant that potential changes to people's care were not identified and could not be implemented.

Is the service responsive?

People we spoke with told us they were well looked after by staff. One person said, “It’s jolly good actually” and another said, “Very good actually, I’ve no complaints”. A relative told us that their family member liked it saying that they were ‘happier here’ than where they were before. Another relative said, “I feel so pleased (X) is here”.

Is the service well-led?

We were told that relatives and people who used the service were asked for their views about the quality of care that was provided and the owner told us that a questionnaire had been circulated to relatives in April 2014. One relative said that they had enjoyed a cheese and wine evening that had been organised at Sussex Clinic.

When we asked to see copies of the questionnaire that had been sent to relatives, we were told that these were not available. The owner told us that some paper records had gone missing and had been removed from the premises. The owner told us that records had not been saved electronically as a back-up.

We saw that people's care records were not kept securely, but were on an open shelf in the manager's office. This meant that people's personal and confidential information was at risk of being misappropriated.

A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

On the day of our inspection there were twenty seven people who used the service. We spoke with six people, the manager,four members of staff and a relative.

We found two of the two issues identified at our last inspection in January 2013 had been attended to.

People told us that staff understood their needs and provided appropriate care and support. One person told us “The carers are brilliant” and “I love it here.” Another person said staff were “Kind and caring.”

We saw there were systems in place to protect people from the risk of infection. For instance, staff told us that they had either recently completed their infection control training refresher course or were scheduled to take it. Additionally the sluices had been attended to and foot operated clinical and domestic waste bins were provided in all areas.

We saw that the provider had an effective system in place to monitor staff training. The training records were up to date.

The provider had systems in place to regularly assess and monitor the quality of service people receive by speaking to visitors and issuing questionnaires and staff were encouraged to raise any concerns.

People told us that they were happy in the home. They said staff were polite nice and friendly. One person said “I cannot speak to highly of the staff they are very good.”

On the day of our inspection there were 24 people accommodated in the home. We spoke with nine people who used the service, the provider and three members of staff. Due to their complex needs, some people were not able to tell us about their experiences. We used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of these people who used the service.

We saw that care workers were considerate in the way they provided care and support. People spoke highly of the care and treatment they received and told us their needs were adequately addressed. The people we spoke with told us they were very happy in the home and told us the staff were kind. One person told us “I would recommend this home to anyone; they couldn’t do anything any better.”

During our inspection we identified several potential infection control risks. These put people living in the home at risk of infection, contamination and cross infection.

The provider was not able to evidence that all staff working in the home were up to date with their mandatory training.

People told us that they were happy with the care they received at Sussex Clinic. They said the staff were kind and attentive. We were told that the registered provider visits frequently and speaks with people about the care they receive.

A few people told us they were sometimes bored as activity within the home was limited and geared mainly towards people with communication difficulties and dementia.