We inspected Sussexdown on 17 May 2018 and the inspection was unannounced. Sussexdown is a ‘care home’ providing accommodation, nursing and personal care and is registered for 77 people. 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.

On the day of the inspection there were 75 people living at the home. The home is divided into three units; the Princess Alexandra unit can accommodate up to 20 people living with dementia, the Princess Alice unit can accommodate up to 34 people with residential care needs and the Douglas Bader unit provides nursing care for up to 23 people. The home caters for people with a range of needs including nursing, physical disability, dementia or mental health conditions. The home is surrounded by large landscaped gardens which was accessible for all people living at the home.

Our observations and feedback received about the care provided at the home demonstrated that people’s experience was variable, depending on which unit of the home people lived in.

The provider had a range of systems and processes in place which aimed to ensure good governance, however they were not consistently effective in identifying shortfalls in practice and the inconsistency in the quality of care people received across the home. For example, there was inconsistency in the person-centred approach people received, inconsistency in the embedding of the provider’s values in staff practice and inconsistent access to meaningful activity, depending on which area of the home people lived in. Records were not consistently completed which did not give assurance that people received the support they required in a timely manner.

There was an inconsistent approach in ensuring relevant people were included in making best interest decisions. For example, one person’s mental capacity assessment said their mother should be involved in all decisions about their care. However, there was no evidence that their mother had oversight of these decisions.

People did not consistently have their needs met in a person-centred way. Feedback and observations of people’s experiences were variable depending on which unit of the home people were living in. In the nursing unit, staff were task focussed and did not spend time to engage and chat with people.

People’s care plans did not consistently consider all their needs. Some care plans lacked information about the person, their likes and dislikes. This meant that some people may not have received care in line with their preferences. People’s access to meaningful activities was inconsistent depending on which unit of the home they lived in. There was a lack of vibrancy in the nursing unit and people were left for long periods of time with little interaction. One person said “I don’t do many activities. I can’t get there on my own. Sometimes they take me down, sometimes not.” People living in other areas of the home had access to meaningful activities which were driven by people’s interests.

People and their relatives did not consistently feel involved in discussions about their care. On the nursing unit of the home, one relative told us, “I come in everyday so my mum’s care should be a three-way process.” People’s care plans demonstrated variable evidence that people, or where appropriate, their relatives had been involved in the review of their care.

We have made a recommendation about involving people’s relatives, where appropriate, in decisions about their care.

People said they felt safe living at the home. One person told us, “I am very well looked after and feel very safe.” Another person told us, “Staff are very good to you and kind. I feel safe here and there are a sufficient number of staff.” Staff were knowledgeable about safeguarding and had received relevant training. The provider had robust recruitme

We spoke with 16 people during our visit. They told us that they were happy with the support they received. One told us, “They’re all very kind and very helpful”. Another said, “There’s a good atmosphere” and, “I can’t find fault with it”.

We spoke with five relatives on the day of our visit and four by telephone afterwards. They were generally very enthusiastic about the home. One said, “They’re always very cheery and very warm towards people”. Another told us, “It gets ten out of ten as far as I’m concerned”. They told us that they felt involved and that the staff were skilled in their work. One explained, “They have a knack of bringing things out of people like my Dad but without forcing him to do things”. Another said, “We don’t worry about Mum now. We know she is safe and that she is with people who care for her”.

We spoke with five members of staff and the manager. Staff told us that they had a good and stable team and that they enjoyed working at the home. One said, “I think this place is brilliant”.

We found that the home was bright and that people looked well cared for. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. There was a wide range of activities on offer and people spoke with enthusiasm about the things that they were involved with. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss.

We found people were involved in the decision making of the home and were supported to maintain their independence and dignity. People told us they were happy and that they had choices. We spoke to relatives who told us their relatives received care and treatment that meet their needs. One relative in feedback to the home wrote ‘‘I really can’t thank you enough for all you and the staff do for her.’’

The provider told us people were assessed before they were admitted to the home. We reviewed the care records and found each person had an assessment prior to coming to the home. We noted that areas included in the assessment included people’s thinking and orientation skills.

During the visit we observed staff engaged with people and their relatives in a warm and supportive manner. We observed staff treated people with dignity and respect. We noted information was displayed in different forms. For example we observed the time table of activities was pictorially displayed.

We found people were protected from the risk of abuse as staff were trained in safeguarding. Staff we spoke to were knowledgeable and knew how to raise a safeguarding alert if there were concerns about people’s safety.

Staff told us they were supported to deliver care and treatment to people at an appropriate standard. We reviewed records and saw staff were regularly supervised and appraised.

The provider had a system in place to monitor and assess the quality of the service delivered.

We visited Princess Alexandra House, which is the unit that has been set up to provide care to people who have dementia.

People accommodated there were not able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. This tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spent 30 minutes watching care and support provided to five people in a lounge during an activity session just before lunch. We also observed lunch being served and people being helped to eat their meal. We found that people had positive experiences. The care staff on duty knew what support they needed and they respected their wishes if people wanted to be left on their own.

The inspection took place on 18 and 22 September 2015 and was unannounced.

Sussexdown provides nursing and care for up to 77 people with a variety of health and care needs. At the time of our inspection the home had full occupancy. The home is divided into three units: Princess Alexandra unit provides 20 places for people living with dementia, the Princess Alice unit can accommodate up to 34 people with residential care needs and the Douglas Bader unit provides nursing care for up to 23 people. Twenty-eight bedrooms have en-suite facilities. Sussexdown was built in 1925 and celebrates its 50th anniversary as a care home in October. The home is surrounded by extensive, accessible, landscaped gardens overlooking countryside. The main building has a sun lounge and library and communal areas include living and dining areas in each unit.

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.

People were protected from the risk of harm and staff knew what action to take if they suspected people were being abused. Accidents and incidents were reported and necessary action taken to minimise the risk of reoccurrence. People’s risks had been identified and assessed appropriately. Information on how to look after people safely was provided to staff. Where people were at risk of developing pressure ulcers, there were guidelines in place for staff on their care and treatment. There were sufficient numbers of staff to care for people safely and meet their needs and the service followed safe recruitment practices. People’s medicines were managed safely by trained staff. The provider had procedures in place to ensure that people were protected from the risk of infection.

New staff completed a three day induction programme and then went on to follow the Care Certificate, a universally recognised qualification. Existing staff had completed qualifications in health and social care. All staff followed a training programme which the provider had implemented in a range of areas of practice. Staff received regular supervisions which took the form of observed practice, however, not all these supervisions had been recorded, but staff were provided with verbal feedback. Staff knew how to gain people’s consent to care and treatment and were aware of the requirements of associated legislation under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They put this into practice. People were supported to have sufficient to eat and drink and maintain a healthy lifestyle and had access to healthcare services. The premises at Sussexdown were designed in a way that reflected people’s personal taste and to aid their mobility and independence.

People were looked after by kind and caring staff who understood them and how they wished to be cared for. People’s spiritual needs were catered for and there was a separate chapel that people could access. A member of the clergy visited every week. People were treated with dignity and respect and, as they reached the end of their life, were looked after by staff to have a private, comfortable, dignified and pain-free death.

There was a wide range of activities on offer for people and they were also supported to follow their own interests and hobbies. Care plans were personalised and provided comprehensive information to staff about people, including their personal histories, likes, dislikes, social, cultural and religious preferences. In the main, care plans were reviewed regularly, but some plans had not been reviewed in line with the provider’s policy. The registered manager was made aware of this at the end of the first day of inspection and consequently put an action plan in place to address this. The service routinely listened to and dealt with people’s complaints to the satisfaction of the complainant, where the complaint was upheld.

The service was well led and people were involved in the development of the service; their feedback was obtained through an annual survey. Staff were also asked for their feedback by the provider and felt well supported by the registered manager. The service had a range of robust quality assurance systems in place to measure the quality of the care delivered and were improvements had been identified, action was taken. Following the inspection, the registered manager put action plans in place to address the issues raised by the inspection team. They worked in partnership with other agencies.