The Sidcup Care Home is a care home registered to provide accommodation care and support for up to 100 people. There are three separate units, two nursing units and one residential unit for people that have no nursing needs. 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. At the time of our inspection there were 95 people living at the service.

This inspection took place on the 12,13 and 15 November 2018 and was unannounced. At the last inspection on 14 and 15 April 2016 the service was rated good.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

At this inspection we found a breach of the Regulations as people’s diverse rights in respect of sensory impairment, culture and spirituality were not always respected or supported. People’s communication needs were not always addressed. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were needed in relation to end of life care planning and training as well as further training on dementia awareness. Some aspects of the complaints and quality monitoring system were not always effectively operated to ensure issues were robustly managed and any learning shared.

We have made two recommendations; one in relation to end of life care recommending that the service identifies and consults guidance from best practice on end of life care. Secondly, that the service look to best practice and research in relation to dementia friendly environments to respond better to the needs of some people at the service.

At this inspection there was an experienced registered manager in place. The previous registered manager had left the service in 2017. A new manager had joined the service in July 2018 after what staff described was a period of some instability. They received confirmation of their successful application to register during the inspection. 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. The new manager had applied to register as the registered manager, they were aware of their responsibilities and had submitted notifications as required. They understood the legal requirement to display their current CQC rating which we saw was on display at the home and on the provider’s website. We had positive feedback from all the staff about the new manager and the changes they had introduced

People told us they felt safe from harm and discrimination. Staff knew how to recognise abuse and the action to take if they were concerned about this. Risks to people were assessed and guidance provided to reduce risks. Accidents and incidents were monitored and action taken to reduce the likelihood of them reoccurring. Medicines were safely managed. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely way. People were protected from the risk of infection and the environment was clean.

Staff received training, supervision and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People gave conse

This unannounced inspection took place on 14 and 15 April 2016.

The Sidcup Nursing and Residential Centre is a care home service with nursing for up to 100 older people with dementia, mental health needs, sensory impairment and physical disability. There were 98 people using the service at the time of our inspection.

We last carried out an unannounced inspection of this service on 9 and 10 December 2014, and found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not take adequate steps to ensure that, at all times, there were sufficient numbers of suitably qualified staff to meet people’s needs. Staff were not supported through training, quarterly supervision and annual appraisal in line with the provider’s policy. The service did not assess, monitor or mitigate risks to people by regularly assessing and monitoring the quality of the services provided.

We asked the provider to make improvements in these areas. The registered manager sent us an action plan telling us how they would address these issues and when they would complete the action needed to remedy these concerns. They also sent us the progress report of the actions they had taken.

At this inspection we found that significant improvements had been made in all these areas. There were enough staff on duty to help support people safely in a timely manner. Staff were supported through training, quarterly supervision and annual appraisal. The service had an effective system and process to assess and monitor the quality of the care people received.

The service had 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.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents and to prevent them happening again. The service had arrangements to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff to support to people. Staff supported people so that they took their medicines safely.

The service had taken action to ensure the requirements were followed for the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

People or their relatives where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff prepared, reviewed, and updated care plans for every person. They completed end of life care plans for people where this was necessary. The care plans were person centred and reflected people’s current needs.

Staff supported people in a way, which was kind, caring, and respectful. Staff protected people’s privacy, dignity, and human rights.

The service recognised people’s need for stimulation and social interaction. The service had a clear policy and procedure about managing complaints. People knew how to complain and would do so if necessary.

The service sought the views of people who used the services, their relatives, and staff to improve the service. Staff felt supported by the registered manager. The service used aud

Most people that we spoke were complimentary of the food provided and with the support received from staff in relation to meeting their nutritional needs. One person told us “I am a vegetarian and I get the food I what. There are a lovely bunch of staff here.” Another person told us “the food is satisfying. I’m offered choices and alternatives if I don’t like it”. However, some people felt that improvements were required to ensure that the drinks trolley was served at 11am and that lunch was served for 12:30 as planned. We observed positive interactions between people using the service and staff during meal times, and this created a pleasant atmosphere for people to eat and drink their food. We found the provider had suitable arrangements in place to protect people from the risk of inadequate nutrition and dehydration.

People using the service and relatives we spoke with told us they were satisfied with the care provided. One person told us staff "look after me very well", and another person said "staff are approachable and very caring". People told us that the food was good, there was an availability of choice and they enjoyed their meals. People using the service and some relatives told us they had noted an improvement in staffing levels. However, some people told us there was a delayed response to call bells by staff. We found that the provider had made improvements to the planning and delivery of people’s care in the care home, and most people’s care plans had been reviewed to reflect people’s current needs. We observed positive interactions between staff and people using the service during activities. However we saw that some people were not adequately supported to meet their nutritional needs at mealtimes. We found the provider had made improvements to the staffing levels within the home to ensure that people’s needs were adequately met.

People using the service told us that staff were “very caring” and “very polite”. They said that the home was responsive to their needs and that they had no concerns about the service.

Staff said that they felt they were provided with all the training required to do their jobs. They appeared to have a good understanding about safeguarding-related issues.

Staff told us that they had a senior member of staff as a supervisor who they met with periodically.

Although we were told that staff meetings for each unit were held every three months, some staff we spoke to could not recall a unit meeting being held in the last three months.

Staff said that they felt that there were enough people on duty to provide the level of care required although due to the dependency levels of some of the residents they were sometimes stretched for time.

People using the service told us that staff were good, generally attentive and hardworking, but that sometimes staffing levels seemed a little low which had resulted in some people waiting for assistance.

People said that they were comfortable raising issues directly with staff and always felt safe using the service.

Overall, people using the service were happy with care being provided by The Sidcup Nursing and Residential Centre although sometimes it was felt that the centre was understaffed – staff members also raised staffing as an issue. Nevertheless, people’s comments were very positive including ‘[staff are] smashing’, ‘[it’s] lovely here’ and ‘couldn’t be in a better place’.

This inspection took place on 09 and 10 December 2014 and was unannounced. At our previous inspection on 04 February 2014, we found the provider was meeting the regulations in relation to the outcomes we inspected.

The Sidcup Nursing and Residential Centre is registered to provide accommodation for up to 100 people who have nursing or personal care needs.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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. There was a new manager and a deputy manager in post at the time we visited.

There were 87 people using the service on the day of the inspection. Most of the people told us they were happy and well looked after. However, staffing arrangement were not adequate to meet people’s needs and to keep them safe at all times. We observed good relationships between staff and people at the service and with their relatives. Staff took time to interact with people in a meaningful way.

Some staff had not received a range of training appropriate to their roles and not had formal supervision in line with the provider’s policy.

The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) were designed to protect people who may not have the ability to make decisions for themselves due to mental capacity difficulties. The service was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS and was in contact with the local authority about what action it should take. People’s capacity to give consent had been assessed in line with the Mental Capacity Act.

The provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the home had policies and procedures in place to guide staff in relation to the Mental Capacity Act (2005) and DoLS, safeguarding and staff recruitment. Risk assessments were in place and reflected current risks for people at the service and ways to try and reduce those risks. Care plans were in place and being reviewed to ensure care provided was appropriate for people. Equipment at the service was well maintained and monitored and regular checks were undertaken to ensure the safety and suitability of the premises.

Staff knew people’s needs and preferences well and interacted positively with people. The service was managing people’s care safely. People and their relatives were supported sensitively in end of life care.

People’s nutritional needs were met. People had access to a range of health and social care professionals when required. There were deficiencies with the system for assessing and monitoring the quality of the service. Audits were not carried out regularly and for some areas where issues were identified, action plans had not always been recorded to evidence that action been taken to ensure people’s welfare and safety.

We found number of breaches of the Health and Social Care Act 2008 (Regulated Activity) regulations 2010 in relation to carrying out quality assurance checks, the training and supervision of care staff and maintaining adequate staffing levels at all time. You can see what action we took at the back of the full version of this report.