This unannounced inspection took place on 05, 07 and17 September 2018.

Across the Bay is a four-storey building and has a passenger lift for people to access all the floors. Communal facilities include two lounges on the ground floor and a dining room on the lower ground floor.

Across the Bay 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. There were eighteen people residing at the home at the time of inspection.

We last carried out a comprehensive inspection at Across the Bay in February 2016. At the inspection in February 2016 we identified a breach to Regulation 18 of the Care Quality Commission (Registration) Regulations as the registered provider had not submitted all statutory notifications in a timely manner. We rated the key question as, 'requires improvement.' However, the service was rated good overall. Following the inspection visit, we asked the registered provider to complete an action plan to show us how they intended to make the required changes. The registered provider submitted an action plan and we used this inspection visit to ensure improvements had been made.

At this inspection visit carried out in September 2018, we found the registered provider had made the required improvements and was now meeting all the fundamental standards.

We found processes were in place to ensure medicines were stored and administered in line with good practice. However, processes were not consistently followed. We have made a recommendation about this.

We saw risk was addressed and managed. Risks assessments were in place to ensure staff were aware of risk to keep people safe from harm. Although risk assessments were in place, we found these did not always formally address all risk. We have made a recommendation about this.

People who lived at the home told us they felt safe and were aware of how to respond to any abusive practice. Staff could identify types of abuse and the associated responsibilities they had in reporting abuse. The registered manager understood the importance of raising awareness of safeguarding principles and ensured they were embedded in all aspects of practice.

People who lived at the home told us there were enough staff to meet their needs. Staff told us they were not rushed and had time to complete all tasks, as well as having time to talk to people. People and relatives told us staff responded in a timely manner when call bells were activated.

We reviewed infection prevention and control processes at the home. The registered provider employed a part time cleaner to carry out cleaning tasks. Although people told us they considered the home clean and tidy we identified some areas where improvements could be made. Following the inspection, we made a referral to the local authority infection prevention and control team so they could support the registered manager to consistently implement good practice guidelines.

People and relatives told us they considered the staff to be appropriately trained. Staff praised the training provided and the supportive nature of the management team.

All the people who lived at the home praised the quality of the food provided. They told us they were consulted with about the menu choices. We observed lunch being served and noted people were not rushed and were offered food according to their preferences and dietary needs.

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.

We saw evidence of multi-agency working to promote effective care. A health professional praised the skills and knowledge of staff who worked at the home. Relatives told us the home was good at meeting the needs of people. Two relatives told us t

This unannounced inspection took place on 09 and 12 February 2016.

Across the Bay is registered to accommodate 24 older people and is situated in Morecambe. The home faces the sea front and is close to Happy Mount Park. Other amenities such as shops and the post office are nearby. The home is a four-storey building and a passenger lift is available to access all the floors. Communal facilities include two lounges on the ground floor and a dining room on the lower ground floor.

There were twenty two people living at the home on the day of inspection.

There was a registered manager in place. 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 service was last inspected on 24 September 2013. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in February 2016, feedback from relatives and visitors was consistently positive. People who lived at the home spoke highly about the quality of service provision on offer. Staffing levels were conducive to meet people’s needs. We observed staff being patient with people and meeting their needs in a responsive manner.

Arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Staff had a sound knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However processes in place were inconsistent to ensure all safeguarding alerts were communicated to the Care Quality Commission (CQC.) This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Robust recruitment procedures were in place to ensure staff were correctly vetted before being employed. Staff retention was good and people said they benefited from staff who knew them well

Suitable arrangements were in place for managing and administering medicines. Regular audits of medicines were carried out by staff.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed. Feedback from health professionals was positive. Systems were in place to monitor and manage risk.

Detailed care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Feedback on the quality of food provided was positive. People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available to people between meals.

The registered manager had implemented a range of quality assurance systems to monitor the quality and effectiveness of the service provided.

The registered provider kept a detailed log of all accidents and incidents which had occurred at the home. However during the course of the inspection we identified two serious injuries that had not been reported, as required to the Care Quality Commission. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The home provided a variety of social activities for people who lived at the home to keep them occupied and entertained.

Staff were positive about the way in which the home was managed. They confirmed they were supported by the registered manager and the registered provider. The registered manager placed an emphasis on ensuring staff were appropriately trained and received regular updates.

The registered manager had adopted an open culture within the home and had built links with the local community and other providers in the area. This allowed goo

On the day of our visit we spoke with the deputy manager, staff, relatives and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at the home.

During the inspection we viewed the environment, looked at care and maintenance records. We also looked at staffing rotas to see how the service deployed staff. One relative we spoke with said, “The care is very good my relative comes here to stay on respite. The home is always clean.” Another relative said, “The staff are wonderful there is always people around to make my relative feel safe.”

Staff members we spoke with had an awareness of residents care needs. We discussed with staff how residents were supported. One member said, “Most of us have been here for a long time and know the residents well.”

We spoke with residents living at Across The Bay. They told us they were happy living at the home and that they liked the staff team and felt cared for. One resident said, “I like the fact there is plenty of staff around the place. It makes me feel at ease.”

Staff told us they felt supported and had regular meetings with the management team. One staff member said, “You can go to them at any time they are always willing to help and support you.”

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

People told us they were happy with their care and support. Their admission to the home had been handled well and they had discussed the support they needed beforehand. One person told us, “The three of us were having rehabilitation together. When I was offered a place here I agreed as I knew my friends were here. It has been a very good choice”.

We observed that staff interaction with people was very good. Staff engaged with them in conversations. They spoke to them respectfully, communicated well and appropriately, and offered assistance when needed. It was evidenced that where possible independence was promoted. People requiring assistance to eat was given this with dignity and patience.

People told us they were given the help and support they needed. They said staff were “Friendly and they all know me really well”, “Very kind and do what I want them to do”, "Staff are great, very caring", “Know me very well. I like a bit of a joke but remind me if I go too far”.

We observed people in the home were relaxed around staff. They were able to express themselves freely and openly. People who were able to express themselves told us staff treated them well and they had no cause for concern. There were no rules to follow and no rigid routines.

We observed how people engaged with staff in various activities of daily living. Staff was always present around people and available to offer assistance when needed.

We spoke with people living at the home during our visit and a selection of staff members. We received positive feedback and comments included;

From residents:

“The staff really look after me, they are really good.”

“You couldn’t get better staff.”

“Staff are lovely. I can get up and go to bed when I like within reason.”

“I like to sit in here its quieter. I can watch TV or look at the view.”

“I like it in here.”

‘’I just tell the staff or the manager and she sorts it for me’’

“The food is very nice.”

“If we don’t like something that is not a problem.”

“The staff know what I like to eat.”

“The staff here are so good and caring, it's chalk and cheese between here and the hospital I came from.”

From staff:

“It’s a really, really good place to work.”

“It is a lovely home to work in. The manager is very hands on working in the home”.