Beach Lawns Residential and Nursing Home is registered to provide accommodation and nursing care for up to 82 people including those who require respite and short term care after a stay in hospital. The service specializes in the care of older people and is divided into four units. Suite A and B are residential units for people not requiring nursing care. Memory Lane is a dedicated unit for people living with dementia and Sandford is for people who require nursing care. Most people in Sandford and Memory Lane have limited communication skills. At the time of our inspection there were 80 people living at the home, but two were in hospital. The home is a large building over three floors with a range of bedroom sizes. There are communal lounges and dining rooms in each unit. Since the last inspection Memory Lane had been refurbished and other units were in the process of being redecorated.

This inspection was unannounced and took place on 9, 10 and 11 November 2016.

Since the last inspection there had been a change in 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. The current registered manager had been in post since July 2016. They were supported by a deputy manager.

At the previous inspection, in August 2015, we found concerns with the level of staff to meet people’s care needs. Following this inspection the provider sent us an action plan including how many staff should be on duty and changes they had made to ensure there were enough staff. During this inspection we checked these changes and the level of staff had improved. We found there was now a suitable amount of staff to support the people at the home. Improvements had been made to the allocation of staff. For example, staff now had additional time to complete paperwork. When people’s needs changed the service was responsive and an increase in staff was made.

People told us they felt safe and we saw evidence most were. Some improvements were required with the way medicines were managed and one person was not transferred safely. Some guidance provided for staff for ‘as required’ medicines needed to be reviewed to ensure there was consistency across the home.

Staff had good knowledge about most people’s needs. Care plans were in place for all people including those who had recently moved into the home. The majority of these were detailed and were updated regularly.

Most people’s care needs were met because staff received regular support and training. People requiring specific diets received them and staff understood about them. People had a choice of meals, snacks and drinks, which they told us they enjoyed. People’s choices and religion were supported and respected by staff.

People were supported by staff who had undergone a safe recruitment procedure. Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns.

People were supported by sufficient staff to enable them to take part in a range of activities according to their interests and preferences. The registered manager was currently recruiting more staff because they had identified people’s needs were changing.

People's health care needs were monitored and met because staff made sure people saw health professionals when it was required and implemented any recommendations made which people agreed to.

Staff and the registered manager had understanding about people who lacked capacity to make decisions for themselves. People had records and we saw the principles being put into practice. Staff understood about Deprivation of Liberty Safeguards (DoLS) and the process to follow to make sure people’s human

Beach Lawns is a care home for up to 82 people. It provides nursing and personal care to older people. This includes people who have physical health care needs and people with dementia. At the time of this inspection there were 79 people living at the home.

The home was divided into four areas. In one area support was provided to people who required nursing care. In two areas people with personal care needs were supported and in the fourth area, known as Memory Lane, 11 people who were living with dementia were cared for.

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 and shares the legal responsibility for meeting the requirements of the law with the provider.

People told us they felt safe at the home and with the staff who supported them. However we found that people’s safety could be put at risk due to a lack of staff in communal areas of the home at some points in the day.

People received the information they needed to help them to make decisions and choices about their care. People’s views and wishes were incorporated into their plans of care. Care plans showed they had been discussed with the person or their representatives. However there was limited information to assist staff to support people to make choices if they were not able to verbally express their wishes. Care plans for people with dementia did not always give details about people’s preferred daily routines. This meant that staff may not be aware of people’s individual preferences.

People’s privacy and dignity was respected, however we saw one instance where someone was supported by a male member of staff when they expressed a wish for a female to help them. We observed that staff assisted people in a respectful manner. We saw staff discreetly asking people about the help they required and assisting people in a manner which promoted their dignity. In Memory Lane we observed there was little positive staff interaction with people during the lunch period. We noted that there was limited interaction with a person who was being physically supported to eat their lunch. The staff member did not offer food at the person’s pace and was seen to put food in the person’s mouth before they had finished the previous mouthful. We also observed that the staff member supporting the person answered the phone and had a conversation whilst assisting the person with their meal. This undermined the persons’ dignity and demonstrated a lack of respect.

People who lived at the home, or their representatives, were involved in the assessment of risk and were able to make choices about how risks would be managed. We saw risk assessments had been completed to make sure people were able to receive support and care with minimum risk to themselves and others.

People who were able to express their views verbally felt they received effective care and support to meet their needs. The care plans we looked at showed people who lived at the home, or their representatives, were involved in the assessment of their needs and the planning of their care. People were able to express their views about the care they wished to receive at the end of their life. We saw people had detailed care plans in place outlining the care they would like and where they wished to receive care.

The home was responsive to people’s individual and changing needs. Additional staffing had been provided to meet one person’s specific needs and changes were made to another person’s care to meet the changes in their physical health care needs.

The home’s management was very visible and demonstrated a good knowledge of the people who lived at the home. Throughout the day we saw the registered manager and deputy talking with people who lived at the home and staff. Everyone looked very comfortable and relaxed with the managers.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards with systems in place to protect people’s rights under the Mental Capacity Act 2005.

The home was divided into four separate units. Two units cared for people who had personal care needs and one unit for people who required nursing care. The fourth area, called Memory Lane, provided care to 11 people who required support with personal care due to a dementia.

Some people were unable to fully express their views due to their frailty or dementia. We therefore spent time observing care practices and talking with staff and visitors, in addition to speaking with people who lived at the home.

People who were able to express their views to us said that they were able to make choices about all aspects of their day to day lives.

Each person had a care plan which demonstrated how care would be provided to meet people’s specific needs. We saw that the care plans were very personal to the individual which enabled staff to provide care in line with people’s needs and preferences.

We were able to speak with the activity worker and were impressed by their enthusiasm and commitment to providing a service to everyone who lived at the home. However, because of the size of the home and the varied abilities of the people who lived there, one activity worker was unable to provide social and mental stimulation to everyone.

People we spoke with said that there was adequate equipment to meet their needs.

The staff personnel files we read gave evidence of a robust recruitment process which ensured that new staff had the relevant skills and were of good character.

Some people were unable to fully express their views due to their frailty or dementia. We therefore spend time observing care practices and talking with staff, in addition to speaking with people who lived at the home.

Without exception everyone we asked said that they were happy with the care and support they received. Comments included “I’m very well looked after here” and “The care has been above my expectations.” People who were unable to verbally communicate with us appeared very content and cheerful.

People said that staff always asked them how they would like to be supported. The care plans that we looked at gave information about people’s likes, dislikes and previous lifestyle choices as well as their physical and mental health needs. This ensured that people received care in line with their needs and wishes.

Everyone we asked said that they would be able to report any worries or concerns to a member of staff. One person said “They always listen to you and take notice of what you say. I wouldn’t hesitate to speak to someone if I was unhappy with anything.”

People felt that there were adequate numbers of staff on duty. We saw that people who liked to spend time in their personal rooms had access to a call bell. People said that if they rang their bell for assistance staff responded quickly.

The home had effective systems in place to monitor the quality of care and ensure ongoing improvements.

We met and spoke with people who live in the nursing unit and the residential units. We briefly observed people in the dementia care unit and watched the interactions they were having with the staff who were looking after them. Some people were unable to tell us how much they were involved in making choices about their care because of their frailty or dementia. Others were able to make the following comments: “I am asked about how I like things done”, “the staff always ensure I am OK with things” and “I enjoy living here and am very well looked after”.

We saw people being well supported by the staff and being offered choices about daily activities. This may be about having a hot or cold drink, returning to their bedroom for a rest, and where they would like to sit in the lounge. We found that all interactions were respectful.

People appeared very relaxed in the company of staff and there was a good rapport between the staff and the people who live in the home.

Not all of the people we met and spoke with during our visit were able evaluate and discuss their care with us, but they were able to make some short comments. “The staff are very kind and caring towards me”, “I get all the help I need” and “my legs are bad at the moment and the nurses have arranged for the doctor to come and see me”.

People made positive comments about the meals they were served. ”The lunch today was very nice”, “we get a choice and I am having an omelette today” and “sometimes my wife comes in and joins me for a meal”. For the midday meal there is a choice of two meals and alternatives can be provided. It is evident that people are offered a choice about what they can have to eat.

Beach Lawns Care Home provides accommodation for up to 82 older people who require nursing and personal care. On the day of inspection there were 81 people living at the home. There are four units in the home; Suite A and B are for people who require personal care, Sandford Unit is for people who require nursing care and Memory Lane is for people living with dementia. The accommodation is arranged in one building over three floors. In each unit there are communal areas including a lounge and kitchenette.

This inspection was unannounced and took place on 4 and 7 August 2015.

There is a registered manager in post but they were on a secondment for six months. 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. In the registered manager’s absence, the deputy manager was managing the home. The deputy manager was being supported by a number of senior managers as well as the registered manager.

People told us that they felt safe but there were risks to their safety. People and staff told us that there were not enough staff to effectively manage the needs of the people. We were told by the registered manager, regional manager and deputy manager that historic budgets were the main source of identifying how many staff were required. There were no systems in place that identified staffing levels based on the needs of the people receiving support.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and had received training in safeguarding. Staff knew what action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home and they knew who to contact externally.

The recruitment process followed good practice and the staff received comprehensive training. However, some staff felt they needed more in depth dementia training. There was good understanding of how to support people who lacked capacity to make decisions for themselves. However, records did not always demonstrate who had been consulted. They were not always assessing people based upon each specific decision. Staff supported people to see other professionals to help with their care. Staff supported and respected the choices made by the people.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. The chef provided alternative options if the people did not want what was on the menu to ensure their preferences were met. However, records for what people had eaten and drunk were not always accurately maintained. The medication processes in the home were good overall.

People and their relatives thought the staff were kind and caring. We observed some positive interactions, but occasionally this was not the case. The privacy and dignity of most people was respected. People were encouraged to make choices throughout their day.

There were detailed care plans for all individuals including life histories. These plans had emerging person centred approach to them; this means that people were central to their care and any decisions made. The needs of the people were reflected within the plans and the staff had good knowledge about them.

People knew how to complain and there were good systems in place to manage the complaints.

There were quality assurance procedures in place, but the online up to date systems were not all shared with us. The systems shared with us did not always identify shortfalls. The registered manager had a clear vision for the home and had systems in place to communicate this. The home had been building links with the local community.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.