We carried out an unannounced inspection of Eventide on 31 July 2018. The last comprehensive inspection took place on 5 July 2017 when we identified breaches of the legal requirements and rated the service requires improvement. On 24 October 2017 we carried out a focused inspection and found improvements had been made and the service was no longer in breach of the regulations. We did not change the ratings at that time as we wanted to be sure the improvements would be sustained.

Eventide is a ‘care home’ that provides care for up to 18 adults. At the time of the inspection 17 people were living at the service. 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.

Eventide Residential Home Limited is a charitable organisation which is overseen by a voluntary committee. The accommodation was in an older style property close to the centre of Bude and local beaches. The accommodation was spread over three floors and there was a working lift. There was a lounge and a conservatory where people could choose to spend their time.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

People told us they felt safe living at Eventide. Comments included; “I feel safe, I just press the call bell and they come quite quickly” and “I had a fall in my room and the staff heard me fall and came straight away so I feel safe.” The atmosphere was relaxed and friendly. Staff supported people to move around and encouraged people to be independent.

People received their medicines as prescribed and their health was well maintained. We identified some concerns in how medicines were administered and medicine recording systems and we have made a recommendation about this in the report.

There was a stable staff team in place who knew people well. New staff were required to complete and induction and some initial training. Training was regularly refreshed. Supervisions, annual appraisals and staff meetings enabled staff to raise any issues or suggestions.

People were supported to have maximum choice and control of their lives. There were no restrictive practices in place and people were able to make day to day choices about where and how they spent their time. They were asked for their views of the service regularly and told us they would not hesitate to raise any concerns. members of the management committee visited the service regularly to talk with people and staff about their experiences.

Care plans outlined people's needs in terms of care and support. There was also information about their personal histories and life experiences. This enabled staff to identify what mattered to people and helped facilitate meaningful conversations. The care plans were reviewed regularly to help ensure they gave an accurate picture of people's needs. Staff told us they worked well as a team and were kept up to date with any changes in needs.

People had access to a range of activities both inside and outside of the service. Staff told us this was an area of the service that had improved since our last inspection. The activities provided were in line with people's interests and preferences.

The registered manager was supported by a deputy manager and senior care workers. Key workers had oversight of individuals care plans and arranged appointments for people. Regular audits were carried out to identify any areas for improvement. The registered manager informed CQC of any significant events in line with their legal ob

We carried out an unannounced comprehensive inspection of this service on 5 July 2017 when we identified breaches of the legal requirements. The breaches related to the safety of the premises, management of medicines, the recording and management of identified risks to people’s health, failing to comply with the recruitment policy, failure to implement an effective induction process for new staff, poor compliance with the requirements of the Mental Capacity Act 2005 (MCA), a failure to display the previous inspection ratings, a lack of effective quality assurance systems and a failure to effectively oversee the service and take action to address concerns raised at previous inspections. Warning notices were issued regarding the safety of the premises, management of medicines, the recording and management of risk, and the failure to effectively oversee the service. Statutory requirements were issued for the other breaches of the regulations.

After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that the legal requirements were now met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eventide on our website at www.cqc.org.uk.

Eventide Residential Home is a care home that provides care and support for up to 18 older people; at the time of the inspection 18 people were living at the service. Eventide Residential Home Limited is a charitable organisation which is overseen by a committee who give their time voluntarily. The accommodation was in an older style property close to the centre of Bude. The accommodation was spread over three floors and there was a lift available. There was a lounge and a conservatory where people could choose to spend their time. At the front of the building there was seating on a pleasant patio which was protected from the sun by an electric awning.

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.

At this inspection we found action had been taken to address most of the concerns raised in the warning notices. Valves to control the water temperature from taps had been fitted. New fire alarms had also been fitted to ensure the alarms could be heard throughout the building. The fire alarms were switched on and in working order.

Systems for the management of medicines had improved. Medicine Administration Records (MAR) where appropriately completed. One person self-administered their medicines and this was documented and reviewed regularly.

Some people had health conditions which meant they needed regular monitoring so staff would be aware of any decline in their well-being. This was documented in care plans and monitoring records were completed appropriately.

Staff had received safeguarding training and there was an updated policy in place to guide them on the action to take if they suspected abuse was taking place.

Auditing and quality assurance systems had been developed to help the management team have an oversight of the service. This included training and supervision matrixes, a robust process for auditing care plans and the introduction of surveys to gather the views of people living at Eventide and their relatives. The registered manager was working in the office four days a week to enable them to complete management tasks effectively. They were supported by a deputy manager and administrative assistant.

Some areas of concern remained in respect of the management o

This unannounced comprehensive inspection took place on 5 July 2017. The last inspection took place on 12 September 2016, when we identified breaches of the legal requirements. The breaches were in relation to a lack of risk assessments, the management of medicines, the safety of the environment, gaps in training particularly in relation to the Mental Capacity Act (2005) and a failure to follow legislation when depriving people of their liberty in order to keep them safe. Following the inspection we received an action plan outlining the steps the provider would take to meet the relevant legal requirements.

Eventide Residential Home is a care home offering care and support for up to 18 older people; at the time of the inspection 18 people were living at the service. Some of these people were living with dementia. Eventide Residential Home Limited is a charitable organisation which is overseen by a committee who give their time voluntarily. The accommodation was in an older style property close to the centre of Bude and local beaches. It was based in a residential street overlooking the golf course. The accommodation was spread over three floors and there was a lift available. There was a lounge and a conservatory where people could choose to spend their time. At the front of the building there was seating on a pleasant patio which was protected from the sun by an electric awning.

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. On the day of the inspection neither the registered manager or deputy manager were on duty. The deputy manager came into the service to support the inspection. Following the inspection the registered manager contacted us to discuss the inspection findings.

We identified some areas of concern associated with the premises. Water from hot taps in hand basins became extremely hot very quickly which meant there was a risk from scalding. Fire door alarms were not activated and potentially hazardous cleaning products were not stored safely.

Medicines were stored appropriately and people received their medicines as prescribed. Some handwritten entries on Medicine Administration Records (MARs) had not been checked or counter signed. Arrangements in place for safeguarding people who chose to self-administer medicines were not robust.

Staff starting work at the service did not receive a comprehensive induction to include training in relation to the fundamental standards of care. Not all staff had two references on file which was contrary to the service policy.

The principles laid down by the Mental Capacity Act (2005) were not consistently adhered to. Mental capacity assessments were not carried out to establish if people were able to consent to their delivery of care. Best interest processes were not followed.

Care plans were well organised and contained information regarding people's day to day personal care needs. However, we did identify some gaps in the care records. Staff told us the systems for ensuring they were up to date with people’s needs were effective.

Limited activities were provided at the service. Staff and committee members were proactive in taking people on trips into the local town. There were plans to introduce more activities such as bingo sessions.

People were encouraged to remain independent. They were able to maintain control over day to day decisions such as where they spent their time and when they went to bed and got up. Some people chose to spend most of their time in their rooms and staff checked on these people regularly to ensure they had all they needed. People told us they were supported safely and they had no concerns regarding staff approach to car

This unannounced comprehensive inspection took place on 12 September 2016. The last inspection took place on 11 March 2014, there were no concerns at that time.

Eventide Residential Home is a care home offering care and support for up to 18 older people; at the time of the inspection 17 people were living at the service. Some of these people were living with dementia. Eventide Residential Home Limited is a charitable organisation which is overseen by a committee who give their time voluntarily. The accommodation was in an older style property close to the centre of Bude and local beaches. It was based in a residential street overlooking the golf course. The accommodation was spread over three floors and there was a lift available. There was a lounge and a conservatory where people could choose to spend their time. At the front of the building there was seating available on a pleasant patio which was protected from the sun by an electric awning.

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 told us they felt safe and were treated with respect and dignity. Relatives and external healthcare professionals were also positive about the service provided at Eventide. Comments included; "I have been fortunate to work with the care home and care team for a number of years. At all times the care staff present as caring, open and approachable. They are able to offer an in depth knowledge of their residents needs and requirements" and "The care is excellent."

Risk assessments were in place for a range of circumstances such as using a wheelchair and bathing and showering. One person had suffered a series of falls in recent weeks. There was no risk assessment in place for this person to guide staff on the action they could take to minimise the identified risk.

A member of staff had taken a decision to stop one person’s medicine because they were concerned it was making them unwell. They had not consulted with any medical professionals before taking this decision. There was no effective system in place to ensure staff recorded when they had applied creams to people in line with their care plan.

We identified some areas of concern associated with the premises. A bath hoist was not securely attached to the floor and was unstable. A fire alarm connected to fire exits had been turned off and so staff would not have been aware had a resident left the building via this route. Water from hot taps in hand basins became extremely hot very quickly which meant there was a risk from scalding.

Staff had not received training in the Mental Capacity Act and associated Deprivation of Liberty Safeguards. The service policy in this area did not contain the most up to date information. Some people were under constant supervision and were not free to leave the service unsupervised due to risks to their well-being. No applications to authorise these restrictions had been made to the local authority as is required by law.

Staff starting work at the service received an induction and training was refreshed periodically. The induction process was not planned in line with current best practice and we have made a recommendation about this in the report.

Staff were empathetic in their approach to people and offered reassurance and support to people when they became anxious or upset. Staff had no concerns about people’s safety and told us if they had they would report them immediately to the management team. They were confident any concerns would be listened to and acted on.

There was a stable staff team in place many of whom had worked at the service for a number of years. Staff told us they enjoyed their work and were well supp

Our previous inspection in May 2013 found that people were not wholly protected from the risks of unsafe or inappropriate care and treatment. This was because guidance and care planning were neither helpful nor adequate and quality monitoring did not identify shortfalls. The registered manager sent us an action plan. This visit showed that improvements had been made and staff were supported to provide and maintain good care.

During this visit we met with seven of the people who were living in the home, the registered manager and two staff on duty, and spoke with two health care professionals. We looked at policies and procedures, care plans, staff records and other records.

People said they liked living at Eventide because it was “homely” and because the staff were friendly. One person who had recently moved in said “One look and I knew this was the place for me”. Another person said, “The staff are all very good to me. They treat me with respect.”

We found that people, sometimes with the support of their family, had been involved in the decision about moving into the home and had agreed with staff how their care was to be provided. We saw that care plans had been reviewed and updated regularly to make sure that staff knew about changes in people’s care needs.

We saw that training had been provided to enable staff to work in a safe way and staff performance had been evaluated. Systems were in place to monitor the quality and safety of the service.

We met with nine of the 15 people who were living in the home, two regular visitors to the home including a health care professional and four staff as well as the registered manager. We looked at the home’s policies and procedures, staff training records and other documents relating to the running of the home.

The home was managed by a committee of volunteers. They had arranged for improvements to be made to the safety of fire doors throughout the home and for suitable locks for bathroom doors to be provided.

People living at Eventide told us this was a friendly home, where people were cared for by staff who knew them well. “They have looked after me very well,” one person told us. Another person said, “Everyone’s nice. They know what I like.” One person told us that they were happy that they were allowed to remain as independent as possible.

However, we found that good care practice that we saw was not supported by guidance for staff. Policies and procedures and care planning were neither helpful nor adequate. This meant that people would be at risk of not receiving appropriate care if the regular staff were unavailable.

Quality monitoring was not good enough to pick up on gaps in provision. This included gaps in record keeping and failure to implement regulations including the Mental Capacity Act 2005.

We saw staff treating people with respect throughout the day. People were offered choice at meal times and could stay in their rooms but were encouraged to join others in the lounge, dining room and conservatory. Several people told us, “The food is very good here.” One person told us, “The staff are polite. I am quite happy.”

Care plans did not not record how people would like their care to be provided which is important for people who cannot speak for themselves or who might lose this ability.

Staff said that all the people living in the home were able to call for help when they needed it. We saw that call bells had been placed so that people sitting in easy chairs could reach their bell. This was important because the home is on three floors and staff were not available to supervise people at all times.

We found that some people living in the home had health conditions that made them vulnerable and in need of consistent care. While we found that people were well cared for at the time of this visit, the training and record keeping systems in place were not sufficiently robust to ensure that this level of care could be maintained and choices and preferences may not be met for people not able to speak for themselves.

The house was pleasant and comfortable but issues with some fittings and equipment in the home posed a risk of harm to people using the service and staff.

People told us that they were able to get up when they wanted and had choices about where they spent their time in and outside of the home. People we spoke with confirmed that they chose how to spend their days, and that they could do what they liked. They told us they had enough to do to keep them occupied. We saw people going in and out of the home freely during our visit.

We saw that people were spoken with in a respectful and caring way. People told us that the staff were “very kind”, “wonderful” and that “they (staff) come quickly when you call on your bell”. One person added that “they will do anything you ask but don’t try to take away our independence”.

People said that the staff were “all lovely” and that they “never felt rushed”. People told us about the activities that they enjoyed. They told us that they liked the position of the home and the fact that they could go out when they wanted.

We saw that people who use the service were happy to approach staff. People told us that they felt safe and that could discuss anything with any of the staff.

The three staff we spoke to said they enjoyed working at Eventide Residential Home Limited. They said there were free to discuss anything with the senior staff and/ or members of the Committee who visit the home regularly.