Lyme Bay View Residential Home is a care home providing personal care to a maximum of 30 older people. They provide care and support for frail older people and those people living with dementia. It does not provide nursing care. The home is a detached house near the town of Seaton in the coastal area of East Devon. There were 25 people living at the service during this inspection.

Lyme Bay View Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

We carried out this comprehensive inspection on 6 and 11 July 2018.

We carried out a comprehensive inspection of this service in June 2017 and rated the service as requires improvement. This was because people were not always protected against hazards such as falls, malnutrition, slips and trips and fire. There were not always safe systems in place to assess risks both to individuals and to the environment. Fire doors had been held open and would not have closed in the event of a fire.

We found improvements had been made at this inspection. For example, flooring which could cause a trip hazard had been replaced. Fire safety had improved. At this inspection all fire doors were closed. People’s nutritional status was monitored and where concerns were identified action had been taken to address these. However, at this inspection we found improvements were required in relation to staff recruitment, staffing levels and deployment and the provider’s quality assurance arrangements.

The service has been rated as requires improvement for a third consecutive time. The Care Quality Commission will be monitoring improvements within the service.

There was a registered manager in post, who had been on planned leave prior to 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.

Recruitment procedures did not ensure all appropriate checks were obtained before staff started working with vulnerable people. Staff were not always effectively deployed or available in communal areas to ensure people’s needs were met in a timely way. We have recommended the provider keep staffing levels and the deployment of staff at the service under review. The provider’s quality monitoring arrangements had not identified these shortfalls. Following the inspection, the provider confirmed they had successfully recruited a kitchen assistant, meaning care staff could spend more time with people using the service.

People using the service and their relatives said they felt safe at the service. Comments included, “I am definitely. For one thing, they make sure the doors are locked for safety” and “I feel safe, I have no worries.” A relative said, “From what I’ve seen it is incredibly safe. I’ve not seen anything I would think that’s not safe, they do it properly.”

People were protected from the risk of abuse. Staff had received safeguarding training, although some were due refresher training. They were aware of how to recognise and report safeguarding concerns. They were confident they could raise any concerns with the registered manager or provider.

Risks to people’s health and wellbeing were identified and plans were in place to mitigate risks without infringing on people’s liberty. The registered manager monitored incidents and accidents to make sure the care provided was safe. Where necessary action was taken to reduce risks. People’s medicines were safely managed and they received their medicines as prescribed. Emergency plans were in place to guide staff and emergency responder

We carried out a comprehensive inspection on 1 and 12 June 2017. The first day of our visit was unannounced. The second day was agreed for when the registered manager was available

Lyme Bay View Residential Home is a care home providing personal care to a maximum of 30 older people. They provide care and support for frail older people and those people living with dementia. It does not provide nursing care. The home is a detached house near the town of Seaton in the coastal area of East Devon. On the first day of the inspection there were 23 people staying at the service.

We carried out a comprehensive inspection of this service in May 2016 and rated the service as requires improvement. There were no requirements issued, because the manager at the time who is now the registered manager had identified areas for improvement and developed an action plan. The registered manager has been at the service for 18 months but was registered with the Care Quality Commission (CQC) in March 2017. A registered manager is a person who has registered with CQC 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 registered manager was very active within the service. They led by example and had a high level of expectation of the staff to deliver good quality care. They were supported by the owner who worked at the home each day. A new deputy manager position had been developed so there was someone who could undertake the managerial role when the registered manager took some planned leave.

People were not always protected against hazards such as falls, malnutrition, slips and trips and fire. There were not always safe systems in place to assess risks both to individuals and to the environment. People were able to be independent using the main staircase. A generic assessment had been completed and individual mobility assessments for each person to look at them as individuals and identify particular risks.

Flooring on the ground floor outside of the kitchen was in a very poor state of repair. A generic risk assessment had been completed regarding the risk to people and staff but had not looked at each individual in relation to their physical needs and the risk this flooring posed to them.

The provider had started to use a new computerised care system which the staff were getting used to using. Staff were regularly weighing people and recording their weights on the system and in a weights folder. However this was not populating the malnutrition assessment tool on the computer system, so staff might not have been alerted to people at risk of malnutrition. The registered manager confirmed they were aware and that they would revert back to paper assessments while they looked into this issue.

Some fire safety concerns were identified. Two fire doors were held open and would not have closed in the event of a fire. We also identified a fire exit door which had a key lock to exit; this had been agreed with the fire service. We were unable to open the door; however the owner was able to. It was apparent that the barrel had become worn; they replaced this between the two days of our visit. The registered manager said they would add checks of these locks to the fire checklist.

The provider had several assurance systems in place to assure themselves the service was running safely. However their systems had not identified these areas of concern in relation to safety risks.

People said they felt safe and cared for in the home. Staff had a good understanding of what constituted abuse and how to report if concerns were raised. There were sufficient, suitably qualified staff to meet people’s needs although there had been staffing difficulties which the provider was actively recruiting to fill. The registered manager and staff had been undertaking addit

We carried out a comprehensive inspection on 10 and 19 May 2016. The first day of our visit was unannounced. Our second visit was announced so that arrangements could be made for us to spend time with the provider, registered manager and manager.

Lyme Bay View Residential Home is a care home providing personal care to a maximum of 30 older people. They provide care and support for frail older people and those people living with dementia. The home is a detached house near the town of Seaton in the coastal area of East Devon. On the first day of the inspection there were 23 people staying at the service, which included one person staying for a short stay referred to as receiving respite support.

We carried out an inspection of this service in August 2014. One breach of legal requirements regarding recording keeping was found. We returned in October 2014 and undertook a focussed inspection to check whether the requirement had been met. We found that the service was then meeting the requirement.

Several people at the home had a dementia type condition and we were unable to fully explore their experience of care and support through conversations. We spent time in communal areas observing the staff interactions with people and the care and support delivered to them.

One of the provider’s representative’s is also the registered manager of the service. They had decided to step down from this role and had submitted their application to deregister with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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 registered person had appointed a manager to manage the service. They were in the process of completing their application with CQC to become the registered manager at the service. The manager had been at the service for six months at the time of our visit. They were very visible at the service and undertook an active role. They were very committed to providing a good service for people in their care and demonstrated a strong supportive approach to people, their relatives and staff. They were supported by the provider’s representative who worked at the home each day and the registered manager.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. The staff and manager undertook additional shifts when necessary to ensure staff levels were maintained. When gaps were not able to be covered agency care workers were used.

The manager demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood that where people lacked capacity a mental capacity assessments needed to be completed and best interest decisions made in line with the MCA. They had recognised that mental capacity assessments had not been undertaken and were in the process of implementing new documentation. They were working with the local authority Deprivation of Liberties Safeguarding team (DoLS) to make appropriate applications to deprive some people of their liberties. Staff had a good understanding about giving people choice on a day to day basis and had received MCA training to help them understand their responsibilities.

People were supported by staff who had the required recruitment checks in place although there was not a clear system to ensure all checks were completed. Staff had received a basic induction. Not all staff had completed the provider’s mandatory training. The manager had recognised this and was working to ensure all staff had undertaken the training and a more thorough induction. They had helped a few staff enrol onto courses of higher qualifications in health and social care. The three senior care workers we spoke with were knowledgeable about the signs of abus

This is a summary of what we found.

This was a follow up inspection to look at required improvements which had been made in relation to records management, following our previous inspection in August 2014. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) detailing the improvements being made.

We found improvements had been made and care records for people living at the home were accurate and fit for purpose. This outcome is now compliant.

One inspector visited the home and spent approximately two hours there. At the time of the inspection there were 17 people who were living at Lyme Bay View and four people who were receiving short term respite support at the home.

During our visit we spoke with seven people who lived at the home. We also spoke with both of the providers, one of which is also the registered manager and three care workers. We looked at care folders and daily records of five people who were receiving care and support at the home.

If you want to see the evidence supporting our summary please read the full report.

The question we asked on this visit were:

Is the service safe?

We found the service was safe because care records were easily accessible and reflected accurately the care people required.

We saw risk assessments to identify risks for people had been completed correctly and care plans reflected the risks which had been identified.

Care workers we spoke with had a good understanding of where records were kept and how they reported and recorded the care and support people had received.

Summary

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 19 people living at Lyme Bay View.

The summary is based on our observations during the inspection. We spoke with eight people living at the home, two visitors and a visiting district nurse to ask their views about the service.

We also spoke with both of the providers, one of which is also the registered manager and six staff.

The inspection was undertaken by one inspector over one day.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not safe because people's personal records including medical records were not accurate and fit for purpose. We looked at five people's personal care records and saw they had risk assessments which had not been completed and care plans and assessments which had not been reviewed in a timely way.

However we found the registered manager had prioritised people’s safety by ensuring there were enough staff on duty with the appropriate qualifications, skills and experience required to ensure people's needs were met. Care workers we spoke with told us the staffing levels allowed them to meet people’s needs. We observed during the inspection care workers had time to talk to people as well as complete tasks.

The home was clean and had processes in place to maintain a hygienic environment. We found the home to be free from offensive odours.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS). Although no DoLS applications had been made, the registered manager was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

The service was effective because the home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated. We saw there was a choice of suitable and nutritious food and drink available in sufficient quantities.

It was clear from our observations and from speaking with people and staff, that staff had a good understanding of people's care and support needs and they knew them well.

Is the service caring?

The service was caring because we saw staff had positive interactions with people. We saw staff approach people with respect and kindness. People were assisted in a manner that maintained their privacy and dignity.

There were opportunities for people to be engaged in activities. On the day of our inspection, we saw people enjoying the outside sensory courtyard garden and having nail care.

We spoke with eight people to ask their views of living at the home. Comments included, “I am quite satisfied, on the whole they do a good job” and “It’s the happiest place I have been in for years”. “Very happy here lovely views”, “Quite happy, I if I wasn’t I would soon tell them” and “I like the staff here, they don’t nag me”.

Is the service responsive?

We found the service was responsive because Systems were in place to make sure the registered manager and the provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home took account of complaints and comments to improve the service. We were told by the registered manager because the unit was small and they were in day to day control at the home they tried to deal with any concerns which were raised at the time.

Is the service well led?

We found the service was well led because the registered manager was supported by a team of committed staff at the home. We were told by staff and people who used the service and their visitors they had confidence in the registered manager and provider and were able to approach them if they had any concerns. Comments included “They are really approachable and are really supportive” and “If I have a concern it is always dealt with” and “It does get sorted out”.

We found the service had systems in place to regularly assess and monitor the quality of the service they provided. They regularly held residents meetings to gather the views of people who used the service.

Care workers told us they were clear about their roles and responsibilities. They demonstrated a good understanding of the ethos of the home. This helped to ensure people received a good quality service at all times.

We carried out our inspection on 9 December 2013. There were 19 people living at the home at the time of the inspection. We spoke with four people who were able to tell us about their experiences at the home and we spent time observing care in the communal areas. Responses were all positive and although most people were living with varying degrees of dementia and unable to tell us directly about their experiences, we saw that their needs were well met in a dignified, inclusive and respectful way. For example, we saw staff chatting with everyone throughout the day and recognising people’s body language signs such as anxiety or showing that they needed assistance or a drink. For example, staff told us that one person really loved their cup of tea and so they always asked them during the day if they would like another cup.

People’s health and welfare needs were identified and well met including wellbeing and social needs. For example, the activities co-ordinator ensured there were activities which suited individual abilities and personal preferences. People were able to go out for a walk with staff, join in an exercise session, spend time with staff on a one to one basis and staff were friendly and ensured that everyone was looked after in the way that was stated in the care plans. This meant care was personalised for individuals. One relative told us “I can’t fault them, they have made such a difference”.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw staff giving medication in a safe way, they received appropriate training and support and that risk assessments were in place.

People told us they felt able to voice any concerns or complaints. People spent time with staff which enabled them to speak on a one to one basis in private. Staff told us how they looked out for signs of distress or negative signs which could mean that someone was not happy with something but may be unable to directly voice concerns due to dementia. We saw the provider did not record or log informal concerns which would be helpful in ensuring they were looked at and actioned and could be audited for any recurring themes. There had been no recent formal complaints but complaint procedures were in place and people, staff and relatives knew about them although one address needed updating.

The service was complaint with all four outcomes that we looked at during this inspection.

Lyme Bay View Residential Home provides care and support for older people. Some of the people living in the home were diagnosed with dementia. We talked with six people who lived at the home, 8 staff including the provider, a health professional and four relatives. Some people had communication difficulties; this meant they could not tell us what it was like to live in the home. We looked at the care records of five people living at Lyme Bay View including records relating to their community nursing support.

There were 16 people living in the home at the time of our inspection. We saw people were able to move freely about the home where able and were comfortable in the company of the staff who supported them. We saw they responded positively to people who came into the home.

We heard from the people we spoke with and their visitors about how they were involved in deciding about their care treatment and support; and saw how people’s care and welfare was provided with dignity and respect in line with their care plan.

The home was clean and tidy and we saw how the manager worked with other professionals to ensure people received appropriate support and that their safety and welfare was protected.

Staffing levels, skills and experience were appropriate to meet the needs of people living in the home.

The provider routinely checked and monitored the services they provided and used the information from those checks to improve their services.

We visited Swallowcliffe unannounced on February 14th 2012 at 09.30-15.00. We were visiting to follow up concerns raised by the multidisciplinary safeguarding team and to assess improvement following our previous inspection where compliance actions were made. We also received a comprehensive action plan from the provider.

There were 16 people living at the home at the time of the inspection. Four rooms were out of action during refurbishment. There are a number of people who live at Swallowcliffe who have a dementia type illness and so some people were not able to comment directly on the care and support provided at Swallowcliffe. We talked to people living at the home; some people were able to verbally express their views and others could not. People told us they were “happy” and “the girls are good to me” and that “staff were lovely and kind”. We spoke to staff, including one who has a family member living at the home. They said that they had no concerns about care delivery. Another said that the home was, “much more relaxed with more staff, which means I can spend time with people”.

We therefore spent most of the inspection in communal areas observing care and the interactions between staff and the people living at the home, talking to people in their own rooms, staff and with the manager.

We saw that people looked well cared for, comfortable and warm. Generally, people looked relaxed in their surroundings, and were able to move around the communal areas, and appeared as ease with the staff that cared for them. We saw staff listening to people’s requests and attending to people respectfully in a timely way. We saw that people were given choice throughout the inspection such as what they would like to drink, where they wanted to sit and what they wanted to do. Staff were visible in the communal areas and there was good engagement between staff and people living at the home.

People’s medication was administered in a safe and reassuring manner. We saw that staff quickly and appropriately reacted to people’s changing behaviour, and recognised when additional support from health and social care professionals was needed.

There were 27 people using services when we carried out an unannounced visit to Swallowcliffe. We carried out the visit after receiving some information of concern.

People living at the home generally have difficulties communicating but we were able to engage with people on varying levels. We saw that people had little choice in how they spent their day. Although staff were kind and friendly and have the information they need in the care plans, they had no time to spend meaningfully with people due to the task workload and a lack of staff able to meet people's needs. However, people were respectfully assisted with their meals in an unhurried and dignified way.

We saw that people spent all day in the same chairs with little engagement other than for tasks. People said that they were bored or would like to go for a walk in the garden but staff were unable to assist them.

We found that the standard of cleanliness in the home was poor. Some areas, although identified by the home, were in need of urgent attention. The manager addressed some of these during the inspection and is keen to make improvements.

There is a new manager who is aware of many of the issues which we raised and has begun to address these using good quality assurance systems. However, these have not yet ensured good quality care in practice and some practices are putting people at risk.