The inspection took place on 9 November and 28 November 2017 and was unannounced on the first day.

The previous inspection was completed in May and June 2016. We found improvements were required at that time in relation to cleanliness; the management of some medicines; meal choices and the dining experience; the planning and delivery of care and the quality assurance arrangements. At that time there was no registered manager in post. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe; effective, responsive and well-led to at least good. At this inspection we found improvements in all areas had been made as the registered manager and provider had followed their action plan.

Lyme Regis Nursing Home 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.

Lyme Regis Nursing Home can accommodate a maximum of 27 older people. There are 23 single bedrooms and two double bedrooms. At the time of the inspection there were 25 people living at the service. The service works closely with local commissioners to provide six beds (intermediate care beds) to help prevent admission to hospital or to facilitate a timely discharge. People using these beds were supported by the community nurses and physiotherapist and occupational therapist. Feedback about intermediate care provided was positive. No-one was receiving respite care at the time of this inspection.

Since the last inspection a manager had registered with the Care Quality Commission (CQC). 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 felt safe at the service. Comments included, “Very comfortable and the staff make me feel safe”; “Staff members often pops head round the door with a smile to say hello” and “The bell is answered quickly.”

Risks were identified and plans were in place to monitor and reduce risks. People were safeguarded from abuse as staff were knowledgeable and understood their role. Professionals said they had no concerns about safeguarding issues or staff practice. One said, “I have not seen any practice of concern. The service works well with us…”

There were sufficient numbers of suitable staff on duty to meet people’s needs. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely. The home environment was clean and the home was free from offensive odour. The provider was taking action to address fire safety issues raised by the Dorset & Wiltshire Fire and Rescue Service.

People had access to relevant health care professionals. Health professionals provided positive feedback about the service and the good working relation developed. A varied and nutritious diet was offered to people which reflected their needs and preferences. People spoke highly about the quality of food.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which helped to protect people’s rights.

Staff were respectful, friendly and kind. Staff supported people to take part activities and supported them to retain their independence. We observed staff spending time engaging people in conversations, and speaking to them in a friendly, warm and politely way.

People received personalised care that was responsive to their needs. Comments included, “They (staff) a

Lyme Regis Nursing Home was last inspected on 25 June 2015 and we found they were meeting all requirements.

There was no registered manager in post at the time of the inspection. The previous registered manager had left their employment in January 2016. The provider had appointed a new manager who was in the process of applying to become the new registered manager however they had not informed us of these significant changes. 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.

Lyme Regis Nursing Home can accommodate a maximum of 27 older people. There are 23 single bedrooms and two double bedrooms. At the time of the inspection there were 23 people living at the home.

The leadership within the home was developing following the significant change in management. There were areas of practice that needed to be improved following a period without a manager. This lead to the provider not having an effective system to check the quality of care people received at the home but improvements were now being made. Peoples individual care records were not always up to date and the systems in place to evaluate and improve the care being given were not robust.

The environment required some updating to ensure it could be effectively cleaned.. People needed more opportunity to choose where to eat their meals and the provider needed to ensure there was sufficient equipment to provide for these choices.

The process of recording when medication was given required some further improvements. Staff needed clear guidance on the dispensing of medication on a 'when required needs' basis.

The risks people faced were not consistently acknowledged in people’s care records. When people came to the service for repeated periods of respite their current needs were not consistently reassessed. Care records were not always accurate and reliable.

People were able to raise concerns with the staff who took action to resolve the presenting issues. People told us they had confidence in the staff to care for them in a professional and empathetic manner. People told us they felt safe. Relatives told us how caring the staff were.

People told us the staff were kind and caring and supported them in a caring way. One person told us “I go out and about and like to sit in the garden, I tell the staff where I am, they tell me I should be accompanied but I am ok and let me take the risk, within reason. I think they show they care about me to take the time and thought to worry about my safety”. A relative told us “I am very happy with the service on offer to my mum. The staff are very professional and communicate any concerns without delay. I feel comfortable knowing mum is safe and being well cared for”

People and their relatives were given information about the running of the home and how they could comment on areas for improvement.

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

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well led?

As part of the inspection we spoke with eight people who lived at the home, four relatives, five care staff, two domestic staff, the deputy manager and registered manager. We reviewed records relating to the management of the home which included, six care plans, daily care and clinical records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that people were cared for in a fresh and clean environment and that the home was well maintained.

There were sufficient staff on duty to meet the needs of people living at the home safely, with both the deputy manager and registered manager available. People told us they felt safe in the home and said, “it couldn’t be better”, “I am very well looked after” and “everyone is very friendly”.

We found that the service was individually tailored to meet people's care needs and that people were treated with dignity and respect by the staff.

There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe. Risk assessments had been undertaken which were regularly reviewed. This helped to ensure people received care that was safe. People were given choice and remained in control of decisions about their care and lives.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We noted that the home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and were aware of recent legal judgements about this.

The home had systems in place which ensured staff learnt from adverse events such as accidents and incidents. These were investigated and followed up which helped risk to be managed and kept people safe.

People at the home benefitted from the close communication and cooperation between staff, relatives and professionals who worked together to protect individuals from abuse.

Is the service effective?

Staffing levels were determined through a dependency tool which ensured there were enough staff on duty at all times to effectively meet the needs of people at the home. From speaking with staff it was clear they understood people’s individual care and support needs.

People’s health and care needs were assessed with their involvement and were continually reviewed and updated wherever a change occurred.

Staff told us they worked as a team and we observed how staff cooperated with each other to make sure no one was kept waiting and everyone received the appropriate care and support.

Is the service caring?

We found that care, treatment and support was person centred, and planned to take account of individual preferences and choice.

Staff were kind and attentive. We saw how staff encouraged and supported people in making their own decisions about how they needed help. People said, “the staff are so helpful, they help me with anything I need” and "they are so kind and polite". One member of staff we spoke with told us they, “love getting to know the people in their care” and learning about people’s previous lives and experience.

We met several relatives who visited the home on the day of the inspection. They told us they were always welcomed at any time. One relative we talked with said, “I really didn’t think Mum would settle so easily but the staff have made sure she’s integrated with others even though Mum is unable to talk herself”.

Is the service responsive?

People’s health and care needs had been assessed prior to their arrival at the home. We reviewed six care plans and saw that records were well organised, up to date and accurate. The care plans confirmed people’s preferences, interests and diverse needs which ensured care and support provided met individual need.

Care plans were regularly reviewed which meant that staff were able to respond promptly to people’s changing needs.

The people we spoke with said that staff were “always around” and told us if they needed anything they would use their call bell. We noticed that staff had time to talk with people in the lounge and with those who chose to stay in their rooms.

Is the service well led?

There were formal and informal systems in place to monitor the quality of the service provided. People, their relatives, outside professionals and the staff were asked for their feedback on the service. Suggestions and ideas for improvement to the service were welcomed and acted on. Meetings between people, their relatives and staff were used as opportunities for issues to be raised, discussed and shared before any changes to the management of the home were implemented.

The home worked closely with other agencies and local services and had developed close working relationships and collaborative working practice which helped to provide an effective service for people.

Clear management structures and lines of accountability were in place. Staff were clear about their roles and responsibilities and had a good understanding of the ethos and values of the home and to quality processes in place.

The home benefitted from the experience and continuity of the registered manager and deputy manager who had both been in post for several years and worked together to ensure a quality service was provided.

We spoke with seven people and one person’s relative. All spoke positively about the home and they told us they were very happy with the level of care they received. We saw that people or their representatives were involved in the planning and delivery of their care. One person told us “The staff are very kind, nothing is too much trouble.” Another person said, “The staff here listen, you can say what you want.”

People’s care needs and risks were assessed and care was delivered to meet their needs. People were protected from harm as there were appropriate safeguarding procedures.

Staff were supported by the provider through appropriate training and the home had suitable systems to monitor the quality of service provided.