This unannounced comprehensive inspection took place on 5 December 2016. The last inspection took place on 18 March 2016. The service was meeting the requirements of the regulations at this time.

Ocean Hill Lodge is a care home which offers care and support for up to 18 predominantly older people. At the time of the inspection there were 16 people living at the service. Some of these people were living with dementia.

The registered manager is one of the providers and has worked in this role for many years. 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. However, a new manager had recently been appointed by the owners in addition to the registered manager and had been in post since October 2016. The registered manager was not present at the time of this inspection.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. There were some incontinence odours experienced by the inspectors on the ground floor of the service. Some people had requested that their bedroom doors were open at all times. The doors were held open by devices that were connected to the fire alarm system. This meant that the device would automatically close in the event of a fire. However, the level of the carpet in some people’s rooms was below that which enabled the door device to work correctly. Carpet pieces and tape had been used to raise up the carpet level to address this issue which led to a potential trip hazard. The service was working with the maintenance person to address this issue.

People were treated with kindness, compassion and respect. There were sufficient numbers of staff to meet people’s needs.

We looked at how medicines were managed and administered. We found people received their medicines as prescribed. Regular medicines audits were consistently identifying if any errors occurred. These were taken up with the identified member of staff and addressed.

Staff were supported by a system of induction training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were opportunities for on-going training and support and development. Some more specialised training specific to the needs of people using the service had been completed by a few staff. The manager told us that further dementia training was planned for all the care staff.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were held on a computer. Paper copies of people’s care plans were also kept for families to view. The computer held care plans and the paper copies and contained detailed information about people’s social and care needs. However, some information held on the computer was not evident on the relevant care plan section. For example, falls recorded on the system were not showing on the falls care plan risk assessment. This was addressed with the IT company at the time of the inspection. This meant that some care plans were not entirely accurate and did not always contain up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Accidents and incidents were recorded at the service. Such events were held on the computer system in each person’s care records. However, the manager was not yet able to pull this information together in one place easily

We carried out an unannounced comprehensive inspection of this service on 08 December 2015. At which one breach of the legal requirements was found. This was because the service had made multiple recording errors, when handling people’s medicines. Also, management were not carrying out appropriate checks on how medicines were being managed. We also saw that cleanliness and infection control procedures in the kitchen were not satisfactory.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook a focused inspection on the 18 March 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to the topics as outlined above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ocean Hill Lodge’ on our website at www.cqc.org.uk’

Ocean Hill Lodge Residential Care Home provides accommodation for up to 18 people who require care and support. The service mainly provides support for older people and people living with dementia. There were 15 people living at the service at the time of our inspection.

The registered manager is one of the providers and has worked in this role for many years. 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.

At our focused inspection on the 18 March 2016, we found that the provider had followed their plan which they had told us would be completed by February 2016 and the legal requirements had been met.

Care plans contained risk assessments which identified when people were at risk, for example from falls. Guidance for staff was contained in care plans and provided detailed information on the action staff should take to minimise the risk.

People told us they considered Ocean Hill Lodge to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service as having a ‘family’ feel. Terms such as ‘homely’ and ‘friendly’ were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

Medicines management had been risk assessed and certain processes changed to improve the system. For example, staff now wore red tabards to make people aware that they were administering medicines. Medicine audits and appropriate daily checks were now taking place. This meant the management were now more aware of areas where issues could occur and took action promptly to deal with them.

Staff understood how to keep people safe and the processes to follow if they wanted to report a safeguarding concern to the local authority. There were emergency evacuation plans in place to ensure people could be safely evacuated in the event of an emergency. Fire safety systems were in place and were regularly monitored. For example by regular testing of the fire evacuation system.

Management made inspectors aware that the service was seeking to recruit new care staff. There were sufficient numbers of staff to meet people’s needs, however, at times agency staff were being used to fill staffing requirements. The registered manager was aware people’s needs were increasing and was recruiting additional care workers for both day and night shifts as a result. The new employees would also be able to cover for any staff absence.

Pre-employment checks such as disclosure and barring service (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refre

Ocean Hill Lodge is a care home that can provide care and support for up to 18 people. At the time of our inspection there were 17 people living in the service.

Mrs Dunn, one of the providers of the service, is also the registered manager and was responsible for the day to day running of the service. 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. We have referred to Mrs Dunn as the registered person throughout this report.

Two inspectors carried out this unannounced inspection of Ocean Hill Lodge on 8 December 2015.

When we inspected the service on 9 and 13 July 2015 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in the service being rated as inadequate. There has been on-going evidence of the provider failing to sustain full compliance since 2013. As a result of this the service was placed into ‘Special Measures’ by the CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.

Following the inspection in July 2015, the registered person sent us an action plan about the action that would be taken to improve the service.

At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection on 9 and 13 July 2015.

People and their relatives told us they were happy with the care and support provided by staff at Ocean Hill Lodge and believed it was a safe environment. One relative said, “I don’t worry when I leave [person’s name] because I know they are safe and happy.”

Staff had developed positive relationships with people and understood their needs well. People were encouraged to be individuals and do what they wanted to do to enable them to have a fulfilling life. People were supported to access the local community and take part in a range of activities of their choice. For example, people went out to local community activities such as the memory café.

There were a range of personalised and appropriate risk assessments in place to help keep people safe. Accidents and incidents were recorded appropriately and investigated where necessary.

The safety of the premises was looked after by the provider who made sure there was regular maintenance of electrical and gas systems. The service had an emergency evacuation plan including details about how people would be evacuated in the event of a fire.

Support was provided by a consistent staff team who knew people well and understood their needs. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff demonstrated they understood how to keep people safe including what they should do if a safeguarding issue was raised.

We found the service had made improvement in the effectiveness of the service. Staff were knowledgeable about the people living in the service and had the skills and knowledge to meet people’s needs.

Staff demonstrated they were skilled and knowledgeable about their roles. The manager had implemented a number of changes to the way staff were supported to do their work. There were opportunities for on-going training and for obtaining additional qualifications.

Staff told us they felt supported by management and received regular one-to-one supervision. The manager showed us documentation for the roll-out of a new annual appraisal system to review staff work performance over the year. We were told staff would begin using the new system in December 2015.

Medicines management had undergone improvement since the last inspection in July 2015. However, we found there continued to be multiple recording errors in the medicine records and a continued failure to ensure sufficient stocks of all required medicines.

Regular auditing of medicines was taking place. However, following a check of daily and weekly auditing results we found audit results were not always an accurate reflection of some of the recording errors found in MARs.

The environment which had consistently been found to have an unpleasant smell, was much better due to deep cleaning and replacement of furnishings. However, we saw that standards of cleanliness in the kitchen did not ensure infection control measures were adequate to keep people safe.

The service was now providing a premises that was properly maintained with a generally clean, bright and inviting environment. Communal areas had been decorated with new comfortable chairs and new curtains. The malodour that had been particularly strong in communal areas was no longer detectable. A comprehensive maintenance programme for decoration of rooms was under way.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support. Staff supported people to eat and drink enough and maintain a balanced diet.

Care records had been rewritten and were up to date. Records were regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Any risks in relation to people’s care and support were identified and appropriately managed.

Care records showed that people had given their consent to their current support arrangements. We observed throughout the inspection that staff asked for people’s consent before assisting them with any care or support. People were involved in making choices about how they wanted to live their life and spend their time.

Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. There was a positive culture in the service, the management team provided strong leadership and led by example. Staff said, “It’s got a lot better recently”., and “I enjoy what I do”.

There were quality assurance systems in place to make sure that areas for improvement were identified and addressed. However, audits concerning medicines and infection control procedures did not reflect the evidence found. Management were visible in the service and regularly checked if people were happy and safe living at Ocean Hill Lodge.

During the inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider had not assured auditing processes were effective and accurate to assess, monitor and improve the quality and safety of the service, particularly medicines managements and cleanliness and infection control procedures in the kitchen.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with six people who lived at Ocean Hill Lodge. People told us they felt the care they received was good and that they liked the staff who were kind and helpful. One person said the staff worked hard and were often busy.

We saw that staff showed, through their actions, conversations and during discussions with us a good understanding of people’s care needs and were friendly, warm and compassionate to those they cared for.

We reviewed the systems for managing medication in the home and found this took place in a safe and appropriate way.

The records held by the home demonstrated a robust and effective recruitment procedure was carried out when appointing new staff.

We reviewed a number of records which staff maintained regarding the care of people who used the service and found these were up to date and stored securely. We also reviewed a number of staff personnel files and found these had been developed since our last inspection and were now ordered, up to date and stored securely.

People told us that staff were kind and helpful. One person told us that they were very satisfied with the care that they received from the staff and that they felt safe and secure in the home. Another person told us that staff were always available when they needed help and that if they rang their call bell it was answered very quickly. They added that the staff provided care to them in a kind and caring way.

Three people told us that they felt at home at Ocean Hill Lodge and one person said "It is great here, I have been in other homes but this is like one big family and the staff are just marvellous". Another person told us "we are all one big family and I like that".

We spoke with two people who were visiting their relatives in the home. One person told us that they were very pleased with the excellent care provided to their relative. Another visitor told us "we are completely satisfied with the home and we have peace of mind to know that XXXX was looked after so well".

The people we spoke with all said that they enjoyed the food they received. We were told that the food was varied and home cooked. The people we spoke with were all clear that if they did not like the menu choice they were able to ask for something different.

The home had a warm and welcoming atmosphere during our inspection visit. We saw that the furnishings and décor were domestic in style and provided a homely and comfortable environment.

Ocean Hill Lodge provides accommodation and personal care for up to 18 predominantly older people. Mrs Dunn, one of the providers of the service, is also the registered manager for the service. 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. We have referred to Mrs Dunn as the registered person throughout this report. We carried out this unannounced inspection of Ocean Hill Lodge on 8 and 13 July 2015.

When we inspected the service in February 2015, we found a number of breaches of legal requirements relating to the following issues. We had concerns about the internal and external environment of the premises, in particular a strong smell of urine throughout the building and a lack of appropriate storage facilities. We saw during this inspection that the service had taken action to provide more appropriate storage. However, there remained environmental concerns because of the continued severe urinary odour in certain areas of the building, in particular in communal areas. The registered manager had not fulfilled the action plan to eliminate the unacceptable smell in the premises. In addition, we found furniture used by people was very worn and dirty. The provider told us there currently were no available funds to replace old and worn chairs and carpets in the service.

The last two inspections highlighted significant gaps in staff training. At this inspection we found staff had received some training, however, the organisation and delivery of appropriate training was not taking place. The registered manager did not have a clear plan for staff about what training was required and when it needed to be undertaken. Staff told us, “Training isn’t great. We’ve had first aid and there is a day of moving and handling planned but it is very hit and miss generally”. Training records showed that not all staff had received relevant training for their role and refresher training was not up-to-date.

At the last inspection we found the service did not have a system for supporting staff by providing regular supervision and appraisal. Staff were not consistently supervised, supported and trained to carry out their roles. Records showed that staff had not had an individual supervision meeting or appraisal since November 2014. Following the last inspection in February 2015 we received an action plan stating that supervision had begun with staff. During this inspection the registered person and staff confirmed that supervision had not happened following the last inspection. The registered person told us she had intended to do this, but lack of time and staff shortages had led to this not happening. Staff confirmed they had not received an appraisal for years, if at all, and had received no professional development, except for minimal training. One staff member told us’ “Supervision is not happening. I have never had an appraisal and I don’t feel I get adequate supervision to do my job”.

At the last inspection we found the registered person had not protected people against the risks of unsafe medicines administration. At this inspection we found the action plan to improve and monitor the administration of medicines had not been met. We found two serious errors when people had received the wrong medicines, multiple medicine administration recording (MAR) errors and failures to have enough prescribed medicines to administer to people. This meant that people were not receiving their medicines at times and that the administration of medicines system generally was not safe.

People’s care and treatment was not being planned and delivered in a way that ensured people's safety and welfare. This issue had also been identified in the previous inspections in September 2014 and February 2015. We saw care records were very brief, did not provide staff with clear direction to be able to meet people’s needs, were not up to date, and were not being adequately reviewed. There was confusion between the registered manager and the care staff about whose responsibility it was to ensure care records were regularly reviewed.

We found the registered person had not ensured people were protected under the Mental Capacity Act (2005) legislation and Deprivation of Liberty Safeguards. The service used a number of potentially unreasonable restrictive interventions such as stair gates on people’s rooms, another stair gate blocking the exit to the stairway on the first floor landing, and a number of alarmed pressure mats placed in peoples’ bedrooms. These were in place to make staff aware that people had got up from bed but also to prevent people coming downstairs in the night. We found no risk assessments in place either about the fire risk that blocking off the stairs could cause or about whether these measures were reasonably restricting people against their will with consideration of their capacity to consent under the Mental Capacity Act 2005. People without capacity to consent to these measures had not been adequately protected.

The service had a complaints procedure; however, people were not aware of how to access it and one person told us they did not feel confident that anything would be done if they did make a complaint. In discussion with the registered person we found an incident which constituted a complaint from a person’s relative, that had not been recorded as a complaint and the person had not received feedback about the issue from the service.

The registered person did not have appropriate systems in place to assess, monitor and improve the quality of the service. This was particularly evident in relation to the lack of medicines audits, infection control audits and supervision and appraisal systems.

Staff interacted with people in a friendly and respectful way and people were encouraged and supported to maintain their independence. For example, one person told us how much they enjoyed going out to a local community club and meeting friends. People made choices about their day to day lives which were respected by staff.

People received care and support that was responsive to their needs and their privacy was respected. People told us staff treated them with care and compassion. Comments included; “They’re nice, if you want anything they [staff] will try to get it”, and “The staff are good. I have no complaints.” Visitors told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

During the inspection we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider’s actions did not sufficiently address the on-going failings. There has been on-going evidence of the provider failing to sustain full compliance since 2013. We have made these failings clear to the provider and they have had sufficient time to address them. Our findings do not provide us with confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations. We are taking further action in relation to this provider and will report on this when it is completed. The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.

You can see what action we told the provider to take at the back of the full version of the report.