This inspection was unannounced and took place on 7 and 14 February 2017. Pinhay House is a grade II listed Victorian mansion, overlooking the sea, just outside Lyme Regis. It is registered to provide accommodation with personal care for up to 25 older people, most of whom are living with dementia. 22 people lived there when we visited.

On 5 May 2016 two breaches of regulations were found in relation to serious concerns about people’s safety and more minor concerns in relation to consent. Following this inspection the service made safety improvements to the environment and worked closely with local health and social care professionals and with the local authority quality monitoring team. We last inspected the service on 29 June 2016 to check if the required improvements had been made, which they had been with evidence of further improvements being made.

The service has a 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.

Staff demonstrated a high awareness of each person's safety and how to minimise risks for people. Personalised risk assessments balanced risks with minimising restrictions to people's freedom. Accidents and incidents were reported and included measures to continually improve practice and reduce the risks of recurrence.

Staff developed positive, kind, and compassionate relationships with people. People appeared happy and content in their surroundings and were relaxed and comfortable with staff that were attuned to their needs. There were lots of smiles, good humour, fun and gestures of affection. People's care was individualised, staff knew people well, treated them with dignity and respect, and were discreet when supporting people with personal care. The service had enough staff to support people's care flexibly around their wishes and preferences

Staff understood the signs of abuse and knew how to report concerns, including to external agencies. They completed safeguarding training and had regular updates.

People experienced effective care and support that promoted their health and wellbeing. Staff had the knowledge and skills needed to carry out their role. Each person had a comprehensive assessment of their health and care needs and care plans had instructions for staff about how to meet those needs. Staff worked closely with local healthcare professionals such as the GP, community nurses and mental health team to improve people's health. People had access to healthcare services for ongoing healthcare support. Staff recognised when a person's health deteriorated and sought medical advice promptly when they were feeling unwell. Health professionals said staff were proactive, sought their advice and implemented it. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely.

People praised the quality of food and were supported to improve their health through good nutrition. Staff encouraged people to eat a well-balanced diet, make healthy eating choices and to exercise and maintain their mobility.

People and relatives were happy with the service provided at Pinhay House. The culture of the home was open, friendly and welcoming. Care was holistic and person centred, staff knew about each person, their lives before they came to live at the home. They understood people's needs well and cared for them as individuals.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards and involved person, family members and other professionals in 'best interest' decision making.

People pursued a range of hobbies, activities and individual interests. For example,

The inspection took place on 29 June 2016 and was unannounced. Pinhay House is registered to provide accommodation with personal care for up to 25 older people, most of whom are living with dementia. The home is a grade II listed Victorian mansion, overlooking the sea, just outside Lyme Regis.

This inspection was to follow up if the required improvements had been made following our last inspection on 5 May 2016. At that inspection we found two breaches of regulations related to people’s safety and to consent. People were at increased risk due to a lack of detail in care records about risks, staff not following instructions. Also related to environmental risks relating to a new keypad system staff were unfamiliar with and hazards for people within the grounds.

At our previous inspection in 2015, we had also identified a breach of regulations relating to people’s safety, although these risks have since been addressed. Following the most recent inspection, the Care Quality Commission (CQC) took enforcement action by serving a warning notice, which required the provider to take further urgent actions to comply with the regulations by 20 June 2016.

Since then, the provider and registered manager contacted relatives to make them aware of the accidents which had occurred at the home, in accordance with the Duty of Candour regulations. They also made people and relatives aware of the findings of the CQC inspection and displayed a copy of the inspection report in the main entrance and on their website. A relative we spoke with confirmed senior staff had been “very open” about the problems found at the home during the last inspection. At this visit, we concluded risks for people had significantly reduced because safety improvements had been made, and the provider has complied with the regulations.

This report only covers our findings in relation to these topics. You can read the report from the last

comprehensive inspection by selecting the 'all reports' link for Pinhay House on our website at

www.cqc.org.uk

The service had a registered manager who registered with the Care Quality Commission on 25 May 2015. 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 were safer because risks were being managed to reduce the risk of avoidable harm. People’s individual assessments had been reviewed and updated, staff had more detailed instructions about how to minimise risks for each person as much as possible. Staff knew about people’s individual risks, and were consistently following the staff guidance in people’s care records. Environmental risks had been reduced because a programme of works had been undertaken which had improved safety with the home and the grounds. Staff had been trained to use new security equipment installed at the home.

In response to the safeguarding alert we raised with the local authority safeguarding team about increased risks for some people living at the home, two local authority representatives visited the home on 12 June 2016. This was to monitor progress and review people’s safety, and they reported positively on improvements underway at the home.

Since our last inspection, all staff had completed update training on safeguarding vulnerable adults and on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood their responsibilities to safeguard vulnerable people from abuse. The provider had arranged for individual supervision meetings with each member of staff. They reiterated to staff their expectations of their role and emphasised the need for increased vigilance of people’s safety around the home.

A trainer had also undertaken practice observation to check staff

Pinhay House is registered to provide accommodation with personal care for up to 25 older people, most of whom are living with dementia. The home is a grade two listed Victorian mansion, near the edge of a cliff overlooking the sea, just outside Lyme Regis.

On 7 and 12 May 2015 we carried out an unannounced comprehensive inspection, where we judged the service to be overall good, but which required improvement in the safe domain. This was because we identified a number of risks related to the premises, in relation to a leaking boiler flue and because the home did not meet current fire regulations. Also, because we witnessed some unsafe moving and handling practices and a lack of detailed moving and handling care plans to instruct staff about how to move people safely. The provider sent us an action plan outlining work planned to meet the people’s safety needs and to comply with statutory requirements, which they said would be completed by the end of August 2015.

On 5 May 2016 we carried out a focused inspection to check on the safety and welfare of people living at the home. This was in response to notifications we received about two serious incidents which occurred at the home over the early May bank holiday weekend. In separate incidents, two people left the home unaccompanied and wandered onto a nearby cliff path, one of whom fell and was seriously injured. The other person was found unhurt and was returned to the home. Over the previous two months, the registered manager had also notified us about two other serious incidents, in which two people had fallen at the home and sustained broken bones.

This report only covers our findings in relation to these topics. You can read the report from the last comprehensive inspection by selecting the 'all reports' link for Pinhay House on our website at www.cqc.org.uk

The service had a registered manager who registered with the Care Quality Commission on 25 May 2015. 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.

When we arrived at the home on 5 May 2016, a further two people had fallen in their bedrooms overnight. One person had been taken to hospital and the second person had sustained facial bruising.

Staff were aware of signs of abuse and knew how to report concerns about suspected abuse, and any concerns reported were investigated. However, people were at increased risk of avoidable harm at Pinhay House because of the lack of clear risk management procedures. There were a high number of unwitnessed falls, with insufficient actions being taken in response to further reduce risks for people. People’s individual risk assessments and care records lacked detail about the level of supervision they needed. Risks for individuals were not effectively communicated within the staff team which led to inconsistent care and safety practices. Some environmental risks had not been identified and others had not been reduced to an acceptable level in a timely way.

Staff offered people choices and supported them with their day to day preferences. However, where people lacked capacity, their legal rights were not fully protected because staff were not acting in accordance with the requirements of the Mental Capacity Act (MCA) 2005. Where people lacked capacity, relatives and health and social care professionals were not consulted and involved in decision making in people’s 'best interest’. This meant people’s legal and human rights were not fully protected.

On 6 May 2016, the day after the inspection, we contacted the provider to request them to take further urgent steps that day to address some of the ongoing safety risks we identified for people at the home. Later that day they contacted us t

People told us they were very happy living at Pinhay House and had choice and control over their lives and were able to give feedback about their lives.

We were told that people are supported to maintain a faith of their choice. At present people have Christian based beliefs. One person said "A lovely man comes to give us communion. It is a lovely peaceful experience. I enjoy his talk but choose not to take communion."

We spent a period of time observing life in the lounge because many of the people in the home had dementia type illnesses. We watched the interactions between staff and people. All interactions were respectful and encouraged independence and choice.

People said there was "lots going on” at the home to keep them busy. We were told about the trips by the nearby donkey sanctuary, craft sessions, ball games, baking sessions and trips in the mini bus. Staff told us there had been access to audio books, visits by a theatre company, garden sessions and a programme where butterflies had been hatched and released to the wild. People were particularly grateful for the one to one sessions where the activity coordinator spent time "chatting and reminiscing”.

All four people we spoke with said they were happy with the care they received and "Felt well cared for". People said the staff answered their call bells promptly. All the people we spoke to said they felt safe at the home.

We spoke to two health care professionals who also said they thought the care provided at the home was very good. We looked at the records for three people and found these were well constructed, accurate, up to date and reflected the care people were receiving.

People have access to NHS services and are referred appropriately to healthcare processionals. Examples included community psychiatric nurses, speech and language therapists, district nurses, GP's and chiropodists.

The home was managed very well. People were protected against the risks associated with medicines because they were managed well at the home.

People were extremely complimentary about the staff. One person said "The only word to use when describing the staff is excellent." Another person said "All the staff, and I mean all, without exception are the kindest you would ever wish to meet."

One person told us "I have never heard or seen them treat anyone with anything but gentleness."

There were good induction and training programmes for staff to access, which meant that people were cared for by competent staff.

Pinhay House residential care home is a grade two listed Victorian mansion, overlooking the sea, near Lyme Regis. The provider is a partnership with two partners. The home is registered to provide accommodation with personal care for up to 25 older people, some of whom are living with dementia. During our visit, there were 18 people at the service, two of whom were staying for a short period of respite care.

The inspection took place on 7 and 12 May 2015 and was unannounced. We last inspected the service in November 2013 and identified concerns about infection control, supporting staff and with record keeping. We received an action plan which showed the home would be compliant by January 2014.

The previous registered manager left in January 2015, a replacement manager was appointed in February 2015 and their registration with the Care Quality Commission was completed on 25 May 2015. They are therefore referred to as the registered manager throughout this report. 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.

As part of the lease agreement, the provider was responsible for the maintenance and upkeep of the building. A number of risks related to the premises were identified during the inspection which needed to be addressed as a matter of urgency. This included a leaking boiler flue, water temperatures in bedrooms which exceeded the Health and Safety Executive recommended limits and the replacement of fire doors to meet regulations. This work was needed to update the premises to meet the needs of people and to comply with all statutory requirements. Following the inspection, we received assurance that work was underway to address the most urgent risks. Suitable and sufficient environmental risk assessments needed to be undertaken, particularly to identify further ways to reduce moving and handling risks for staff and people.

Although several staff had left the service recently, some experienced staff had been recruited and further recruitment was underway. People were supported so they could receive care at a time convenient for them by some staff working extra hours to ensure sufficient numbers of staff.

Staff demonstrated a good understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty.

Staff were knowledgeable about people’s care needs and improvements in staff training were underway. People were supported to maintain their health and to access ongoing support from health care services. Health and social care professionals were positive about the care and support provided for people.

People were treated with dignity and respect and staff were caring and compassionate towards them. They were supported to express their views and be involved in decision making about their care.

People received care that was individual to their needs. Staff knew people well, about their needs and preferences and how they liked to spend their day. People were supported to remain active and independent and to pursue a variety of hobbies and interests. People’s views were sought and improvements made in response to any concerns raised.

The service was well led and promoted a culture that valued each person and staff. People, relatives and staff said the home was well run and they had confidence in the provider and the registered manager. The home had a range of quality monitoring systems in place and had identified further improvements which were being implemented.

We identified one breach of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.