Sea Bank House was inspected on the 08 and 14 November 2018 was unannounced.

Sea Bank House 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.

Sea Bank House Care Home is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people and there are two lounges and a separate dining room for people to enjoy.

At our last inspection in July 2017, the service was rated as ‘Requires improvement’. We found medicines were not always managed safely as records relating to medicines were not always accurate. This was a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection, the registered provider sent us an action plan indicating how improvements would be made and compliance with the regulation reached. Due to technical problems, we were unable to review this prior to the inspection. In addition, after the last inspection we met with representatives of the provider and asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions ‘safe’ and ‘well-led’ to at least good.

At this inspection in November 2018 we found some improvements had been made. We looked at four people's medicine records and saw three of these were accurate. The fourth person's record required updating. Prior to the inspection we saw this had been carried out and the person's medicines had been reviewed by external health professionals. We have made a recommendation about the safe management of medicines.

We found a risk assessment was not followed in relation to a person's equipment and we were informed no manufacturers instructions had been followed when the equipment was fitted by staff. This was a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

We noted documentation did not consistently reflect people’s needs and audits had not identified the concerns we found on inspection. This was a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

You can see the action we told the provider to take in the full version of the report.

At the time of the inspection visit there was a no manager in place who was registered with the Care Quality Commission. 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.

We reviewed recruitment records and saw checks were carried out to ensure prospective employees were suitable to work with vulnerable people. On discussion with the manager we learnt that following initial checks being carried out, these were not repeated during the person’s employment at the home. The manager told us they were in the process of addressing this.

Relatives and people who lived at the home told us they were consulted and involved in care planning. People and relatives told us staff were friendly and respectful and caring in nature.

We found the home was clean and tidy and staff were seen to wear protective clothing when this was required. We noted the newly refurbished shower room did not have facilities for hand washing. The manager told us they were addressing this and on a second day of the inspection we saw hand washing facilities were being installed.

We saw documentation which evidenced the service sought feedback from people who lived at the home and relatives. Documentation asked people to share their opinions on what the home did well and what nee

Sea Bank House was inspected on the 03 and 10 May 2018 April 2018 and the inspection was unannounced. Sea Bank House is registered to provide personal care for up to 23 older people who require support with personal care. At the time of the inspection there were 14 people receiving support.

Sea Bank House 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.

Sea Bank House Care Home is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people. Some day care services are also available. The home is set on three floors with a lift to the first and second floor. There is a small paved garden to the front of the home and a raised decked area to the rear.

At the time of the inspection there was a manager who was registered with the Care Quality Commission (CQC). The registered manager no longer worked at the home and had not completed the process of deregistering with the CQC. There was an acting manager in place who worked at the home. They told us they were in the process of applying to the CQC to become the registered manager of Sea Bank House.

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.

The inspection was prompted in part by information of concern that a person using the service did not receive prompt care and support and was not referred quickly to a health professional. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of infection and the timely referral of people to external health professionals. This inspection examined those risks.

We also used this inspection to check improvements had been made since our inspection in June 2017. At our last inspection in June 2017 we found three breaches of regulation. We found the registered provider had not displayed their rating on their website, referrals to Lancashire Safeguarding Authorities and the Disclosure and Barring Service were not always made and checks had not identified these actions were required.

We served a Fixed Penalty Notice to the registered provider for the failure to display the rating on their website. This has now been paid.

We asked the registered provider to take action to make improvements for the other areas we had noted. They sent us an action plan which explained the action they planned to take. The action plan recorded that improvements would be made by August 2017.

At this inspection in May 2018 we found improvements had been made. The acting manager completed a series of checks and investigations to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these. People told us they could raise their views on the service provided and they felt involved in the running of the home.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

At this inspection in May 2018 we checked to see if medicines were managed safely. We found improvements were required. We found records were not always accurate and people could not be assured they would receive their medicines safely. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulat

This comprehensive inspection was carried out on the 07 and 21 June 2017. The first day of the inspection was unannounced.

Sea Bank House Care Home is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people. Bedroom accommodation is on three floors which can be accessed by a lift. There is a communal lounge and a separate dining area. There is seating in a small garden at the front of the home.

The home has a manager who is registered with the Care Quality Commission. 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.

We last inspected Sea Bank House in July 2015. We identified no breaches in the regulations we looked at.

During this inspection visit carried out in June 2017 we asked people if they felt safe. People we spoke with told us they did. However, we found that allegations and evidence of abuse were not always referred to external bodies in a timely way. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to make in the full version of the report.

We looked at the auditing systems in place to identify shortfalls at the home and drive improvement. We found checks on medicines, care records and the environment were carried out. We saw evidence that accidents and incidents were monitored and the registered manager could explain actions taken to minimise reoccurrence. However, we found that required checks were not always carried and had not identified the shortfalls we found during the inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to make in the full version of the report.

It is a statutory requirement that registered providers of health and social care services display their performance assessment from the last Care Quality Commission inspection report. We found the rating from the inspection carried out in July 2015 was not displayed on the registered provider’s website. This was a breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Requirement as to display of performance assessments.) You can see the action we told the provider to make in the full version of the report.

We found documentation we viewed was not always complete or up to date. We found risks to people were identified, however the action required to maintain people’s safety was not always recorded. During the inspection visit we raised this with the registered manager. Prior to the inspection concluding we were informed documentation had been updated.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found appropriate applications to deprive people of their liberty were made to the local authorities as required.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed the required checks had been carried out prior to starting work at the home.

Staff told us they met with the manager on an individual basis to discuss their performance. Staff were complimentary of the training provided and told us further training was being arranged to ensure their skills remained up to date.

We discussed staffing with people who lived at the home. People and their relatives told us staff were “busy.” During the inspection we saw staff were patient and kind with people who lived at the home. We saw people were supported at a pace appropriate to their individual needs. We have made

The registered manager told us that the menus were always available to people at the home, and were displayed on the dining room wall. She explained that staff now consulted people each day regarding their menu choice to ensure they were happy with the food on offer to them. She added that people living at the home had also been consulted about having locks on their bedroom doors. She explained that people had declined to have locks fitted and that this had been documented within people's care plans. We were advised that discussions regarding the fitting of locks to bedroom doors had been added to the home's pre-admission assessment process, and that if a new resident to the home requested a lock, then one would be fitted.

During this inspection we spoke with five people who used the service. We also spoke with several staff members. The feedback we received was generally very positive. People expressed satisfaction with their care and spoke highly of the manager and staff. Their comments included:

‘’They (the staff) know me. We always have a laugh!’’

‘’I am quite satisfied with everything here. I have no concerns at all.’’

‘’I am very happy with this home. It’s the best move I have ever made.’’

‘’The staff, the cleanliness, the food - everything is smashing.’’

Whilst the majority of comments we received were positive, one person commented, ‘’I think it’s a shame that they sold the bus. It was great to be able to get out!’’

During the inspection, we looked at standards in relation to the care and welfare of people who used the service and arrangements for gaining their consent for care and treatment. We also looked at processes for ensuring that the home was maintained in a clean and hygienic manner. We assessed the home’s processes for recruiting staff and monitoring standards. We did not identify any concerns with these areas.

However, we identified some concerns in relation to the area of respecting and involving people who use services. We asked the manager to take action to address our concerns and will carry out further work to ensure they are addressed.

We spoke to 6 people who use the service. All of them said they had been given information about the service that helped them understand the kind of services available to them. They all believed they were very much involved in the decision making processes relating to the care and support they received. People thought the manager and staff were good at keeping them informed of developments, and were interested in their care and support arrangements. If they had issues about the service, people felt happy to approach the management team with a view to raising their concerns.

People living at the home told us that the staff talk to them to find out how they like to be supported and take account of their points of view. People living at the home telling us that intimate physical care or treatment is always carried out sensitively and in private. We were informed by people at the home, that the staff always try and check that it is ok to go ahead with personal care and support, so that they know people are happy and comfortable with what is happening to them. People living at the home said that they felt safe and secure at the home, and felt that the care they received was always of a high standard and based on their personal requirements. One person said that they liked felt safe, but not over-protected. It is clear from taking to people and looking at the records that a balance is offered to people in everyday events and activities, between the reasonable risks people want to take and their personal safety. Discussions with people living at the home showed that they believed they received care and support that was safe, and based on their individual needs and requirements.

This inspection was carried out on the 01 and 03 of July 2015 and the first day was unannounced. This means we did not give the provider prior knowledge of our inspection.

We last inspected Sea Bank House on the 18 October 2013 and identified no breaches in the regulation we looked at.

Sea Bank House is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people. The home has planting and benches set in the front gardens and a seated decking area is available at the rear of the home.

The home is located in Knott End and is close to local shops. It is situated over three floors with lounges and dining areas on the ground floor. The first and second floor are accessed by a lift.

The home has a manager who is registered with the Care Quality Commission. 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.

During the inspection we saw people were supported to be as independent as possible. We observed staff responding to people with compassion and empathy and people were seen to be engaging with staff openly.

People told us they liked the food provided at Sea Bank House and we saw people were supported to eat and drink sufficient to meet their needs. We saw evidence that when appropriate, people were referred to other health professionals for further advice and support.

We checked to see if medicines were managed safely. We looked at a sample of Medicine and Administration Records (MAR) and saw the record and amount of medicines at the home matched. We found there were suitable arrangements in place for the ordering and disposal of medicines. However we found best practice for storing medicines was not always followed. We have made a recommendation about the storage of some medicines.

During the inspection we visited all areas of the home. This allowed us to check the home provided suitable facilities for the people who lived there. In some rooms we saw there were no window restrictors in place to minimise the risk of falls, or to prevent people from injury if they walked into them. We also saw there was no documented risk assessment in place for a balcony area.

We have made a recommendation about the management of risk associated with falls from heights.

There were sufficient numbers of staff on duty to meet people’s assessed needs and staff were knowledgeable of these. The staff we spoke with could explain the reporting processes in place if they suspected people were at risk of harm or abuse and everyone we spoke with told us they felt safe. We found the processes for reporting allegations of abuse to the Care Quality Commission required improvement.

We saw care documentation provided information on the needs, wishes and preferences of people who lived at the home and during the inspection we observed care being delivered in accordance with these.

Processes to ensure that people’s freedom was not inappropriately restricted were in place and staff were able to describe restrictive practices that may indicate a person is being deprived of their liberty.

People who lived at Sea Bank House, their relatives and staff we spoke with told us the registered manager was approachable and listened to them. We saw systems were in place to monitor the quality of the service.