What life is like for people using this service:

•At our last inspection in August 2016, the provider was found to be in breach of Regulation 18 (Failure to notify). At this inspection, we found improvements had been made and all notifiable events were being reported to the Care Quality Commission (CQC).

•The provider supported staff to provide effective care for people through person-centred care planning, training and supervision. They ensured the provision of best practice guidance and support met people's individual needs.

•People participated in a range of activities that met their individual choices and preferences. Staff understood the importance of this for people and provided the structured support people required. This enabled people to achieve positive outcomes and promoted a good quality of life.

•The service met the characteristics of Good in all areas.

•More information is in the full report.

Rating at last inspection: The service was last rated Good, last report published 19 August 2016.

About the service: Solent Cliffs is a care home that was providing personal and nursing care to 31 people at the time of the inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made in Well Led since our last inspection and the service had met the characteristics of Good in all areas. The inspection was also prompted in part by notification an incident following which a person using the service sustained an injury. The information shared with CQC about the incident indicated potential concerns with moving and handling. We checked this in looking at the quality and safety of the service. Information of concern had also been shared with the Commission regarding the provision of end of life care and person-centred care. We looked into these concerns as part of the inspection process.

The inspection took place on 20 July 2016 and 21 July 2016. It was unannounced. At our previous inspection in May 2015 we found breaches of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not consistently provide care and support that met people’s needs; the provider did not always follow the principles of the Mental Capacity Act 2005 where people lacked capacity; the provider did not always support people in a safe manner by means of effective risk assessment; and people were not always treated with dignity and respect. The provider sent us an action plan describing how they intended to meet the requirements of these regulations by March 2016. They kept us informed about their progress by means of monthly updates. At this inspection we found the provider had made sufficient improvements in these areas and was now meeting the requirements of the regulations.

Solent Cliffs Nursing Home Limited is registered to provide accommodation, personal care and nursing care for up to 40 older people and people living with a physical disability. At the time of our inspection the home was fully occupied. People had a variety of nursing needs, including some with very complex needs, and some who were receiving end of life care.

Accommodation was on two floors. There were three shared rooms. One was occupied by a couple. Shared areas included a sensory room, dining room, conservatory and a quiet lounge. There were facilities for people and their visitors to make hot drinks in the sensory room.

There was a registered manager in post. 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 provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to store medicines safely and administer them safely and in accordance with people’s preferences.

Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of and put into practice the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and specialist nurses.

Care workers had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. People were able to take part in leisure activities which reflected their interests. People were kept aware of the provider’s complaints procedure, and complaints were managed in a professional manner.

The home had a warm, welcoming atmosphere. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

We have made a recommendation about making sure information in people’s care records is complete and consistent.

We spoke with six people who use the service and three relatives of people living at the home. People we spoke with told us a number of positive comments about the service. They told us that members of staff were “very caring” and gave them the support and care they needed and wanted. We were told that they had opportunities to give feedback to the manager about the running of the service and their views would be listened to acted up on.

People commented about the cleanliness of the home; it was “always clean”. They told us they were able to make choices about their daily routines.

This inspection took place on 21 May and 28 May 2015. It was unannounced.

Solent Cliffs Nursing Home Limited is registered to provide personal care, nursing care and accommodation for up to 40 older people and people living with a physical disability. At the time of our inspection there were 34 people living at the home. They were supported by a total of 65 staff. People had a variety of nursing needs. Accommodation was arranged over two floors in a combination of single and shared rooms. There was an enclosed garden with seating areas, a main lounge, dining area, conservatory and a quiet lounge.

There was a registered manager in post. 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 manager had been registered with us since January 2012.

Staff were aware of the need to obtain people’s consent to their care and treatment. However where people lacked capacity to make certain decisions, the service was not consistent in how it applied the principles of the Mental Capacity Act 2005 and its associated code of practice to make sure decisions were made in the person’s best interests.

We saw occasions when the actions and language used by some members of staff did not demonstrate that they respected people’s dignity and individuality.

People did not consistently experience care and support that was based on their needs and how they preferred to be supported. They were not always assisted to be independent and have their own routine. The service had identified that people’s care plans were not always fit for purpose and was taking action to address this.

The service did not always manage risks effectively to ensure people’s safety and wellbeing were promoted.

Staff were aware of their responsibilities to report any concerns about possible abuse. The service had procedures to follow in the event of emergencies.

There were enough staff to support people to the required standard and to keep them safe. The provider carried out the necessary recruitment checks before staff started work. Staff were supported in their responsibilities by effective training and supervision.

Arrangements were in place and followed to store and administer medicines safely. People’s health and welfare were supported by access to other healthcare services and by arrangements to make sure they had enough to eat and drink.

Although we observed examples of some staff not treating people with respect, people had positive, caring relationships with other staff who supported them. Staff often took steps to promote people’s dignity and privacy. People were able to participate in decisions about their care and support, and their views were listened to, although not always acted on.

Where people were identified as needing nursing care for a particular condition, there were detailed care plans in place. However other care plans and risk assessments lacked the necessary detail.

A variety of leisure activities, hobbies and entertainments were available to people. The service recorded and managed complaints in order to learn from them and improve the service.

There was a friendly, homely culture with open communication between the staff, people living at the home and their relations. Staff felt supported and motivated. There was a management system in place and arrangements were in place to monitor and improve the quality of the service people received. However, these systems were not always effective as they had not identified the concerns we found during our inspection.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report.