This inspection took place on 15 and 17 August 2017 and was unannounced on the first day and announced on the second.

The Laleham provides accommodation and personal care for up to 60 people. Some people may be living with dementia. Bedrooms are on three separate floors and are accessed by a passenger lift. There are various communal rooms, including lounges and dining rooms. The service faces the sea and has parking at the front. There were 51 people using the service when we inspected.

There was a registered manager working at the service. 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 of the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was not available on the first day of the inspection; we were supported by the head of care, senior carer and administrator. We met with the registered manager on the second day of the inspection.

We last inspected the service in August 2016. We found significant shortfalls in the service. The provider had failed to make sure care plans were person centred. The registered persons had not given staff detailed guidance to ensure people were supported safely with their mobility and behaviours that may challenge. The registered persons did not have effective systems in place to monitor and mitigate the risks to people’s health, safety and welfare. The registered persons had not kept accurate and complete records in respect of each person. The registered persons had failed to ensure there were enough staff on duty at all times to meet people’s needs.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that improvements had been made.

At the last inspection, potential risks had been identified but the measures to reduce these risks were not detailed enough to keep people safe. At this inspection, there was detailed guidance for staff to follow to mitigate potential risks and keep people safe including how to move people safely.

At the last inspection, there were not sufficient staff on duty at night to meet people’s needs. Staffing levels had been increased and there were sufficient staff on duty. Staff were recruited safely. Staff were supported by the registered manager through one to one supervisions and yearly appraisals.

Staff received training to make sure they had the skills and knowledge to carry out their roles. At the last inspection, specialist training such as diabetes and challenging behaviour had not been completed by staff. At this inspection, senior staff had received training in diabetes and further training sessions were booked. Staff had received training in how to manage behaviour that might challenge.

At the last inspection, medicines were not always stored at the recommended temperature to ensure medicines were effective. At this inspection, medicines were stored safely, people received their medicines when they needed them.

People’s care plans at the last inspection, were not always accurate. Details about people’s healthcare needs had not been recorded consistently. At this inspection, care plans were detailed and had been reviewed regularly and up dated to reflect people’s changing needs. People had signed to say they had discussed their care plan and attended reviews with healthcare professionals.

Audits were in place to monitor the quality of the service people received. When shortfalls were identified action plans were put in place to ensure the shortfalls was rectified. Accident and incidents were recorded and reviewed by the registered manager. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Checks had been made on the environ

This unannounced inspection was carried out on 9 August 2016.

The Laleham provides accommodation and personal care for up to 60 people. Some people may be living with dementia. Bedrooms are on three separate floors and are accessed by a passenger lift. There are various shared rooms, including lounges and dining rooms. The service faces the sea and has parking at the front. There were 48 people using the service when we inspected.

At the previous unannounced, comprehensive inspection of this service on 21 and 22 May 2015, a breach of one legal requirement was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met the legal requirement. At the time of this inspection the provider had complied with the majority of the issues but there was still an outstanding issue with some walking aids which were stacked together in the lounge area. The walking aids were not always placed where people could reach and use them, if they choose to get up and move from their chairs.

There was a new registered manager in place since 21 January 2016. People, relatives, health care professionals and staff told us that the service had improved since the appointment of the new 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.

Potential risks had been identified but the measures to reduce these risks were not detailed enough to give staff the guidance to ensure people were safe. These included the use of bed rails, behaviour risk assessments and moving and handling risk assessments.

There were sufficient staff on duty during the day and evening but at night there were not enough staff available to meet the needs of people in the service. Staff had been recruited safely and received support through one to one meetings with the registered manager and there was a yearly appraisal to discuss their training and development needs. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively, however, staff had not received further specialist training in diabetes and challenging behaviour to ensure they had a full understanding and knowledge of people’s individual needs.

Medicines were not always stored within the recommended temperatures to ensure they were safe to use. People received their medicines when they needed them.

Checks and audits were in place to monitor the quality of service people received. However, the shortfalls highlighted in this report had not always been identified. Accidents and incidents were recorded and analysed by the registered manager, but trends of the number of accidents/incidents at night had not been identified, six out of the eight accidents recorded in May 2016 had been when night staff were on duty.

Checks had been made on the premises to ensure the service was safe. Equipment to support people with their mobility, such as the hoists had been serviced to ensure that they were safe to use.

People felt safe and were supported by staff who understood how to report and recognise abuse, and systems were in place to ensure that people’s finances were protected.

The requirements of the Mental Capacity Act 2005 (MCA) had been met. The registered manager had assessed people’s capacity to make decisions when this was needed. People who needed to make more complex decisions had best interests meetings with people who knew them well and health care professionals.

People told us they enjoyed the food. They were supported to receive a balanced diet in line with their c

This unannounced inspection was carried out on 21 and 22 of May 2015.

The Laleham provides accommodation and personal care to up to 60 people. Some people may have dementia. Bedrooms are on three floors accessed by a passenger lift. There are various shared rooms including lounges and dining rooms. The service faces the sea and has parking at the front. There were 39 people using the service when we inspected.

We last inspected The Laleham on 6 and 9 of January 2015 when the provider was not meeting the requirements of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found the provider had taken action to meet the Regulations.

There was no registered manager at the service. The acting manager was new in post and was in the process of applying for their registration. 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Policies and procedures were in place relating to the Mental Capacity Act 2005 (MCA) and the DoLS. Where people lacked the mental capacity to make decisions, the home was guided by the principles of the MCA to ensure any decisions were made in the person’s best interests. A DoLS application, for the administration of a medicine for a person who was not able to consent, had recently made to the local authority, who consider any restrictions made on a person’s liberty.

Risks to people had not always been recognised and managed to make sure people were safe. Action was taken to minimise risks, but accidents and incidents had not been regularly reviewed to identify themes and patterns. Systems to monitor and audit the quality of the service had been introduced but action was not always taken to rectify some of the shortfalls identified. The acting manager had introduced new risk management procedures and was working on addressing the shortfalls found at the last inspection of January 2015.

Care plans were not always up to date. Arrangements to assess people’s capacity were in place but some people had not had their capacity assessed.

There was a complaints process that was visible on the noticeboard and people said it was easy to understand. However complaints were not always dealt with efficiently.

Regular checks of emergency equipment and systems had been completed and the fire risk assessment had been regularly reviewed. People had individual emergency evacuation plans .

There were enough staff at the service to meet people’s needs. Staff had received safeguarding training and knew how to recognise and report abuse. Safeguarding and whistleblowing policies and procedures were easily visible.

Recruitment processes were in place to check that staff were of good character There was a training programme to make sure staff had the skills and knowledge to carry out their roles and meet people’s needs. Staff knew people’s life histories and understood what people liked and did not like. Staff talked to people about their care plans and listened to what people had to say.

There were procedures to make sure that medicines were managed safely and people had the support they needed to manage their health needs. People’s physical health was monitored and people were supported to see healthcare professionals when they needed to.

People and their relatives were happy with the standard of care at the service and said they were involved with the planning of their care.

People’s views were sought through questionnaires and conversations with staff. Family meetings had been introduced and relatives said they were encouraged to share their views and become involved in the on going development of the service. There was an open and transparent culture and staff understood their roles and what their accountabilities were.

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