We undertook an unannounced comprehensive inspection of this home on 18 December 2017 following concerns we had received from the local authority and commissioners about the standards of clinical care provided at the home. We found these concerns had been addressed and a new management structure had been implemented in the home to improve the clinical support and management available. Following our inspection a further matter was raised about the way in which a clinical incident was dealt with in the home. This was being dealt with by the local authority and commissioners at the time of our report.

This home was last inspected in March 2017 when we found the registered provider was in breach of one Regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. The registered provider had failed to ensure there was sufficient staff available to meet the needs of people. At this inspection we found the registered provider had taken action to address this concern and was compliant with this Regulation.

West Cliff Hall 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.

The care home provides accommodation, nursing and personal care for up to 59 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 49 people lived in the home.

There was not a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 newly appointed general manager had been in post for five weeks at the time of our inspection and they had started the application process to be the registered manager for West Cliff Hall. They had taken steps to improve the overall leadership in the home; however this needed time to become established in the home and provide an effective network of support for people and staff.

Whilst steps had been taken to address the clinical leadership in the home, the registered provider and general manager required time to ensure these roles were effective in the management of clinical incidents.

People mostly received care which was person centred and individual to their specific nursing needs, although daily care records were not always person centred. Steps were being taken to address this.

West Cliff Hall provided care for people at the end of their life although there were no people in the home receiving end of life care at the time of our inspection. We saw feedback from families of people who had passed away at the home thanking staff for the support and kindness they had been offered at this difficult time.

Risks associated with people’s care, including the safe administration of medicines, had been identified and actions identified to mitigate these.

Staff knew how to keep people safe and understood how to report any concerns they may have about the care people received.

There were sufficient staff deployed to meet people’s needs and ensure their safety and welfare. Staff recruited to the home had been assessed as to their suitability to work with people.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

People mostly received nutritious food in line with their needs, likes and preferences.

People were cared for in a kind and compassionate way and were encouraged to interact with each other and participate in a wide variety of stimulating activities and events

West Cliff Hall provides care for up to 59 people who require residential or nursing care. People had a variety of complex needs including dementia, physical health needs and mobility difficulties. At the time of our inspection there were 47 people using the service.

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.

We could not be assured people received their medicines at the times they required.

Staff were not appropriately deployed to meet people’s needs at all times.

Leadership at management level was inconsistent and the culture of the home impacted on staff moral.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies in place to keep people safe.

Staff knew each person well and had a good knowledge of the needs of people, especially those people who were living with dementia.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

The food menus offered variety and choice. The chef prepared meals to meet people’s specialist dietary needs. People were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People knew who to talk to if they had a complaint. Complaints were passed on to the manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person their relatives and where appropriate other health and social care professionals.

People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

The management team and staff understood their respective roles and responsibilities. The registered manager and the interim manager were approachable and understanding to both the people in the home and staff who supported them.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.