Lyme Bay View Residential Home is a care home providing personal care to a maximum of 30 older people. They provide care and support for frail older people and those people living with dementia. It does not provide nursing care. The home is a detached house near the town of Seaton in the coastal area of East Devon. There were 25 people living at the service during this inspection. Lyme Bay View Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
We carried out this comprehensive inspection on 6 and 11 July 2018.
We carried out a comprehensive inspection of this service in June 2017 and rated the service as requires improvement. This was because people were not always protected against hazards such as falls, malnutrition, slips and trips and fire. There were not always safe systems in place to assess risks both to individuals and to the environment. Fire doors had been held open and would not have closed in the event of a fire.
We found improvements had been made at this inspection. For example, flooring which could cause a trip hazard had been replaced. Fire safety had improved. At this inspection all fire doors were closed. People’s nutritional status was monitored and where concerns were identified action had been taken to address these. However, at this inspection we found improvements were required in relation to staff recruitment, staffing levels and deployment and the provider’s quality assurance arrangements.
The service has been rated as requires improvement for a third consecutive time. The Care Quality Commission will be monitoring improvements within the service.
There was a registered manager in post, who had been on planned leave prior to the inspection. 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.
Recruitment procedures did not ensure all appropriate checks were obtained before staff started working with vulnerable people. Staff were not always effectively deployed or available in communal areas to ensure people’s needs were met in a timely way. We have recommended the provider keep staffing levels and the deployment of staff at the service under review. The provider’s quality monitoring arrangements had not identified these shortfalls. Following the inspection, the provider confirmed they had successfully recruited a kitchen assistant, meaning care staff could spend more time with people using the service.
People using the service and their relatives said they felt safe at the service. Comments included, “I am definitely. For one thing, they make sure the doors are locked for safety” and “I feel safe, I have no worries.” A relative said, “From what I’ve seen it is incredibly safe. I’ve not seen anything I would think that’s not safe, they do it properly.”
People were protected from the risk of abuse. Staff had received safeguarding training, although some were due refresher training. They were aware of how to recognise and report safeguarding concerns. They were confident they could raise any concerns with the registered manager or provider.
Risks to people’s health and wellbeing were identified and plans were in place to mitigate risks without infringing on people’s liberty. The registered manager monitored incidents and accidents to make sure the care provided was safe. Where necessary action was taken to reduce risks. People’s medicines were safely managed and they received their medicines as prescribed. Emergency plans were in place to guide staff and emergency responders should an emergency happened. For example, a fire. Equipment and the premises were checked and serviced regularly to ensure safety.
People benefitted from a variety of meals to suit their tastes and promote their health and wellbeing. Menus considered people’s likes, dislikes and dietary needs. Staff supported people to access health care services such as their GP and community nurse, as well as specialist professionals such as speech and language therapists or dementia specialist.
Staff supported people to make their own decisions and to have as much control over their daily lives as possible. Where people did not have capacity to consent to their care and treatment this was assessed. Where people had their liberty restricted an application for a Deprivation of Liberty Safeguards (DoLS) had been made to the local authority. Staff demonstrated an understanding of the rights of people irrespective of their age or disability.
Staff were supported to carry out their role through a programme of induction, supervision, and training. Refresher training was due and planned for. We have made a recommendation in relation to the on-going delivery of staff refresher training to ensure all staff have the skills and knowledge to deliver effective care and support.
People said staff were kind and caring. Staff treated people with respect and in a friendly manner and ensure their dignity and privacy was maintained. People were encouraged to be as independent as possible.
People received personalised care that was responsive to their needs. Care plans reflected people’s needs and preferences. An activities person was employed for 18 hours per week. Activities provided were based on the needs and preferences of people. The provider had recognised activities could be improved and they were advertising for another part time activity person.
The provider had a complaints procedure and people and their relatives felt confident that any concerns would be dealt with. No complaints were raised during this inspection. The complaint records showed one complaint had been received by the service since the last inspection. This had been fully investigated and a full response was made to the complainant.
The service was well led by the registered manager; their assistant and the provider. Although we identified areas where action needed to be taken, these were being addressed.
People, relatives and staff were able to contribute to decision making in the home and described the management of the service as approachable and responsive. There were a number of audits and quality assurance checks regarding the safety and quality of the services, including seeking the views of people who lived at the home. Feedback from people using the service showed they would welcome more regular ‘residents’ meetings’.
We found two breaches 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 the report.