This inspection took place on 20, 23 and 28 August 2018. The first two days of our inspection were unannounced. We returned to speak to the registered manager on 28 August following their return from annual leave.At our last inspection in August 2017 we rated the service as Requires Improvement and found breaches of regulations 12 and 17. The breaches concerned the safe administration of people’s medicines and the effectiveness of the provider’s quality monitoring system.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and effective to at least good. During this inspection we found continued breaches of regulations 12 and 17 and a further breach of regulation 16. The latter breach concerned the investigation of complaints.
Shoreline 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 home accommodates up to 43 people in one adapted building across two floors. At the time of inspection, there were 37 people using the service. The provider was developing a separate upstairs unit for people living with dementia type conditions.
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.
People received their oral medicines in a safe manner. However, the documentation failed to demonstrate that people were receiving their topical medicines (creams applied to the skin) as prescribed.
People were nursed in bed using bedrails without protective covers that would reduce the risks of entrapment therefore there was an increased risk. During our inspection bumper cushions were sourced for most people. A further delivery was required to ensure everyone was protected. Assurances were provided by the provider and the registered manager that all bedrails in use would have the necessary covers. Airflow mattresses to reduce the risk of people developing pressure sores were not routinely monitored.
We found complaints made about the service required more thorough investigation to prevent complaints of a similar nature being made in the future.
Fire service personnel visited the home during our inspection and found work was required to update fire safety. The provider stated they would follow the advice of the fire service and make the necessary changes.
Fluid intake charts did not include the target levels of fluid people could be expected to consume to maintain appropriate hydration levels. We found the staff had failed to complete people’s daily records to show the care and treatment they had provided.
People’s personal risks had been identified and risk assessments had been written to give staff the necessary guidance on how to keep people safe. However, we found the actions had not always been taken to mitigate the risks.
Following discussion with the provider and the registered manager about our findings they wished to point out that they would take whatever actions were necessary to make improvements.
Staff presented as kind and caring. We observed staff delivering compassionate care. However, this care was undermined by the failings of the service to keep people safe and document the care and treatment delivered to people who were living in the home at the time of our inspection.
People were complimentary about the food. The food served appeared appetising. We found mealtimes were very busy with people being left unsupervised in the upstairs dining rooms. We made a recommendation about reviewing people’s dining experience.
Communication systems were in place. The staff handover notes which staff used to pass on pertinent information between shifts did not direct staff to include useful information, relevant to each person’s care. We made a recommendation about this.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Pre-employment checks were carried out on staff before they began working in the service. This was to ensure staff were of suitable character to work with people needing support. Once employed in the service, staff were supported through an induction period. They received training and supervision from their line manager together with an annual appraisal.
The registered manager monitored people’s dependency needs to monitor the staffing levels on duty. Rotas’ showed there were consistent numbers of staff on duty each day to meet people’s needs.
People were offered activities each day to provide stimulation and engage them in activities which met their needs. Adapted equipment was in use for those people who did not have the dexterity to use small items.
Arrangements were in place for people to receive appropriate end of life care. The registered manager reviewed the death of each person in the care home to learn if the service could improve in the support they offered to people.
Surveys had been used to monitor the quality of the services. The largely positive results had been aggregated and were on display in the home.
Partnership working was in place with other professionals. Staff made referrals to other key professionals for their support and guidance in managing people’s care. The advice given by the professionals was incorporated into care plans and reviewed as necessary.
You can see what action we told the provider to take at the back of the full version of the report.