Lyme Bay View Residential Home

Lyme Bay View Residential Home is a large detached period property on the outskirts of Seaton overlooking the sea. The house has a large landscaped garden which people can access with support. They are registered to provide accommodation with personal care for up to 30 older people with long term medical conditions or memory loss. At the time of our inspection there were 24 people using the service. Four of these people were receiving respite care.

People’s experience of using this service and what we found

People told us they were happy living at the service and felt safe.

Medicines were managed safely. There were safe systems of recruitment in place. Staffing levels had been increased to make sure people's needs were met at all times.

Staff received safeguarding training and knew what to do if they thought someone was at risk.

Risks to people and the environment were identified and well managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and staff said the service was well led and they felt their opinions were sought and listened to. The registered manager worked alongside the staff and was very visible, they knew people well and focused on delivering person centred care.

The provider had systems in place to monitor the service and improve outcomes for people. The registered manager monitored accidents and incidents and identified any actions that needed to be taken to prevent future occurrences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update the last rating for this service was good (published 3 October 2019).

Why we inspected

The inspection was prompted in part due to the length of time since we last undertook an inspection and a new registered manager was in post. As a result, we undertook a focused inspection to review the key questions of safe and well led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyme Bay View Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 22 people living at the service during this inspection.

People’s experience of using this service and what we found

The service had improved since the last inspection, the provider had checks and audits in place to assess the safety of the service and identify problems which could be rectified. They had produced a Service Development Plan which identified and reviewed concerns and the actions being taken. The provider had been working with the local authority quality assurance and improvement team (QAIT), regarding putting in place a more robust quality monitoring process.

People lived in a service that kept them safe. Staff had been recruited safely and had received training on how to recognise and report abuse. Medicines were safely managed. There was appropriate control of infection processes in place which meant people lived in a home which was clean.

People at Lyme Bay View were valued as individuals and treated with kindness and compassion. Staff knew each person well and engaged positively with people throughout the day. Staff knew how to communicate with people, so people understood the options available to them.

People were very positive about the staff and said they were treated with dignity and respect and their visitors could visit at any time. They said staff were caring and kind. People’s care plans included information for staff about the support they required to meet their needs.

Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken.

People’s and relatives’ views were sought, and opportunities were taken to improve the service. Staff were supervised, supported and were clear about what was expected of them. People were cared for by staff who received regular training that was tailored to meet the needs of the people living in the service.

People’s needs and preferences regarding food and drink were known and respected. People were positive about the food they received. Comments included, “It's lovely food.”

People were supported to access healthcare services. Staff recognised deterioration in people's health and sought professional advice appropriately and followed it.

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.

People received personalised care to meet their needs. They took part in activities and pursued their hobbies and interests. People enjoyed a variety of social activities which included in house activities, trips out, social events and family visits.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it.

Procedures were in place for people to identify their wishes for their end-of-life care. This included any wishes they had for receiving future treatment or being resuscitated.

More information is in the full report.

Rating at last inspection and update: The last rating for this service was requires improvement (published 1 March 2017) and there were two breaches of regulations. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Following this inspection, the ratings for the service has improved and is now good.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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. On the first day of the inspection there were 23 people staying at the service.

We carried out a comprehensive inspection of this service in May 2016 and rated the service as requires improvement. There were no requirements issued, because the manager at the time who is now the registered manager had identified areas for improvement and developed an action plan. The registered manager has been at the service for 18 months but was registered with the Care Quality Commission (CQC) in March 2017. A registered manager is a person who has registered with 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 registered manager was very active within the service. They led by example and had a high level of expectation of the staff to deliver good quality care. They were supported by the owner who worked at the home each day. A new deputy manager position had been developed so there was someone who could undertake the managerial role when the registered manager took some planned leave.

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. People were able to be independent using the main staircase. A generic assessment had been completed and individual mobility assessments for each person to look at them as individuals and identify particular risks.

Flooring on the ground floor outside of the kitchen was in a very poor state of repair. A generic risk assessment had been completed regarding the risk to people and staff but had not looked at each individual in relation to their physical needs and the risk this flooring posed to them.

The provider had started to use a new computerised care system which the staff were getting used to using. Staff were regularly weighing people and recording their weights on the system and in a weights folder. However this was not populating the malnutrition assessment tool on the computer system, so staff might not have been alerted to people at risk of malnutrition. The registered manager confirmed they were aware and that they would revert back to paper assessments while they looked into this issue.

Some fire safety concerns were identified. Two fire doors were held open and would not have closed in the event of a fire. We also identified a fire exit door which had a key lock to exit; this had been agreed with the fire service. We were unable to open the door; however the owner was able to. It was apparent that the barrel had become worn; they replaced this between the two days of our visit. The registered manager said they would add checks of these locks to the fire checklist.

The provider had several assurance systems in place to assure themselves the service was running safely. However their systems had not identified these areas of concern in relation to safety risks.

People said they felt safe and cared for in the home. Staff had a good understanding of what constituted abuse and how to report if concerns were raised. There were sufficient, suitably qualified staff to meet people’s needs although there had been staffing difficulties which the provider was actively recruiting to fill. The registered manager and staff had been undertaking additional duties where there were gaps on the rota and they had been using the services of three local agencies where this was not possible. There were suitable recruitment checks in place.

There was a safe system to ensure the safe management of medicines at the service. Medicines were administered by staff who had been trained regarding medicine management. Staff had received regular supervisions and support with their performance and future development. New staff undertook an induction when they started working at the service. Staff understood their responsibilities in relation to the Mental Capacity Act (MCA) (2005) and Deprivation of Liberty Safeguards (DoLS). They gained people’s consent and maintained their rights.

People were supported to have a balanced and variable diet. Where people had specific dietary requirements these were catered for. People’s health needs were managed well and they saw health and social care professionals when they needed to and staff followed their advice.

Staff were very caring and kind. They treated people with respect and dignity at all times. There was a friendly atmosphere at the home and a culture led by the registered manager about it being the people’s home. People’s care plans on the provider’s computer system were personalised and guided staff how to meet their needs. These care plans were regularly reviewed.

There was a designated activity coordinator to support people to engage in activities that they were interested in. The registered manager had increased the provision of activities by implementing additional hours for a staff member to be able to undertake individual sessions for people in their rooms.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the registered manager. There had been one concern since our last inspection which had been investigated and where issues had been identified these had been learning. The registered manager was aware of their responsibilities in relation to the provider’s complaints policy and the action they needed to take. People, relatives and staff were asked their views and these were taken into account in how the service was run.

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. The home is a detached house near the town of Seaton in the coastal area of East Devon. On the first day of the inspection there were 23 people staying at the service, which included one person staying for a short stay referred to as receiving respite support.

We carried out an inspection of this service in August 2014. One breach of legal requirements regarding recording keeping was found. We returned in October 2014 and undertook a focussed inspection to check whether the requirement had been met. We found that the service was then meeting the requirement.

Several people at the home had a dementia type condition and we were unable to fully explore their experience of care and support through conversations. We spent time in communal areas observing the staff interactions with people and the care and support delivered to them.

One of the provider’s representative’s is also the registered manager of the service. They had decided to step down from this role and had submitted their application to deregister with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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 registered person had appointed a manager to manage the service. They were in the process of completing their application with CQC to become the registered manager at the service. The manager had been at the service for six months at the time of our visit. They were very visible at the service and undertook an active role. They were very committed to providing a good service for people in their care and demonstrated a strong supportive approach to people, their relatives and staff. They were supported by the provider’s representative who worked at the home each day and the registered manager.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. The staff and manager undertook additional shifts when necessary to ensure staff levels were maintained. When gaps were not able to be covered agency care workers were used.

The manager demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood that where people lacked capacity a mental capacity assessments needed to be completed and best interest decisions made in line with the MCA. They had recognised that mental capacity assessments had not been undertaken and were in the process of implementing new documentation. They were working with the local authority Deprivation of Liberties Safeguarding team (DoLS) to make appropriate applications to deprive some people of their liberties. Staff had a good understanding about giving people choice on a day to day basis and had received MCA training to help them understand their responsibilities.

People were supported by staff who had the required recruitment checks in place although there was not a clear system to ensure all checks were completed. Staff had received a basic induction. Not all staff had completed the provider’s mandatory training. The manager had recognised this and was working to ensure all staff had undertaken the training and a more thorough induction. They had helped a few staff enrol onto courses of higher qualifications in health and social care. The three senior care workers we spoke with were knowledgeable about the signs of abuse and how to report concerns. However only half of the staff had completed training in safeguarding of vulnerable adults.

People were supported to eat and drink enough and maintained a balanced diet. We had concerns that the monitoring of people’s diet and fluid intake was not being managed effectively. The manager put in place new fluid monitoring charts with an improved oversight of the amount of fluids people received. People and a visitor were positive about the food at the service.

People said staff treated them with dignity and respect at all times and in a caring and compassionate way. People received their medicines in a safe way because they were administered appropriately by suitably qualified staff. The manager had worked with the local pharmacist and put in place effective procedures and auditing.

People had access to activities at the service. People were encouraged and supported to develop and maintain relationships with other people at the service to avoid social isolation.

People’s needs and risks were assessed before and on admission to the home. Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s routines and wishes. However they were not updated with people’s changing needs. On the second day of our visit a new care file format had been put into place with more detailed care plans. These gave staff guidance about how to support people safely. The manager said these would be reviewed on a monthly basis or as people’s needs changed. People were involved in making decisions and planning their own care on a day to day basis. People said they were referred to health care services when required and received on-going healthcare support.

People were at risk of accessing chemicals. This was because they were stored in a cupboard which had a sign stating it should be locked. On two occasions the cupboard was not locked. We have made a recommendation about the safe storage of chemicals at the service.

The home had a homely atmosphere with no unpleasant odours. The premises were well managed to keep people safe. The provider had been undertaking a major refurbishment of the house, redecorating corridors and communal areas and replacing some windows.

The provider had a quality assurance and monitoring system in place. This included regular audits and annual surveys for the provider to assess the effectiveness of the service provided. The manager actively sought the views of people and staff through regular meetings. There was a complaints procedure in place which the provider was updating to reflect other outside agencies staff could contact. The manager had a clear understanding of how to respond to concerns.

This was a follow up inspection to look at required improvements which had been made in relation to records management, following our previous inspection in August 2014. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) detailing the improvements being made.

We found improvements had been made and care records for people living at the home were accurate and fit for purpose. This outcome is now compliant.

One inspector visited the home and spent approximately two hours there. At the time of the inspection there were 17 people who were living at Lyme Bay View and four people who were receiving short term respite support at the home.

During our visit we spoke with seven people who lived at the home. We also spoke with both of the providers, one of which is also the registered manager and three care workers. We looked at care folders and daily records of five people who were receiving care and support at the home.

If you want to see the evidence supporting our summary please read the full report.

The question we asked on this visit were:

Is the service safe?

We found the service was safe because care records were easily accessible and reflected accurately the care people required.

We saw risk assessments to identify risks for people had been completed correctly and care plans reflected the risks which had been identified.

Care workers we spoke with had a good understanding of where records were kept and how they reported and recorded the care and support people had received.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 19 people living at Lyme Bay View.

The summary is based on our observations during the inspection. We spoke with eight people living at the home, two visitors and a visiting district nurse to ask their views about the service.

We also spoke with both of the providers, one of which is also the registered manager and six staff.

The inspection was undertaken by one inspector over one day.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not safe because people's personal records including medical records were not accurate and fit for purpose. We looked at five people's personal care records and saw they had risk assessments which had not been completed and care plans and assessments which had not been reviewed in a timely way.

However we found the registered manager had prioritised people's safety by ensuring there were enough staff on duty with the appropriate qualifications, skills and experience required to ensure people's needs were met. Care workers we spoke with told us the staffing levels allowed them to meet people's needs. We observed during the inspection care workers had time to talk to people as well as complete tasks.

The home was clean and had processes in place to maintain a hygienic environment. We found the home to be free from offensive odours.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS). Although no DoLS applications had been made, the registered manager was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

The service was effective because the home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated. We saw there was a choice of suitable and nutritious food and drink available in sufficient quantities.

It was clear from our observations and from speaking with people and staff, that staff had a good understanding of people's care and support needs and they knew them well.

Is the service caring?

The service was caring because we saw staff had positive interactions with people. We saw staff approach people with respect and kindness. People were assisted in a manner that maintained their privacy and dignity.

There were opportunities for people to be engaged in activities. On the day of our inspection, we saw people enjoying the outside sensory courtyard garden and having nail care.

We spoke with eight people to ask their views of living at the home. Comments included, 'I am quite satisfied, on the whole they do a good job' and 'It's the happiest place I have been in for years'. 'Very happy here lovely views', 'Quite happy, I if I wasn't I would soon tell them' and 'I like the staff here, they don't nag me'.

Is the service responsive?

We found the service was responsive because Systems were in place to make sure the registered manager and the provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home took account of complaints and comments to improve the service. We were told by the registered manager because the unit was small and they were in day to day control at the home they tried to deal with any concerns which were raised at the time.

Is the service well led?

We found the service was well led because the registered manager was supported by a team of committed staff at the home. We were told by staff and people who used the service and their visitors they had confidence in the registered manager and provider and were able to approach them if they had any concerns. Comments included 'They are really approachable and are really supportive' and 'If I have a concern it is always dealt with' and 'It does get sorted out'.

We found the service had systems in place to regularly assess and monitor the quality of the service they provided. They regularly held residents meetings to gather the views of people who used the service.

Care workers told us they were clear about their roles and responsibilities. They demonstrated a good understanding of the ethos of the home. This helped to ensure people received a good quality service at all times.

People's health and welfare needs were identified and well met including wellbeing and social needs. For example, the activities co-ordinator ensured there were activities which suited individual abilities and personal preferences. People were able to go out for a walk with staff, join in an exercise session, spend time with staff on a one to one basis and staff were friendly and ensured that everyone was looked after in the way that was stated in the care plans. This meant care was personalised for individuals. One relative told us 'I can't fault them, they have made such a difference'.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw staff giving medication in a safe way, they received appropriate training and support and that risk assessments were in place.

People told us they felt able to voice any concerns or complaints. People spent time with staff which enabled them to speak on a one to one basis in private. Staff told us how they looked out for signs of distress or negative signs which could mean that someone was not happy with something but may be unable to directly voice concerns due to dementia. We saw the provider did not record or log informal concerns which would be helpful in ensuring they were looked at and actioned and could be audited for any recurring themes. There had been no recent formal complaints but complaint procedures were in place and people, staff and relatives knew about them although one address needed updating.

The service was complaint with all four outcomes that we looked at during this inspection.

There were 16 people living in the home at the time of our inspection. We saw people were able to move freely about the home where able and were comfortable in the company of the staff who supported them. We saw they responded positively to people who came into the home.

We heard from the people we spoke with and their visitors about how they were involved in deciding about their care treatment and support; and saw how people's care and welfare was provided with dignity and respect in line with their care plan.

The home was clean and tidy and we saw how the manager worked with other professionals to ensure people received appropriate support and that their safety and welfare was protected.

Staffing levels, skills and experience were appropriate to meet the needs of people living in the home.

The provider routinely checked and monitored the services they provided and used the information from those checks to improve their services.