Archived: Ocean View Care Home

Ocean View 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 had a 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.

This inspection was unannounced and took place on 23, 25 and 30 April 2018.

The home had previously been inspected in November 2016 where it was rated Requires Improvement. At that time we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to how the home managed people’s medicines, the safety the environment, the safety of the staff recruitment processes and how the home monitored the quality of the service provided to people.

Following the last inspection, we asked the provider to complete an action plan to tell us what they would do to improve the key questions of safe and well-led to good. The provider sent us an action plan in relation to the actions necessary to meet the fire safety requirements but not one for the other areas for improvement we identified.

At this inspection in April 2018, we found people could not be assured they would receive safe care and treatment. We identified a number of issues in relation to the quality and safety of the support provided. These included issues around medicines administration, mitigating risks, care planning, staff training, opportunities for engagement, as well as the management of the home. Further improvements were necessary to the environment in relation to cleanliness and its suitability for people living with dementia, as well as safety issues such as trip hazards and limited handwashing facilities.

Prior to this inspection the home had been placed into “whole home” safeguarding process by Torbay and South Devon NHS Trust (the Trust). This meant the Trust had received information that people were at risk of harm and they were carrying out their own investigation and taking action to protect people where necessary.

Risks to people’s health and safety were not being managed well. Risk assessments and care plans did not always provide staff with sufficient information to guide them in their actions to protect people. Where guidance was provided this was not always being followed. For example, people requiring assistance from staff to manage their pressure area care and continence needs were not receiving an appropriate level of support. We found one person had been experiences harm and we made a referral to the Trust’s safeguarding team in relation to their care.

Some people’s medicines were not managed safely. While most people received these safely, we observed some unsafe practice. One person was not offered their medicines in a way that meant they were less likely to refuse them and we found unused medicines stored in open and unnamed pots in the medicine trolley. This meant people were at risk of not receiving their medicines as prescribed.

Some people had a high risk of falls. These people did not have an assessment or a management plan in place to mitigate these risks. The home’s accident records did not accurately reflect the number of falls one person had sustained. People’s risk of falling was increased due to the poorly maintained carpets. The join in the carpet in the lounge room and in a person’s bedroom, were coming apart causing a potential trip hazard.

The home was found to be unclean and, in places, offensive smelling. There were limited handwashing facilities in some bathroom and toilets. Some sinks did not have a hot water supply fitted and one where there was no sink, did not have hand-cleansing gel. The provider told us they had a refurbishment plan for the home. However, at the time of the inspection we found furniture and carpeting were unclean and some was in a poor state of repair.

The environment was not suited to the needs of people living with dementia. There was no signage around the home to help people orientate themselves and to find the toilets or the communal areas. There were no pictures on the walls and no items of interest for people to engage with or which could be used to stimulate conversation. People’s bedroom doors were indistinguishable from each other. The locks used on people’s bedrooms doors were not suitable for people with impaired dexterity or for those people who might not have the cognitive ability to open a lock and a door handle at the same time.

At the previous inspection in November 2016, we identified the home had failed to obtain disclosure and barring checks (police checks) for two members of staff. At this inspection, we found that although the home had undertaken the necessary pre-employment checks for a newly appointed member of staff, the home had failed to obtain a check for the staff identified at the previous inspection.

People were unable to tell us whether there were sufficient staff on duty to meet their needs. The registered manager and staff said there were sufficient staff available. However, during our observations, we saw staff only attend to people when providing them with support to eat and drink. Some people had not received support with their personal care. At times people were unsupervised in the communal areas, including those people who were at a high risk of falls.

Those people who were able to share their views with us said they felt safe at Ocean View. Staff had received training in safeguarding people from abuse as well as in the Mental Capacity Act 2005 (MCA). However, it was not clear that staff were always putting their learning into practice. Staff were not being supported to recognise the environment within which people were living was not respectful and did not meet people’s emotional and psychological needs. Staff spoke about people with affection and friendliness. However, people’s dignity and privacy were not always respected by the staff, registered manager and provider. We observed people sitting in their underwear and other people in an unkempt state and we heard derogatory remarks made about people.

We also observed good practice from staff and saw them to be friendly and caring when engaging with people individually. It was clear staff knew people well when engaging with them in conversation. People were seen to enjoy staffs’ company and those people who had limited verbal communication were seen to make eye contact with them and smile. Staff told us how much they enjoyed working at the home. One member of staff said they thought of the people living in the home as “family” and another said people were “loved” by the staff.

Staff told us they received regular supervision and had the training they needed. However, from our observations and from reviewing care records and those relate to staff training, we identified staff required further training to support people’s physical and mental health needs. People’s pressure area care, continence management, as well as their needs related to living with dementia and mental health conditions were not being appropriate or safely supported.

There were few opportunities for people to engage in leisure or social activities to provide stimulation and engagement. We observed people spending long periods of time without any staff involvement or engagement other than when they were being supported to eat and drink. When people were engaged in an activity or when receiving staff attention, it was clear they enjoyed this.

People told us they enjoyed the food provided by the home. People were offered a choice of meals and staff were aware of their preferences. Those people who required their food to be modified, such as pureed due to swallowing difficulties, received appropriate support. However, for those people at risk of malnutrition and dehydration, monitoring of their food and fluid intake was not effective in ensuring they received enough to eat and drink.

At the previous inspection in November 2016, we found the home’s quality assurance and monitoring systems were not effective and had failed to identify the concerns identified at that inspection. At this inspection, in April 2018, we found improvement had not been made and the home did not have effective systems in place to assess, monitor and improve the quality of the service provided. The registered manager told us feedback from people was sought, but there was no record of this.

The provider and registered manager told us they were committed to making improvements and recognised the home had not been providing the level of care and support it should. A staff meeting had been arranged for the third day of the inspection to discuss the changes needed to improve people’s experiences and to ensure they received the care and support they required.

We found shortfalls in the care and service provided to people. We identified 12 breaches in regulations. The overall rating for this service is 'Inadequate' and the service is th

This inspection took place on the 3, 4 & 7 November 2016; the first day of our inspection was unannounced. One adult social care inspector carried out this inspection. Ocean View was previously inspected in April 2014, when it was found to be compliant with the regulations relevant at that time.

The home had a 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.

People's medicines were not always managed safely; although the manager assured us people were receiving their medicines, records did not always match with what was held in stock. This meant we were unable to determine that people were receiving their medicines as prescribed. Where people were prescribed medicines to be given “as needed,” there was no guidance provided for staff as to when this should be used. Although staff had received training in the safe administration of medicines, their practice was not always safe. For instance, where specific medicines needed additional monitoring, staff did not always ensure best practice was followed. This had led to the home being unable to account for nine tablets. On the second day of the inspection, we found the medicines trolley had been left open and unattended. This meant the home did not have a robust system in place to ensure people or unauthorised staff could not access medicines. People were given time and encouragement to take their medicines at their own pace and staff always sought people’s consent. The home had appropriate arrangements in place to dispose of unused medicine. We saw medicine that required refrigeration was kept securely at the appropriate temperature.

People may not be protected from the risk of harm as they were living in an environment that may not be safe. Whilst some premises checks had been completed there were no recordings of water testing or water temperatures being carried out. These checks are important as they allow staff to monitor that water is at its optimum temperature to kill legionella bacteria and protect people from scolding when having a bath or shower.

Records showed that routine checks on fire and premises safety had not been completed in line with the home’s legal responsibilities. A fire risk assessment had been completed in June 2016 and an action plan had been developed in relation to providing fire detection and fire fighting equipment as well as a number of maintenance issues relating to the home’s fire doors. There was no record of any action having been taken to complete the requirements of the assessments. This meant the provider had known there were risks in relation to fire safety but had not taken action to resolve them. We have shared these concerns with Devon and Somerset Fire Service.

People were not protected by safe recruitment procedures as the arrangements for recruiting staff had not ensured all staff employed were suitable to work with vulnerable people. We reviewed staff recruitment and found the registered manager had not carried out Disclosure and Barring Scheme checks (police check) for two members of staff currently working at the home.

We looked at home’s quality assurance and governance systems and found the provider did not have effective systems to assess and monitor the quality and safety of the service provided at the home. The quality assurance and monitoring systems had failed to identify a number of concerns we found at this inspection. Whilst some premises checks had been carried out, risks to people's health and wellbeing had not always been identified, assessed or mitigated.

People said they felt safe and well cared for at Ocean View; their comments included “I do feel safe,” “I’m very happy,” “It’s ok, I have no complaints.” Relatives told us they did not have any concerns about people’s safety.

People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. These included safeguarding, first aid, pressure area care, infection control, moving handling, and food hygiene. Some staff had received additional training in the Mental Capacity Act and Deprivation of Liberty Safeguards.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People told us they were involved in their care and support, attended regular reviews, and had access to their records. We saw staff sought people’s consent and made every effort to help people make choices and decisions.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedure for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The home had a keypad system in operation to keep safe those people who would be at risk should they leave the home unaccompanied. Those people who were safe to leave without staff support were given the keypad number to the front door, ensuring that their legal rights were protected and they were not deprived of their liberty.

People's care plans were informative, detailed, and designed to help ensure people received personalised care. Care plans were reviewed regularly and updated as people's needs and wishes changed. People were supported to follow their interests and take part in social activities.

Risks to people's health and safety had been assessed and regularly reviewed. Each person had a number of detailed risk assessments, which covered a range of issues in relation to their needs, which included personal emergency evacuation plan (PEEP).

People told us they enjoyed the meals provided by the home. Comments included, “the food is good”, “very nice,” and “there’s always a choice.” The daily menu was displayed on a board in the main hallway and each morning care staff supported people to choose what they wanted for eat. People were freely able to help themselves to snacks and drinks when they wanted, and we saw people who were not able, being offered snacks and drinks throughout the day.

People, relatives, and staff spoke highly of the registered manager and provider, and told us the home was well managed. Staff described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns. The home had notified the Care Quality Commission of all significant events, which had occurred in line with their legal responsibilities.

We found three 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.

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. The summary is based on our observations during the inspection, speaking with four people who lived in the home, three staff who supported them, two relatives, speaking with the provider, the Registered Manager, speaking with one healthcare professional, and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. Several people told us they felt safe living in the home. During our inspection we spent 30 minutes observing people in the lounge. We noted the interactions were good and showed staff respected people at the home. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Registered Manager told us they had not needed to submit any applications since our previous inspection in October 2013. Proper policies and procedures were in place and we saw evidence that they had previously liaised with the local DoLS team. The Registered Manager understood when an application should be made, and how to submit one. Equipment such as hoists, lifts, fire alarm systems, and heating systems were well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

People who lived in the home told us they were happy with the care and support they received. Comments included 'the staff are very good here', 'I'm happy here' and 'I've got a roof over my head and something to eat, it's all ok'. Staff had received training to meet the needs of the people who lived at the home. We spoke with staff who were able to tell us how they met people's care needs. We observed the care provided and spoke with the people who lived in the home. This gave us evidence that staff knew people well. People's health and care needs were assessed. Where people were not able to make certain choices and decisions we found evidence that relatives, representatives, healthcare professionals and advocates had been involved in the care planning process. Regular care plan reviews were carried out to ensure they reflected people's current needs.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff were patient and went at the person's pace when assisting them with their mobility, food, and medication. We received information from a relative who told us 'the residents' welfare and happiness comes first and foremost, and everything is done in the best interests of the residents'. Another relative told us "I've been quite happy with the care". We spoke with a visiting healthcare professional who told us 'They're pretty good'.

Is the service responsive?

People's needs had been assessed before they moved into the home. The Registered Manager visited people and carried out an assessment to ensure the service was able to meet their needs. We saw the complaints procedure was available for people who lived in the home. Several people told us they felt able to speak to the Registered Manager or staff if they were unhappy about something. They felt confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

The service worked with other agencies and services to make sure people received their care in a joined up way. We spoke with a visiting healthcare professional who told us 'Any changes to medication or recommendations are followed through'. They did comment that the home didn't always contact them about continuing concerns. Staff told us they were clear about their roles and responsibilities. Staff told us they had regular meetings with the Registered Manager and Supervisor. Staff commented "The manager is very open, approachable and fair' and 'I can go to them for help. They will always be there for me'. This helped to ensure that people received a good quality service at all times.

When we inspected on 26 September 2013 we found that the provider had made improvements. They had obtained feedback from people who lived at the home, their relatives, staff and professionals who came into regular contact with the home. Records showed that positive feedback had been obtained and issues were being responded to. People's views were being analysed to inform an annual improvement plan. People who lived at Ocean View told us it was, "doing well" and "yes, it's fine."

The provider had begun to analyse incidents in order to identify trends. They had carried out necessary water safety checks, which had previously been lacking.

We found that people and staff interacted in a relaxed, friendly manner. Care workers were aware of the need to obtain consent for care. They had regard for the legal requirements to act in the best interests of those who could not make decisions themselves. Staff were scheduled to complete relevant training in the Mental Capacity Act in August 2013.

People's care needs had been assessed and care was delivered in line with those needs. We saw that reviews had been undertaken regularly. When people's condition had changed advice had been sought from health professionals and care plans had been updated accordingly.

The provider had systems in place to protect people from the risk of abuse. Staff had received training in the safeguarding of vulnerable adults. Where a concern had been identified the manager had responded appropriately. The provider also had effective recruitment procedures.

We found that the provider did not yet have robust quality assurance systems. Monitoring of the service was on an ad hoc basis and there was no analysis of incidents or people's feedback.