Shoreline Nursing Home

Shoreline nursing home is a care home which provides nursing and residential care to older people and young adults with physical health conditions and dementia. The home can support up to 43 people. At the time of the inspection they were 37 people living at the home.

Shoreline is a large adapted building over two floors. There are two areas of the home for people with nursing and residential care needs and there is one area for people living with dementia.

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

People were safe living at the home. They received good care which met their individual needs. One relative said, “I'm very happy with [person’s] care. I can't fault it. All of the staff are good. Nothing is ever too much trouble. Staff are very accommodating. They listen and are willing to try suggestions. Communication from the home is good.”

The systems in place to make sure people received good care were effective. Leaders were open and transparent. Staff were skilled to deliver the right support to people, which ensured positive outcomes in relation to their care.

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 requires improvement (published 10 April 2020). The provider completed an action plan after the last inspection 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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9 and 10 March 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when they would to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contained those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

Shoreline nursing home is a care home which provides nursing and residential care to older people and young adults with physical health conditions and dementia. The service can support up to 43 people. At the time of the inspection 40 people were using the service.

Shoreline is a large adapted building over two floors. There are two units for people with nursing and residential care needs and there is one unit for people living with dementia.

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

Good improvements had taken place since the last inspection. The provider had made changes to the running of the home. People, relatives and staff said they were much happier and the quality of care at the home had improved. One person said, “It’s a nice, friendly atmosphere here and the [registered] manager and owner are both approachable. I'd recommend here, no problem at all.”

Quality assurance procedures needed continued development. Good leadership was in place which supported people to achieve positive outcomes and improved staff morale. Feedback had been used to drive improvement. The home had good links with the community.

People said staff kept them safe. Continued improvements were needed in the management of risk. The provider had improved oversight of the service and this had led to lessons being learned. There were enough staff on duty to support people safely. People were supported with their medicines, however we made a recommendation in relation to medicine records. The home was clean.

Staff with the right skills and experience supported people with all aspects of their care. Staff knowledge of mental capacity had improved. Continued improvements had taken place in the environment.

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 said they were well cared for by staff who knew them well. Staff were responsive when people’s needs changed, and care was dignified. People and staff spoke positively about each other. People were involved in all aspects of their care, and staff supported people to be as independent as they could be.

People received individualised care and support from staff. The quality of care records had improved. Good procedures were in place to support people with end of life care. People said they had many opportunities to have social contact with people. People knew how to make a complaint and were confident that it would be addressed.

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 inadequate (published 20 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made. The provider remained in breach of regulations 12 and 17.

This service has been in Special Measures since 17 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection to review the warning notice issued followed the last inspection. We completed a comprehensive inspection to review all of the improvements which the provider said they had carried out.

Enforcement

The requirements of the warning noticed have been addressed. However, we have identified breaches in relation to the management of risk, record keeping and quality assurance processes.

Please see the action we have told the provider to take at the end of this report.

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.

Shoreline nursing home is a care home which provides nursing and residential care to older people and young adults with physical health conditions and dementia. The service can support up to 43 people. At the time of the inspection 40 people were using the service.

Shoreline is a large adapted building over two floors. There are two units for people with nursing and residential care needs and there is one unit for people living with dementia.

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

People were not supported in a safe way. An incident had not been dealt with safely. Staff did not carry out observations of people for safety within agreed timeframes. These actions increased the risk of harm to people. Staff at all levels did not understand risk and were not responsive to risk. Records to keep people safe were not always accurate and needed to be improved.

The quality of the service had deteriorated since the last inspection. Action plans and quality assurance measures had not resulted in improvement. Staff failed to follow the policies in place and a system of reporting incidents had not been robustly followed. There was an overall lack of oversight of the service which increased the risk of potential harm to people.

Staff were not supported to carry out their roles safely. The failings at the service demonstrated that staff did not understand or apply their training. Decisions were made to people’s care without support from health professionals and recommendations from them were not applied correctly. Improvements to the environment had been taking place; continued improvements were needed.

Staff did not have a sound understanding of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care records did not support the delivery of care. People said they were happy with the activities in place. Staff raised funds to provide activities. Positive feedback had been received in relation to end of life care.

There was a lack of recognition when people were non-compliant with their care. This meant care was not consistently dignified. Some people experienced gaps in their hygiene because staff with the necessary skills were not on duty to support them. People and relatives said care staff were kind and compassionate. People were involved in their care; however records did not always support this.

People were very positive about the care and support which they received from staff. They said they were happy with all aspects of their care. Relatives were generally positive. Where concerns were raised from relatives, they had started to be addressed during inspection.

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 requires improvement (Published 10 October 2018). We met with the provider following the last inspection. They completed an action plan to show what they would do and by when to improve.

At this inspection we found the service had not improved. This meant the provider was still in breach of regulations. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to providing safe care to people and ensuring care is dignified; ensuring staff with the right knowledge and experience are on duty and support for staff to carry out their roles. We also identified breaches in relation to record keeping and maintaining the quality and oversight of the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider and registered manager to review progress since the inspection. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

Shoreline Nursing Home is a large two storey property, pleasantly located on the seafront at Redcar. The service provides care and support for people who require nursing and personal care. It is registered to accommodate up to a maximum of 44 people and at the time of our inspection there were 41 people using the service.

At the time of our inspection the home did not have a registered manager in place. 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 were informed that the previous manager had left the service on 9 June 2017 and that a new manager had been recruited but was currently working their notice elsewhere. Following the inspection we received confirmation that the new manager had taken up the role on 24 July 2017.

The service was last inspected on 4 February 2015 and was found to be in breach of Regulations 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because some staff training had not been completed and mental capacity assessments had not been carried out on people. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found these issues had been addressed.

During this inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because systems in place to monitor the quality of the service were not always effective in generating improvements. People’s feedback was sought via an annual survey but this was not analysed to look for common themes which could lead to improvements in the service. Records relating to the care and treatment of people using the service were not always accurate or complete.

You can see what action we told the provider to take at the back of the full version of the report.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety although the certificates for some of these checks were not on site at the time of our visit.

People’s care plans were not always fully completed or up to date. They contained information on tasks staff were to perform to provide care but were not always written in a way to describe people’s likes, dislikes and preferences. Care plans were regularly reviewed but were not being audited.

Appropriate systems were in place for the management of medicines so people received their medicines safely.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

Risks to people’s safety had been assessed and reviewed. Risk assessments had been personalised to each individual and covered areas such as nurse call failure, moving and handling, tissue viability and choking. This enabled staff to have the guidance they needed to help people to remain safe.

We saw from records and observations that there were sufficient staff on duty however some agency staff were being used and people we spoke with felt staff were busy and stressed.

We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

We saw staff had received supervision on a regular basis and an annual performance development review.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. Capacity assessments were being undertaken when necessary.

We saw people were provided with a choice of healthy food from a balanced menu and a plentiful supply of hot and cold drinks were served throughout the day. The mealtime experience was calm and unhurried but there was very little interaction between people and staff in one of the dining rooms.

People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Staff knew people well. People told us they were happy and felt very well cared for.

We saw there were plenty of activities going on within the service. Activities staff encouraged participation or engaged with people on a one to one basis to prevent social isolation.

The provider had a system in place for responding to people’s concerns and complaints and we saw evidence of this being used effectively.

Staff meetings were held regularly and staff told us they felt able to contribute their ideas regarding the positive running of the service. The views of the people using the service were also sought via resident meetings and used to make improvements.