This comprehensive unannounced inspection took place on the 13 and 16 February 2018.

Continuing Care Services t/a The Promenade is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is located in the seaside town of Hornsea, in the East Riding of Yorkshire. Accommodation is provided in single and shared bedrooms for a maximum of 24 older people, some of whom may be living with dementia. During this inspection the service was fully occupied.

The service had 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 and associated Regulations about how the service is run.

At the last inspection on the 26 July 2017 the service was rated 'Requires Improvement' overall. We issued a requirement notice for a continued breach in Regulation 12, safe care and treatment, and a warning notice for a continued breach in Regulation 17, good governance. You can read the report from our last inspections on our website at www.cqc.org.uk. After the inspection the provider completed an action plan explaining what they would do to meet the requirements of the regulations.

During this inspection we saw evidence to confirm that the service had improved and achieved compliance with Regulation 12 and Regulation 17.

The registered manager, deputy manager and staff had worked hard to introduce new systems and procedures. Medicines systems had been reviewed and quality monitoring of the service had been developed and strengthened. Records had improved and were clear about people’s consent and consultation.

People received their medicines safely as prescribed. The provider had reviewed and improved their practice to record topical medicines. Following the last inspection a full review of people’s topical medicines had been completed. Topical medicine application records were used that included a body map to record the application of creams prescribed for use, 'as and when required'. Daily checks for completion had been implemented and were carried out by senior staff, and the registered and deputy manager completed monthly audits of these records. There was a clear procedure for receiving medicines into the service and accurate records were kept of each prescription, the name, strength, route and quantity of the medicine, and when it was received by the service.

Regular audits were carried out to identify any shortfalls in practice and we saw people were encouraged to share their views about the service. The service worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

A recent survey had been issued to gain the opinion of people and their relatives about areas of the service provision. We found the service had received a positive response to the questions asked which the registered manager had evaluated. Staff felt supported by the management team and spoke positively of working at the home. They received on-going training and support they needed to assist people effectively.

Risks to people had been identified and assessed and care plans contained guidance for staff in terms of how to support people. Other care plans contained detailed guidance regarding how to safely support people.

People told us they felt safe living at the home and staff were trained in recognising and understanding how to report potential abuse. There were sufficient staff available to meet people’s needs and safe recruitment procedures were followed in order to ensure the suitability of workers.

Information about people’s health needs and contact

This inspection was carried out on 26 July 2017 and was unannounced.

Continuing Care Services t/a The Promenade is a care home which provides accommodation for up to 24 people. We will refer to the service as ‘The Promenade’ throughout this report.

The Promenade supports older people, some of whom may be living with dementia. The service is located in Hornsea, in the East Riding of Yorkshire. Accommodation is provided across two floors with a stair lift to provide access to the first floor. There is a garden with seating at the rear and the front of the property looks directly over the sea. At the time of our inspection there were 23 people living at The Promenade and three people using the service for day care.

At our last inspection in May 2016, we found two breaches of the Health and Social Care Act 2008. These related to safe care and treatment and good governance. We rated the service as requires improvement. The registered provider sent us correspondence on 22 July 2016 in the form of minutes from a meeting which stated what action the service would take to address the issues.

At this inspection we found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance and an additional breach in relation to requirements as to display of performance assessments.

The service had a manager who was registered in post in September 2016. 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. The registered manager was present during this inspection. The registered manager will be referred to as 'manager' throughout the report.

There was a positive atmosphere at The Promenade and people told us how much they liked staying there. Staff were friendly, helpful and were all positive about their experience of working at the service. The manager had only been registered as the manager for a short time when we inspected but demonstrated she was committed to changing systems and processes to improve the service delivered to ensure they met their regulatory obligations. However, we identified continued shortfalls and omissions with the recording and management of medicines.

We found not all of the changes made to the processes and audits had been robust and did not identify the issues highlighted during this inspection. Consent, consultation, medicines management and quality assurance processes needed to be strengthened to ensure people received a consistent and safe service.

The manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC as required. Copies of the most recent report from CQC were on display at the service. However, we noted when planning this inspection that the current CQC rating for the service was not accessible through the registered provider's website. This meant any current or prospective users of the service, their family members, other professionals and the public could not easily assess the most current assessments of the provider's performance.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted. The principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were not always being followed. Capacity assessments were not always carried out and peoples consent was not always sought.

People told us they felt safe at The Promenade and we saw there were systems and processes in place to protect people from the risk of harm. Staff were clear about how to recognise and report any suspicions of abuse and risks to

This inspection took place on 12 May 2016 and was unannounced. At our last inspection of the service on 9 April 2014, the registered provider was compliant with all of the regulations we checked at that time.

The Promenade is located in Hornsea and is close to local transport links. The service has places for up to 24 older people who may have memory impairment. Bedrooms are shared across two floors and a chair lift provides access to the rooms on the first floor. The front of the property looks directly over the sea and there is a conservatory viewing area. There is a large garden to the rear of the property with an outside seating area.

The registered provider is required to have a registered manager in post and on the day of the inspection, there was a manager in place, although they were not registered with the Care Quality Commission (CQC) and had not yet submitted an application for registration. A registered manager is a person who has registered with the 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 recording of medicines was not managed appropriately in the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations

2014.

We found that quality assurance systems were not currently in place and therefore issues of concern in relation to care planning, medication and notifications had gone undetected. Record keeping within the service also needed to improve. This was a breach of Regulation 17 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.

The manager understood the Deprivation of Liberty Safeguards (DoLS). However, we found that the Mental Capacity Act 2005 (MCA) guidelines were not always followed. We have made a recommendation about this in the report.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes. Staff did not use restraint, and this was confirmed during conversations with staff.

People's nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People told us they were well cared for. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living at the service. People were able to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported. However, we found that some care plans did not accurately reflect people’s current level of need.

People were offered a variety of different activities and were supported to go out, when possible, to access facilities in the local community, although people did indicate they would like more outings.

Systems were in place to record comments and complaints and people and their relatives had opportunities to provide feedback about the service. However, we saw that actions in relation to comments and suggestions needed to be more accurately recorded.

Our inspector visited the service and assessed nine essential standards of quality and safety which helped us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them 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 that used the service had effective care plans in place to ensure they received the care they required to meet their needs safely. We found people that used the service were protected from the risk of abuse or harm. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and one application had been submitted in the last year. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

The premises were safe, clean and hygienic. Equipment was well maintained and serviced regularly, therefore not putting people at unnecessary risk.

Is the service effective?

Peoples' health and care needs were assessed with them, and they were involved in writing their plans of care. Care was only given to people when they consented to it. Specialist dietary, mobility and equipment needs had been identified in care plans where required. A complete review of the food provision meant people received an improved and more effective service and so their nutritional needs were well met. People said that care plans reflected their current needs.

Peoples' needs were taken into account with the layout of the service, which enabled people to move around freely and safely. They were effectively assisted with their mobility needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. This was particularly evident at lunch time when we observed staff assisting people with their meal. People commented, “I'm quite happy here", "I am treated well and the staff are very helpful" and "The care I get is highly satisfactory".

Peoples' preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with peoples' wishes.

Is the service responsive?

People received the care they needed in line with the information that had been assessed and recorded in their care plans. People were treated as individuals and their personal likes and preferences were well known by the staff group.

People knew how to make a complaint if they were unhappy. People said that they had not needed to make a complaint but knew who to talk to about their concerns. We looked at how complaints had been dealt with, as there were records of two complaints made in the last twelve months. We found that they had been satisfactorily addressed and the responses had been open, thorough, and timely. People were assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The manager had ensured people that used the service had a detailed care plan in place and that all staff were clear about their responsibilities to follow these.

People that used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. However, staff told us they did not have any involvement in the system.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and they clearly understood their responsibilities to deal with complaints. All of this helped to ensure that people received a good quality service at all times.

Our inspection took place just two weeks after a new manager had commenced in their post and so we found they had already initially reviewed the service and had identified areas of the service they wished to improve upon. We found the home was compliant. However, we have used the 'provider may wish to note' comments to highlight where further work was needed to ensure the provider sustained this compliance. We had confidence the manager was aware of the regulations and knew where they wanted to implement changes and improvements.

We found that people that used the service received satisfactory care and support that met their needs and respected their rights. People told us they were happy living at the Promenade. They said, "We are treated well", "Staff look after us very well and are always there" and "Staff are kind to us and treat us with respect."

We found that there were suitable and safe systems in place for the management of medication.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. We acknowledged that the manager was new in post and planned to ensure that all future staff recruitment met the requirements of regulation 21.

There was an effective quality monitoring system in place to obtain peoples' views. There was an effective system in place to support the manager which was supplied by the provider.

We visited The Promenade on 6th November 2012 following an inspection in July 2012 that identified several issues. This visit was to look at the areas raised specifically in the first inspection and included care plans and risk assessments being reviewed and updated, accident forms and various other records being completed correctly, quality assurance and audit systems, and further input and support for the registered manager of the home from the provider.

As this was a follow up visit to look at specific areas, we did not speak to people using the service or staff, as this had been done in the previous inspection.

We saw that the manager and staff had made good progress in updating paperwork and files, and that these were now fit for purpose. Regular reviews were being carried out, and people now had care plans that were reflective of their current needs. Analysis of accidents and incident was now occurring more effectively, and relatives were being informed more effectively following any incident.

We had asked the provider to produce an action plan following the initial inspection. The action plan did not address a lot of the issues raised in the inspection, and it was clear that some of the actions in the plan had not been followed through effectively by the provider at the time of our further visit.

We spoke with seven people in the home and they told us they were quite happy living there. They told us they thought the staff upheld their privacy and dignity and respected their rights.

They said they had opportunities to make their own decisions on a daily basis and that the staff provided them with the care they needed when they asked for it.

People told us they were satisfied with the arrangements for handling their medication and finances and that they enjoyed their independence.

They said they felt safe living at The Promenade and that they had confidence their belongings were secure. Any concerns, they said they would tell the manager, staff or a relative.

People at the home described it as ‘lovely’. They enjoyed the garden and the aviary. People enjoyed the meals and knew that they could ask for alternatives if they wished. They said that if they had a grumble, complaint or concern, that they would go straight to the manager.