About the service: Highcliffe Care Centre provides accommodation and personal care for a maximum of 60 older people, including people who live with dementia or associated conditions. The service accommodated 52 people at the time of the inspection.

People’s experience of using this service: There were four breaches of regulation made at the last inspection with regard to good governance, need to consent, safe care and treatment and fit and proper persons employed. At this inspection it was found improvements had been made to the service and it was no longer in breach of its legal requirements.

People were safe and they told us staff were approachable. Staffing levels were sufficient to meet people’s needs safely and flexibly. Staff knew about safeguarding procedures.

Appropriate checks were carried out before they began work with people. People received suitable support to take their prescribed medicines.

People were cared for by staff who were kind and compassionate. The atmosphere within the home was friendly and welcoming. People and their relatives were involved and supported in decision making. People's privacy was respected and their dignity maintained.

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.

Staff had a good understanding and knowledge of people’s care and support needs. They received the training they needed and regular supervision and support. People were supported to access health care professionals when required. People had food and drink to meet their needs.

Risk assessments were in place which identified current risks to people as well as ways to reduce those risks. There was an open culture of learning when things go wrong. Staff worked well with other agencies to ensure people received appropriate care.

Activities and entertainment were available to keep people engaged and stimulated. People's views and concerns were listened to and action was taken to improve the service.

The manager monitored the quality of the service through audits and feedback received from people, their relatives, staff and external agencies.

The home was being refurbished and people were very positive about the changes taking place. Plans were in place to ensure it was becoming better designed to promote the independence and involvement of people who lived with dementia.

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

Rating at last inspection: The service was rated requires improvement (4 April 2018) and breaches of regulations were found. At this inspection improvements had been made and the service was no longer in breach of its legal requirements.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection and to follow up that improvements had been made.

Follow up: We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated good. We will continue to monitor the service through the information we receive.

This inspection took place on 4 and 7 December 2017 and was unannounced.

Highcliffe Care Centre 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. This home does not provide nursing care. At the time of our inspection there were 53 people living at the home.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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.

During this inspection the registered manager was absent and we were supported by the deputy manager and the regional manager.

We found the service had breached a number of regulations. The service had not undertaken the necessary checks to ensure staff were suitable to work with vulnerable people. Safety checks of equipment and premises were not routinely carried out. Risks to people were not always identified. People did not always receive their medicines as prescribed. People did not always receive support in maintaining their specific dietary requirements relating to moral or ethical beliefs.

The service failed to maintain suitable records for the management of the service. We also found that the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure that people received appropriate care and support.

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

The provider had systems in place to ensure people were protected from abuse and harm. Staff had completed safeguarding training. The service ensured appropriately trained staff were deployed to support people. Staff told us they received regular supervisions and appraisals.

People we spoke with were positive about the choice and quality of meals. People were supported to maintain good health and had access to healthcare professionals. People were able to make day to day decisions about where and how they spent their time. Care plans did not always reflect people’s current needs.

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.

The provider had a comprehensive activities program with both individual and group activities. People and relatives told us staff were kind and caring. People and relatives were involved in reviews of their care and support. Staff worked well together and were respectful of each other. People, relatives and staff were complementary about the registered manager and the deputy manager.

The inspection took place on 20 June 2016 and was unannounced. A second day of inspection took place on 24 June 2016 and was announced.

We previously inspected the service on 10 October 2013 and found the service met the regulations we inspected against at that time.

Highcliffe Care Centre is a two storey, purpose built care home that provides residential care and support for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 60 people using the service.

At the time of our inspection 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.

During this inspection we found the provider had breached a regulation. Pre-assessments were completed prior to people moving to Highcliffe Care Centre. This was to ensure the home could meet people’s needs. Clinical assessment tools were completed with people and their families on the day of admission. During the inspection we found these documents didn’t always correspond which impacted on people’s care such as pressure damage. Appropriate equipment was not always identified and implemented for people. For example, an airflow mattress for a person with a high risk of pressure damage.

Some records were inaccessible and could not be located by the registered provider. We have made a recommendation about information governance procedures.

People and their relatives told us they felt safe and well looked after living in the home. People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews.

Staff we spoke with were confident in their role in safeguarding people from potential abuse. Staff received regular training and were knowledgeable about the different types of abuse and the organisations procedure on safeguarding.

During the medicines round people were given the time and support they needed to take their medicines. Medicines were managed effectively with safe storage and appropriate administration. All records were complete and up to date with regular medicine audits being carried out.

We reviewed the rotas and saw staffing levels were consistent. Staff personnel files showed clear recruitment procedures had been followed and all staff had the appropriate checks in place.

The home had an emergency kit bag which contained records such as personal emergency evacuation plans (PEEPs), fire file and the service’s business continuity plan. It also included emergency equipment such as a light, a high visibility vest and an albac mat (to be used for vertical and horizontal evacuations for people with mobility issues).

Staff told us they completed an induction before starting work at Highcliffe Care Centre. Staff received regular training in areas such as safeguarding, moving and handling, safe handling and medicines and first aid. The home had identified champions covering areas such as dementia, wound care, nutrition and end of life.

Staff told us they received regular supervisions, as well as annual appraisals. Records we viewed reflected this.

The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place where appropriate.

We observed during mealtimes that people enjoyed their meals, some independently and others with support from staff. There were choices available for people and support was provided by staff with patience and at an appropriate pace to each individual.

Care plans were personalised, detailed and contained people’s personal preferences, likes and

People living in the home we spoke with said that they were happy with the service provided by the staff. One person told us that they had "No problems" and "They're really nice here and I have a good time” another said "They are always polite and kind”.

We spoke to a visiting relative who told us that they were very confident that their family member was being looked after. She told us that the care was "Excellent", another visitor, when asked about the care being given to their relative, said "I trust the staff; they are really good with my husband". Another said they found the staff were helpful and said the manager was "Really approachable”.

People living in Highcliffe Care Centre were living in a well maintained and decorated home which met their needs and gave them a pleasant place to spend their time.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people. For example the care records, environment, health and safety and the quality of the food being provided. Audits and regular checks were being used to monitor the quality of the service and identify any improvements which could be made.

People’s personal records including medical records were accurate, up to date and fit for purpose. Staff records and other records relevant to the management of the services were accurate and fit for purpose. Records were kept securely and could be located promptly when needed.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Those people living in the home we spoke with, said that they were happy with the service provided by the staff. One person told us that they had “No problems” and that they “Look after me well”. another said “The staff are lovely”.

We spoke to a visiting relative who told us that they were very confident that their family member was being looked after. She told us that the care was “Really good”. Another visitor, when asked about the care being given to their relative, said “I thank God every day that she is in here and not somewhere else” and another said they found the staff were helpful and “Would go out of their way” to make sure there relative was comfortable. All spoken to confirmed they had been involved in developing the care plan and were happy with the content of the document.

People told us that they were very happy with the service and they appreciated the staff and the managers. They told us that the meals were “Really nice” but there have been some changes and they were not sure what they would be being served today. A visitor told us that she and her relative were “Always happy” with the food. The relative told us that she had meals with her relative and they enjoyed all of the meals served.

People who lived in the home and visitors told us that they felt the staff could not do any more. They said that the care was very good and staff worked well with people. People said the manager was excellent and individual members of staff were said to be ‘considerate and thoughtful’.