Ocean View Care Home (known as Ocean View) provides accommodation and personal care for a maximum of 25 people. People who live at Ocean View have dementia or mental health needs. Some people also have physical disabilities. The home does not provide nursing care. People who live at the home nursing and healthcare through the local community health teams. Accommodation is provided over two floors with a passenger lift providing access to the first floor. However, there are a number of rooms unsuitable for people with impaired mobility as they are accessed by stairs. At the time of the inspection, 17 people were living at the 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.

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Ocean View provides accommodation and personal care for up to 25 older people who may be living with a dementia or have needs relating to their mental health. At the time of our inspection there were 22 people living at the home. Ocean View does not provide nursing care. Where needed this is provided by the community nursing team.

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 conce

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. 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.

We inspected at Ocean View on 29 and 31 July 2013 and found that the provider did not have effective quality assurance systems at that time. We found that people had not had a recent opportunity to feedback their views about the quality of the care provided and to influence improvements. We also found that there had been no analysis of incidents in order to identify trends or risks.

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.

Ocean View was last visited by the Care Quality Commission in April 2011. The home was then known as Las Flores.

During this visit we (The Care Quality Commission) found that there was one outcome with which the provider was non-compliant. However, people living at the home that we spoke with were happy with the care they received and we did not see any practice that gave us cause for concern.

On our visit to the home we spoke with the manager and owner as well as two staff and eight of the people living there about the ways in which people were involved in making decisions about the services they received.

People we spoke with were positive about their lives and said they felt well treated. We heard staff address people appropriately, using their preferred names. Staff gave us examples of choices that they gave people such as what time they got up, where they ate, and how they spent their time.

We spent time observing the care being delivered to people, as not everyone was able to discuss the care that they received. We also looked at some care records to see how people’s care was planned and delivered. There was good information available about people's lives before they lived in the home, which enabled staff to get to know them as individuals. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We spoke with people living at the home about the food they received. They told us that they enjoyed the food and that there was always a choice. They also told us it was well cooked and plentiful. One person told us that they had been having 'trouble with their gums' and that the staff had offered them soft food like omelettes.

People told us that they felt safe and that they could talk to the staff about anything.

We toured the communal areas of the home and looked in some bedrooms. The home was clean and tidy throughout. However, the provider may wish to note that there was one area where there was a strong unpleasant smell.

We saw a list of training that staff had completed. We saw that Ocean View provided staff with a thorough ongoing training programme, which included First Aid, Food Hygiene and Moving and Handling as well as additional specialised training which relates more directly to the individual needs of people who live in the home, such as dementia. Staff told us that the manager was very approachable and that they could talk to her about anything.

People's care records were not always accurate and up to date.

19 people lived at Ocean View when we inspected. We spoke with 6 of those people and two other people's relatives. People were positive about living at the home. Comments included, "I'm fine here no problems, I get out around the town and I'm happy." Another person said, "I like to talk with the staff". A relative of one person described the home as,"a bit more relaxed and homely".

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.