This inspection took place on 20, 23 and 28 August 2018. The first two days of our inspection were unannounced. We returned to speak to the registered manager on 28 August following their return from annual leave.

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 expe

We inspected Shoreline Nursing Home on 27 June and 6 July 2017. The inspection was unannounced. This meant that the staff and provider did not know we were coming.

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 require

We inspected Shorline Nursing Home on 4 February 2015. This was an unannounced inspection. which meant that the staff and provider did not know that we would be visiting.

This is a first inspection of a newly registered service. Shorline Nursing Home is an established service which had been registered previously under a different provider. The service provides personal and nursing care for up to 44 people. The majority of people were older people. The service is purpose built and is situated on the sea front in Redcar.

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.

There were systems and processes in place to protect people from the risk of harm. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

There were individual risk assessments in place. These were supported by plans which detailed how to manage the risk. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that the registered manager had commenced a programme of supervision with staff. The registered manager had planned appraisals with staff.

We saw that there were some gaps in the training that staff had received. We saw that 70% of staff had undertaken health and safety training and that 68% of staff had undertaken training in fire. Records showed that 49% of staff had undertaken training in safeguarding in the last 3 years. We saw that only 8% of staff had undertaken training in the Mental Capacity Act 2005 and that 3% of staff had undertaken training in food hygiene. At the time of the inspection very few staff were trained in first aid. We pointed this out to the office administrator who immediately arranged training. Following the inspection we received information which showed that 63 % of staff have now received training in first aid. We were told by the provider that they were committed to ensuring that all staff were fully trained. They told us that when they took over the service in June 2014 many of the staff had not received training for some time. They told us that since June they had organised a large amount of training and that they were committed to ensuring that all staff were fully trained in the very near future.

People told us that there was enough staff on duty to provide support and ensure that their needs were met

Staff were not assessing the capacity of people who used the service prior to making an application a Deprivation of Liberty Safeguarding (DoLS) order. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

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

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people. When people became anxious staff supported them to manage their anxiety and also provided reassurance.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However, some needed further detail to ensure care and support was delivered in a way that they wanted it to be.

People’s independence was encouraged and they were encouraged to take part in activities and outings. At the time of the inspection the service was in the process of interviewing for an activity co-ordinator to plan and take part in activities and outings.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.  These regulations have been replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we took at the back of the full version of this report.