This inspection took place on the 28 June, 03 July and 06 July 2018 and was unannounced.

Our inspections in December 2014, September 2015 and April 2016 found breaches of regulation and we took appropriate enforcement action in April 2016. This was because they had not sustained the necessary improvements needed to meet the breaches of regulation. We received an action plan from the provider that told us they would meet the breaches of regulation by December 2016. We carried out a comprehensive inspection on the 9 and 10 January 2017 and found that whilst there were areas still to embed in to everyday practice, there had been significant progress made and that they had met the breaches of regulation.

Whitebriars 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. Whitebriars provides care and support for up to 26 older people some who are living with a dementia type illness or memory loss.

The service had 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 undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service now met legal requirements. We found improvements had been made in the required areas.

The overall rating for Whitebriars has been changed to good.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks, including swallowing problems and risk of choking, and moving and handling. With preventive measures in place to reduce risk. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes. There were systems for the management of medicines and people received their medicines in a safe way. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

People were supported to eat a healthy and nutritious diet. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals. Staff had received fundamental training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health and mental health needs such as diabetes and dementia. People were supported to make decisions in their best interests. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good un

We inspected Coast Home Care (Whitebriars) on the 9 and 10 January 2017. This was an unannounced inspection

Coast Home Care (Whitebriars) combines a care home, known as Whitebriars and a Domiciliary Care Agency (DCA) known as Coast Home Care. The care home provides care and support for up to 26 older people some who are living with a dementia type illness or memory loss. People can also stay for short periods of time on respite (temporary) care. The staff team also supported three people who occasionally came for day care support. At the time of this inspection 21 people were living at the home.

The DCA provides home care services to people within the local area. Some need support with domestic arrangements. Most are living with some degree of memory loss and need a range of support with personal care. Visits range in number and time to suit individual need. At the time of the inspection, the DCA supported 41 people which included 20 people who received support with personal care. The DCA is run from a separate office within the care home with a separate staffing group.

We carried out an unannounced inspection on 03 and 10 December 2014 of both services where we found improvements were required in relation to the management of medicines in the care home. We received an action plan from the provider and returned to carry out a further inspection on 9 and 11 September 2015. At that inspection although some improvements had been made we also found that improvements were required in relation to risk management and record keeping. The provider sent us an action plan and told us they would address these issues by November 2015. We carried out an inspection of both the care home and DCA on 22, 25 and 26 April 2016 to check that the provider had made improvements and to confirm that legal requirements had been met. We found that the improvements had not been sustained and there were continued breaches of regulation. We took appropriate enforcement action at this time. We received an action plan from the provider that told us they would meet the breaches of regulation by December 2016.

This unannounced comprehensive inspection on the 9 and 10 January 2017 found that whilst there were areas still to embed in to everyday practice, there had been significant progress made and that they had met the breaches of regulation previously in breach.

Following the resignation of the registered manager, the provider had appointed a manager for both the care home and DCA. We received confirmation that the appointed managers had started the process to register with CQC. 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 have reported on the services provided by the care home and DCA separately under the evidence sections of the report.

Whitebriars

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Care plans reflected people’s assessed level of care needs and were based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cus

Coast Home Care (Whitebriars) combines a care home, known as Whitebriars and a Domiciliary Care Agency (DCA known as Coast Home Care). The care home provides care and support for up to 26 older people some who are living with a dementia type illness or memory loss. People can stay for short periods on respite care or can choose to live at the home. The home also supported three people who occasionally came for day care support. At the time of this inspection 20 people were living at the home.

The DCA provides home care services to people within the local area. Some need support with domestic arrangements. Most are living with some degree of memory loss and need a range of support with personal care. Visits range in number and time to suit individual need. At the time of the inspection, the DCA supported 41 people which included 20 people who received support with personal care. The DCA is run from a separate office within the care home with a separate staffing group.

We carried out an unannounced inspection on 03 and 10 December 2014 of both services where we found improvements were required in relation to the management of medicines in the care home. We received an action plan from the provider and returned to carry out a further inspection on 09 and 11 September 2015. At that inspection although some improvements had been made we also found that improvements were required in relation to risk management and record keeping. The provider sent us an action plan and told us they would address these issues by November 2015. We carried out this inspection of both the care home and DCA on 22, 25 and 26 April 2016 to check the provider had made improvements and to confirm that legal requirements had been met. Our inspection was unannounced to the care home and announced to the DCA.

The home and the DCA had a combined 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. An acting manager had been appointed to manage the DCA and they told us that it was their intention to register as manager for the DCA.

We have reported on the services provided by the care home and DCA separately under the evidence sections of the report.

Whitebriars

There was a lack of leadership and oversight of the home. Attempts had been made to improve auditing but this was done by four separate people in isolation with no oversight or analysis of the findings and no evidence that lessons had been learned when shortfalls were identified.

The management of medicines were not safe. The procedures for giving and signing of medicines were inadequate with lots of gaps in the recording of medicines so it was not always clear if they had been given. Medicines required in an emergency situation for one person were not held in the home.

When accidents and incident occurred these were not always explored fully to determine if care practices were safe and if further action should be taken to prevent further incidents.

Care documentation for people in receipt of day care was either not in place or provided very basic information. Record keeping in relation to fluid monitoring did not show that people had been adequately hydrated and equally there were gaps in the recording of the application of skin creams.

Despite the shortfalls and the fact that the home had been through an unsettled period with low staff morale, we found that the recent restructuring of the management team was still new and the provider, management team and staff were all committed to improving the shortfalls. Some staff told us that staff morale was slowly improving and although they thought there was a way to go they felt things were heading in the right direction. After our inspection w

People we spoke with told us they were able to choose what they did during the day. One person told us “I can do what I’m doing now, I can watch TV or I can go downstairs and join in with activities, singing and all that.” Another person told us that they “were not an activities person”, but they enjoyed staying in their room and doing what they wanted to. Another person told us they were able to go out independently when they chose to. Two people told us that they were “as happy as they could be” living at the home. They explained this by telling us they would prefer to live in their own homes but accepted they were unable to do so. Other people told us they enjoyed the trips out and would go as often as they could. People told us that food was generally good and they had a choice. One person told us the cook prepared specific meals for them each day.

Coast Home Care (Whitebriars) combines a care home and a Domiciliary Care Agency (DCA). The care home provides care and support for up to 26 older people who may be living with a dementia type illness or memory loss. People can stay for short periods on respite care or can attend the home for day care. Staff can provide end of life care with support from the community health care professionals but usually cares for people who need prompting and minimal personal care support. At the time of this inspection 24 people were living at the home.

The DCA provides home care services to people within the local area. This service is run from a separate office within the care home with a separate staffing group. The DCA provision was not included as part of this as no areas of concern have been raised about this service since the last inspection.

This inspection took place on 9 and 11 September 2015 and was unannounced.

The service had 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.

The provider had not ensured that robust health and safety checks were in place to ensure people’s safety. We found that windows were not restricted and all equipment did not have suitable safety checks completed. This meant that people may be at risk from injury from risks within the environmental and when using some equipment.

Information gathered about accidents and incidents was not used to review and respond to any trends within the home and the risks around people administering their own medicines were not managed to ensure associated risks were managed effectively. Staff knew people well and were able to tell us about the care they required. However, some care plans were missing or not up to date. This meant there was a lack of clear guidance for staff to follow to ensure consistent care. Some daily records were not completed in a consistent way others were poorly completed and did not promote safe and consistent care.

Systems for quality monitoring were not always effective to ensure the service was well managed in all areas.

Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of the staff and atmosphere in the home. People told us they felt they were safe and well cared and had their choices respected. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. People had access to health care professionals when needed.

Medicines were stored safely, all medicines were administered and disposed of by staff who were suitably trained.

There was a variety of activity and opportunity for interaction taking place in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager and provider.

People were very complementary about the food and the choices available. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home and this was promoted by the staff and management arrangements. Staff enjoyed working at the home and felt supported. People were encouraged to share their views though ‘residents meetings’ and satisfaction surveys.

We found two breaches 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 this report.