Archived: Lyme Regis Nursing Home

Lyme Regis Nursing Home is a residential care home providing personal and nursing care to up to 27 people. The service provides support to older people with a range of nursing needs; some of the people living in the home are living with dementia. At the time of our inspection there were 25 people using the service.

People's experience of using this service and what we found

People, staff and a visiting professional all told us about the ongoing positive impact the manager was having on the home.

People lived in a home where monitoring, oversight and strong leadership were ensuring that the safety and quality of the care they received was reviewed and improved.

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

Rating at last inspection and update

The last rating for this service was requires improvement (supplementary report published 6 June 2023). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 17.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lyme Regis Nursing Home is a residential care home providing personal and nursing care to up to 27 people. The service provides support to older people with a range of nursing needs; some of the people living in the home are living with dementia. At the time of our inspection there were 20 people using the service.

People's experience of using this service and what we found

People and staff all told us about the positive impact the manager was having on the home. We identified areas for further improvement; however, significant improvements had been made to the risk management systems within the home.

People lived in a home were environmental risks were substantially better managed, and were supported by staff who understood the risks they faced. Staff were confident in how they reduced the majority of these risks.

Staff received support and guidance to ensure people received safe care and treatment. they valued this support and were proud of their work.

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

Rating at last inspection and update

The last rating for this service was requires improvement (supplementary report published 6 June 2023). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 12.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lyme Regis Nursing Home is a residential care home providing personal and nursing care to up to 27 people. The service provides support to older people with a range of nursing needs; some of the people living in the home are living with dementia. At the time of our inspection there were 23 people using the service.

People’s experience of using this service and what we found

The home had recently had a change of manager. A new manager started their employment on the second day of our inspection. They were visiting the home on our first visit. The new manager spent time meeting people and modelling good person centred care during our visits.

People were not always supported to have maximum choice and control of their lives and staff did not always supported people in the least restrictive way possible and in their best interests; despite the policies and systems in the service supporting this practice. We have made a recommendation about the implementation of the Mental Capacity Act (MCA) code of practice.

A program of audits had been developed and completed. However, these audits and the oversight in place had not identified all the areas of concern identified during our inspection. Areas for development that had been identified and addressed previously had not been maintained.

Environmental risks were not always managed sufficiently to protect people. Fire doors were not working effectively at the start of our inspection and some parts of the home were not clean and secure. The manager and provider were responsive to our concerns. Risks to people were regularly reviewed. However, we identified some risks had not been assessed appropriately and the oversight of risks associated with safe eating and drinking was not sufficient. We also identified specific risks to people due to care plans not being followed. We heard from people who had been distressed by the way risks were managed. The manager and clinical lead began to address these issues during our inspection.

There were enough safely recruited staff to meet people’s needs, we did note the communal area was sometimes not supervised by staff when people were spending time there.

People received their medicines safely. Accidents and incidents were managed appropriately. Each accident or incident was reviewed by the clinical lead to ensure staff had taken appropriate action.

People were supported by staff who had received safeguarding training and understood how to report concerns. Two people raised concerns with us about situations that had caused them distress. We shared these with the new manager, and they responded to these appropriately.

People and their relatives were positive about the home and the way staff cared for people.

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

Rating at last inspection

The last rating for this service was requires improvement (published August 2022).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about consistent oversight. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the oversight of eating and drinking and effectiveness of fire doors, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. The manager was responsive and put measures in place to reduce risks during our inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and recommendations

We have identified breaches in relation to the management of risk and the management of the home.

Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about the implementation of the Mental Capacity Act Code of Practice.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lyme Regis Nursing Home is a nursing home providing personal and nursing care to up to 27 people. The service provides support to older people with a range of nursing needs; some of the people living in the home are living with dementia. At the time of our inspection there were 19 people using the service.

People’s experience of using this service and what we found

Although the provider had made improvements at the service since our last inspection, not enough time had passed for the changes to be embedded at the service during this inspection. The Care Quality Commission (CQC) need to be assured going forward the provider's quality monitoring systems and oversight will continue, and effectively identify concerns.

The provider had produced an action plan reflecting the improvements required by CQC, the Clinical commissioning group (CCG) and local authority. This was monitored and updated regularly by the management team and helped to promote further improvements.

People and their relatives said the service was safe. They told us, “I feel safe with the staff. They are pretty good” and “I am absolutely safe. The staff are very careful with me”. People were receiving a safer service because risk assessments had been reviewed and updated and were used to help minimise risks associated with people’s health and support needs.

People and their relatives were being involved in the development of more person-centred care plans. A relative told us, “I have recently read (loved ones) care plan and can honestly say that this truly reflects the high level of care and attention which (they) have received”.

Risks relating to fire safety had been addressed since the last inspection. The service had been visited by a fire safety officer on 30 June 2022, who confirmed work had been completed to meet the Fire Safety Order issued by the fire service.

Improvements were seen in relation to staffing. The staff team had stabilised with the use of regular agency staff. This meant people received care from regular staff they had got to know and trust.

People received their medicines as prescribed, including topical creams.

Staff had a good understanding of recognising signs of abuse and felt confident any safeguarding concerns reported were listened and responded to.

We were assured the service were following safe infection prevention and control procedures to keep people safe. Work continued to improve the general environment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had developed a new admissions process for staff to follow to ensure robust initial assessments were made to be able to confirm people’s needs could be met by the service.

People had access to health care professionals. The management team were building relationships with local health professionals and where necessary, made referrals for additional advice and support.

Staff said they were well supported and had received training to help them work safely. They reported improved communication, team working and staff morale.

The management team had improved communication with people and their relatives. People's relatives told us they were more informed about changes and felt involved in their loved one's care and support. One relative said, “I have total confidence in the staff, and we are very grateful for them all here”.

Work continued to develop a positive person-centred culture. The management team had introduced new ways to ensure people received the care and support they preferred and required.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 27 April 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 16 February 2022. Six breaches of legal requirements were found. These were, person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, need for consent, staffing and good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lyme Regis Nursing Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lyme Regis Nursing Home is a nursing home providing personal and nursing care to up to 27 people. The service provides support to older people with a range of nursing needs; some of the people living in the home are living with dementia. At the time of our inspection there were 25 people using the service

People’s experience of using this service and what we found

People lived in a home that had undergone substantial management and staff changes. The last registered manager had left in November 2021 and since this time there had not been stable management. The turnover of staff had been high with agency staff providing the majority of hours. A new manager was appointed during the course of this inspection.

People told us the staff were kind and helpful we saw this was the case. We also saw that they were busy and there was a focus for staff on getting through tasks. People did not always receive the right care for them. Assessments of need and the resultant care plans did not contain detail about people’s preferences for how their care was delivered or detail about their care.

People lived in a home where risks were not effectively or sufficiently managed and this placed them at risk of harm or injury. The Fire Service had issued a safety order. The provider had three months to make the improvements required by the Fire Service. Risks associated with environment including cleanliness were not managed sufficiently. Risks people faced related to the integrity of their skin were not safely managed. People who had moved into the home at the start of February 2022 had not had the risks they faced assessed or personalised plans of care, to mitigate these risks, developed. People did not always receive their medicines as prescribed. These issues were not all addressed in a robust and effective manner during our inspection.

Staff understood how to wear PPE appropriately. People received visitors safely.

There were not always enough staff deployed in the home. The staff had mixed opinions as to how well supported they felt. The oversight of training and induction improved over the course of our inspection. At the start of the inspection, people were being care for by staff who had not had appropriate inductions and in some instances, they were working more hours than their visa allowed. This was with the agreement of the providers.

People felt safe and were supported by staff who understood how to report safeguarding concerns.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not embedded to support safe practice.

Where people could not consent to live in the home, Deprivation of Liberty Safeguards had not always been applied for appropriately.

People told us they enjoyed the food. Mealtimes were not always a relaxed and pleasurable experience due to maintenance work. People’s weights were not always being checked within the time frames that reflected the risks they faced.

Recording was not sufficient to monitor risk, or the quality of care people were receiving.

People had not been asked for their views about changes in the home and people and relatives had not been kept up to date with management changes.

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

Rating at last inspection and update

The last rating for this service was good (published 5 August 2021).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The inspection was prompted in part due to concerns received about oversight, staffing and environmental risks. We have found evidence that the provider needs to make improvements. We received further information of concern and a decision was made to widen the scope of the inspection.

You can see what action we have asked the provider to take at the end of this full report.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection, that rated those key questions, to calculate the overall rating. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyme Regis Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, risk management, person centred care, the application of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and oversight at this inspection.

Please see the action we have told the provider to take related to oversight, staffing, person centred care and the application of the MCA at the end of this report.

We have taken enforcement action requiring the provider to ensure people receive safe care and treatment and are protected by DoLS.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Lyme Regis Nursing Home is a nursing home providing personal and nursing care for up to 27 people aged 65 and over. At the time of the inspection 25 were using the service. The service works closely with local commissioners to provide three beds (intermediate care beds) to help prevent admission to hospital or to facilitate a timely discharge. People using these beds were supported by the community nurses, physiotherapist and occupational therapist

People’s experience of using this service and what we found

At this inspection, we saw improvements in several areas and three previous breaches had been met in relation to safeguarding, staffing and good governance.

Everybody said they felt safe and said the staff team were trained to meet their needs. Comments

included, “Things here have been wonderful really. Yes, I am feeling safe. I am getting the help and encouragement I need” and “We both feel safe here”. Relatives also said in their experience the service was safe; comments included, “I know that he is safe and in a secure environment. This is very reassuring for me”.

The provider had systems to protect people from the risk of abuse. Risks were minimised because staff knew how to recognise and report any suspicions of abuse.

There were enough suitably skilled and experienced staff on duty to meet the needs of people currently living at the service. The majority of people said staff came quickly when needed.

People received their care safely because risk assessments were carried out and action taken to minimise risks where appropriate. Medicines were safely managed. Staff administering medicines had received training and had their competency assessed.

Each person had their needs assessed before they moved into the service. This helped to make sure the staff could meet people’s needs and expectations.

The environment was comfortable and clean throughout and new signage was in place to help people recognise various spaces. The registered manager explained this work was in progress.

Nurses and care staff received training appropriate to their roles and had the knowledge and skills they needed to safely provide care.

People’s nutritional needs and preferences were met, and they were complimentary about the food served at the service. The service worked well with health care professionals to provide timely care to people to ensure their health was maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Since the last inspection a new and experienced registered manager had been appointed. The registered manager was supported by an enthusiastic deputy. People and relatives felt the service was well managed. Comments included, “The Manager is very helpful…” and “The manager is approachable”. Professional’s comments included, “There have been massive improvements with (the register manager); she is open, responsive and helpful. The place is calmer and cleaner…definitely well managed now”.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Rating at last inspection

The last rating for this service was requires improvement (published 22 August 2019).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 2 July 2019 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safeguarding service users from abuse; staff deployment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyme Regis Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice

Measures were in place to prevent the spread of infection by visitors to the service. A visiting area with a separate entrance and exit had been created to reduce the need for people to move through the main building. Visits had been suspended at the time of our visit in line with recommendations from the Director of Public Health. Any visitors, relatives, professionals or contractors were expected to have a COVID-19 lateral flow tested just prior to the visit. Personal Protective Equipment (PPE) was made available to them.

Staff were provided with adequate supplies of PPE and were seen to be wearing this appropriately. Regular observations of staff practice and compliance with PPE were undertaken by the registered manager or deputy manager to ensure good practice was maintained.

The registered manager kept people and families up-to-date with the current situation through regular emails and phone calls. People we spoke with understand the need for the extra precautions and said they felt safe at the service. Comments included, “They are taking good care of me. I’ve had my vaccine” and “I am happy and safe here”.

Regular COVID testing was carried out at the service for both staff and people living there. There was an action plan in place in the event of a positive Covid-19 test. Staff completed daily checks on people's current health status to help identify if someone was showing signs of being unwell. There was a clear policy in place for new admissions to the service to ensure the risk of infection was safely managed.

The service had appropriate infection control policies and procedures in place. The registered manager had kept up to date with current guidance and communicated changes to staff promptly.

Lyme Regis Nursing Home is a nursing home providing personal and nursing care for 22 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

People’s experience of using this service and what we found

Quality assurance systems designed to assess, monitor and improve the quality and safety of the service provided had not been effective. There was a breach of regulation related to the governance of the home.

Risk management was not robust. Four people did not have adequate risk assessments and we identified shortfalls in the support they received to stay safe and well. Risks related to taking medicines safely and appropriately were not always recorded appropriately. We highlighted this and improvements were made during our inspection. People and relatives told us the service was safe. Staff understood the risks people faced and how to minimise those risks for them. Risks to most people's health, safety and wellbeing were assessed. Risk management plans were put in place to make sure risks were reduced as much as possible.

Processes designed to reduce the risk of abuse and address any allegation had not been followed effectively. There was a breach of regulation.

There were not enough staff to meet people’s needs and ensure the quality of the service they received. This was addressed during our inspection. There was a breach of regulation.

People were supported by staff with the skills and knowledge to meet their needs. Staff had regular training and felt confident in their role.

Most people had care plans that included detail about people's individual needs and preferences.

People were supported by staff that were compassionate, caring and treated them with dignity and respect. Staff knew people well and used knowledge about their lives and communication needs to inform the care and support they provided.

This meant people received person centred care from staff who developed positive, meaningful relationships with them. People had opportunities to socialise and pursue their interests and hobbies.

People and relatives told us that Lyme Regis Nursing Home provided a friendly, welcoming and relaxed environment. The environment suited the people living there, however as people’s needs change we have made a recommendation about reviewing how dementia friendly the home is.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were not encouraged to express concerns about their care. We have made a recommendation about this.

People, relatives and staff spoke highly of the deputy manager and staff team. Staff were enthusiastic about their work and proud of the service they provided. They felt supported by their colleagues within the home.

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

Rating at last inspection

The last rating for this service was Good. (published January 2017)

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks. We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. As a result, we planned a focused inspection to review the Key Questions of Safe and Well-led only.

During the inspection we identified further concerns and we made the decision to undertake a comprehensive inspection to ensure we understood people’s experience of care in the home.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. We found breaches of regulations.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The previous inspection was completed in May and June 2016. We found improvements were required at that time in relation to cleanliness; the management of some medicines; meal choices and the dining experience; the planning and delivery of care and the quality assurance arrangements. At that time there was no registered manager in post. 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 of safe; effective, responsive and well-led to at least good. At this inspection we found improvements in all areas had been made as the registered manager and provider had followed their action plan.

Lyme Regis Nursing Home 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.

Lyme Regis Nursing Home can accommodate a maximum of 27 older people. There are 23 single bedrooms and two double bedrooms. At the time of the inspection there were 25 people living at the service. The service works closely with local commissioners to provide six beds (intermediate care beds) to help prevent admission to hospital or to facilitate a timely discharge. People using these beds were supported by the community nurses and physiotherapist and occupational therapist. Feedback about intermediate care provided was positive. No-one was receiving respite care at the time of this inspection.

Since the last inspection a manager had registered with the Care Quality Commission (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.

People felt safe at the service. Comments included, “Very comfortable and the staff make me feel safe”; “Staff members often pops head round the door with a smile to say hello” and “The bell is answered quickly.”

Risks were identified and plans were in place to monitor and reduce risks. People were safeguarded from abuse as staff were knowledgeable and understood their role. Professionals said they had no concerns about safeguarding issues or staff practice. One said, “I have not seen any practice of concern. The service works well with us…”

There were sufficient numbers of suitable staff on duty to meet people’s needs. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely. The home environment was clean and the home was free from offensive odour. The provider was taking action to address fire safety issues raised by the Dorset & Wiltshire Fire and Rescue Service.

People had access to relevant health care professionals. Health professionals provided positive feedback about the service and the good working relation developed. A varied and nutritious diet was offered to people which reflected their needs and preferences. People spoke highly about the quality of food.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which helped to protect people’s rights.

Staff were respectful, friendly and kind. Staff supported people to take part activities and supported them to retain their independence. We observed staff spending time engaging people in conversations, and speaking to them in a friendly, warm and politely way.

People received personalised care that was responsive to their needs. Comments included, “They (staff) always have time” and “I couldn’t wish for anywhere better.” A professional said, “My experience is that the needs and preference of residents is well managed.” People knew how to raise concerns and were confident the registered manager would deal with them appropriately and resolved them where possible.

There were systems in place to obtain people's views about the service. The registered manager regularly assessed and monitored the quality of the service to ensure standards were met and maintained. Feedback from the local Clinical Commissioning Group was positive and their monitoring visits showed significant improvements since our last inspection. We were told, “The manager has been in post several months and made significant improvements.”

There was no registered manager in post at the time of the inspection. The previous registered manager had left their employment in January 2016. The provider had appointed a new manager who was in the process of applying to become the new registered manager however they had not informed us of these significant changes. 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.

Lyme Regis Nursing Home can accommodate a maximum of 27 older people. There are 23 single bedrooms and two double bedrooms. At the time of the inspection there were 23 people living at the home.

The leadership within the home was developing following the significant change in management. There were areas of practice that needed to be improved following a period without a manager. This lead to the provider not having an effective system to check the quality of care people received at the home but improvements were now being made. Peoples individual care records were not always up to date and the systems in place to evaluate and improve the care being given were not robust.

The environment required some updating to ensure it could be effectively cleaned.. People needed more opportunity to choose where to eat their meals and the provider needed to ensure there was sufficient equipment to provide for these choices.

The process of recording when medication was given required some further improvements. Staff needed clear guidance on the dispensing of medication on a 'when required needs' basis.

The risks people faced were not consistently acknowledged in people’s care records. When people came to the service for repeated periods of respite their current needs were not consistently reassessed. Care records were not always accurate and reliable.

People were able to raise concerns with the staff who took action to resolve the presenting issues. People told us they had confidence in the staff to care for them in a professional and empathetic manner. People told us they felt safe. Relatives told us how caring the staff were.

People told us the staff were kind and caring and supported them in a caring way. One person told us “I go out and about and like to sit in the garden, I tell the staff where I am, they tell me I should be accompanied but I am ok and let me take the risk, within reason. I think they show they care about me to take the time and thought to worry about my safety”. A relative told us “I am very happy with the service on offer to my mum. The staff are very professional and communicate any concerns without delay. I feel comfortable knowing mum is safe and being well cared for”

People and their relatives were given information about the running of the home and how they could comment on areas for improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well led?

As part of the inspection we spoke with eight people who lived at the home, four relatives, five care staff, two domestic staff, the deputy manager and registered manager. We reviewed records relating to the management of the home which included, six care plans, daily care and clinical records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that people were cared for in a fresh and clean environment and that the home was well maintained.

There were sufficient staff on duty to meet the needs of people living at the home safely, with both the deputy manager and registered manager available. People told us they felt safe in the home and said, 'it couldn't be better', 'I am very well looked after' and 'everyone is very friendly'.

We found that the service was individually tailored to meet people's care needs and that people were treated with dignity and respect by the staff.

There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe. Risk assessments had been undertaken which were regularly reviewed. This helped to ensure people received care that was safe. People were given choice and remained in control of decisions about their care and lives.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We noted that the home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and were aware of recent legal judgements about this.

The home had systems in place which ensured staff learnt from adverse events such as accidents and incidents. These were investigated and followed up which helped risk to be managed and kept people safe.

People at the home benefitted from the close communication and cooperation between staff, relatives and professionals who worked together to protect individuals from abuse.

Is the service effective?

Staffing levels were determined through a dependency tool which ensured there were enough staff on duty at all times to effectively meet the needs of people at the home. From speaking with staff it was clear they understood people's individual care and support needs.

People's health and care needs were assessed with their involvement and were continually reviewed and updated wherever a change occurred.

Staff told us they worked as a team and we observed how staff cooperated with each other to make sure no one was kept waiting and everyone received the appropriate care and support.

Is the service caring?

We found that care, treatment and support was person centred, and planned to take account of individual preferences and choice.

Staff were kind and attentive. We saw how staff encouraged and supported people in making their own decisions about how they needed help. People said, 'the staff are so helpful, they help me with anything I need' and "they are so kind and polite". One member of staff we spoke with told us they, 'love getting to know the people in their care' and learning about people's previous lives and experience.

We met several relatives who visited the home on the day of the inspection. They told us they were always welcomed at any time. One relative we talked with said, 'I really didn't think Mum would settle so easily but the staff have made sure she's integrated with others even though Mum is unable to talk herself'.

Is the service responsive?

People's health and care needs had been assessed prior to their arrival at the home. We reviewed six care plans and saw that records were well organised, up to date and accurate. The care plans confirmed people's preferences, interests and diverse needs which ensured care and support provided met individual need.

Care plans were regularly reviewed which meant that staff were able to respond promptly to people's changing needs.

The people we spoke with said that staff were 'always around' and told us if they needed anything they would use their call bell. We noticed that staff had time to talk with people in the lounge and with those who chose to stay in their rooms.

Is the service well led?

There were formal and informal systems in place to monitor the quality of the service provided. People, their relatives, outside professionals and the staff were asked for their feedback on the service. Suggestions and ideas for improvement to the service were welcomed and acted on. Meetings between people, their relatives and staff were used as opportunities for issues to be raised, discussed and shared before any changes to the management of the home were implemented.

The home worked closely with other agencies and local services and had developed close working relationships and collaborative working practice which helped to provide an effective service for people.

Clear management structures and lines of accountability were in place. Staff were clear about their roles and responsibilities and had a good understanding of the ethos and values of the home and to quality processes in place.

The home benefitted from the experience and continuity of the registered manager and deputy manager who had both been in post for several years and worked together to ensure a quality service was provided.

People's care needs and risks were assessed and care was delivered to meet their needs. People were protected from harm as there were appropriate safeguarding procedures.

Staff were supported by the provider through appropriate training and the home had suitable systems to monitor the quality of service provided.