Coast Care Centre

Coast Care Centre is a care home with nursing and accommodates up to 44 people in a purpose built home. The service provides discharge to assess accommodation for some people and is commissioned by East Sussex County Council. Some people are supported at the service for longer periods of time. The service supports adults whose primary needs are nursing although some people live with dementia. At the time of our inspection there were 37 people living at the service.

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

Risks to people had been identified however there were some risk assessments missing. Identified risks relating to medicine management, diabetes and wound management were missing in some care plans. The registered manger did take immediate steps to complete the missing assessments.

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; however, the policies and systems in the service did not support this practice. Some mental capacity assessments were not decision specific and it was not consistently clear who was involved in best interest meetings. Similarly, this was raised with the registered manager who took steps to improve these documents.

We found one care plan lacking detail about a person’s care and support. This was again immediately addressed by the registered manager and we were reassured from speaking with staff that staff knew the person well and there were no immediate risks to their welfare.

The registered manager had promoted a positive culture at the service which resulted in an engaged staffing team which ensured good outcomes for people. People, relatives and staff were all given opportunities to feedback about the service and people’s cultural and personal differences were respected and celebrated.

People told us they felt safe and staff were able to tell us about how they managed risk and reported concerns. We saw enough staff during the inspection to support people and medicines were administered safely. People lived in a clean environment and infection prevention and control policies were in place and put into practice. Accidents and incidents had been reported, reviewed by the managers and any learning to support people in the future was shared with staff.

People’s care was provided in a person-centred way and people were supported with their communication needs. There were activities for people that could be done in a group or as one to one support. People and their relatives told us they were confident to raise issues and complaints if they needed to and had confidence that concerns would be acted on in most cases. Staff had completed training in end of life care and knew the important aspects of care and support for people at this important time.

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 (report published 2 February 2021) and there were breaches of regulation. 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.

At our last inspection we recommended that complaints against the service were recorded and investigated in line with the service policy and that the complaints process was made accessible to people and relatives. At this inspection we found that improvements had been made.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 December 2022. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safe care and treatment of people and the governance of the service.

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, responsive 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 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 Coast Care Centre 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.

Bexhill Care Centre is a care home with nursing and accommodates up to 43 people in a purpose-built building. The service provides step down nursing and in commissioned by East Sussex County council to assist social services and the National Health service during the COVID-19 pandemic. The services supports adults whose primary needs are nursing care although some may also be living with dementia. At the time of the inspection there were 32 people living at the service.

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

Discrepancies were found on respect forms and do not attempt cardiopulmonary resuscitation (DNACPR) forms with regard to capacity to make decisions. Not all people living with diabetes had a care plan and risk assessment in place to inform staff of risks. Contingencies were not in place to advice staff if a person refused medicines or if a person had low blood sugars, what actions were necessary. Some risks had been managed well for example, regular reviews and monitoring of people’s nutritional needs. A new electronic care system had recently been introduced and although this was still being embedded, it had improved the quality of records.

The home had a policy for people who refused medicines however there was no documentation to show what follow up had been made and therefore no record kept of people having medication re-offered, which contravened their own policy. Protocols for ‘as required’ (PRN) medicines were not in place for everyone that required them. There was no system in place to monitor pain relief, including those who were in receipt of end of life care. Medicines were stored and disposed of correctly. Staff responsible for giving medicines had all been trained and good practice was observed with the use of body maps for recording areas of soreness.

Staff were aware of what action to take with safeguarding issues and were able to describe their training and exactly who they would raise issues to. People told us that they felt safe and relatives told us they had confidence in the staff and were happy that their loved ones were looked after safely. Accidents and incidents were recorded with any serious issues being escalated to the local authority and CQC. Staff were recruited safely and there were always enough trained staff covering each shift. Infection prevention and control procedures were in place and were effective.

Some care plans did not fully reflect people’s needs. Some people living with diabetes and others who were towards the end of their lives did not have specific care plans in place to inform staff. Although auditing processes had improved at the service and there was a regular schedule of management oversight, this had not yet fully embedded as evidenced by missing and inaccurate care plans. Accident and incident investigations had improved. The registered manager was a visible presence at the service and created a positive culture among staff. The registered manager understood their responsibilities under the duty of candour.

No formal process was in place for getting feedback from those that lived or worked at the service and most meetings had been suspended due to the pandemic. However, there was positive feedback on websites associated with care home quality and a number of written compliments from relatives had been received.

Although a new pre-assessment form had been developed the process was not yet fully embedded. Professionals expressed concern that sometimes only basic information was recorded. Involving relatives and loved ones in the pre-assessment process was inconsistent. Recording of people’s fluids showed daily differences in the amounts offered and the amounts consumed with no information to explain why or what additional action might be required. People’s nutritional needs were met. People were supported to access health and social care professionals. The service had a training manager who ran induction course for all new staff, the content depending on past experience. Current training was up to date and there were always enough trained staff on duty each shift. The layout of the service met people’s needs.

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.

A generic complaints policy was in place but was not easily accessible to everyone. No complaints were recorded nor any minor issues or concerns. We were aware of some issues that had been raised but there were no records to demonstrate they had been addressed. We have made a recommendation about the management of issues.

There had been several people at the service who were at the end of their lives, but no training had been provided for staff to cover this area. Staff however were able to tell us the important aspects of caring for people at that time of their lives and most staff had experience of this aspect of care.

Care plans were in the process of being transferred to a computerised system. It was clear that this new system was more accessible to staff, but it had not been fully transferred yet. Staff knew people and their support needs. People’s communication needs were met. The pandemic had meant that group activities had been put on hold, but staff still spent time with people in their rooms, talking to them and supporting them.

People were well cared for and we observed several positive interactions between staff and people. Relatives and professionals told us that the staff were consistently caring and looked after people with compassion. Despite the service following the isolation and zoning guidelines during the pandemic, staff still made time for people and spent time with them whenever possible. Care plans were person centred. People’s privacy, dignity and independence were all promoted and supported by staff.

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

Rating at last inspection

A targeted inspection took place (published 15 September 2020) which was not rated. We reported breaches of regulations.

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

At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

This service was registered with us on 01/05/2020 and this is the first rated inspection.

Why we inspected

This was a planned inspection based on the previous findings at our targeted 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 coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about management of risk medicines, and governance. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of diabetes with no care plans telling staff how to manage risks to people. There was a further breach relating to medicines with no process to follow when medicines were refused, no PRN protocols in place and no record of pain management. There was another breach relating to ineffective auditing processes.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The concerns were about people’s safety, risk management, medicines, infection control and the governance framework of the service. We inspected using our targeted methodology developed during the Covid-19 pandemic to examine those specific risks and to ensure people were safe.

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

Not all safeguarding issues had been investigated or recorded. There was a lack of investigation by managers into the cause of accidents and incidents and few plans had been put in place to mitigate further accidents from occurring. We spoke to staff who were aware of the process of reporting safeguarding but managers had failed to act on reports received.

The recording of wound management was poor with not all wounds being documented. NICE guidelines had not been followed with regard to measuring and recording wounds. Body maps provided insufficient information about the status of wounds, whether they were healing or not. A skin tear had been recorded on an accident form but there was no further documentation or photograph. Documentation relating to turning people who had pressure sores was poor with one showing only three turns in an eight-day period. No investigation had taken place into falls, no advice sought from other professionals and no assessments were in place to minimise further falls.

Medicines were not always managed safely. Medicine administration records (MAR) were hard to read and codes were inconsistently used. Counting medicines and recording refusals was inconsistent and it was not clear whether people had received their medicines or not. No clear protocol was in place for ‘as required’, (PRN) medicines. The management of pain relief medication was inconsistent and staff were not monitoring the effectiveness of different forms of pain relief. Some prescribed medication was missing. Clinical equipment in place for use in the event of a person choking, had not been checked to ensure it was fit for use.

There was a lack of managerial oversight with auditing processes. Issues had been identified relating to recording key information on support plans which had not been addressed. Some support plans relating to specific areas of support were missing and others lacked information and had missing entries. Daily notes contained entries that were written in an undignified way. This was brought to the attention of the registered manager who took immediate steps to address the situation. There was lack of oversight relating to accident reports and no changes made to risk assessments following accidents.

Systems were in place to effectively manage infection, prevention and control. Personal protective equipment (PPE) was available and used by staff and all visitors and regular staff completed a health questionnaire and had their temperature taken when entering the building. Since lock down visits from relatives were only made if their loved ones were in receipt of end of life care and the same infection control precautions were taken.

Rating at last inspection:

This service was registered on the 1 May 2020 and this was the first inspection. This was a targeted inspection.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific 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.

Enforcement:

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our

reinspection programme. If we receive any concerning information we may inspect sooner.