Archived: Seaswift House Residential Home

Seaswift House Residential Home (hereafter known as Seaswift House) is a residential care home in the town of Seaton in walking distance of the town and seafront. The home is three converted town houses linked together and provides personal care for up to 15 people aged 65 and over. At the time of our inspection there were 14 people using the service, 1 of these people was in hospital at the time of our visit.

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

People and relatives said they felt safe at the service and complimented the staff team and the engagement with the registered manager and provider.

We found the quality and safety of the service had deteriorated since our last inspection in September 2022 and some previous breaches of regulation remain along with additional breaches. The provider's systems and processes designed to identify shortfalls, and drive improvement had not been fully completed and remained ineffective.

Risks to people were not always assessed, monitored, mitigated or managed effectively. Care plans were not always put in place to guide staff to mitigate risks. This meant staff were not always aware of the risks to people they supported.

People's needs were not fully assessed to ensure care was appropriate for their needs and they were not always supported by enough staff to support them safely.

Due to staff shortages the registered manager had needed to undertake care duties to support people. Improvements were made after the inspection visit and additional agency staff were requested to cover staff shortages and enable the registered manager to be able to undertake managerial responsibilities.

People's medicines were not safely managed to ensure people received their medicines safely.

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

The recruitment process in place had improved. The registered manager had a checklist in staff recruitment files to ensure they had the required recruitment checks in place.

The registered manager and provider were very visible at the home and spoke with people and relatives on a daily basis. They were open and honest and recognised that some areas of the home’s management process had deteriorated, which placed people at risk. As part of the local authority Provider Quality Support Process (PQSP) they were working with the local authority to manage those risks and keep everybody informed.

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 (published 28 October 2022) 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 the provider remained in breach of regulations.

Why we inspected

Seaswift House came out of the local authority whole service safeguarding process on 29 September 2022 and received ongoing support from the local authority Quality Assurance and Improvement team in a Provider Quality Support Process (PQSP).

As part of this process the local authority Quality Assurance and Improvement team and Eastern Care Services team visited the home at the beginning of January 2023. They shared worrying information about what they had found at their visit, which raised significant concerns. The areas of concern they raised were around risk management, staffing, medicines, safe working practices and escalating concerns. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. 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 inadequate based on the findings of this 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.

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

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

Enforcement and Recommendations

We have identified breaches in relation to staffing, safe care and treatment, consent, safeguarding people from abuse and improper treatment and good governance at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The provider has informed us they will be submitting an application to CQC to deregister the service. We will work with the local authority to monitor progress during the home closure. We will continue to monitor information we receive about the service, which will help inform our next action.

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 the provider does not deregsiter the service, 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.

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

Although we saw the provider had implemented improvements since our last inspection there were still areas of concern which had not been identified by the providers quality monitoring processes.

Improvements were needed to ensure fire safety measures at the service were more robust. Staff required further support in identifying risks and embedding this into their daily work. Improvements needed to be made in how people's medicines were managed.

Staff had not always been recruited safely. Although work had started to review staff recruitment files, we identified gaps in newly appointed staff files which had not been reviewed. The provider had a program of training staff were completing.

There were enough staff to support people, and people did not have to wait long if they wanted assistance from staff. There were no restrictions on visiting arrangements and staff took action to reduce the likelihood of the spread of infections. Improvements were needed in more thorough cleaning of people’s rooms.

The registered manager and staff understood their responsibilities to keep people safe from abuse and discrimination. People were supported to eat a balanced diet. People were referred to health professionals when their needs changed. People’s health and care needs assessments were updated as their needs changed.

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 in the service supported this practice.

People and staff spoke positively about the new registered manager and the improvements they had made at the home. Comments included, “Everything is changing in a good way…the manager has made all the difference…” Staff told us there was better communication within the team and daily handovers ensured they were aware of any changes or new risks.

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 (published 3 March 2022) 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 some improvements, but the provider remained in breach of some regulations.

Why we inspected

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.

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 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 remained 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 Seaswift House on our website at www.cqc.org.uk.

Seaswift House is a residential care home in the town of Seaton in walking distance of the town and seafront. The home is three converted town houses linked together and provides personal care for up to 15 people aged 65 and over. At the time of our inspection there were 10 people using the service.

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

People were receiving meals in line with the guidance following their assessments with the speech and language team (SALT). The cook had guidance in the kitchen identifying people’s specific dietary needs and knew their likes and dislikes.

Staff were clear about who required additional support with their diet and was able to tell us the consistencies of diet and fluids they required.

We observed that the one person received the meals and fluids as specified in the guidance in the kitchen. Although they had received the same meal three times that week and said they would prefer a change. The staff member sat with the person in their room and was very patient, was chatting with the person and did not rush them.

We saw people enjoying their meal in the communal area of the home. They said they liked the food, and both cleared their plates.

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 (3 March 2022)

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

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

However, the information shared with the Care Quality Commission (CQC) about the incident indicated potential concerns about the management of the risk of choking. This inspection examined those risks. 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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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

Follow up

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.

Seaswift House is a residential care home in the town of Seaton in walking distance of the town and seafront. The home is three converted town houses linked together and provides personal care for up to 15 people aged 65 and over. At the time of our inspection there were 14 people using the service, one of these people was staying at the hospital.

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

There was a lack of robust oversight from the provider to ensure the quality and safety of care being provided to people. The provider had systems in place to audit the service. This included a computerised care plan system which enabled them to have an overview of people's care. However, because information was not recorded on this system the oversight was not accurate.

Systems in place were not always effective in order to identify and manage risks associated with people’s care. Some key risks which people faced were not being adequately assessed and checked by the management team to ensure information was up to date and effective in directing staff to keep people safe.

People were at risk of poor nutrition and hydration as there was poor oversight of people's fluid and diet intake. There was no clear oversight about whether people had lost weight and whether appropriate referrals to health care professionals had been made.

Opportunities to make improvements to people's care and support were missed as there was no robust analysis of accidents and incidents undertaken.

Poor oversight and management of medicines put people at risk of not receiving their prescribed medicines.

The provider did not have a robust system to ensure relevant checks were made to ensure staff were of good character and suitable for their role prior to employment.

People had had access to health care professionals. Improvements were needed in the recording of contacts and visits from health professional's which the registered manager said they would implement.

Staff had received formal supervisions in 2021 but these had lapsed due to a Covid-19 outbreak at the home. However, the registered manager was undertaking shifts and working alongside staff, so had the opportunity to observe staff practice and discuss concerns.

Staffing levels met people’s needs, although the registered manager and care coordinator had needed to undertake numerous shifts when there were shortfalls, taking them away from their managerial roles and responsibilities. People said there were usually enough staff and that their requests for assistance were usually dealt with promptly. We observed requests for assistance were promptly responded to. Comments from people included, “They (staff) can’t always come immediately but I don’t wait too long”. However, care staff were responsible for other duties, which impacted on the sociable time they had to spend with people.

People said they liked the food. Comments included, “No complaints on that front. There is always a choice and enough to eat. I am never hungry”. However, improvements were needed in ensuring practice and people's records met people’s nutritional needs. The provider had introduced an external catering company, who delivered frozen food which was reheated in special ovens. They said people had found the transition difficult but were now relatively happy with the food. They told us they always ensured there was fresh fruit and vegetables available and homemade cakes.

We were assured that Infection prevention and control measures at Seaswift House were in place. Staff wore PPE effectively and safely and in accordance with current government guidelines. We discussed with the registered manager that there was no housekeeping staff at the home, so staff undertook cleaning in the morning and the night staff had cleaning duties they completed. There was no additional cleaning of touch points. The registered manager implemented this straight away and additional cleaning was started during our inspection.

People said they felt safe and were happy living at Seaswift Residential Home. We found there was a calm, warm welcoming and relaxed atmosphere. Comments from people included, “Life here is very good. I haven’t come across any upset or things I do not like. I feel safe”.

External contractors undertook regular servicing and testing of moving and handling equipment, fire equipment and stairlift maintenance.

Staff confirmed they had received training in relation to safeguarding issues and had an understanding of the types of abuse. The provider said they would improve their recording of concerns raised with them and the actions they had taken.

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 registered manager and provider were working with staff to complete the required training to support people safely. New staff shadowed experienced staff to learn the role and completed an induction sheet. Staff new to care had been enrolled on the care certificate, training for staff new to care.

The registered manager registered with CQC in September 2021, this was their first role as a registered manager. They had completed a level five qualification in leadership. The registered manager had implemented changes which included a new electronic care plan system. They were open and honest and responsive to areas of concern we identified during our visits.

The provider had engaged with people, relatives and healthcare professionals about the running of the service. Although they had not shared their findings.

People's experience of using this service:

People were supported by staff that were caring, compassionate and treated them with dignity and respect. Seaswift House provided a friendly, welcoming and peaceful environment for people and visitors.

People received person centred care from staff who developed positive, meaningful relationships with them. Staff knew about people's life history and their personal circumstances. Care plans were detailed and up to date about people's individual needs and preferences. People were encouraged to socialise and pursue their interests and hobbies.

People and relatives said the service was safe. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. People's concerns were listened and responded to. Accidents, incidents and complaints were used as opportunities to learn and improve the service.

People were supported by staff with the skills and knowledge to meet their needs. Staff had regular training and felt confident in their role. They worked in partnership with local health and social care professionals to keep people healthy.

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 service was well led. People, relatives and professionals gave us positive feedback about the quality of care. They said the registered manager and lead partner were approachable, organised, and acted on feedback. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment with continuous improvements in response to findings.

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

Rating at last inspection: Good. (report published 25 May 2017).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection. At this inspection, the service remained Good.

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

The service has 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.

Staff developed positive, kind, and compassionate relationships with people. People appeared happy and content in their surroundings and were relaxed and comfortable with staff that were attuned to their needs. There were lots of smiles, good humour, fun and gestures of affection. People's care was individualised, staff knew people well, treated them with dignity and respect, and were discreet when supporting people with personal care. The service had enough staff to support people's care flexibly around their wishes and preferences.

Staff demonstrated a good awareness of each person's safety and how to minimise risks for people. Personalised risk assessments balanced risks with minimising restrictions to people's freedom. Accidents and incidents were reported and included measures to continually improve practice and reduce the risks of recurrence. Staff understood the signs of abuse and knew how to report concerns, including to external agencies. They completed safeguarding training and had regular updates. People knew how to raise concerns and complaints , and were provided with information about how to do so. Any concerns raised were robustly dealt and further improvements made. A detailed recruitment process was in place to ensure people were cared for by suitable staff. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely.

People experienced effective care and support that promoted their health and wellbeing. Staff had the knowledge and skills needed to carry out their role. People praised the quality of food and were supported to improve their health through good nutrition. Staff encouraged people to eat a well-balanced diet, make healthy eating choices and to exercise and maintain their mobility. People had access to healthcare services, staff recognised when a person's health deteriorated and sought medical advice promptly. Health professionals said staff were proactive, sought their advice and implemented it.

People and relatives were happy with the service provided at Seaswift House. The culture of the home was open, friendly and welcoming. Care was holistic and person centred, staff knew about each person, and their lives before they came to live at the home. They understood people's needs well and cared for them as individuals. People pursued a range of hobbies, activities and individual interests such as reading, arts and crafts and organised quizzes and games such as Bingo and Scrabble. Where people chose to remain in their rooms, staff spent time chatting with them to keep them company.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards and involved person, family members and other professionals in 'best interest' decision making.

People received a good standard of care because management team set high expectations of the standards of care expected. There was a clear management structure in place, staff understood their roles and responsibilities, and felt valued for their contribution. Staff were motivated and committed to ensuring each person had a good quality of life. The service used a range of quality monitoring systems such as audits of care records, health and safety and medicines management. This helped them to make continuous improvements in response to their findings.