Marine View Rest Home

Marine View Rest Home is a residential care home providing nursing care and support for up to 19 people. At the time of the inspection, the service was supporting 13 people. People were living with a range of mental health needs including dementia and degenerative conditions.

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

Due to the COVID-19 pandemic, the provider had ensured that appropriate infection control procedures were in place to keep people safe. This included increased cleaning and ensuring adequate supplies of personal protective equipment (PPE) were available. Staff completed training in relation to COVID-19. We were assured the provider managed infection prevention and control through the COVID-19 pandemic.

The provider and staff had worked hard to develop strong leadership. Quality monitoring systems had been embedded and morale was high amongst the staff team. We received positive feedback in relation to the care people received and how the service was run. One relative told us, “It’s a terrific place with nice staff, they treat [my relative] well”.

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 14 May 2019).

Why we inspected

We undertook this focused inspection in light of concerns we had received in respect to the care people were receiving. Concerns included quality monitoring and assessments of risk. A decision was made for us to inspect and examine those risks. Therefore, this report covers our findings in relation to the Key Questions: Is it Safe? and Is it Well-led?. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.

For those key questions not looked at on this occasion, the ratings from the previous comprehensive inspection were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marine View Rest 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.

Marine View Rest Home is a residential care home providing personal care to a maximum of 19 people in an adapted building combining two terraced houses over three floors. At the time of the inspection 13 people were living at the home. The people living there have a range of health and mental health needs including people living with dementia and degenerative conditions.

People’s experience of using this service:

• The provider led by example in providing person centred care and interacting warmly with everyone at the home and their relatives and visitors. However, there were shortfalls in the provider’s understanding of their responsibilities to notify the Care Quality Commission (CQC) of changes to their statement of purpose in relation to supporting people with specialist needs of all ages and changing the provider’s sole trading status.

• The provider with the support of a consultant and senior care staff was working to an action plan to ensure their quality assurance promoted a culture of improvement.

• Systems have improved in relation to the recording of incidents and accidents. They were monitored and analysed over time and action taken to improve care and risk assessments in response to any emerging trends and themes.

• People’s needs, choices and preferences were known by staff and their care plans were personalised and benefitted from improved guidance that detailed how staff should support their specialist needs.

• There were improvements in how staff received the training, competencies and support they required to respond to people’s specialist needs and the provider identified future training needs in response to referrals and people’s changing needs.

• The outcomes for people were personalised and reflected the caring values of the people supporting them.

• People and their relatives told us they felt safe. One person told us, "It feels safe here to me, it’s like a second home and the staff are very good.” Another person told us, “My things are safe in my room, and I get my inhaler when I need it.” A relative told us, “The staff are very good, they wanted to know about my relative and understand things like their medicines. They set about sorting this out with the GP straight away.”

• People were safe from the risk of abuse. Guidance enabled staff to provide the care and support that people living with complex needs who may be at risk of self-neglect needed in relation to their health and emotional wellbeing.

• People were cared for in a clean and hygienic environment that had benefitted from redecoration throughout the building. The provider had worked hard at involving people in this process and people spoke highly of the improvements and how they enjoyed being able to access the building and local community independently. One person told us, “New carpets, freshly painted it’s amazing it’s really improved. It’s brilliant what they have done.”

• People were comfortable with staff and we saw caring relationships had developed between people and staff. Staff and managers were approachable and knew people well.

• People were being supported to make decisions in their best interests and this was reflected in care planning.

• When new staff were recruited the provider had processes in place to ensure staff were recruited safely. Checks were also undertaken to ensure staff were safe to work within the care sector.

• People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. One person told us, “The staff are all very nice and I get on with all of them, anything that needs doing will help and I’m free to come and go which is important.”

• Staff were asked for their opinions on the service and these were acted on. Staff told us they felt supported within their roles.

• People were supported to maintain a healthy nutritious diet and had access to healthcare services and professionals as and when needed. One person told us, “I always have a choice of food. If I don’t like something I can always have an omelette or something else.” Another person told us that their keyworker had arranged a GP visit and helped arrange for special cream for their legs.

• People had access to their local community and had access to range of activities that met their interests and reflected their diverse needs and culture.

Rating at last inspection:

Requires improvement. (Last inspection report published 10 May 2018). This was the second consecutive time the service had been rated Requires Improvement. The service was rated as Good at this inspection.

Why we inspected:

This was a planned comprehensive inspection based upon the previous rating. Because of the

last inspection rating we asked the provider to complete an action plan to demonstrate how they would meet the shortfalls at the home. We inspected to review this action plan and any improvements made. Improvements had been made to the service people received since our last inspection.

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.

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

Marine View Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and personal care for 19 people in two linked buildings that are adapted for the current use. The home provides support for people living with complex needs and additional support needs in relation to mobility and sensory needs. There were 14 people living at the home at the time of our inspection.

The home had a manager who was also the registered provider. A registered provider is a person who has registered with the Care Quality Commission to manage the home. Like registered managers, 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 home is run.

At the last inspection on the 5 April 2016 the home was rated as ‘Requires Improvement’. We asked the provider to make improvements in relation to gaining sufficient feedback about the service from people and their relatives, identifying risks associated with people self-administering their medicines and ensuring people’s changing needs were suitably recorded and reflected in care plans. This report discusses our findings.

At this inspection improvements had been made in some areas. The provider had established and gained sufficient feedback from people and their relatives to inform improvements in the home. There were systems in place, including annual feedback surveys and meetings that ensured people and their relatives views were regularly encouraged and used to improve the home. Overall people and their relatives were positive about the home and told us they felt listened to by the provider. However, further areas of improvement were identified, including four breaches of regulation in relation to providing personalised care, safe care and treatment, good governance of quality assurance and health and safety and complying with the requirement to suitably display the homes Care Quality Commission’s (CQC) performance rating. This is the second consecutive time the service has been rated ‘Requires Improvement’.

Records and assessments were not consistently reviewed or used to inform staff fully of people’s needs, mitigate risks to people’s wellbeing and safety. The registered provider and staff acknowledged that people’s initial placement assessments, risk assessments and care plans were not detailed enough fully guide staff on how to meet people’s needs and make manage any impact this may have on others living at the home. Care plans were not personalised enough to reflect people’s emotional needs, for example in relation to progressive health conditions or bereavement. Accident reporting was not sufficiently investigated or personalised in relation to outcomes and actions.

Practice around the safe administration of medicines was not consistently safe. Staff were trained and knowledgeable about people’s medicines, and ensured they were given in a respectful and timely manner. However, there was a lack of guidance on how ‘as required’ and ‘self-administered’ medicines should be given. Self-administered medicines were not consistently risk assessed to ensure risks to people and others, were assessed, managed and mitigated. Practice around quality assurance and the home’s governance was not always sufficiently robust in managing individual risk.

People and their relatives told us that staff were skilled and knew how to support them. Staff felt well supported by the registered provider and external trainer and consultant through supervision and essential training. However, staff also told us that they did not always feel they had sufficient training or experience to support people with more complex needs, for example people with progressive health conditions.

Mental Capacity Act 2005 (MCA) assessments were not always completed to ensure people’s capacity was suitably assessed when making decisions that could put them at risk of harm. Staff had a good understanding of how they should work in line with the principles of the MCA. People were supported to have maximum choice and control in their lives. The provider was meeting the requirements of the Deprivation of Liberties requirements.

The registered provider completed environmental risk assessments and a programme of regular health and safety checks to ensure quality was measured and maintained. We observed audit activity for areas including, fire safety, food hygiene and infection control.

People and their relatives felt the home was safe and that they were treated with dignity and respect. People could tell us why they felt safe and protected from the risk of abuse. Staff could tell us about different types of abuse and how they should report it. Staff told us the home had zero tolerance to abuse.

People and their relatives told us they enjoyed the food and the warmth of the home. People’s nutritional needs were met and they told us they had choice of food and drinks. People’s rights and privacy were respected.

People and relatives told us there were suitable levels of skilled staff available to meet people’s needs safely. Staff were supportive of people’s right to take positive risks and make decisions. The registered provider and staff acknowledged they were working additional hours as the deputy manager had been absent for two months. Recruitment of two new staff had taken place in response to this and the home was still providing staff cover in line with its dependency tool. A dependency tool is an evidenced based approach, that assesses the needs of the people being supported and the level of staffing required. The provider had safe recruitment procedures in place to ensure people were supported by caring and responsible staff.

We found 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 the report.’

Marine View Rest Home provides accommodation for nineteen people who need support with their personal care needs. On the day of our inspection there were thirteen people living in the home. One person was living with dementia and another had a neurological condition. The home is a large property, spread over three floors, with a communal lounge and dining room.

The service had a manager who was also the registered provider of the home. A registered provider is a ‘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.

Risk assessments had been undertaken for most risks. They considered people’s needs and abilities as well as hazards in the environment. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments, instead risks were assessed and managed to enable people to be independent. However, not all risks had been assessed. For example, a bed rails risk assessment was not in place to enable the provider to ensure that the least restrictive option had been considered and to ensure that bed rails were the safest method to use. One person used an air mattress to minimise the effects of pressure damage to their skin. However, appropriate mechanisms were not in place to monitor the setting of the mattress to ensure that it was correct and suitable for the person, therefore potentially increasing their risk of skin breakdown. One person administered their own medicine. The provider had not ensured that a risk assessment was in place to identify and mitigate the risks this may have created.

People were positive about the leadership and management of the home. One person told us “The manager listens to me, they are as straight as a dye.” There was a positive culture within the home. There was a relaxed, homely and friendly atmosphere which complied with the provider’s aims and was embedded in staff’s practice. However, there were minimal mechanisms in place to gain feedback to enable the provider to monitor the quality of the service provided and drive improvement. Records had not always been updated to evidence the good practice carried out by staff. For example, care plans were reviewed on a monthly basis but no changes in people’s conditions were recorded in the monthly reviews. Staff had taken appropriate action to ensure that people’s needs were met but had not documented this to inform other staff of their actions and to ensure that staff were provided with up to date information about the person’s care.

The lack of risk assessments for some practices and the insufficient monitoring of equipment to ensure that it continued to meet people’s needs meant that some people’s safety was potentially at risk. The lack of detail in monthly review records meant that staff were not provided with up to date information on people’s conditions. Minimal quality assurance processes did not enable the provider to monitor the quality of the service and take appropriate actions to drive improvement. These are areas in need of improvement.

There were sufficient numbers of staff to ensure people’s needs were met and their safety maintained. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns. People felt safe, one person told us “There is always someone around if you need help.”

People received their medicines on time and told us that if they were unwell and needed medicines that staff provided these. One person told us “I have a medical condition. They give me medication, I have to wait until it kicks in and then I feel very safe.” People were asked for their consent before being offered medicines and were supported appropriately. There were safe systems in place for the storage, administration and disposal of medicines.

People were asked their consent before being supported with anything and were encouraged to make their own decisions, enabling them to live their lives how they chose to. People had access to relevant health professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that people were being provided with safe and effective care. People’s health needs were assessed and met and they received good health care to maintain their health and well-being.

People could choose what they had to eat and drink and told us that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received support from relevant health professionals and that their foods were fortified to increase their calorie intake.

The provider had a complaints policy. People and relatives felt that the provider was approachable and were confident that if they were to raise concerns that these would be listened to and acted upon.

People were treated with dignity, their rights and choices respected. Observations showed people being treated in a respectful and kind manner. People’s privacy was maintained. When staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy maintained. One person told us “They attend to your every need and treat you with dignity and respect.”

Staff knew people well. Support was provided to meet people’s needs, preferences and interests. There were minimal organised activities. However, people preferred to choose how they spent their time. Some people chose to access the local community and enjoyed visits to friends and local shops. Others preferred to spend time in their rooms reading newspapers, watching television or playing musical instruments. People were able to make suggestions as to how they wanted to spend their time and these were listened to and respected.

People who used the service told us that they liked living at the home, they were happy with the care they received and the service met their needs. They told us that staff were 'Very kind and caring' and there was always someone around to provide help and support. One person who used the service told us, "I'm very satisfied, I can come and go as I please and that suits me.'

We saw that individual care plans provided guidance for care workers, to ensure that the assessed, current and on-going support needs of people using the service could be met consistently and safely.

We found that care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a sensitive and respectful manner.

There were effective systems in place to reduce the risk and spread of infection.

We saw that the service had effective recruitment procedures in place. Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

People's personal records including medical records were accurate and fit for purpose.