Seaview Residential Home Limited

Seaview Residential Home Limited is a residential 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. Seaview Residential Home is registered to provide care for up to 18 people. At the time of the inspection, there were 15 people living at the service, some of whom had a diagnosis of dementia.

People’s experience of using this service:

• People told us they liked living at Seaview Residential Home and felt safe. One person said, “The service here is excellent.”

• There were enough staff to meet people’s needs and they had been recruited safely. Staff received appropriate training and support to enable them to carry out their role effectively.

• Appropriate safeguarding procedures were in place to protect people from the risk of abuse. Staff knew how to report concerns and were confident that anything they raised would be taken seriously by management.

• Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately.

• People had access to health and social care professionals where required and staff worked together co-operatively and efficiently.

• Staff treated people with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what was important to them.

• People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them.

• People, their relatives and staff members commented positively about the management of the service and felt that the service was well-led. The provider was engaged with the running of the service and staff and people told us they were approachable.

• The registered manager and provider carried out regular checks on the quality and safety

of the service.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 23 April 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

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

The home accommodates up to 18 people and at the time of our inspection 12 people were living at the home. These people were all aged over 65 years and some were living with dementia. The service had two double bedrooms and 14 single bedrooms over three floors. There was a passenger lift so people could access each floor. Ten bedrooms had an en suite toilet with a wash hand basin and two bathing facilities were available to people. The home also had a main lounge, two smaller lounges, a conservatory and a separate dining room.

This inspection took place on 27 February and 7 March 2018 and was unannounced. The gap in the inspection dates was due to adverse weather conditions and the availability of key people.

At the time of the inspection there was not a registered manager in post at the service, there was a manager who had taken over the overall running of the service and was planning to apply to become registered to manage the home. 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 and associated Regulations about how the service is run.

The laundry area was not properly maintained, in a poor state of repair, was unclean and cluttered. There was no process in place to prevent cross contamination between dirty items entering the laundry and clean items leaving the laundry. There were no records to show when the laundry room had last been cleaned and it was not a clean, hygienic or safe environment in which to launder people’s clothes which increased the risk of cross infection.

Not all staff had up to date infection control training and infection control procedures were not robust and put people at risk of harm.

Where accidents, incidents, and near misses had occurred there was a process in place which recorded the incident. However, the information provided of the incident/accident or near miss was not always detailed and actions required to mitigate risks or prevent reoccurrence had not always been considered, followed up or implemented.

People and their families felt the home was safe and staff were aware of their responsibilities to safeguard people.

There were enough staff to meet people’s needs and recruiting practices ensured that all appropriate checks had been completed.

People received their medicines safely. Staff who administered medicines had received training and had their competency to administer medicines assessed to ensure their practice was safe.

Staff understood the need to gain people’s consent to care and treatment. However, people’s capacity to make decisions had not always been assessed in line with The Mental Capacity Act 2005.

People's needs were met by staff who were supported appropriately in their roles, however some staff refresher training in essential subjects was overdue.

People were supported to have enough to eat and drink and there was a choice of food which people told us they enjoyed eating.

Staff demonstrated an understanding of people’s health care needs and people were supported to access healthcare services when required. There were clear procedures to help ensure people received consistent support when they moved between services.

Staff knew people well and demonstrated an in-depth knowledge of their individual needs. Staff developed caring and positive relationships with people and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were provided with appropriate mental and physical stimulation through a range of varied activities.

People’s wishes and preferences for the care they wished to receive at the end of their life was clearly recorded which would, if provided, help to support people to have a comfortable, dignified and pain-free death.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. People and their families were encouraged to provide feedback on the service provided both informally and through quality assurance questionnaires.

People and their families were able to complain or raise issues on a formal and informal basis with the manager and were confident these would be resolved. This contributed to an open culture within the home.

There were systems in place to monitor the quality and safety of the service provided. With the exception of the laundry area, the environment was well maintained and measures had been taken to adapt the environment to aim to meet the needs of people living at the home including those people living with dementia.

People and their families told us they felt the home was well-led and were positive about the manager who understood the responsibilities of their role.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Seaview Residential Home provides care and accommodation for up to 18 older people including those living with dementia. At the time of the inspection 17 people were living at the home. These people were all aged over 65 years and some were living with dementia.

The service had two double bedrooms and 14 single bedrooms over three floors. There was a passenger lift so people could access each floor. Ten bedrooms had an en suite toilet with a wash hand basin. At the time of the inspection there was only one bathroom available with bathing facilities for people located on the ground floor. A bathroom on the first floor had been decommissioned and the provider had plans to refurbish it but there were no dates for this to be completed by. The home had two lounges and a separate dining room.

The service had 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.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The registered manager and staff had a good understanding and awareness of the MCA. Capacity assessments were carried out where people were unable to consent to their care or treatment and DoLS applications were made when needed.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People received their medicines safely.

Staff were motivated and skilled to provide a good standard of care. Staff were supervised in their work and had access to a range of relevant training courses.

People said there was a choice of food and that they liked the food. People were supported to receive adequate nutrition and fluids.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

Staff demonstrated a caring attitude to people who they treated with kindness and respect. People were able to exercise choice in how they spent their time. Care plans included details about people’s social and emotional needs so staff had guidance on how to support people with issues such as risks of becoming socially isolated.

People and their relatives were satisfied with the standard of care. Each person’s needs were assessed and this included obtaining a background history of people. Care plans showed how people’s needs were to be met and how staff should support people. Care was individualised to reflect people’s preferences.

There were a number of activities for people although the registered manager had identified this needed to improve and was actively recruiting a staff member to provide and facilitate activities. Areas of the environment had been adapted to provide stimulation and interest for people who were living with dementia. These included specialist signage to help people orientate themselves and a garden area with recreations of a shop, bus stop and train station to provide interest to people.

The complaints procedure was provided to people and their relatives. People said they had opportunities to express their views or concerns, which were listened to and acted on.

The management of the service demonstrated a commitment to learning and implementing current practice developments in residential social care. Relatives commented that the staff and registered manager communicated well with them.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service which the provider used to make any improvements. This included obtaining the views of people and their relatives regarding the service provided.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring, responsive, safe, effective and well led?

This is a summary of what we found-

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and provided care which was in line with their agreed plan of care. People told us staff were kind and responsive to their needs at all times. We saw that people's needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind and respectful manner.

Is the service responsive?

People's needs were assessed and reviewed regularly to ensure their needs were met. People and their representatives were encouraged to participate in care planning and review. The registered manager regularly spoke with people and their representatives to ensure their needs were being met.

We saw people had been encouraged to express their views on the meal provision at the home and, as a result of this, meal times had been changed and a more varied menu provided to cater for people's needs. This meant that people were able to express their views of the care they received and have them acted upon.

Is the service safe?

People told us they felt safe in the home and when being cared for by staff. People were cared for by people who had the appropriate skills and experience to ensure their safety and welfare. Staff had a good awareness of the needs of people who lived at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw the home had appropriate policies and procedures in place to protect people from the risk of abuse. Staff were aware of these policies and had a good understanding of how to report any concerns they may have. This meant people received care which ensured their safety and welfare.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received the care they needed to maintain their independence and dignity. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is the service well-led?

People told us the registered manager was were very approachable and responsive to any concerns they raised. Formal feedback questionnaire for the service since our last inspection in May 2013 showed people, their relatives and healthcare professionals who visited the service were happy with the level of care and support the home provided. People told us the staff team worked well together and were very responsive to any concerns or issues they raised.

Staff received appropriate support through supervision sessions and discussions with the registered manager. This meant staff were clear about their roles and responsibilities and management were supportive of their roles.

We saw that the home was undergoing some refurbishment with the minimum disruption to people.

We saw that people had access to various areas within the home to engage with others and could also access their own private rooms at any time. We observed people participating in a planned activity session and that a programme of activities was advertised for all to attend.

People had personalised their rooms with their own possessions including their own furniture.

We saw that the home had risk assessments in place for people using equipment to support their independent living safely. We saw that people had their care discussed and agreed with them and that formal agreement to these care plans was in place. During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences.

We observed people at a mealtime have positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. People were given choices about the food they would like to eat.

We spoke to the new manager, two care staff and the cook. Our observations provided evidence that people's individual wishes and needs were considered and met. The manager and staff were aware of people's likes, dislikes and abilities and through observation, discussion and review of individual records we saw how these were appropriately supported.

We looked at four care records. The care planning system was going through a review led by the new manager and we looked at two old and two new style of records. Both styles provided basic personal information on the persons assessment of needs, preference's, likes and dislikes and daily activities however the new style was more person centred and provided structure and consistency to the records.

Everyone we spoke with at the home confirmed that the staff were caring and competent; one person stated that 'they are very busy but always have time for me'. The told us that they felt safe in the home

The recorded registered manager was no longer employed, the provider had informed the Commission in September 2011. A new manager had been appointed and was familiarising themselves with the home, systems, policies and procedures.