Seahorses

We found the following examples of good practice.

The provider worked closely with the registered manager to ensure safety of people living at the service. They would only allow a new admission after a confirmed negative result of the Covid-19 test of a person.

The number of occupied beds enabled easier social distancing. The management were aware of zoning guidelines but did not need to implement it as no people were Covid-19 confirmed or suspected till date. There was a contingency plan to utilise a bedroom in the far end of the site if a barrier nursing was required.

The provider ensured there was a sufficient stock of personal protective equipment (PPE) and the vetted supplier ensured it complied with the quality standards. Staff had infection control training and understood the correct donning and doffing procedure.

People were supported by a stable and committed team of staff whom they knew well. This helped people to recognize the individual staff with the need to wear face masks.

Staff were well supported and praised the management team, comments included; “We locked pretty early to visitors, it was a good idea. We treat people as our family.” and “We've kept being Covid-free, I think it’s a case of extra precautions and working well as a team.” The provider considered risks and impact of the inspection on the individual staff members, this included around their health conditions as well as their caring responsibilities.

Regular testing for Covid-19 took place for both people living at the service and the staff. There was a comprehensive contingency plan what to do in case of an outbreak.

The provider ensured people’s relatives were able to get in touch with people, for example by using technology.

Further information is in the detailed findings below.

Seahorses is a residential care home registered to provide personal and nursing care to older people. The service can support up to 20 people. There were 14 people living at the home at the time of the inspection.

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

People living at Seahorses told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines safely and as prescribed.

People told us staff were caring. Staff consistency enabled people to receive good care from staff who knew them well. Staff did all they could to promote independency and we saw examples of such practices.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home

The home was well-led by a registered manager who was committed to improving people’s quality of life. The service had a clear management and staffing structure in place and staff worked well as a team. The provider had effective quality assurance systems in place to monitor the quality and safety of the service. Staff worked well with external social and health care professionals.

Rating at last inspection and update

The last rating for this service was Good (published 21 November 2017).

Why we inspected

The inspection was prompted in part due to concerns received around Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards DoLS as well as poor referrals and staff training. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective sections of this full report.

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.

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

Seahorses is registered to provide accommodation and personal care for up to 20 people. On the day of our inspection there were 15 people living at the home. People were living with various stages of dementia and associated conditions.

At our last inspection on 4 and 23 March 2016 we found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Records did not show the Mental Capacity Act (MCA) 2005 had been followed in relation to consent, the home was not always clean, risks were not always identified and appropriately managed, medicines were not always managed safely and audits were not always effective. In addition the environment and décor of the home did not always support people living with dementia.

At this inspection we found the home had made improvements to address the areas of concern and bring the service up to the required standards.

There was a registered manager in post. 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 understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included people who were deprived of their liberty. Records relating to the MCA were accurate and up to date. People were offered choices and their decisions were respected.

The home was clean and free of malodours. Cleaning schedules were in place and staff followed schedules using personal protective equipment. New carpets and easy clean furniture had been installed and the bathrooms, toilets and laundry were clean and smelt fresh.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

People received their medicines as prescribed and systems were in place to safely store and manage medicines. Medicine records were accurate and up to date.

Records in relation to people who used the service were complete and accurate. The registered manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements.

Whilst some improvements had been made the décor and environment did not always support people living with dementia. The registered manager was aware and understood the need to improve the environment. We have made a recommendation in relation to the dementia environment.

We were greeted warmly by staff at the service who seemed genuinely pleased to see us. The atmosphere was open and friendly.

People told us they were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff that were extremely knowledgeable about people’s needs and provided support with compassion and kindness. All staff had received dementia training. People received quality care that was personalised and met their needs.

There were sufficient staff to meet people’s needs. Staff responded promptly where people required assistance. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The service responded to people’s changing needs. People and their families were involved in their care and how their care progressed and developed.

Staff spoke extremely positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was very approachable and supportive and that there was a very good level of communication and trust within the service.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who clearly understood the dietary needs of the people they were catering for.

The last inspection to the service was on 15 May 2014. Shortfalls in the safety and suitability of the premises and assessing and monitoring the quality of the service were identified. In October 2014, a review was undertaken to assess whether improvements had been made to address the shortfalls. The provider and registered manager provided sufficient information to evidence improvements had been made.

Seahorses is registered to provide accommodation and personal care for up to 20 people. However, due to no longer using bedrooms allocated for double occupancy, 18 people were usually accommodated. During the inspection, there were 17 people living at the home. People were living with various stages of dementia and associated conditions.

A registered manager was employed by the service. 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 registered manager was available for the majority of the inspection.

Audits to monitor the quality of the service were not effective, as shortfalls were not being identified and addressed. Potential risk was being addressed on a generic basis with control measures impacting on people’s welfare or activity. This included locking all internal doors to prevent people entering unsupported and removing call bell chords, in response to minimising harm.

Not all areas of the home were clean. This included less visible areas, such as the underside of the bath hoist and along the beading of over-bed tables and in the groves of the dining room chairs. Infection control guidance was not consistently being followed as toiletries and unnamed topical creams were being stored in bathrooms.

Staff knew people well and were aware of their needs. However, care plans did not demonstrate this knowledge. Information did not state how staff should manage particular behaviours or resistance to care. Some care plans lacked clarity regarding the support people required.

Staff and the registered manager told us they received a range of training to complete their role effectively. However, records were disorganised and did not reflect the training staff had completed. Due to this, it was not clear if staff had received training in core subjects such as safeguarding people and dementia care.

Staffing levels were in the process of being increased as it had been identified, an additional member of staff during the day would be beneficial. During the inspection, the home was calm and people were not waiting for assistance. Staff had time to sit and talk with people.

People were given their medicines in a person centred manner. However, some shortfalls in the procedures increased the risk of error. People were fully supported to meet their health care needs by regular consultations and intervention from professionals such as GPs and district nurses.

The registered manager was committed to people’s wellbeing and ensured staff had the right qualities of care and compassion, to support people effectively. Staff had established a good rapport with individuals and treated people with kindness. Staff spoke to people in a friendly manner and promoted their privacy and dignity.

People were supported by staff who felt valued and were well supported by each other and management. Staff had day-to-day contact with the registered manager and regularly met more formally, to discuss their work.

People had enough to eat and drink. The menu did not offer a choice of main meal although staff and the registered manager confirmed alternatives would be given if required. There were no concerns with people losing weight. Meals were generally cooked “from scratch” and specialist diets could be accommodated.

Systems were in place to enable people, their relatives and staff to give their views about the service. Recent surveys showed full satisfaction in all areas. Relatives were aware of how to make a complaint although did not feel they need to do so.

We found six breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we required the provider to take at the end of this report.

Formal and recorded feedback from people using the service and their relatives was undertaken and the results were now collated and acted upon. A range of health and safety and care practice audits had been implemented.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, the staff, speaking with relatives of people who use the service, talking with commissioners of the service and from looking at records. We also requested the provider to send more information to us after the inspection.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

The care home had a person-centred approach in their delivery of care and this was evidenced at the inspection. Care workers who provided care to people ensured that people's needs were taken care of, which included checking that their needs were addressed. Care was provided in privacy and in a dignified way. Care staff knew each person at the service as an individual and what their preferences were. People were given choice in the way their care was provided.

Is the service responsive?

We saw that people's needs were met. The provider ensured that appropriate interventions were taken where people were at risk because of their health. Examples of good practice we saw included referral to and intervention by the GP, dietician and speech and language therapist when people were not taking enough food or fluids. There was also a community mental health nurse contracted by the provider to screen people for confusion, dementia progression or depression.

Is the service safe?

Day to day care provided by the staff to people was safe. There were enough staff to provide care in a prompt manner and ensure that people did not have to wait for their needs to be met. Basic health and safety requirements were handled satisfactorily. However, we found evidence that people were at risk from the safety of the premises and related maintenance requirements. The provider did not have some necessary checks in place to ensure that the premises did not pose a risk to people's health and safety. We made referrals to other agencies regarding the premises.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have 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.

Is the service effective?

People were complimentary about the care they received and had no complaints when we asked. Relatives and commissioners of services confirmed this when we asked. It was clear from our observations and from speaking with staff they had a good understanding of peoples care needs and that they knew them well.

Is the service well-led?

The care home had a registered manager in post who worked with the other staff to provide management oversight of care provided. The registered manager took responsibility for quality and safety of the care with their involvement in risk assessment, care planning and care delivery. Although people could have a say in the operation of the care home, this was not routine or recorded to monitor improvement. There were some basic audits in place, but an effective quality system was not in place to ensure risks to people and others were adequately addressed.

People were offered a varied diet and the home ensured that nutritional needs were assessed and monitored on an ongoing basis.

We observed that the care staff were skilled at the meeting the needs of people with dementia and responded to people living in the home in a caring and professional manner.

The home had safe procedures in place for the administering and storing of medications.

We found there were shortfalls in the provision of staff which meant people did not all receive the support they required, particularly at mealtimes. The home did not employ a cook and the meals were prepared and served by the care staff.

We found that the home was clean and hygienic and free from odours.

We found that medications were being safely stored and administered.

The home had an established staff team who understood the needs of the people living in the home but improvements were needed to the recruitment process and the documenting of staff records.