Seaway Nursing Home

We found the following examples of good practice.

• Safe arrangements were in place for visitors. This included confirmation of a negative lateral flow test, temperature checks, and the use of personal protective equipment (PPE). Visiting professionals showed evidence of vaccination status or exemption.

• There were adequate supplies of personal protective equipment (PPE) throughout the home. PPE stations were located outside of people’s bedrooms. Staff were seen appropriately using PPE.

• There were arrangements to admit people safely to the home. This included testing and isolation in line with guidance.

• People were supported to understand and comply with visiting and social restrictions in line with all best practice guidance and this was communicated and updated as needed.

• The provider followed relevant COVID-19 testing guidance. This included staff testing requirements as well guidance on testing for people using the service and visitors.

• Maintaining the mental health of people and staff was a priority with proactive support from the service to encourage peoples well-being. This included supported activities within the home and support to maintain contact with family and friends.

• There were clear cleaning schedules in place which included the frequency of cleaning high touch areas. Records showed compliance with the cleaning schedule.

• The home had an up to date infection control policy and carried out regular infection control audits.

• Staff were trained and knew how to immediately instigate full infection control measures to care for a person who developed symptoms, who tests positive or who has been exposed to the virus to avoid the virus spreading to other people and staff.

Seaway Nursing Home is a care home registered to provide nursing and residential care and accommodation for 20 people with various health conditions, including dementia and sensory impairment. There were 20 people living at the service on the day of our inspection. Seaway Nursing Home is a converted property located in Hove, East Sussex.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. One person told us, “It’s not as good as my own house, but it’s a good second, the staff are lovely”.

People enjoyed as independent a lifestyle as their conditions allowed and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “I’m looking forward to the roast today”. A relative added, “I don’t leave here worried about [my relative], she is in good hands here. I think [registered manager] is a great manager”.

People felt the service was well presented and welcoming to them and their visitors. A relative told us, “I’m always made welcome when I visit”. People told us they thought the service was well managed and they enjoyed living there. A relative told us, “The manager is always here, as far as I think, the home is run well”.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care from dedicated and enthusiastic staff that met their needs and improved their wellbeing. A member of staff said, “I really like the residents. We listen to them and support them. The world can be a bit scary to them sometimes and we make sure they feel secure and happy”.

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

Rating at last inspection: Requires Improvement (report published 14 January 2019).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any concerning information we may inspect sooner.

Seaway Nursing Home is a ‘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. Seaway Nursing Home is registered to provide care and accommodation for 20 older persons with nursing, residential care and physical care needs. At the time of this inspection, there were 12 people living at the service.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in many areas since the previous inspection. However, despite the improvements that we identified, we were unable at this inspection to determine whether the current service provision had been fully embedded and could be sustained over time, should the number of people living at the service increase.

The overall rating for Seaway Nursing Home has been revised to Requires Improvement. We will review the overall rating of Requires Improvement at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

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.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. However, despite the improvements identified in relation to staffing levels, we were unable at this inspection to determine whether the current service provision and levels of safety could be sustained over time, should the number of people living at the service increase.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. The service had an ongoing action plan and significant improvements had been made since the last inspection. However, the delivery of the action plan would need to be monitored over time to ensure that the improvements identified could be fully implemented and sustained.

Care plans described people’s needs and preferences and staff knew people well and how they wished to receive their care. However, despite the improvements identified in relation to the planning and delivery of personalised care, we were unable at this inspection to determine that the systems of care planning had been fully embedded and could be sustained over time, should the number of people living at the service increase.

Suitable measures had been taken to ensure that people were safe, but their freedom was not restricted. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

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

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff, and they were encouraged to be as independent as possible.

People were encouraged and supported to eat and drink well and there was a varied daily choice of meals. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included quizzes, singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions. People were also encouraged to stay in touch with their families and receive visitors.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and staff were aware of these.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Staff had received supervision meetings and had formal personal development plans.

People's individual needs were met by the adaptation of the premises. Peoples’ end of life care was discussed and planned and their wishes had been respected. People had access to technology to ensure they received timely care and support.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Seaway Nursing Home is situated in Hove, East Sussex and is one of two homes owned by the provider, Seaway Nursing Homes Limited. Seaway Nursing Home is registered to accommodate 20 people. At the time of the inspection there were 16 people accommodated in one adapted building, over three floors. Each person had their own room and had access to communal bathrooms, lounge and gardens,

The home had a registered manager. A registered manager 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 home is run. The management team consisted of the registered manager and an area manager who was based at the home.

At the previous inspection on 22 February 2017 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of Safe, Effective and Well-led. At this inspection we continued to have concerns. The overall rating for this service is now ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Staff had an understanding of safeguarding adults; however, it was not evident if systems and processes considered people's safeguarding if they experienced an unexplained injury. There was an over-reliance on restrictive practices to manage people’s needs and behaviour. Appropriate procedures had not always been followed to ensure that these were in compliance with legal requirements. Risks to people's safety had not always been managed and guidance provided by external healthcare professionals had not always been implemented to ensure people received safe care and treatment. These were areas of concern. As a result three safeguarding referrals were made to the local authority by CQC following the inspection.

There was mixed feedback in relation to staffing levels and observations raised concerns with regards to the practices used by staff to meet people’s needs. This was an area of concern.

People were not always supported in a person-centred way and their dignity and privacy was not always respected. The environment did not provide people with opportunities to socialise or interact with one another. Some people, particularly those who were less independent, spent large amounts of time with very little stimulation or interaction with staff, other than when providing support to meet their basic care needs. People were at risk of social isolation, although a dedicated activities coordinator took time to interact and engage with people, there were concerns about the lack of stimulation when they were not working. These were all areas of concern.

There was a lack of oversight of the home from both the registered and area manager. Quality assurance processes were not always effective. When audits had been conducted shortfalls had not always been identified. The registered manager and provider had not consistently monitored the systems and processes within the home to ensure that they were meeting people’s needs and to continually improve the service. The registered manager and provider had not always submitted notifications to CQC to inform us of incidents and events that had occurred at the home to ensure that appropriate action had been taken. Records did not always contain sufficient detail and were not always completed. It was not always evident if people had received appropriate care or if staff had failed to update the records. The leadership and management of the home was an area of concern.

Areas in need of improvement related to guidance to inform staff’s practice on the administration of ‘as and when required’ medicines and the need to adhere to organisational policies in relation to recruitment practices.

People and a relative told us that staff were kind, caring and compassionate and our observations confirmed this. One person told us, “Staff are very good, kind and patient”. A relative told us, “The care is as good as it can be”. People told us that they felt safe, comments included, “Staff are always looking out for me when I move about” and “Yes, I am safe here”. People received their medicines on time and there were safe systems in place for the ordering, storage and disposal of medicines. Most risks in relation to people’s care had been assessed and managed and practice changed as a result. People were protected by the prevention and control of infection.

People received support from external healthcare services when required and told us that they had faith in staff’s abilities to notice when they were unwell. People were able to share their views and opinions through annual surveys and bi-annual residents’ meeting. The provider had a complaints policy and people told us that they felt able to raise concerns and complaints without fear of repercussions. Staff were trained and competent and supported people in accordance with their needs and preferences. People received good end of life care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read what action we told the registered manager to take at the back of the full version of the report.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to recruitment practices, the analysis of accidents and incidents and management oversight of the service. Additionally, areas of improvement were identified in relation to guidance for staff around PRN (as required) medication, and staff training.

The overall rating for Seaway Nursing Home remains as requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been made and sustained.

Seaway Nursing Home is registered to provide accommodation and care, including nursing care for up to 20 people. They specialise in supporting older people, some of whom are living with dementia or chronic health conditions. On the day of our inspection there were 17 people living at the service, who required varying levels of support.

There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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 provider had safe recruitment procedures, however these had not always been followed. We looked at the staff files for all members of staff currently employed by the service, and found that several contained gaps and omission in relation to the pre-employment checks the provider is required to obtain for members of staff. This placed people at risk of receiving care from staff that were not safe to work with vulnerable people. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and is an area of practice that requires improvement.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, we found the monitoring of accidents and incidents was not robust. Additionally, when we raised our concerns with the management of the service in relation to gaps in recruitment files and further evidence we found in respect to staff conduct and staff not engaging with training, we were told that the management of the service was aware of these issues, but had not acted upon them. Furthermore, accident and incident records identified that many people were at high risk of falls. The provider had recognised that falls prevention training was required and had included this on their training matrix. However, we saw that this training had not taken place for staff. People were placed at risk, as the provider did not have adequate systems and processes to monitor and mitigate any risks relating the health, safety and welfare of people using services and others. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and is an area of practice that requires improvement.

Staff had received essential training and there had been opportunities for additional training specific to the needs of people. However, we saw that several members of staff had not received essential updated ‘refresher’ training in a timely manner, and further work was required in relation to the provision of training specific to the needs of people who used the service. This is an area of practice that needs improvement.

We have made a recommendation about the provision of training specific to the needs of people using the service.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. However, guidance for the use of ‘as required’ (PRN) medicines was not available. We have identified this as an area of practice that needs improvement.

We have made a recommendation about the management of medicines.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Safe? Very much”. Another said, “There doesn’t seem to be a shortage [of staff]”. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

People chose how to spend their day and they took part in activities in the service and the community. Where appropriate, people were also encouraged to stay in touch with their families and receive visitors.

People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is very good”. Special dietary requirements were met, and people’s weights were monitored with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. A relative said, “I believe that [my relative] has only lived as long as he has, because of the care he’s got here”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. Staff had received both one-to-one and group supervision meetings with their manager. One member of staff told us, “I have supervision every few months. I have discussed issues in the past and they have been resolved”.

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

There was a manager was in post, however they had not currently registered with the CQC. The service had been without a registered manager for approximately five months. 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.

People’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, safe procedures for the administration of the medication were not routinely being followed, which placed people at potential risk of receiving their medicines incorrectly. We have identified this as an area of practice that needs improvement.

Where people lacked mental capacity to make specific decisions, the staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. However, despite senior staff having appropriate training and knowledge, we found that care staff had not received formal training around the MCA. We have identified this as an area of practice that needs improvement.

Staff had received essential training, however, this training had not routinely been updated. There were also limited opportunities for additional training specific to the needs of the service, such as end of life care, the care of people with dementia and caring for people with chronic conditions, such as diabetes. We have identified this as an area of practice that needs improvement.

People chose how to spend their day and they took part in activities in the service. It is acknowledged that meaningful activities had previously been planned and taken place for people. However, we saw no activities taking place on the day of our inspection, and no formal provision had been made to provide activities for people in the planned absence of the activities co-ordinator. We have identified this as an area of practice that needs improvement.

People were not actively involved in developing the service. Other than the complaints process, there were no formal systems of feedback available for people, their friends or relatives to comment on the service and suggest areas that could be improved. We have identified this as an area of practice that needs improvement.

The provider undertook some quality assurance audits to ensure a level of quality was maintained. However, further quality review and auditing systems needed to be kept up to date. For example, the most recent infection control audit had taken place in August 2015. Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow. We have identified this as an area of practice that needs improvement.

Support for the manager to increase their knowledge, and to share learning and best practice to drive up quality at the service had not been made available or explored. Additionally, the manager was responsible for managing the service, but also split their time between being on the rota as the nurse in charge on some days. In light of the concerns identified in respect to medication procedures, staff training, oversight of documentation and auditing systems, it was clear that the current management arrangement in place was not effective and had resulted in a reduction in quality of the service. We have identified this as an area of practice that needs improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. A relative told us, “I know [my relative] is safe”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable in safeguarding adults and what action they should take if they suspected abuse was taking place.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People told us they felt well looked after and supported and stated that staff were friendly and helpful. We observed friendly and genuine relationships had developed between people and staff. One person told us, “I am always treated with dignity and respect”. A relative told us, “There is a good caring environment”. People were encouraged to stay in touch with their families and receive visitors. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People knew how to make a complaint. They said they felt listened to and any concerns or issues they raised were addressed. Risks associated with the safety of the environment and equipment were identified and managed appropriately.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, and the manager was always available to discuss suggestions and address problems or concerns. One member of staff told us, “We can go to the manager at any time, the manager is lovely”. Another said, “We are a good team, we pull together when it’s tricky, it’s all about the residents”.

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.

As part of this inspection we spoke with two people who used the service, a visiting relative, the registered manager, a registered nurse, the chef and two care workers.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

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

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us "I wouldn't have my [relative] anywhere else".

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

There were systems in place to ensure that people's medication was managed appropriately and safely.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs. A relative told us 'They always involve me with my [relative's] care plan'.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service told us "I really like the staff". A relative told us 'The carers here are brilliant'. We observed that people were treated with consideration, dignity and respect.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Where appropriate, people completed a range of activities in and outside the service. The home had a dedicated sensory room for people to use.

People's needs were assessed before they moved into the service and detailed and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people's individual needs.

We were told by the registered manager that the service had good systems in place to monitor its own standards of service delivery. The registered manager told us they carried out a range of internal audits, including quality monitoring, medication and environmental health and safety.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon. However we identified some shortfalls in respect to the frequency of satisfaction surveys and meetings for residents/relatives.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us 'This is very much a nice place. The staff are very good to me'. A relative of a person who used the service told us 'Any problems and they get on it straight away. All in all it's very good'. A member of staff we spoke with told us 'I think that everyone here is safe and happy'.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service. The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

We spoke with two members of staff during our inspection and were told that they felt valued and supported and that their training needs had been met. We also found that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.