Seaview Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The culture at Seaview Nursing Home was difficult to assess at this time because of the mixed feedback received from some staff and indications of a possible closed culture. A closed culture is a poor culture that has a potential to impact on positive outcomes for people if not addressed. It was clear that at this time, there was work to do to ensure that the vision and plans for Seaview Nursing Home was shared with all staff as some staff had spoken of an uneasy working environment. Comments from staff included, “It’s been a difficult time, changes brought in, I don’t feel listened to really,” “It feels like we are not doing things right, don’t feel supported,” and “I think things are better, more open and honest now, we have support, and the manager is out on the floor supporting us.”

The service aimed to give people consistently good quality care in line with the organisations vision. However, poor communication between management, staff, people, families, and some health professionals had created barriers in the past year. The new management team was working hard to open channels to communicate, and this was proving to be positive. We were told that communication was improving between staff and external health professionals

We received mixed feedback regarding the leadership in the home, some staff we spoke with were positive regarding the culture and the vision of the service, whilst others were less positive. Feedback included, “We hit a low point, changes in leadership, but I really think we are going in the right way.” However, we were also told, “There have been changes, not sure, things seem to a bit on the edge,” and “Things are not right at the moment, but we have new nurses starting so that will be good, and a new deputy manager, so time will tell.”

Feedback from visitors was also mixed. We were told, “I think the staff are so good, do a hard job, but always polite,” and “Not enough staff, new faces, and so it’s difficult to get information, but the new manager is approachable, and I trust things will get better.”

We have spoken to the new senior management about the concerns of developing a closed culture and they would be addressing this through meetings to facilitate open communication and take action as required.

The management team and staff understood and supported people’s cultural and spiritual needs. People were treated equally, and their individual needs considered when completing care plans in line with their preferences.

The provider had recently appointed inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. These leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The interim manager was experienced and understood the context in which they delivered care, treatment and support. They had good oversight of staff and people’s needs and were passionate about making improvements. However, provider oversight had not been fully effective in identifying issues.

The service has been rated Requires Improvement consistently since 2019, improvements when made were not consistent or embedded into everyday practice. The area manager and management team had plans in place to consistently improve the service but were realistic that it will not be a quick fix.

People did not always feel they could speak up and that their voice would be heard.

Staff had not always confident or free to speak up. Staff told us they would raise concerns that were related to people and their care to ensure safety. However, they would not raise other concerns to the management team as they felt that they were not listened to.

However, from talking to staff during the inspection process, we were confident that the new leadership had lowered barriers and staff told us, “We can go the manager, he is approachable, things are much more open now, I feel supported.”

The manager told us they had an open-door policy where staff could talk to them at any time. There were staff meetings and supervision and daily flash meetings with all staff.

There were whistleblowing and safeguarding policies in place and staff understood both the responsibility they had to use them, and how to use them.

Staff told us that felt able to raise concerns. The provider and manager understood their responsibilities under the duty of candour. The Duty of Candour is to be open and honest when untoward events occur.

Since the interim manager was appointed, we have received notifications as required. We were not fully assured that we had received notifications prior to that for some months due to lack of documentation. During our assessment we found that the management team were open and transparent about the difficulties of finding certain documents. They admitted things had gone wrong and demonstrated how they had used these to make improvements.

People and their relatives confirmed they knew how to complain, and a copy of the complaints policy was available in the home and on the service website. Relatives told us they would make a complaint if they needed to but would talk to staff first. There were no records of any complaints, and a new record of complaints log has been introduced in the service.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The manager said that the mental health and well-being of staff were regularly discussed since the change of management to ensure staff felt supported through changes. The home was proud to be inclusive and supported both staff and people that used the service. The manager said the staff team was multicultural and everyone was respectful of each other.

Staff felt they were treated as individuals and their needs were taken into consideration, such as shift times being re-arranged to fit in with family commitments if required.

The provider had procedures in place to promote staff well-being and worked to ensure flexible working conditions if required. There were robust measures in place to monitor, maintain and promote good mental well-being across the staff group. There was a formal recruitment process and equality, diversity and inclusion policy in place to guide equitable and fair recruitment and selection procedures. Staff were encouraged to undertake training in equality and diversity.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a quality assurance framework in place, however, this had not identified the shortfalls and concerns found during the inspection, such as staff deployment to ensure people’s safety and reduce risk of isolation, care plans and risk assessments not reflecting people’s needs accurately, the continued issues with the environment, and the management of unpleasant odours. There was also a lack of oversight in certain areas, for example, the management of distressed behaviours, this was because the documentation completed by staff did not always reflect the use of de-escalation techniques and of how they successfully met their mental health needs. During the assessment process we received an action plan that told us how they were going to review people’s care plans and risk assessments. We saw the area manager sitting with nurses and discussing how to use the computerised care plan to capture peoples’ needs. The new management team were very responsive to feedback and took things forward immediately and therefore we did not think a breach of regulation was proportionate at this time.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Feedback from health professionals identified that there had been concerns regarding poor communication, unplanned ward rounds, poor personal care of people, poor management of clinical emergencies, and concerns regarding the environment on Coral Unit. They have also reported that since the change of the management, and raising their concerns, there have been positive changes. Further meetings between external health professionals and the home management team have been planned to ensure that communication continues to improve and therefore improve partnership working and outcomes for people.

The staff team told us they were proactive in building relationships with other social care organisations and into the local community to improve peoples’ well-being. However, there was work to be done to ensure younger people and those who lived with mental health problems were enabled to access services and clubs that would give them the opportunity to mix and make friends of their own age.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Discussions with the management team and staff demonstrated they recognised the importance of learning lessons and continuous improvement to ensure they people received care and support that was safe and effective.

Safeguarding concerns, complaints, accidents, incidents and near misses were recorded however, there was minimal evidence of review, and root cause analysis. Therefore, emerging themes were not always being identified and preventative action taken, to reduce the risk of reoccurrence.

Staff told us they were supported to learn and develop. Some staff told us of support they received, through supervision and training. During the assessment, senior members of the management team confirmed they had identified areas to improve and were reviewing their service development plan to ensure it included all relevant areas and more clearly evidenced priorities for driving improvement.