Sea Bank House

Sea Bank House is a residential care home providing personal care to 13 older people at the time of the inspection. The service can support up to 23 people. Bedrooms are of single occupancy and there are various communal spaces for people’s comfort.

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

Staff followed correct procedures to ensure people received their medication on time and as prescribed. Staff consistently followed effective infection control procedures. A relative said, “I would expect to see very good standards with PPE and infection control and they have not let me down.” Staff created care plans based on each person’s needs aimed at maintaining healthy lifestyles. Everyone we spoke with commented about a positive, very caring environment with strong leadership. A staff member told us, “I love it here, we’re like a family.” The registered manager completed regular checks of the service to ensure everyone’s safety and welfare.

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 04 November 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we received about the service. The inspection was prompted in part due to concerns received about personal care, wound care and working with other agencies. 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.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

Sea Bank House is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 23 people.

Sea Bank House is situated in the seaside town of Knott End On Sea. There are two lounges and a separate dining room for people to enjoy. Parking is available outside the home.

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

Risk assessments were carried out and care documentation recorded the actions required to minimise risks. Staff we spoke with told us they had completed safeguarding training and would report any concerns to the registered manager or external authorities to ensure people were protected from avoidable harm. The registered manager followed safe recruitment practices and staff were deployed effectively, so they could meet people’s needs.

The registered manager carried out regular checks on areas such as medicines, infection control, accidents and incidents and the environment to ensure shortfalls were identified and actioned and successes celebrated.

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.

People were cared for in a safe, clean and homely environment by staff who were caring, competent and knowledgeable about people’s needs. Training and supervision was arranged to ensure staff had the skills to carry out their role. People told us they were “comfortable” and described staff as “kind and caring.” They explained the food was good, enjoyable activities were arranged, and they were supported to access medical advice if they needed this.

People were treated with dignity and respect and staff we spoke with us told us how they respected people and ensured their privacy and dignity was maintained. Care was person centred, met people's needs and achieved good outcomes. People were cared for at the end of their life in line with their wishes.

The registered manager had promoted an open, caring culture within the home and a strong ethos of teamwork to support people to live happily and safely. Staff and the registered manager worked closely together, and with external health professionals, to help enable people to have the best outcomes possible.

People were consulted and asked their views on the service provided. The registered manager provided people with surveys and a comment book for people to give feedback. Any comments were actioned whenever possible. People told us they were happy at the home and were confident any comments or complaints they made would be listened to.

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 requires improvement (published 29 December 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Sea Bank House 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.

Sea Bank House Care Home is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people and there are two lounges and a separate dining room for people to enjoy.

At our last inspection in July 2017, the service was rated as ‘Requires improvement’. We found medicines were not always managed safely as records relating to medicines were not always accurate. This was a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection, the registered provider sent us an action plan indicating how improvements would be made and compliance with the regulation reached. Due to technical problems, we were unable to review this prior to the inspection. In addition, after the last inspection we met with representatives of the provider and asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions ‘safe’ and ‘well-led’ to at least good.

At this inspection in November 2018 we found some improvements had been made. We looked at four people's medicine records and saw three of these were accurate. The fourth person's record required updating. Prior to the inspection we saw this had been carried out and the person's medicines had been reviewed by external health professionals. We have made a recommendation about the safe management of medicines.

We found a risk assessment was not followed in relation to a person's equipment and we were informed no manufacturers instructions had been followed when the equipment was fitted by staff. This was a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

We noted documentation did not consistently reflect people’s needs and audits had not identified the concerns we found on inspection. This was a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

You can see the action we told the provider to take in the full version of the report.

At the time of the inspection visit there was a no manager in place who was registered with the Care Quality Commission. 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.

We reviewed recruitment records and saw checks were carried out to ensure prospective employees were suitable to work with vulnerable people. On discussion with the manager we learnt that following initial checks being carried out, these were not repeated during the person’s employment at the home. The manager told us they were in the process of addressing this.

Relatives and people who lived at the home told us they were consulted and involved in care planning. People and relatives told us staff were friendly and respectful and caring in nature.

We found the home was clean and tidy and staff were seen to wear protective clothing when this was required. We noted the newly refurbished shower room did not have facilities for hand washing. The manager told us they were addressing this and on a second day of the inspection we saw hand washing facilities were being installed.

We saw documentation which evidenced the service sought feedback from people who lived at the home and relatives. Documentation asked people to share their opinions on what the home did well and what needed to improve. The manager told us they were preparing to repeat the annual survey and would respond to comments when they were received. There was a comments box in the reception of the home for people, relatives and visitors to leave any comments they wished.

People told us they did not have to wait for help and staff were attentive to their needs. We timed two call bells which were answered promptly. We observed staff were patient and spent time with people chatting and supporting them when they needed help. Staff and relatives we spoke with voiced no concerns regarding the staffing arrangements at the home. Rota’s we viewed showed the staffing was arranged in advance and staff confirmed replacement staff were provided if unplanned absences occurred.

Staff told us and we saw documentation which evidenced staff attended training to enable them to maintain and update their skills. We also saw evidence and staff confirmed, they had regular supervision with their line manager to discuss their performance.

People were asked to express their end of life wishes. Documentation was available to plan this area of people’s care if people wanted to share their needs and wishes.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was required.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they requested it. We found staff were available to help people if they needed support.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they valued them as individuals. Staff were gentle and patient with people who lived at the home and people told us they felt respected and valued.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the manager or the local authority safeguarding team so people were protected. During the inspection process we received information of concern from a member of the public. We discussed this with the manager who immediately acted to investigate the concerns raised.

There was a complaints procedure available at the home. People we spoke with told us were confident any complaints they may wish to make would be addressed by the manager. Relatives told us they were aware of the complaints procedure and told us the manager would respond to any complaints made.

People told us there were a range of activities provided. They said they could take part in these if they wished to do so. People told us they were asked if they wanted to take part in activities and if they declined, their wishes were respected. We saw there was an activities planner on display at the home.

The manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Relatives we spoke with told us they could speak with the manager if they wished to do so and they found the manager approachable.

This is the third time the service has been rated Requires Improvement.

Further information is in the detailed findings below.

Sea Bank House 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.

Sea Bank House Care Home is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people. Some day care services are also available. The home is set on three floors with a lift to the first and second floor. There is a small paved garden to the front of the home and a raised decked area to the rear.

At the time of the inspection there was a manager who was registered with the Care Quality Commission (CQC). The registered manager no longer worked at the home and had not completed the process of deregistering with the CQC. There was an acting manager in place who worked at the home. They told us they were in the process of applying to the CQC to become the registered manager of Sea Bank House.

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 inspection was prompted in part by information of concern that a person using the service did not receive prompt care and support and was not referred quickly to a health professional. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of infection and the timely referral of people to external health professionals. This inspection examined those risks.

We also used this inspection to check improvements had been made since our inspection in June 2017. At our last inspection in June 2017 we found three breaches of regulation. We found the registered provider had not displayed their rating on their website, referrals to Lancashire Safeguarding Authorities and the Disclosure and Barring Service were not always made and checks had not identified these actions were required.

We served a Fixed Penalty Notice to the registered provider for the failure to display the rating on their website. This has now been paid.

We asked the registered provider to take action to make improvements for the other areas we had noted. They sent us an action plan which explained the action they planned to take. The action plan recorded that improvements would be made by August 2017.

At this inspection in May 2018 we found improvements had been made. The acting manager completed a series of checks and investigations to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these. People told us they could raise their views on the service provided and they felt involved in the running of the home.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

At this inspection in May 2018 we checked to see if medicines were managed safely. We found improvements were required. We found records were not always accurate and people could not be assured they would receive their medicines safely. This was a breach of Regulation 12 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.

During this inspection in May 2018, the service had not met one of the regulations inspected. This is reflected in the rating ‘well-led.’

Care records we viewed identified risk and documented the support people required to maintain their safety. We noted one care record required further information regarding the risk controls and support required to minimise harm. We also noted two risk assessments required more information regarding risk controls in place. We have made a recommendation about this.

We viewed documentation relating to the recruitment of staff. We found the documentation did not request the specific dates of employment. We have made a recommendation about this.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Sea Bank House.

Staff told us they received training to enable them to maintain and refresh their skills. We saw a training matrix which recorded the training staff had completed.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. People also told us they were offered more if they wanted this. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they finished their meal. Staff were available to help people if they needed support.

We found the environment was clean and we observed staff wearing protective clothing when required. This minimised the risk and spread of infection.

People and relatives we spoke with told us they were happy with the staffing arrangements at the home. We observed staff spending time with people and the atmosphere was relaxed and unhurried. Staff we spoke with raised no concerns with the staffing arrangements at the home.

The acting manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

This is the second time the service has been rated Requires Improvement.

Sea Bank House Care Home is situated in the seaside town of Knott End On Sea. The home is registered to provide care and accommodation for up to 23 older people. Bedroom accommodation is on three floors which can be accessed by a lift. There is a communal lounge and a separate dining area. There is seating in a small garden at the front of the home.

The home has a manager who is registered with the Care Quality Commission. 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.

We last inspected Sea Bank House in July 2015. We identified no breaches in the regulations we looked at.

During this inspection visit carried out in June 2017 we asked people if they felt safe. People we spoke with told us they did. However, we found that allegations and evidence of abuse were not always referred to external bodies in a timely way. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to make in the full version of the report.

We looked at the auditing systems in place to identify shortfalls at the home and drive improvement. We found checks on medicines, care records and the environment were carried out. We saw evidence that accidents and incidents were monitored and the registered manager could explain actions taken to minimise reoccurrence. However, we found that required checks were not always carried and had not identified the shortfalls we found during the inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to make in the full version of the report.

It is a statutory requirement that registered providers of health and social care services display their performance assessment from the last Care Quality Commission inspection report. We found the rating from the inspection carried out in July 2015 was not displayed on the registered provider’s website. This was a breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Requirement as to display of performance assessments.) You can see the action we told the provider to make in the full version of the report.

We found documentation we viewed was not always complete or up to date. We found risks to people were identified, however the action required to maintain people’s safety was not always recorded. During the inspection visit we raised this with the registered manager. Prior to the inspection concluding we were informed documentation had been updated.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found appropriate applications to deprive people of their liberty were made to the local authorities as required.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed the required checks had been carried out prior to starting work at the home.

Staff told us they met with the manager on an individual basis to discuss their performance. Staff were complimentary of the training provided and told us further training was being arranged to ensure their skills remained up to date.

We discussed staffing with people who lived at the home. People and their relatives told us staff were “busy.” During the inspection we saw staff were patient and kind with people who lived at the home. We saw people were supported at a pace appropriate to their individual needs. We have made a recommendation regarding the staffing at the home.

People who lived at Sea Bank House told us they considered staff were caring. One person told us staff were, “alright.” We observed people being supported with kindness and compassion.

During the inspection we saw an external entertainer visited the home to provide entertainment for people who lived there. We asked people at the home how they spent their time. We received mixed feedback. We were told, “I read a lot of magazines, I like watching quizzes on TV.” And, “I just read, there’s not much else to do.” We spoke with a member of staff who told us they were completing a qualification in the provision of activities. They said they were keen to build upon the activities already provided.

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

Most people told us they enjoyed the food at the home. We observed the breakfast and lunchtime meal and saw this was a positive experience for people who lived at Sea Bank House. People were able to choose where they ate their meal and alternative foods were provided if people did not like the meal provided.

People who lived at the home told us they could speak with the manager if they wished to do so. Surveys were offered to relatives and people who lived at the home as a way of receiving feedback. The registered manager told us they did not hold ‘residents and relatives meetings as they were poorly attended. They told us the operational manager was developing a newsletter to provide relatives with up to date information.

People who lived at the home and their relatives told us the manager was approachable. People who lived at Sea Bank House told us they would welcome seeing the registered manager more frequently. We passed these comments to the registered manager for their consideration.

People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

'They (the staff) know me. We always have a laugh!'

'I am quite satisfied with everything here. I have no concerns at all.'

'I am very happy with this home. It's the best move I have ever made.'

'The staff, the cleanliness, the food - everything is smashing.'

Whilst the majority of comments we received were positive, one person commented, 'I think it's a shame that they sold the bus. It was great to be able to get out!'

During the inspection, we looked at standards in relation to the care and welfare of people who used the service and arrangements for gaining their consent for care and treatment. We also looked at processes for ensuring that the home was maintained in a clean and hygienic manner. We assessed the home's processes for recruiting staff and monitoring standards. We did not identify any concerns with these areas.

However, we identified some concerns in relation to the area of respecting and involving people who use services. We asked the manager to take action to address our concerns and will carry out further work to ensure they are addressed.