Seaview

People's experience of using this service: The service was safe. Risk reduction methods were in place to minimise the likelihood of people coming to harm. Staff knew the signs of abuse or harm and they reported their concerns in line with company safeguarding policies and procedures. Medicines were managed well, and the home was exceptionally clean and tidy.

People had achieved good outcomes through effective support from staff and access to external healthcare professionals.

Staff were experienced and competent in their roles. They received good training which supported them to deliver effective care. The support people received was personalised and adapted to meet people's varying needs and wishes.

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. Staff encouraged people to maintain or regain their independence.

Staff displayed caring values. They treated people with kindness, patience, dignity and respect. People were well cared by staff who knew them well.

Staff assisted people to join in with a range of activities and to maintain links with their families and the local community. People were often supported by staff to access local amenities.

The governance of the service had improved since our last inspection. The service delivered good quality, person-centred care. The safety and quality of the service was monitored through regular checks and audits. The management team strived to achieve high standards through continuous improvement.

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 (published April 2018).

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in line with our inspection programme.

This unannounced comprehensive inspection took place on 16 and 17 January 2018. This means that neither the provider nor the staff at Seaview knew we would be visiting the home. At the last inspection in November 2016, we identified breaches of regulations which related to safety, consent and the governance of the service. We found improvements had been made in most areas but not enough to ensure compliance with all of the statutory requirements.

This is the second consecutive time that this service has been rated as 'requires improvement'.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, responsive and well-led to at least good. An action plan was sent to us by the registered manager in February 2017 which showed that the majority of required actions were completed and that any outstanding actions had a defined target date of 28 February 2017.

However, at this inspection we found that although the registered manager and the deputy manager had made improvements throughout the service, the governance was not robust enough to fully identify or completely address some of the continued issues we highlighted during this visit.

We found record keeping continued to require improvement. In particular, medicine administration records and clinical care plans required some attention to ensure comprehensive detail was included in respect of all people, their needs and specific risks they may face due to their health conditions. We have made a recommendation about this.

The provider has failed to display their previous performance assessment as legally required. We are dealing with this matter outside of the inspection process.

There was a well-established registered manager in post; however they were on annual leave at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 deputy manager, who was also the lead nurse, assisted us in the registered manager’s absence.

People told us that they felt safe living at Seaview with the support from staff. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they should take if they suspected abuse. The local authority safeguarding team and commissioning teams informed us that were no current concerns about this service.

Records relating to accidents and incidents were kept including matters of a safeguarding nature. Incidents were recorded, investigated and reported in a timely manner to other relevant authorities such as the local authority or CQC.

The service managed general risks associated with the health and safety of people, including the completion of regular checks of the property, equipment and utilities in line with their legal responsibilities. People’s individual care needs had been assessed for risks related to daily living; however some clinical care plans did not describe specific risks related to health conditions such as epilepsy. Care records had been reviewed and updated on a monthly basis.

Medicines were stored in a safe and secure place. The staff followed policy and procedures regarding the ordering, receipt, storage, administration and disposal of medicines. We found that medicines were administered safely and when people needed them however, record keeping around medicine administration required improvement to ensure it was more detailed.

Staff records showed the recruitment process was robust and staff had been safely recruited. Training was up to date, and the staff team were supported through supervision and appraisal sessions. There were sufficient numbers of staff deployed to meet people’s needs.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. All staff now demonstrated an understanding of the MCA and worked within its principals, including gaining consent to care for people who lacked mental capacity.

The service involved external health professionals as necessary to meet people’s needs and to support their general health and well-being. People’s specific nutrition and hydration needs were met. We saw people enjoyed a variety of meals prepared by the cook. People were given a choice around mealtimes.

The care plans in place were very person-centred. People’s individual needs were assessed and continuingly reviewed and an appropriate and current plan of care was in place.

We saw all staff treated people with dignity and respect. They displayed friendly, kind and caring attitudes and people told us the staff were nice to them. We observed people enjoying pleasant relationships with staff and it was evident they knew each other well.

Staff had plenty of time to provide a wide variety of stimulating activities which people enjoyed. One-to-one and group support was available to people to reduce social isolation and meet their social, cultural and religious needs. Visitors were welcomed into the home at any time.

The service had received four complaints since our last inspection. We saw that the registered manager investigated and managed complaints thoroughly and in a timely manner. The complaints procedure was on display and had been shared with people who used the service and their supporters. The service had received a large amount of compliments and ‘Thank you’ cards.

Regular quality assurances checks were undertaken by the registered manager. The deputy manager and nursing staff also checked daily, weekly and monthly care monitoring tools and medicine administration records to monitor the quality of care people received and to check it was appropriate to their needs On some occasions, actions had not been fully recorded to show what action had been taken to address issues highlighted in audits, although we found this had no impact on the service people received.

A recent annual survey had been issued to gain the opinion of people and relatives about how the home was managed and how it could be improved. We found the service had received a positive response to the questions asked which the registered manager had evaluated. Staff spoke highly of working for the organisation and the registered manager and they told us they felt valued and appreciated.

We found one breach of the Health and Social Care Act 2008. This related to Regulation 17: Good Governance. You can see what action we told the registered provider to take at the back of the full version of this report.

Seaview provides short breaks, as well as permanent nursing care and accommodation, for up to 20 people with complex needs, including learning and physical disabilities, dementia and acquired brain injury. At the time of this inspection seven people were using the service.

The service was required to have a registered manager but there was no registered manager at the time of our inspection. The current manager had applied to become the registered manager. This application was still being considered when we inspected. 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.

During this inspection we found the provider had breached regulations 11, 12, and 17. Medicines records did not show medicines were managed appropriately. The medicines fridge was not operating at the correct temperature. Nurses and care workers lacked personalised guidance to ensure people received when required medicines consistently and correctly. Records of topical medicines like creams and ointments were inaccurate.

Some people did not have the relevant care plans in place to ensure all of their needs were met. Care plans were not always personalised so that people received the individual care they needed.

Care records did not accurately account for all of the care people required or had received. This included people at risk of poor hydration and people prone to skin damage.

The provider was not following the requirements of the Mental Capacity Act (MCA). Applications for Deprivation of Liberty Safeguards (DoLS) authorisations for relevant people had not been made in a timely manner. People did not have care plans to guide care workers about the support they needed with decision making. Decisions had been taken in people’s best interest without the necessary MCA assessment having been carried out. Care records contained some blank consent forms which people had not yet signed.

Some assessments had also not been completed including, nutritional assessments, spiritual assessments and activities plans. Some care records were left blank or contained gaps in recording, such as oxygen level charts, blood sugar level charts and fluid balance charts.

Fluid balance charts had not been analysed to check people were adequately hydrated. The provider had not been proactive in ensuring essential care records were accurate and fit for purpose.

You can see what action we have asked the provider to take at the back of the full version if this report.

Some health and safety checks weren’t being completed, such as checks of the emergency lighting system. The fire risk assessment was overdue and the gas safety and legionella certificates were not available to view.

People said they were happy with their care. They confirmed they were treated with dignity by kind and considerate care workers. People told us they felt safe living at the home.

Care workers knew about safeguarding adults and the provider’s whistle blowing procedure. They knew how to report concerns and told us did not have any concerns about people’s safety.

There were enough staff on duty so that people had their needs met a timely manner. We found effective recruitment checks in place to ensure care workers were suitable to work with people living at the home.

Care workers confirmed they were well supported. Essential training was up to date including health and safety, food hygiene, infection control, first aid, medicines, moving and handling, safeguarding, fire safety, equality and diversity.

People told us they were happy with the meals provided at the home and said they were given choices. People received patient support from care workers and were provided with the specialist equipment they needed.

People told us and records confirmed they had access to external health professionals such as GPs, community nurses and speech and language therapists.

People gave us examples of how care workers had responded to their requests for assistance.

We observed care workers participating in activities with people. People said activities were provided for them to take part in.

People knew how to complain and told us they had no concerns about their care. There had been no complaints made about the home.

People and care workers described the home as having a positive and welcoming atmosphere.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We contacted a number of health and social care professionals to find out their opinion of the service. Their comments and our observations throughout the inspection led us to conclude that people's health, safety and welfare was protected because the provider worked in co-operation with others.

We found there was enough equipment to promote the health, independence and comfort of people who used the service.

We found that staff were very happy in their work. We concluded appropriate checks were undertaken before staff began work and effective recruitment and selection procedures were in place.

There was an effective complaints system available. It was clear that comments and complaints people made were responded to appropriately and that this helped ensure a culture of openness.

'I can ask for my painkillers and I get them'

'If I need the doctor I can see him but it can take a few days'

'The staff look after us. They are very nice'

'I look after my own tablets and keep them in a drawer, locked away'

'The regular staff are good, care is consistent'

'[The relative] sees the doctor quickly when she needs to'.

Overall, we found that medicines were managed in a safe way.

We found care and treatment was planned and delivered in a way that ensured people's safety and welfare. We found staff clearly understood people's individual care needs and saw they were providing the support people required and were caring and attentive to them.

We found record keeping had improved which meant up to date information was available about people's needs and how these were to be met. There were good systems in place to ensure essential information was shared which meant staff had up to date information about how to support people.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found that medicines were not managed in a safe way.

However, we found people were not protected from the risks of inadequate hydration. There was no robust system to identify where people had insufficient fluid intake or how to manage and review this. We found people were not protected from the risk of developing pressure ulcers. There was no robust system to assess people and ensure an effective plan of care was put in place, monitored and evaluated. Pressure relieving equipment was being used incorrectly and not being checked.

We found continuing shortfalls in record keeping which was inaccurate, particularly in respect of monitoring of people's hydration.