Seaview Haven

Seaview Haven is a residential care home providing personal care for up to 44 people. At the time of the inspection there were 33 people living there. The home accommodates people across three different floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

A new Director of Care and a new registered manager had been employed immediately following the previous inspection. They carried out regular audits to monitor the quality of care. The new Director of Care role provided a clinical and overall oversight of the whole service, including the registered manager on behalf of the provider. They and their staff team had worked hard to ensure that the breaches found at the previous inspection had been addressed and robust systems embedded into practice. The provider was supportive and there had been investment to further promote good quality care at Seaview Haven.

People were safe at the service. Staff had been trained to safeguard people from abuse and understood how to manage risks to people to keep them safe.

There were enough staff to support people and the staff worked well as a team. Recruitment checks had been undertaken on staff to make sure they were suitable to support people.

People had a choice of comfortable spaces to spend time in at the service. The provider had adapted the premises when needed to meet people's needs.

The premises were clean and tidy. Staff followed current hygiene practice to reduce the risk of infections with new effective systems in place. Visitors to the service were given information to help them reduce the risk of catching and spreading infection. Health and safety checks of the premises and equipment were carried out at regular intervals.

People's care and support needs were assessed prior to them using the service. Their care plans set out for staff how these needs should be met.

Staff understood people's needs and how they should be supported with these. They received relevant training to help them to do this. Staff were supported by the registered manager to continuously improve their working practices to help people achieve positive outcomes.

Staff were calm, kind and respectful of people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to stay healthy and well. Staff helped people eat and drink enough to meet their needs, to take their prescribed medicines and to manage their healthcare conditions.

People and staff's feedback indicated that since the previous inspection there had been great improvement in the way the service was run. People and relatives generally were satisfied with the quality of care and support they received.

The registered manager reviewed accidents, incidents and complaints to identify how the service could improve.

People were encouraged to have their say about how the service could improve. The registered manager used their feedback along with regular audits and checks, to monitor, review and improve the quality and safety of the support provided.

The service worked with other agencies and healthcare professionals. The provider and management team acted on their recommendations to improve the quality and safety of the service for people.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Seaview Haven on our website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was inadequate (published 11 March 2021) and there were multiple 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 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance. This service has been in Special Measures since 11 March 2021. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. We also 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Seaview Haven is a residential care home providing personal care for up to 44 people. At the time of the inspection there were 33 people living there. The home accommodates people across three different floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

People were not always safe at the home as any risks to their health and wellbeing had not been assessed and planned for. People did not have care plans in place so they were at risk of not having their care and support needs met.

People were not protected from the risk of cross infection due to poor infection and control practices in the pandemic. People did not always receive their medicines in a safe way.

There were not always enough staff on duty and they did not have the necessary skills, training and supervision to support people effectively. Staff felt undervalued and demoralised with low morale.

Lessons were not always learned when things went wrong. There was poor oversight of the service and a lack of consistent managers in post. There was a lack of effective monitoring and systems in place to monitor the safety and quality of care were ineffective. Systems in place were not effective at sharing important information

People had access to healthcare professionals who told us they had good communication with the service.

Staff were recruited in a safe way. Relatives spoke positively about the care staff and how they supported their family members, particularly during the pandemic.

People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests; the policies and systems in the service were put in place.

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 July 2019). The service had a targeted inspection (published October 2020) which was not rated. The service has deteriorated to inadequate. This is based on the findings at this inspection.

Why we inspected

We received concerns in relation to staffing levels, risks and safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Following the inspection the provider supplied an action plan with timescales for completion. They have committed to improving the service and working with health and social care professionals to do this. They have already began to make improvements throughout the service and have kept CQC updated on the progress.

Enforcement

We have identified four breaches in relation to: the safe care and treatment of people; safeguarding people from abuse; inadequate staffing levels and staff training; management oversight of the service, and a lack of monitoring quality and safety at this inspection.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to have updates on the provider’s action plan to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Seaview Haven is a care home providing accommodation for up to 44 older people, including those living with dementia. At the time of our inspection, there were 38 people living at the home, with one person in hospital.

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

There was a calm and organised atmosphere when we visited. People were happy and comfortable. There were good interactions between people and the staff who supported them.

Risks to people’s safety had not always assessed, monitored and recorded. This related to the management of people’s pressure sores and the use of a specific type of chair which restricts a person’s mobility. The management team were open, honest and transparent in relation to these safety incidents. They had taken action to find out what went wrong and learn from this. One incident of a person with a serious pressure sore is currently being investigated by the local authority safeguarding team at the time of this report.

Communication issues had been identified by health and social care professionals not being able to get in touch with the home by telephone. As a result, the home had increased the use of more telephone lines and mobile phones.

Further improvements were also identified by both professionals and the management at the home to improve their partnership working to ensure positive outcomes for people. This would ensure health information is passed over quickly between both parties as soon as possible. This is work in progress with some changes already made.

The registered manager was aware of their role, was visible and had an oversight of the service. They were supported by other senior staff with delegated responsibilities. When required, they worked with the local safeguarding team to provide information.

People were supported by adequate numbers of staff on duty to fully meet their needs. Staff had picked up extra shifts and agency staff were used when necessary. People told us there needs were met in a timely way. The management team were in the process of recruiting more staff to supplement and increase the staff team.

People were protected by living in a home which had suitable arrangements in place for the prevention and control of inspection.

Rating at last inspection

The last rating for this service was good (published July 2019).

Why we inspected

We undertook the targeted inspection to check on specific concerns we had which related to the safe care and treatment of people, specifically the numbers of staff on duty, communication issues, the numbers of people with a pressure sore and the oversight of the service.

CQC have introduced targeted inspections to follow up on a Warning Notice or other 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 found the provider needs to make improvements in some areas. The provider had already taken action to mitigate the risks to prevent a reoccurrence

.

We made two recommendations to improve practice in relation to pressure sores and partnership working.

Please see the safe and well led sections of this full report.

You can read the report from out last comprehensive inspection, by selecting the ‘all reports’ link for Seaview Haven on our website at cqc.org.uk.

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.

People’s experience of using this service:

At our previous inspection in September 2018 there was a lack of robust quality monitoring systems in place to ensure the quality and safety of the service and record keeping was not comprehensive. This inspection found improvements had been made.

At our previous inspection in September 2018, people did not have risks assessed relating to their health, safety and welfare and people were not receiving their medicines in a safe way. This inspection found improvements had been made. Robust risk assessments were now in place. People’s individual risks were identified, and the necessary risk assessment reviews were carried out to keep people safe. For example, risk assessments for moving and handling, falls and skin care. Medicines were now safely managed on people’s behalf.

Prior to this inspection, we had received information about staffing levels being inadequate to meet people’s needs in a timely way. This information was not substantiated, although it was clear there had been issues with staffing levels up until approximately two months previously.

The service provided safe care to people. One person commented: “I feel 100% safe, they look after everyone with kindness.”

Care plans for people had now been brought up to date and detailed people’s individual needs, wishes and choices. People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate.

Most people informed us that they were not keen on some of the food that was served. We raised this with the manager, who agreed to look into further training for the cooks to improve the foods on offer.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were trained and competent. Until February 2019, staff had not been receiving on-going supervisions in order for them to feel supported in their roles and to identify any future professional development opportunities. The new manager ensured this was remedied and now all staff were receiving this level of support.

Rating at last inspection: Requires improvement (report published in October 2018).

Why we inspected: The inspection was prompted in part due to both the Care Quality Commission and local authority receiving information of concern about the timeliness of people’s care and treatment; pressure area care; staffing levels and training and the general leadership and management of the service. This inspection found that the concerns were not substantiated. Following our inspection, we spoke with various health and social care professionals as part of a safeguarding meeting. At this meeting it was agreed that the service did not meet the threshold for a whole home safeguarding process. This was because we were all assured that the service was working hard to improve the overall leadership and management of Seaview Haven.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Seaview Haven is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Seaview Haven is a care home which previously belonged to the local authority. It has undergone an extensive refurbishment and provides a high standard of fixtures and fittings. This was the provider’s first inspection.

The service was registered for 29 people. There were 27 people living at the home at the time of inspection, many of whom were living with dementia. Seaview Haven is a care home situated in a residential area of Ilfracombe. It has accommodation sited over three floors, some rooms with extensive sea views. However, at the time of inspection the upper floor was not in use, except for one person who had chosen to live on that floor.

The service had a manager who had registered with the Care Quality Commission (CQC) in July 2018. A registered manager is a person who has registered with the 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 registered manager was supported by the nominated individual and the deputy manager who formed the management team. They had worked together for the previous four months.

The service had been registered with the CQC since October 2017. In that time, two other previous managers had led the service. However, both had left within a short space of time and had not been registered with CQC. This effectively meant that since the service was registered, it had operated without a stable registered manager in place until recently.

Despite the management team working closing together, there was a definite lack of leadership and oversight of the whole service. This was due in part because the management team had previously managed services with a different type of service user group with a different type of need.

People’s health, safety and welfare were put at risk because there were many risks to the environment, both inside and outside of the building. People’s individual risks had not always been assessed and managed in a safe way. There was a lack of quality monitoring and inconsistency in record keeping.

Because of the seriousness of the concerns found on the first day of inspection, we wrote to the provider and management team setting out our concerns. They recognised and acknowledged the concerns raised. They were upset and disappointed at the findings but agreed with the judgements. They recognised action was required and put together an action plan with timescales for action. They confirmed their commitment to addressing all concerns and their assurances to improve the safety of people living at the service. On the second and third day of inspection, all the concerns had a plan to put them right. Some of the work had already been completed and some areas made safe whilst a permanent fix was made. Health and social care professionals had been contacted and arrangements for assessments to be made.

People were not protected from unsafe and unsuitable premises. The provider’s quality assurance systems did not take place regularly and had therefore not picked up the deficits and shortfalls identified during the inspection. The provider had not completed an environmental risk assessment or monitoring checks to ensure the environment was safe. In particular, we highlighted risks due to open access to unsafe areas both inside and outside of the building. No monitoring checks had been undertaken in relation to bedrails and beds to ensure they were safe and at the correct settings for the individual person. Checks on window restrictors were in place but these had not identified all the windows in the building which did not have one in place to prevent people falling out of windows.

There was an ineffective system in place to protect people from the risks associated with their care and health needs. There were no risk assessments regarding people’s nutritional needs, skin integrity, falls or safe moving and handling. Therefore, it was not possible to provide consistent guidance for care staff on how to support people with their care in a safe and proper way.

People did not receive person-centred care that met their needs and reflected their choices, preferences and interests. Care plans did not contain information about people’s care needs and had not been updated to reflect people’s changing needs. People and relatives had been involved in care planning but these had not been regularly reviewed. Where people needed specialist professional guidance, these had not always been referred in a timely way subjecting people to increased risks.

Staff did not always treat people with dignity and respect, although people and relatives were complimentary of staff. Some staff had developed effective interactions between themselves and people.

People received an appetising diet that gave choice and preferences. Residents could choose what meals they would like on the menu. However, for people who received a pureed diet, it was not always clear why they needed it and it was presented in a manner which meant people were unable to identify specific tastes.

People and their relatives gave positive feedback about the service and felt safe and cared for. During our visits, the majority of staff were kind and caring in their approach to people and treated them with respect. However, they had not ensured people’s dignity was always maintained. Some people had their call bell out of reach and other areas of the home had no call bell fitted to allow people to call for assistance.

There was a divide between the management team and the care staff team. Staff spoke openly about this and the management team were in the process of addressing the issues.

There was a limited range of activities on offer. These did not always include activities which were in line with people’s preferences, choices or hobbies. People living with dementia did not have activities which were most suitable to them.

The majority of people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, some people were cared for in bed in their ‘best interests’ but there was no reason why these people could not get out of bed.

Staff understood how to protect people from abuse and who to report any concerns to.

Staff struggled to understand the concept of personalised care and at times looked upon their role as task based. They had received training but the management team were unsure as to how valid the training had been and were looking at other types of training materials. Staff received supervision in their roles but this was overdue. The management team had introduced a competency based supervision by overseeing staff’s care practice and giving feedback.

The management team were a strong team of dedicated and caring senior staff. They acted as role models for the staff but there was a lack of respect shown from some staff which made an unpleasant atmosphere. Care workers felt unsupported and were not always motivated in their work. However, the management team were addressing this to drive the service forward and make Seaview Haven a place of choice for staff to work.

We found four breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made three recommendations about the monitoring of staffing levels, reviewing how dignity was promoted, seeking current guidance on activities and a suitable environment for people living with dementia.