This unannounced comprehensive inspection took place on 5, 12 and 14 September 2018.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.