We inspected Seaway Nursing Home on the 22 February 2017 in light of concerns we had received. We previously carried out a comprehensive inspection at Seaway Nursing Home on 10 February 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the management of medicines. The service received an overall rating of ‘requires improvement’ from the comprehensive inspection on 10 February 2016. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to recruitment practices, the analysis of accidents and incidents and management oversight of the service. Additionally, areas of improvement were identified in relation to guidance for staff around PRN (as required) medication, and staff training.
The overall rating for Seaway Nursing Home remains as requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been made and sustained.
Seaway Nursing Home is registered to provide accommodation and care, including nursing care for up to 20 people. They specialise in supporting older people, some of whom are living with dementia or chronic health conditions. On the day of our inspection there were 17 people living at the service, who required varying levels of support.
There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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 provider had safe recruitment procedures, however these had not always been followed. We looked at the staff files for all members of staff currently employed by the service, and found that several contained gaps and omission in relation to the pre-employment checks the provider is required to obtain for members of staff. This placed people at risk of receiving care from staff that were not safe to work with vulnerable people. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and is an area of practice that requires improvement.
The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, we found the monitoring of accidents and incidents was not robust. Additionally, when we raised our concerns with the management of the service in relation to gaps in recruitment files and further evidence we found in respect to staff conduct and staff not engaging with training, we were told that the management of the service was aware of these issues, but had not acted upon them. Furthermore, accident and incident records identified that many people were at high risk of falls. The provider had recognised that falls prevention training was required and had included this on their training matrix. However, we saw that this training had not taken place for staff. People were placed at risk, as the provider did not have adequate systems and processes to monitor and mitigate any risks relating the health, safety and welfare of people using services and others. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and is an area of practice that requires improvement.
Staff had received essential training and there had been opportunities for additional training specific to the needs of people. However, we saw that several members of staff had not received essential updated ‘refresher’ training in a timely manner, and further work was required in relation to the provision of training specific to the needs of people who used the service. This is an area of practice that needs improvement.
We have made a recommendation about the provision of training specific to the needs of people using the service.
Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. However, guidance for the use of ‘as required’ (PRN) medicines was not available. We have identified this as an area of practice that needs improvement.
We have made a recommendation about the management of medicines.
People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Safe? Very much”. Another said, “There doesn’t seem to be a shortage [of staff]”. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.
People chose how to spend their day and they took part in activities in the service and the community. Where appropriate, people were also encouraged to stay in touch with their families and receive visitors.
People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).
Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is very good”. Special dietary requirements were met, and people’s weights were monitored with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.
People felt well looked after and supported. We observed friendly relationships had developed between people and staff. A relative said, “I believe that [my relative] has only lived as long as he has, because of the care he’s got here”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.
People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People said they felt listened to and any concerns or issues they raised were addressed.
Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. Staff had received both one-to-one and group supervision meetings with their manager. One member of staff told us, “I have supervision every few months. I have discussed issues in the past and they have been resolved”.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 . You can see what action we have asked the provider to take at the back of the full version of this report.