This inspection was conducted on 5, 7, 14 and 30 June 2017. The first day of the inspection was unannounced and we advised the provider of our intention to return on the second and third day. The fourth day of the inspection was an announced visit to meet with the registered manager, as he was on authorised leave on the earlier inspection dates.

Mary Seacole Nursing Home is a purpose built 50 bedded NHS care home with nursing, which provides accommodation for people who require permanent or respite nursing care. This includes care and support for people who are living with dementia and people with end of life care needs. The premises are arranged over three floors, with the second floor used for administrative areas. The ground floor and first floor provide single occupancy bedrooms with ensuite facilities, communal dining rooms, lounge areas, adapted bathrooms, an activity room, a relaxation room for people using the service and two passenger lifts. There is a seven bedded transitional neurological rehabilitation unit for people who have had a neurological injury or have been diagnosed with a long term neurological condition, which offers dedicated areas for people to develop and improve upon their independent living skills. Facilities include a laundry room, a therapeutic exercise room, a communal lounge and an adapted kitchen. There are landscaped gardens and a terrace at the rear of the premises for use by people on all of the units, and the building is within short walking distance of local shops, cafés and other amenities. At the time of the inspection 44 people were using the service; 38 people were receiving permanent or respite nursing and six people were using the transitional neurological rehabilitation unit.

There was a registered manager in post, who has managed the service for several years. 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.

At the previous inspection in April 2016 the service was rated as ‘Requires Improvement’. There were no breaches of Regulations; however we had made three recommendations to the provider. We had recommended that improvements were made to address the storage temperature for medicines and address the lack of clinical guidance for staff to assess people’s pain. It was recommended that the provider implemented a supplementary system to enable staff to quickly access Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) information and that the provider sought guidance from a reputable source about how to put in place person centred care planning that reflected people’s wishes and interests. At this inspection we found that the provider had taken appropriate actions to fully address all three recommendations.

There were sufficient staff deployed to provide people with the care and support they needed. Clear systems were in place to make sure that staff were recruited in a safe way.

Assessments were in place to identify potential and actual risks that could harm people, restrict their independence and impact on their safety and wellbeing. Information about how to manage these risks was contained in people’s care plans.

Staff had received safeguarding training and knew what actions to take to protect people from the risk of abuse. This included a good understanding of the provider’s whistleblowing policy in regards to raising any concerns about the conduct of the service.

Training, supervision and support was provided so that staff could confidently undertake their roles and responsibilities. There had been a positive focus on training to understand and meet the needs of people living with dementia and this training was highly regarded by staff for its usefulness .

The Care Quality Commission

This inspection took place on 6, 7 and 24 April 2016. The first day of the inspection was unannounced and we informed the provider that we were returning on the second day. The third day of the inspection was an unannounced visit during a weekend.

Mary Seacole Nursing Home is a purpose built 50 bedded NHS care home with nursing, which provides accommodation for people who require permanent or respite nursing care. This includes care and support for people who are living with dementia. The premises are arranged over three floors, with the second floor used for administrative areas. The ground floor and first floor provide single occupancy bedrooms with ensuite facilities, communal dining rooms, lounge areas, adapted bathrooms, an activity room and two passenger lifts. There is a seven bedded transitional neurological rehabilitation unit for people who have had a neurological injury or have been diagnosed with a long term neurological condition, which offers dedicated areas for people to develop and improve upon their independent living skills, including a laundry room, a therapeutic exercise room and a kitchen. There are landscaped gardens and a terrace at the rear for use by people on all of the units and the premises is within short walking distance of local shops, cafés and other amenities. At the time of the inspection 45 people were using the service; 43 people were receiving permanent or respite nursing and two people were using the neurological rehabilitation unit.

There was a registered manager in post, who has managed the service for several years. 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.

At the previous inspection in September 2015 we found three breaches of regulation and made one recommendation in relation to improvements the provider needed to implement. The breaches of regulation were in regards to the provider not ensuring that people were protected from the risks associated with receiving a medicine service not safely managed, not protecting people against the risks associated with receiving a service that did not have sufficient numbers of staff deployed at all times and not protecting people from the risks associated with staff not receiving appropriate supervision to enable them to carry out their duties. A recommendation was for the provider to seek good practice guidance for the use of mobile armchairs. Following the inspection the provider sent us an action plan which highlighted the action they would take in order to improve. At this inspection we found the provider had met the breaches of regulation and had taken action to implement the recommendation.

The provider had achieved improvements in relation to the management of medicines. However, we found that medicines were not being stored at an appropriate temperature in line with the manufacturers’ guidance. This meant that people were at risk of receiving prescribed medicines that could have changed composition or deteriorated. We also found that although staff told us they visually assessed if people who were not able to verbally express their views were in pain, we did not find evidence of the use of structured clinical assessment tools to support staff to make appropriate judgements about people's pain management.

There were sufficient staff on duty to provide people with care and support; however, staff were not always safely and effectively deployed. This placed people at risk as they were not able to locate staff at all times. Robust systems were in place to ensure that staff were safely recruited.

Assessments were in place to identify potential and actual risks that could harm people, restrict their independence and impact on their safety and wellb

We spoke with eight people using the service and the relatives of three other people. People told us they felt consulted about their care and were asked for their consent on a daily basis. One person said, "the nurses know I like to get up late but they will always come in and check if I have changed my mind."

The care plans showed that people's care was planned and delivered in a way that took into account their individual needs and wishes. There were systems in place to ensure that people's needs were regularly monitored and reviewed. One person said, "I've been here longer than most and think the nurses give their best." A relative said, "the care is excellent and the manager is fantastic."

People told us they liked the food and were offered choices, although a few people said they would like to be offered foods that met their cultural needs. We saw that people were provided with the appropriate support and encouragement they needed to meet their nutritional needs.

Some people told us that staff appeared to be busy during the mornings but they felt their needs were being safely met.

There were systems in place to seek the views of people using the service and their representatives and to monitor the quality of the service. People using the service and their representatives said they regularly saw the manager on the units and found him approachable.

We spoke with eight people using the service and three of their visitors. People told us what it was like to live at the care home and described how they were treated by staff. People using the service made positive comments, such as, “this is number one care”, “staff try their best” and “staff know me well. They are very respectful.” People told us they were given choices about their care.

People were asked about their needs, preferences and interests as part of the planning and delivery of their care.

People were receiving safe and appropriate care, which took into account their preferences and interests. People told us they felt safe and knew how to raise concerns. We saw there were measures in place to protect people from the risk of abuse.

We found people’s medications were being safely managed.

Staff received regular training and support to meet the needs of people using the service, including training to meet the specific needs of people living at Mary Seacole Nursing Home.

People were given information about how to make complaints and any complaints were investigated.

People were generally positive about the home. They seemed comfortable and well cared for. People told us the staff were friendly and the home was clean. People also liked the food. The home organised activities for people but even so, many people were frail and spent long periods of time in their room.

This inspection took place on 1, 2 and 3 September 2015. The first day of the inspection was unannounced and we informed the registered manager we were returning on the subsequent days. At our previous inspection on 9 September 2013 we found the provider was meeting regulations in relation to the outcomes we inspected.

Mary Seacole Nursing Home is a purpose built 50 bedded NHS care home with nursing, which provides accommodation for people who require permanent or respite nursing care. This includes people who are living with dementia. The premises is arranged over two floors and provides single occupancy bedrooms with ensuite facilities, communal dining rooms, lounge areas, adapted bathrooms, an activity room and two passenger lifts. There is a seven bedded transitional neurological rehabilitation unit for people who have had a neurological injury or have been diagnosed with a long term neurological condition, which provides dedicated areas for people to develop and improve upon their independent living skills, including a laundry room, a therapeutic exercise room and a kitchen. There are landscaped gardens and a terrace at the rear for use by people on all of the units and the premises is within short walking distance of local shops, cafés and other amenities. At the time of the inspection the rehabilitation unit was at full occupancy and there were seven vacancies in the units for permanent and respite nursing care.

There was a registered manager in post, who has managed the service for several years. 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 system for managing medicines was not as safe as it should have been. People were supported to meet their nutritional and hydration needs, although some of our observations showed that staff were stretched and very busy at meal times.

There were not always enough staff to meet people’s needs, including their needs for social stimulation. People and relatives told us they did not think there were enough staff on duty and staff were always very busy. People had access to visiting health care professionals including a consultant geriatrician, GP service, occupational therapists and physiotherapists. The provider was working towards improving people’s access to more frequent podiatry.

An activities programme was in place, and the service arranged entertainments and events. Despite this, there was little evidence of how people who were bedbound or did not frequently come out of their bedrooms were supported to receive social stimulation.

A safe and rigorous system of staff recruitment was demonstrated, whch helped to protect people from the risk of being cared for by unsuitable staff. However, we found there were not always enough staff to meet people’s needs. People and relatives told us they did not think there were enough staff on duty and staff were always very busy. Records showed staff were supported with training, group meetings and an annual appraisal. However, one-to-one formal supervision was not in place.

Measures were in place to protect people from the risk of abuse. Staff had received training and understood how to identify and report any concerns to the registered manager.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff understood the legal requirements of MCA and were in the process of making DoLS applications to the authorising body.

Staff spoke with people in a respectful manner, however, some people’s dignity had not been fully maintained by inappropriate bedroom curtains that did not close properly.

Care plans identified people’s needs, which were regularly reviewed and up to date. However, we found limited information about how the service met the needs of people living with dementia. A range of risk assessments had been completed for people, which covered areas of daily life including falls prevention, nutrition and pressure area care. We found that risk assessments had not been carried out for the use of mobile armchairs, which we observed staff experience difficulty with manoeuvring.

The registered manager was described as having an open, supportive and approachable management style. People and their representatives knew how to make complaints and told us they were confident that complaints were taken seriously. There were systems in place to monitor the quality of the service and there was evidence that learning took place from audits, complaints and other feedback from people, their relatives and stakeholders. However, the significant shortfalls found in relation to staffing arrangements and medicines management had not been identified or addressed by the quality monitoring system in place.

We have made a recommendation to the provider regarding the use of mobile armcahirs within the service.

We found three breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 in relation to staffing levels, staff supervision and medicines. You can see what actions we asked the provider to take at the back of the main report.