This inspection took place on 14 and 15 February 2017. The first day of the inspection was unannounced. This meant that the registered provider and staff did not know we would be visiting. The second day of inspection was announced. The service was last inspected in February 2016 and was meeting the regulations we inspected at that time.

Mulroy's Seaview is a converted property on the seafront at Redcar. The service is situated near to the town centre with a wide range of facilities. The service provides personal and nursing care to a maximum of 27 people who have a mental health condition and some of whom also have a physical disability. At the time of our inspection 27 people were using the service.

There was a registered manager in place. 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.

People told us they felt safe at the service. Risk to people using the service were assessed and plans put in place to reduce the chances of them occurring. Regular checks of the premises and equipment were made to ensure they were safe to use. Plans were in place to support people in emergency situations. There were procedures to safeguard people from the types of abuse that could potentially occur in care settings. People’s medicines were managed safely. There were enough staff deployed to keep people safe. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

People told us staff were effective at supporting them and received the training they needed to do so. Staff received training in a wide range of areas and spoke positively about the training they received. Staff were supported through regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to maintain a healthy diet and to access external professionals to maintain and promote their health.

People spoke positively about the support they received, describing staff as kind and caring. People told us staff supported them to maintain their dignity, and treated them with respect and promoted their independence, especially by encouragement and prompts. Throughout the inspection we saw numerous examples of kind and caring support. People were supported to access advocacy services where needed.

People told us they were involved in planning their own care and that staff took time to talk with them about what they wanted. Support was based on people’s assessed needs and preferences and was person-centred. People were supported to access activities they enjoyed. There was a complaints policy in place and people we spoke with said they knew how to complain if needed.

People spoke positively about the registered manager, who was a visible presence around the service. Staff said they were supported by the registered manager and deputy managers and said the service was well-led. Feedback from people using the service was sought through an annual questionnaire and monthly meetings. The registered manager and deputy manager carried out a number of quality assurance checks to monitor and improve standards at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

We inspected Mulroy's Seaview Nursing Home on 17 February 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. On the first day the administrator was on holiday so we were unable to review all of the information related to recruitment processes. Thus, on 4 and 8 March 2016 an inspector gathered information and completed the inspection.

Mulroy's Seaview is a converted property on the seafront at Redcar. The service is situated near to the town centre with a wide range of facilities. The service provides personal and nursing care to maximum number of 27 people who have a mental health condition and some of whom also have a physical disability.

The home had a registered manager in place and they are the registered provider. 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 last inspection in December 2015 we found that the service was not meeting the regulations relating to good governance, staff recruitment and staff training. We issued warning notices in respect of the regulations on good governance and staff recruitment. We required the registered provider to meet these two regulations by the 7 February 2016.

We did not review the actions the registered provider had taken to improve staff training as they had informed us this would be fully completed by July 2016. However, we did find that the registered provider was working to ensure all the staff received the required training and they did show us what they had already achieved. We did find that a realistic schedule was in place to ensure all of the staff had refresher mandatory training and condition specific training by July 2016.

At the last inspection we found that robust recruitment procedures were not in place. The registered manager had not asked prospective staff to complete an application form before they started work. Disclosure and Barring Service check (DBS) were available on two of the three staff files looked at, however this check was not always carried out before staff started work. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults.

At this inspection we found that the registered manager had provided additional hours for the administrator to ensure all of the staff files were completed. The administrator had ensured that all of the staff had completed the application forms and obtained references. DBS check had been sent for and the majority were now in place. The registered manager also ensured all new starters completed the Care Certificate. The Care Certificate sets out learning outcomes, competences and standards of care that are expected.

At the last inspection we looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. We found that the service did not have a health and safety audit. Other audits that had been completed were ineffective as they did not pick up on areas of concern that we identified at this inspection. Staff meetings were irregular and not all staff had been invited to attend. Team meetings provide staff with the opportunity to share information.

At this inspection we found that both the registered manager and deputy manager had worked hard to strengthen the governance arrangements. The deputy manager had developed a wide range of audits and for each of these they had critically reviewed the performa

We inspected Mulroy's Seaview Nursing Home on 2 December 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Mulroy's Seaview is a converted property on the seafront at Redcar. The service is situated near to the town centre with a wide range of facilities. The service provides personal and nursing care to maximum number of 27 peoples who have a mental health condition and some of whom also have a physical disability.

The home had a registered manager in place. 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.

Robust recruitment procedures were not in place. The registered manager did not ask prospective staff to complete an application form before they started work. Application forms are a way of finding out about the person, their employment history, training and qualifications and determining if they are suitable for the intended role. Staff files did not contain any references. This meant that checks had not been made to make sure that the person was a good employee or of good character. Disclosure and Barring Service check (DBS) were available on two of the three staff files looked at, however this check was not always carried out before staff started work. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. This helps employers make safer recruiting decisions and also to prevent unsuitable people from working with children and vulnerable adults.

Staff had not received regular supervision or an annual appraisal.

Some plans of care for people who used the service had been written in 2008 / 2009 and were not up to date. Care plans had not been reviewed an updated to ensure that current needs were included.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The registered manager had submitted applications to the supervisory body (local authority) and these had been authorised with no conditions attached. The registered manager had failed to inform CQC in respect of the outcome. This will be dealt with outside of the inspection process.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The service did not have a health and safety audit. Other audits that had been completed were ineffective as they did not pick up on areas of concern that we identified at this inspection. Staff meetings were irregular and not all staff had been invited to attend. Team meetings provide staff with the opportunity to share information.

Staff had not received training in MCA, DoLs or Managing violence and aggression

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures. Sufficient numbers of staff were on duty to ensure that people’s needs were met.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Systems were in place for the management of medicines. Nurses have received medicine update training, however have not had their competency assessed.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as behaviour that challenges, absconding, smoking, using the stairs and nutrition. This enabled staff to have the guidance they needed to help people to remain safe. People told us that there were enough staff on duty to meet people’s needs

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

The main kitchen had been out of action for many months which had impacted on the variety of food that could be produced, however people commented that the food provided was always of a good quality. The main kitchen was due to open Monday 7 December 2015 and new menus had been introduced. Nutritional screening had been completed, however there were gaps in people being weighed and some staff had incorrectly scored on the nutritional screening tool.

The service employed a person solely to manage all health appointments. People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

There was a breach of Regulation 18 (Notification of other incidents) of The Care Quality Commission (Registration) Regulations 2009. The Care Quality Commission will deal with this outside of the inspection process.

A number of people who used the service were unable to express their views to us due to their general medical conditions. In order to determine how care and treatment was provided we spoke with staff, observed their practices and looked at some people's care records.

We saw the care plans were written with co-operation from people who used the service, their families, friends or representatives. We saw the care plans had signed consent to treatment whilst in the care of the home.

Care plans were written in a way that helped ensure people's care needs and preferences were met.

We saw staff had very in depth knowledge of the people they cared for and had experience in dealing with their complex needs. We observed staff helping people who used the service and saw they were confident in their roles, assisting people when required or requested and asking for help from other members of staff should the need arise.

We saw all staff in the home had national vocational qualifications in Health and Social Care, or were given the opportunity to obtain the qualification. The home had their own in house assessor to ensure staff were given the maximum support available.

People who used the service who were spoken with during the inspection told us that they were involved in making decisions about the care and support received and that they felt well supported.

One person said "I'm happy here, I like my room, there is everything I want." Another person commented "I can go out when I want to, I like a walk to the shops".

A person spoken to said "I feel safe here, staff look after me." Another person said "The staff know me well and take care of me."

We were told "There are always staff around if you need them". One person commented that they liked to stay in their room a lot and staff always called in to make sure they were alright.

People spoken to commented about their meetings and felt that their comments and suggestions were heard and taken on board. Examples included additions to the menu and a trip out to a market.

During this inspection we looked at the care records for three people, spoke with the manager and two deputy managers, a registered nurse and two members of staff. We also spoke with six people who used the service and two relatives and spent time observing daily life within the service.

People we spoke with told us that they were satisfied with the care and support provided to them. Comments included, “The staff support me in the way I need supporting.” “I believe I am well supported and cared for.”

We found that care/support plans provided staff with the information they needed to meet people's needs.

We found that a range of health and care professionals were involved in meeting people's needs.

We found that the premise was not as well maintained as it should be. We were, however satisfied that the provider was taking the appropriate actions to address this.

There were sufficient staff and appropriate skill mix to meet people's health and social care needs.

Records were accessible to staff and in the main up to date.