We carried out an unannounced comprehensive inspection of Seahaven Care Home on 17 and 18 January 2018. This meant that the provider and staff did not know we were coming.

At the last comprehensive inspection of the service on 19 and 20 October 2016 we identified breaches of regulation 12, safe care and treatment, regulation 17, good governance and regulation 18, staffing. The provider had not fully assessed the risks to the health and safety of people who used the service. The provider failed to ensure that the premises were safe to use for their intended purpose. We found the provider did not appropriately manage the deployment of staff at meal times to ensure people received dedicated support when they needed it. The provider did not have effective systems in place to assess, monitor and improve the quality and safety of the service provided. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We carried out a focused inspection on 15 June 2017 to check that the service was meeting legal requirements. During the inspection we found the provider had made improvements in some areas. However, we found the provider had not completed all the actions set out in their action plan. We found there were continuing breaches of regulations. This was because the provider had not adequately assessed the risks to the health and safety of people who used the service, plans to mitigate risks and to provide personalised care were not specific to the identified risk. Policies and procedures had not been reviewed.

At this inspection the service had made the required improvements. We found no breaches of regulations and the service was meeting the legal requirements. The premises were safe and the registered manager carried out regular premises checks to ensure all aspects of health and safety were being met. People’s care plans reflected their individual needs and risks were assessed. The registered manager had reviewed and updated all of the policies and procedures to make sure they reflected current legislation.

Seahaven Care Home is a ‘care home’ located in South Shields. People in this care home receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Seahaven Care Home accommodates people in one adapted building and on the date of this inspection there were 16 people living at the home.

There was a registered manager in post who has been registered with the Care Quality Commission (CQC) to provide regulated activities since December 2017. 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 that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults.

Staff were safely recruited, had appropriate checks, references and they were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented.

The premises were safe. Regular checks of the premises, equipment and utilities were carried out and documented. On the first day of inspection the laundry room was left unlocked but the registered manager had a keypad lock installed straight away to remove any risk to residents. Infection control me

This inspection took place on 15 June 2017 and was unannounced. This meant the provider and staff did not know we were coming.

Seahaven Care Home is a residential home which provides personal care for up to 28 people. There were 21 people living there at the time of our inspection, some of whom were living with dementia and mental health needs. The accommodation is over three floors.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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

At our previous inspection in October 2016, we identified breaches of regulation 12, safe care and treatment, regulation 17, good governance and regulation 18, staffing. The provider had not fully assessed the risks to the health and safety of people who used the service. The provider failed to ensure that the premises were safe to use for their intended purpose. We found the provider did not appropriately manage the deployment of staff at meal times to ensure people received dedicated support when they needed it. The provider did not have effective systems in place to assess, monitor and improve the quality and safety of the service provided. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. The inspection was also prompted in part following concerns raised regarding staffing levels, staff’s ability to manage behaviours that may challenge, care practices, environmental issues and governance within the service. This report covers our findings in relation to these issues and the three key areas of safe, effective and well led.

During this inspection we found the provider had made improvements in some areas. However, we found the provider had not completed all the actions set out in their action plan. We found there were continuing breaches of regulations. This was because the provider had not adequately assessed the risks to the health and safety of people who used the service, plans to mitigate risks and to provide personalised care were not specific to the identified risk. Policies and procedures had not been reviewed.

The provider had not ensured staff had appropriate training to support people using the service. Staff supervisions and appraisals were planned and some had taken place. However we noted that some staff supervisions were not taking place in line with the provider’s own policy of six times a year.

Areas where substances that are hazardous to health were being used were left unlocked. The premises continued to require refurbishment and repair.

People’s personal care records were not always stored securely. Personal hygiene charts were being used, these were not personalised and appeared to be more of a list of tasks to be completed and ticked off.

Records relating to food and fluid intake were not totalled or reviewed.

The provider's quality monitoring processes were not always effective in identifying areas which required improvement.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Access to the stairs had been addressed to ensure people were safe. Key pads were now in place.

The carpet in one person’s room had been made safe.

Staffing levels had been reviewed and increased on night duty. Plans were in place to increase the levels of staff on day duty.

The provider had tak

This inspection took place on 19 October 2016 and was unannounced. A second day of inspection took place on 20 October 2016 and was announced.

Seahaven Care Home is a residential home which provides personal care for up to 28 people. There were 17 people living there at the time of our inspection, some of whom were living with dementia. The accommodation is over three floors.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

We last inspected the home on 30 and 31 March 2016 and found the provider had breached the regulations for safe care and treatment, good governance and recruitment. Following the inspection we issued a warning notice to the provider.

At the last inspection we found that the registered provider did not have accurate records and procedures to support and evidence the safe administration of controlled drugs, when required medicines and prescribed creams. We found people were not always protected from the risk of infection. Thorough background checks were not always carried out before staff started working at the service, which left people vulnerable to the risk of the provider employing unsuitable staff. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support.

During this inspection we found the provider had made improvements in some areas. However, we found the provider had breached Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider had not fully assessed the risks to the health and safety of people who used the service and taken reasonable steps to mitigate such risks. The provider's quality monitoring processes were not always effective in identifying improvements. Staff deployment at meal times was not managed appropriately. We have made a recommendation about the specialist needs of people living with dementia.

You can see what action we told the provider to take at the back of the full version of the report.

Infection prevention and control measures had improved although this area did not form part of the registered manager’s quality assurance checks. There were adequate supplies of alcohol hand gel, hand wash, paper towels and disposable gloves and aprons and waste bins in bathrooms were pedal operated to reduce the risk of infection spreading. Additional infection control measures were detailed in people’s care plans where appropriate.

Medicines management had improved. Medicines were stored securely and managed safely and effectively. People received their prescribed medicines when they needed them. Prescribed creams were administered in the right way and at the right frequency, in line with the instructions on people's prescriptions.

Staff understood their safeguarding responsibilities and told us they would have no hesitation in reporting any concerns about the safety or care of people who lived there. Records confirmed staff received regular supervision sessions and an annual appraisal to discuss their performance and development.

People’s meal time experience was inconsistent. Meals were served individually rather than by table which meant some people had their meals whilst others on the same table had to wait. Some staff had little interaction with people they supported to eat while others explained what they were doing.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been authorised for relevant people.

The

The inspection took place on 30 and 31 March 2016. The first visit on 30 March 2016 was unannounced. The second visit on 31 March 2016 was announced. The last inspection of this service was carried out in September 2014. The service met the regulations we inspected against at that time.

Seahaven Care Home is a residential home which provides personal care for up to 28 people, with dementia or general care needs. There were 20 people living there at the time of our inspection; six of whom were receiving short term care. The accommodation is over three floors.

The service had a registered manager. 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.

We found the provider had breached Regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records and procedures to support and evidence the safe administration of controlled drugs, when required medicines and prescribed creams. We found people were not always protected from the risk of infection. Thorough background checks were not always carried out before staff started working at the service, which left people vulnerable to the risk of the provider employing unsuitable staff. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support.

We have made a recommendation about meal times.

People received their medicines when they needed them. Records of prescribed daily medicines were completed accurately.

People, their relatives and staff felt the service was safe. One person said, “I feel safe here.” A relative told us, “[Family member] is safe and very happy here.” Staff told us if they had any concerns about safeguarding issues they would report it immediately. Staff told us they had confidence in the management team to follow up safeguarding concerns properly.

People told us they were happy with the food which looked healthy and appetising. People’s health needs were assessed and monitored, and staff contacted relevant health care professionals when necessary. A visiting health care professional told us, “Staff come with me to observe and my recommendations are followed well by the staff.”

People and relatives spoke positively about the staff. One person told us, “The staff are good, they look after me well.” A relative said, “I can’t fault the staff here. They are all brilliant from the manager to the cleaners. They know how to look after [family member], much better than I could.” People were treated with respect and their independence was promoted. There were positive interactions between staff and the people who lived at the service.

Care plans we viewed were well written and contained specific guidance on how staff could care for a person in the way they needed and wanted. Care plans were reviewed regularly and when people’s needs changed. People had access to a range of activities and the opportunity to go on outings in the local area.

People, relatives and staff gave us positive feedback about the registered manager. They told us the registered manager was approachable and always willing to listen and help. One staff member told us, “They’re brilliant, so approachable.” Staff told us Seahaven was a nice place to work and there was a good atmosphere.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out this inspection as the provider did not have effective systems in place on our previous visit on 1 May 2014 to identify, assess and manage risks to the health, welfare and safety of people who used the service.

During our inspection we were assisted by the new manager who is in the process of collating all of the necessary information to become registered with the CQC.

A single inspector carried out this inspection.The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

We saw that risks to people’s safety had been identified and assessed to ensure that appropriate care and support was provided to keep them safe. Relatives told us they were confident people were safe. One said, “My mother likes the staff and feels safe as you could get.” Another relative told us, “They treat my wife really well. I come every day at different times and everything is always the same.”

We found that people who were using the service were protected from abuse as the provider had procedures in place for the staff to follow if they suspected anyone was at risk. Staff were confident about the action they should take if they believed anyone was at risk of abuse. The evidence we found showed people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke to the manager and staff who told us that they had undertaken training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). (These are safeguards to ensure care interventions do not deprive people of their liberty and that decisions are made in the best interests of the person).The manager told us that one person, who lacked capacity to make decisions, was currently under a DoLS authorisation to maintain their safety. The manager expressed an understanding of the procedures and principals of this legislation. Following a recent court ruling regarding depriving people of their liberty in care settings the provider may wish to review the living arrangements of individual residents, to identify where their circumstances may amount to a deprivation of liberty, according to the revised definition.

Staff were provided with the training and support they needed to ensure people received caring and consistent support. The provider carried out checks to ensure people were treated well. Relatives were asked for their feedback and felt listened to by the service.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. We found that people who used the service were receiving the care and support they needed. The staff we spoke with could describe how they met the assessed needs of the people they were providing care and support to. Relatives and health and social care professionals told us people received good and appropriate care.

Relatives acting on behalf of people using the service were given appropriate information and support regarding their relative’s care and treatment and understood the care and treatment choices available to them.

Support for staff was provided through training, supervision and appraisal. The staff we spoke with confirmed they received supervision and appraisal, during the previous 12 months.

We found that the provider did not have a robust system of quality audits in place to identify gaps in care records and take appropriate action to address these gaps. Although the provider logged relevant information, such as details of incidents, accidents and complaints, we did not find evidence that this was analysed to identify trends and patterns in order to improve the care that people received.

Is the service caring?

People said they received good care. One person said, “The care staff are good and nothing I ask of them is too much trouble.” Another person said, "It is like home from home.” Family members told us that staff treated their relative with affection. They said, "The staff are caring”, and, “They take time to talk and explain things to you".

Our observations during our inspection confirmed that staff delivered care in line with people’s care plans. We saw that staff were attentive, kind and gentle whilst delivering care and continually explained to people what they were doing.

Is the service responsive?

We observed that staff provided personalised care and they respected people’s choices and wishes. Those people who needed a ‘mental capacity assessment’ or a ‘best interest’s decision’ had these made by the right people. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were encouraged to be involved in decisions about their care and treatment. A relative told us, “My relative is really happy there.” Relatives participated in regular reviews of their relative’s care and felt that the service responded to any concerns or issues. One relative commented, “They (staff) keep us informed. We feel free to speak with them. We always have done. If we have had concerns, they’ve always done something about it”.

Is the service well led?

Staff were confident that if they were to raise any safeguarding concerns, these would be taken seriously by management.

The provider had ensured staff received appropriate training and support, which meant staff were motivated and professional in the way they carried out their work.

Systems were in place to communicate with people. Relatives were regularly involved and consulted about the service to ensure any issues were promptly addressed.

You can see our judgements on the front page of this report.

People’s assessed needs were addressed and incorporated along with an individual’s wishes and preferences about how their care should be given. Risks to people who used the service, and risks to staff, were being assessed and actions taken to reduce possible harm. A resident we spoke with confirmed she was satisfied with the care she received and had no concerns. A visiting relative we spoke with told us how the care staff were ”fantastic” and how she can walk away from the home happy knowing her mother is cared for appropriately. She also told us there have been occasions when she had needed to bring some issues to the attention of the manager, but these concerns had been dealt with to her satisfaction. Care records had recently been revised and were up to date and showed people and their families had been involved in their development. We spoke with a number of people throughout the day both in their own bedrooms and in small groups in the lounge. They told us they were happy with the service and how much they appreciated the staff and the manager. The told us the food was good and one said "There is always enough to eat and drink”.

We did not ask people their opinions of the service on this occasion because we were following up on the actions taken by the provider following the last inspection of the service in June 2012.

We spoke with people who use the service and with their relatives. One person we spoke with told us “how good the staff were and how she liked living at Seahaven Care Home. One relative we spoke with said he had been "very impressed by the care his wife was receiving and could not fault the place.”

This inspection visit was arranged to check on the improvements that the home had made following our last inspection in November 2011. We found improvements had been made to safeguard people living in the home and promote their wellbeing. However we found the provider needed to take a more professional and direct approach to risk assessment and to how they managed individual risk. This would allow the home to focus fully on the needs of the individual and allow anyone examining records to understand how to deliver care and manage risk for that individual.

Many of the people who used the service were unable to talk directly to us about the care they received. To help us understand the experiences people had we spent time watching what was going on in the service. This helped us to record how people spend their time, the type of support they get and whether they had positive experiences. We also checked records and talked with visitors and staff.

We found that improvements were needed to make sure that people received effective, safe and appropriate care, treatment and support that met their individual needs.