This inspection took place on 3 and 5 July 2018 and was unannounced. The last inspection was in April 2017, where we found four breaches of regulations relating to recruitment, person centred care, staffing, and governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

At this inspection in July 2018, we found the provider had failed to follow their action plan. We identified significant shortfalls in the quality of the care people were receiving and 10 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found two breaches of the Care Quality Commission (Registration) Regulations 2009.

Seahorses nursing home is a ‘care home’. People in care homes receive accommodation and nursing or 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. Seahorses nursing home accommodates up to eight people in one adapted building. The majority of people in the service were living with Huntington’s disease. At the time of this inspection there were eight people living in the service.

There was a registered manager in post. 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 did not have the financial resources needed to provide and sustain the service to the required standards. They had not informed us about their current financial position which was directly impacting on the care people were receiving.

A system was not in place to ensure there were sufficient numbers of staff on duty to support people and meet their individual care needs. There were not sufficient numbers of skilled, trained and experienced staff to meet people's needs effectively at all times. The provider had reduced staffing levels since the last inspection in April 2017, and this had directly impacted on the care people received placing them at extreme risk of harm.

Governance systems were not operated effectively in order for them to provide an accurate overview of the service. Proper monitoring was not in place to review, identify shortfalls and inform an ongoing plan for improvement. The provider's systems had failed to identify the issues we found during our inspection. Audit and monitoring systems had either not been sustained or were ineffective to ensure that the quality of care was consistently assessed, monitored and improved.

Monitoring systems were not effective to demonstrate accidents and incidents were appropriately analysed to identify hazards, trends or themes, to mitigate the risks of further accidents and incidents.

Thorough risk assessments were not carried out routinely to identify and mitigate risks in relation to people's care and support needs. Risks affecting people had not been reviewed since April 2018.

The culture within the home did not promote a holistic approach to people's care to ensure their physical, mental and emotional needs were being met. Staff spoke abruptly when interacting with people, and did not provide emotional reassurance when people became distressed.

The service was not following the principles of the Mental Capacity Act 2005. Minimal improvement had been made to ensure the way that people’s care was delivered did not restrict their freedom more than necessary.

The service did not ensure that safeguarding procedures were followed when there were two significant thefts from people using the service. Systems were not improved to reduce the risk of recurrence.

The provider had not put in place all that was reasonably practicable to maintain

This inspection took place on 25 April 2017 and was unannounced.

Seahorses Nursing Home is a service that provides accommodation, nursing care and support for up to eight people living with Huntington's disease. Huntington's disease is an inherited condition

that can affect movement, cognition and behaviour.

At the time of the inspection, there were seven people living at the service.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

During this inspection, we found that the registered provider was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not have robust oversight of the service's operations. The registered provider did not take an active role in the governance of the service and the registered manager did not have sufficient time to undertake all responsibilities required of the role. This resulted in a lack of regular and robust auditing to ensure the service was effective and of a good quality. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was not meeting the requirements of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). Where people were unable to give consent to specific aspects of their care, there was no record to show that these decisions had been made in the person’s best interests. Some people were subject to restraint, however, the service had not considered if there was a deprivation of people’s liberty and if appropriate authorisation was required. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvement was needed in the way the service recruited staff. Some documentation relating to employment checks were not available so we could see that staff were suitable for the role. This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provision of periodic supervision and performance management for staff was not adequate. Staff had not received formal supervision for 12 months. Not all staff had received necessary training updates and assessment of their competence. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

People received their medicines in a timely manner. However, improvements were needed to ensure medicines were stored at the correct temperature and dated when opened to ensure they did not expire. Staff had not received recent medicines training or had annual competency checks in line with national guidance.

Risk assessments were completed to ensure that people were kept safe. However, we found that the level of information needed to be more detailed to ensure that staff had up-to date and clear guidance to help them support people safely. The use of bed rails and associated risks needed to be assessed more comprehensively, and we have made a recommendation about this.

Information recorded in people’s care plans was not consistent across the service. Some held detailed information on people’s social care needs, others only gave brief information. Where reviews had taken place, no changes were made to the main pages of the care plan to demonstrate that the review was comprehensive.

Activity provision was provided by care staff when time allowed. More detailed information on people’s social care needs will help to inform individual needs and preferences for social activity, and we have made a recommendation about this.

Staff respected people's privacy and dignity and interacted with people in a caring, respect

We met five people who used the service and spoke with four of them about their experiences of the service they were provided with. People told us that they were happy living in the service. Two people put their thumbs up when we asked if they were happy living in the service, this indicated that they had answered, "Yes." Another person answered, "Yes I am." Another person said, "I am very well looked after, I cannot speak highly enough of them."

We saw that the staff interacted with people in a caring, respectful and professional manner. Staff attended to people's verbal and non-verbal requests for assistance promptly.

We looked at the care records of three people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. We found that the service worked with other professionals involved in people's care to ensure they were provided with a consistent service.

We found that people were supported by sufficient numbers of staff who were trained to meet their needs.

We found that the premises were appropriate to meet the needs of the people who used the service. Equipment used to support people to maintain their independence was fit for purpose and safe to use.

We did not speak with people who used the service. The purpose of this inspection was to check that the provider had made improvements following our last inspection of 29 October 2012. We found that the provider was meeting the standards that we inspected.

We spoke with three of the seven people who used the service. One person said, "I am happy with the care here." The other two people spoken with answered our questions with, "Yes" or, "No" answers. These answers were provided both verbally and non verbally.

People told us that their choices were listened to and acted upon. They told us that the staff treated them with respect and they felt that their needs were met.

We saw that the staff interacted with people in a caring, respectful and friendly manner.

The people we met with during our visit on 26 October 2011 weren't able to tell us specifically how they were involved in the planning and running of Seahorses Nursing Home. However, we saw that staff had a very good understanding of people's individual ways of communicating and supported people to make choices about what they wanted to do and where they wanted to be.

We saw that people were comfortable and relaxed throughout the duration of our visit.

We did not speak with people about assessing and monitoring the quality of service provision. However, when we asked staff members if they could change anything at all to make people's lives in the home better, some of the responses and suggestions we received included: A bigger mini bus and larger doorways to accommodate wheelchairs better. One member of staff also told us that they felt the amount of paperwork they have to fill in now, takes valuable support time away from the people living in the home.

This inspection took place on 16 December 2014 and was unannounced.

Seahorses Nursing Home is a service that provides accommodation, nursing care and support for up to eight people living with Huntington's Disease. At the time of the inspection, there were seven people living at the Home. 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 and associated Regulations about how the service is run.

The staff were kind, friendly and attentive to people’s needs. The staff noticed if people were concerned about anything and took action to sort problems out. They used a thoughtful approach when talking with and assisting people and treated each person as an individual and with respect.

People received their medication at the correct time, as prescribed and in the way that suited their health needs. Referrals were made to healthcare professionals and specialists when people became unwell or needed more help. When plans of care were reviewed, people and where appropriate, relatives were consulted and involved in discussions about how to ensure the needs of the person were met.

Nursing care and support was provided to people by sufficient numbers of staff who had completed training and had the skills and knowledge they needed to carry out their role. Staff knew how to protect people from abuse and understood when a person’s freedom was being restricted. They also knew the action to take to ensure their rights were being respected.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. Staff had completed this training and people had their capacity to make decisions for themselves assessed. Policies and procedures were in place and the manager had liaised with the supervisory body about making an application when people were at risk of having their liberty restricted or deprived.

The manager made changes to care practice when concerns were raised. Staff described the manager as approachable and willing to listen to the suggestions they made. Staff were happy working at the home and felt part of a staff team that worked well together.

Concerns and complaints were acted upon and resolved to the satisfaction of the person raising their concern. Action had been taken to gain the views of people regarding the quality of the nursing, care and support provided. Checks of the premises, records held and the way the staff worked had been regularly carried out to make sure the home was well run and people received the care and support they required.