About the service: The service is a residential care home which provides nursing and personal care. At the time of this inspection there were 17 people living in the home.

People's experience of using this service: The service was safe. Risk reduction methods were in place to minimise the likelihood of people coming to harm. Staff knew the signs of abuse or harm and they reported their concerns in line with company safeguarding policies and procedures. Medicines were managed well, and the home was exceptionally clean and tidy.

People had achieved good outcomes through effective support from staff and access to external healthcare professionals.

Staff were experienced and competent in their roles. They received good training which supported them to deliver effective care. The support people received was personalised and adapted to meet people's varying needs and wishes.

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. Staff encouraged people to maintain or regain their independence.

Staff displayed caring values. They treated people with kindness, patience, dignity and respect. People were well cared by staff who knew them well.

Staff assisted people to join in with a range of activities and to maintain links with their families and the local community. People were often supported by staff to access local amenities.

The governance of the service had improved since our last inspection. The service delivered good quality, person-centred care. The safety and quality of the service was monitored through regular checks and audits. The management team strived to achieve high standards through continuous improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (published April 2018).

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in line with our inspection programme.

Seaview is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate 20 people in one adapted building. At the time of our inspection 17 people with physical and mental health related conditions were using the service.

This unannounced comprehensive inspection took place on 16 and 17 January 2018. This means that neither the provider nor the staff at Seaview knew we would be visiting the home. At the last inspection in November 2016, we identified breaches of regulations which related to safety, consent and the governance of the service. We found improvements had been made in most areas but not enough to ensure compliance with all of the statutory requirements.

This is the second consecutive time that this service has been rated as 'requires improvement'.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, responsive and well-led to at least good. An action plan was sent to us by the registered manager in February 2017 which showed that the majority of required actions were completed and that any outstanding actions had a defined target date of 28 February 2017.

However, at this inspection we found that although the registered manager and the deputy manager had made improvements throughout the service, the governance was not robust enough to fully identify or completely address some of the continued issues we highlighted during this visit.

We found record keeping continued to require improvement. In particular, medicine administration records and clinical care plans required some attention to ensure comprehensive detail was included in respect of all people, their needs and specific risks they may face due to their health conditions. We have made a recommendation about this.

The provider has failed to display their previous performance assessment as legally required. We are dealing with this matter outside of the inspection process.

There was a well-established registered manager in post; however they were on annual leave 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. The deputy manager, who was also the lead nurse, assisted us in the registered manager’s absence.

People told us that they felt safe living at Seaview with the support from staff. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they should take if they suspected abuse. The local authority safeguarding team and commissioning teams informed us that were no current concerns about this service.

Records relating to accidents and incidents were kept including matters of a safeguarding nature. Incidents were recorded, investigated and reported in a timely manner to other relevant authorities such as the local authority or CQC.

The service managed general risks associated with the health and safety of people, including the completion of regular checks of the property, equipment and utilities in line with their legal responsibilities. People’s individual care needs had been assessed for risks related to daily living; however some clinical care plans did not describe specific risks related to health conditions such as epilepsy. Care records had been reviewed and updated on a monthly basis.

Medicines were stored in a safe and secure place. The staff followed policy and procedures regarding the ordering, receipt, storage, administration and disposal of medicines. We

The inspection took place on 26 November 2016 and was unannounced. This meant the provider did not know we were coming. We last inspected the service on 5 November 2013 and found the provider was meeting the regulations we inspected against. Prior to this inspection the home had been closed from January 2016 to October 2016 in order to carry out essential maintenance work due to flooding.

Seaview provides short breaks, as well as permanent nursing care and accommodation, for up to 20 people with complex needs, including learning and physical disabilities, dementia and acquired brain injury. At the time of this inspection seven people were using the service.

The service was required to have a registered manager but there was no registered manager at the time of our inspection. The current manager had applied to become the registered manager. This application was still being considered when we inspected. 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.

During this inspection we found the provider had breached regulations 11, 12, and 17. Medicines records did not show medicines were managed appropriately. The medicines fridge was not operating at the correct temperature. Nurses and care workers lacked personalised guidance to ensure people received when required medicines consistently and correctly. Records of topical medicines like creams and ointments were inaccurate.

Some people did not have the relevant care plans in place to ensure all of their needs were met. Care plans were not always personalised so that people received the individual care they needed.

Care records did not accurately account for all of the care people required or had received. This included people at risk of poor hydration and people prone to skin damage.

The provider was not following the requirements of the Mental Capacity Act (MCA). Applications for Deprivation of Liberty Safeguards (DoLS) authorisations for relevant people had not been made in a timely manner. People did not have care plans to guide care workers about the support they needed with decision making. Decisions had been taken in people’s best interest without the necessary MCA assessment having been carried out. Care records contained some blank consent forms which people had not yet signed.

Some assessments had also not been completed including, nutritional assessments, spiritual assessments and activities plans. Some care records were left blank or contained gaps in recording, such as oxygen level charts, blood sugar level charts and fluid balance charts.

Fluid balance charts had not been analysed to check people were adequately hydrated. The provider had not been proactive in ensuring essential care records were accurate and fit for purpose.

You can see what action we have asked the provider to take at the back of the full version if this report.

Some health and safety checks weren’t being completed, such as checks of the emergency lighting system. The fire risk assessment was overdue and the gas safety and legionella certificates were not available to view.

People said they were happy with their care. They confirmed they were treated with dignity by kind and considerate care workers. People told us they felt safe living at the home.

Care workers knew about safeguarding adults and the provider’s whistle blowing procedure. They knew how to report concerns and told us did not have any concerns about people’s safety.

There were enough staff on duty so that people had their needs met a timely manner. We found effective recruitment checks in place to ensure care workers were suitable to work with people living at the home.

Care workers confirmed they were well supported. Essential

There were 13 people using the service at the time of our inspection. We spoke with five people who used the service and one relative to find out their opinions of the service. People were complimentary about the care. A relative told us, “We’re very happy with the care.”

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We contacted a number of health and social care professionals to find out their opinion of the service. Their comments and our observations throughout the inspection led us to conclude that people’s health, safety and welfare was protected because the provider worked in co-operation with others.

We found there was enough equipment to promote the health, independence and comfort of people who used the service.

We found that staff were very happy in their work. We concluded appropriate checks were undertaken before staff began work and effective recruitment and selection procedures were in place.

There was an effective complaints system available. It was clear that comments and complaints people made were responded to appropriately and that this helped ensure a culture of openness.

We spoke with three people and one relative who were happy with the support they or their relative received with their medicines. People told us:

“I can ask for my painkillers and I get them”

“If I need the doctor I can see him but it can take a few days”

“The staff look after us. They are very nice”

“I look after my own tablets and keep them in a drawer, locked away”

“The regular staff are good, care is consistent”

“[The relative] sees the doctor quickly when she needs to”.

Overall, we found that medicines were managed in a safe way.

We looked in detail at the care provided to six of the eleven people using the service. They told us they enjoyed living at Seaview and they were happy with the care and support they received. Their comments included, “I really like it here”, “It is great here” and “It is a nice place to live.”

We found care and treatment was planned and delivered in a way that ensured people’s safety and welfare. We found staff clearly understood people’s individual care needs and saw they were providing the support people required and were caring and attentive to them.

We found record keeping had improved which meant up to date information was available about people’s needs and how these were to be met. There were good systems in place to ensure essential information was shared which meant staff had up to date information about how to support people.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with a person who used the service about how their medication was managed. They told us that staff “do meds fine”. However, they were also concerned that a change to medication that had been suggested a week earlier had not come about. We spoke with one relative who did not express any concerns regarding medication.

We found that medicines were not managed in a safe way.

People who were able to tell us about how they were cared for said, “They’re smashing. They do anything for you. I think a lot of them” and “I get well looked after. Staff are great, always there when you want them”.

However, we found people were not protected from the risks of inadequate hydration. There was no robust system to identify where people had insufficient fluid intake or how to manage and review this. We found people were not protected from the risk of developing pressure ulcers. There was no robust system to assess people and ensure an effective plan of care was put in place, monitored and evaluated. Pressure relieving equipment was being used incorrectly and not being checked.

We found continuing shortfalls in record keeping which was inaccurate, particularly in respect of monitoring of people's hydration.

A number of people who used the service were unable to express their views on the care and support they received due to the nature of their condition. We spoke with relatives visiting some of the people who lived at, or who were staying at Seaview.

One of them told us that their relative received the help she needed to eat meals and take fluids and that their personal care needs were met. Another told us the staff spent time with people and helped them to participate in a lot of social activities. They told us that their relative generally got the care they needed but that some days it was evident some “staff have a done a better job” than others. They told us that they had discussed some minor issues with the acting manager who had always put things right.

Another visitor told us their relative, who had been staying for a short while, needed help with positional changes every four hours to prevent pressure wounds developing on their skin. They said that this essential care had been provided during their stay up until the day of our inspection when no staff had attended their relative to carry out this essential care for over four and a half hours.

We visited the home unannounced on 22 May 2012 from 10.30am to 5.15pm as part of our routine programme of inspections. We visited again the following day between 9.40am to 3.20pm. There were nine people staying there at the time of our visit, three of whom were living there permanently.

We spoke with five people who were staying there. Not all people who used the service could comment about their care due to their disabilities, but some could. However, we spoke in detail with relatives of four of these people.

One person told us that the staff had been “fantastic” and “I don’t want to leave”. They said that staff had been very supportive during their stay and had helped them achieve their goals. Their relative told us that they had “found everything excellent” and that the staff were helping to arrange specialist equipment to help his relative.

Another visitor told us that their relative had moved there from another care service and that since moving to Seaview, their relative had been given more support to get out and about and this had significantly improved their relative’s quality of life. They told us, “I feel confident (my relative) is being well cared for when I’m not here”.

Another visitor told us the service was “brilliant”; the food was “fantastic “. They also said their relative was able to participate in social activities and visitors were always welcomed.

We also spoke in depth with three members of staff and the registered manager. They confirmed that they felt supported to carry out their role, and that they received regular training. They told us that the staffing levels were good and the company running the home provided the resources they needed or requested.

Following the inspector’s visits, brief information was received via our website from someone who wished to remain anonymous. This person told us they had visited Seaview and had concerns that people were not getting the care services they were paying for. They also said that they had heard staff expressing unhappiness about the way the home was managed and the way staff were treated by the manager and his management team. No further details were provided and as this person had not provided any contact details, we were unable to obtain any further information about their concerns.

However, we were satisfied that following our discussions with people staying at Seaview, their relatives and members of the staff team during our two visits, no evidence was provided to us to indicate any concerns of the nature described to us via our website. If further detailed information was subsequently provided to us, we would, of course, review this again.