We inspected Seaway Nursing Home on the 4 December 2018. We previously carried out a comprehensive inspection at Seaway Nursing Home on 12 and 13 March 2018. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to people not receiving person centred care, people not being treated with dignity and respect, people’s consent to care and treatment not being sought correctly, the provision of meaningful activities, safeguarding procedures not being implemented, assessments of risk and healthcare guidance not being followed, the environment and equipment available at the service, quality monitoring, the provider notifying the CQC of important events, record keeping and staffing levels. We also found further areas of practice that required improvement, in relation to recruitment practices, the recording of PRN ‘as required’ medicines and promoting people’s independence. The service received and overall rating of ‘Inadequate’ from the inspection on 12 and 13 March 2018 and was placed into Special Measures. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Seaway 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. Seaway Nursing Home is registered to provide care and accommodation for 20 older persons with nursing, residential care and physical care needs. At the time of this inspection, there were 12 people living at the service.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in many areas since the previous inspection. However, despite the improvements that we identified, we were unable at this inspection to determine whether the current service provision had been fully embedded and could be sustained over time, should the number of people living at the service increase.

The overall rating for Seaway Nursing Home has been revised to Requires Improvement. We will review the overall rating of Requires Improvement at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

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.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. However, despite the improvements identified in relation to staffing levels, we were unable at this inspection to determine whether the current service provision and levels of safety could be sustained over time, should the number of people living at the service increase.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. The service had an ongoing action plan and significant improvements had been made since the last inspection. However, the delivery

The inspection took place on 12 and 13 March 2018. The first day of the inspection was unannounced, on the second day the registered manager, area manager, staff and people knew to expect us. Seaway Nursing Home 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.

Seaway Nursing Home is situated in Hove, East Sussex and is one of two homes owned by the provider, Seaway Nursing Homes Limited. Seaway Nursing Home is registered to accommodate 20 people. At the time of the inspection there were 16 people accommodated in one adapted building, over three floors. Each person had their own room and had access to communal bathrooms, lounge and gardens,

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager and an area manager who was based at the home.

At the previous inspection on 22 February 2017 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of Safe, Effective and Well-led. At this inspection we continued to have concerns. The overall rating for this service is now ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Staff had an understanding of safeguarding adults; however, it was not evident if systems and processes considered people's safeguarding if they experienced an unexplained injury. There was an over-reliance on restrictive practices to manage people’s needs and behaviour. Appropriate procedures had not always been followed to ensure that these were in compliance with legal requirements. Risks to people's safety had not always been managed and guidance provided by external healthcare professionals had not always been implemented to ensure people received safe care and treatment. These were areas of concern. As a result three safeguarding referrals were made to the local authority by CQC following the in

We inspected Seaway Nursing Home on the 22 February 2017 in light of concerns we had received. We previously carried out a comprehensive inspection at Seaway Nursing Home on 10 February 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the management of medicines. The service received an overall rating of ‘requires improvement’ from the comprehensive inspection on 10 February 2016. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to recruitment practices, the analysis of accidents and incidents and management oversight of the service. Additionally, areas of improvement were identified in relation to guidance for staff around PRN (as required) medication, and staff training.

The overall rating for Seaway Nursing Home remains as requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been made and sustained.

Seaway Nursing Home is registered to provide accommodation and care, including nursing care for up to 20 people. They specialise in supporting older people, some of whom are living with dementia or chronic health conditions. On the day of our inspection there were 17 people living at the service, who required varying levels of support.

There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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 had safe recruitment procedures, however these had not always been followed. We looked at the staff files for all members of staff currently employed by the service, and found that several contained gaps and omission in relation to the pre-employment checks the provider is required to obtain for members of staff. This placed people at risk of receiving care from staff that were not safe to work with vulnerable people. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and is an area of practice that requires improvement.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, we found the monitoring of accidents and incidents was not robust. Additionally, when we raised our concerns with the management of the service in relation to gaps in recruitment files and further evidence we found in respect to staff conduct and staff not engaging with training, we were told that the management of the service was aware of these issues, but had not acted upon them. Furthermore, accident and incident records identified that many people were at high risk of falls. The provider had recognised that falls prevention training was required and had included this on their training matrix. However, we saw that this training had not taken place for staff. People were placed at risk, as the provider did not have adequate systems and processes to monitor and mitigate any risks relating the health, safety and welfare of people using services and others

This inspection took place on the 10 February 2016. Seaway Nursing Home was last inspected on 16 June 2014, where no concerns were identified. Seaway Nursing Home is registered to accommodate up to 20 people who require support with nursing and personal care. They specialise in supporting older people, some whom are living with dementia or chronic health conditions. Accommodation was arranged over three floors. On the day of our inspection, there were 17 people living at the service. Seaway Nursing Home is part of a group of three services owned by the same provider in the Brighton and Hove area.

There was a manager was in post, however they had not currently registered with the CQC. The service had been without a registered manager for approximately five months. 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’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, safe procedures for the administration of the medication were not routinely being followed, which placed people at potential risk of receiving their medicines incorrectly. We have identified this as an area of practice that needs improvement.

Where people lacked mental capacity to make specific decisions, the staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. However, despite senior staff having appropriate training and knowledge, we found that care staff had not received formal training around the MCA. We have identified this as an area of practice that needs improvement.

Staff had received essential training, however, this training had not routinely been updated. There were also limited opportunities for additional training specific to the needs of the service, such as end of life care, the care of people with dementia and caring for people with chronic conditions, such as diabetes. We have identified this as an area of practice that needs improvement.

People chose how to spend their day and they took part in activities in the service. It is acknowledged that meaningful activities had previously been planned and taken place for people. However, we saw no activities taking place on the day of our inspection, and no formal provision had been made to provide activities for people in the planned absence of the activities co-ordinator. We have identified this as an area of practice that needs improvement.

People were not actively involved in developing the service. Other than the complaints process, there were no formal systems of feedback available for people, their friends or relatives to comment on the service and suggest areas that could be improved. We have identified this as an area of practice that needs improvement.

The provider undertook some quality assurance audits to ensure a level of quality was maintained. However, further quality review and auditing systems needed to be kept up to date. For example, the most recent infection control audit had taken place in August 2015. Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow. We have identified this as an area of practice that needs improvement.

Support for the manager to increase their knowledge, and to share learning and best practice to drive up quality at the service had not been made available or explored. Additionally, the manager was responsible for managing the service, but also split their time between being on the rota as the nurse in charge on some days. In light of the concerns identified in respect to medication procedures, staff training, oversight of documentation and auditing systems, it

Our inspection team was made up of an Adult Social Care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with two people who used the service, a visiting relative, the registered manager, a registered nurse, the chef and two care workers.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

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?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us "I wouldn’t have my [relative] anywhere else".

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

There were systems in place to ensure that people’s medication was managed appropriately and safely.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs. A relative told us “They always involve me with my [relative’s] care plan”.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service told us "I really like the staff". A relative told us “The carers here are brilliant”. We observed that people were treated with consideration, dignity and respect.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Where appropriate, people completed a range of activities in and outside the service. The home had a dedicated sensory room for people to use.

People’s needs were assessed before they moved into the service and detailed and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people’s individual needs.

We were told by the registered manager that the service had good systems in place to monitor its own standards of service delivery. The registered manager told us they carried out a range of internal audits, including quality monitoring, medication and environmental health and safety.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon. However we identified some shortfalls in respect to the frequency of satisfaction surveys and meetings for residents/relatives.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

During our inspection we spoke with four people who used the service and a visiting relative. We also spoke with three staff members; these were the registered manager, a registered nurse and a care worker. We also took information from other sources to help us understand the views of people who used the service, which included meeting minutes.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us “This is very much a nice place. The staff are very good to me”. A relative of a person who used the service told us “Any problems and they get on it straight away. All in all it’s very good”. A member of staff we spoke with told us “I think that everyone here is safe and happy”.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service. The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

We spoke with two members of staff during our inspection and were told that they felt valued and supported and that their training needs had been met. We also found that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.