Mulroy's Seaview Nursing Home

Mulroy’s Seaview Nursing Home is a residential care home providing personal and nursing care to up to 27 people in one adapted building. The service provides support to adults with mental health conditions. At the time of our inspection there were 23 people using the service.

People’s experience of using this service and what we found

This was a targeted inspection that considered risk management and premises safety.

We reviewed risk management and found people remained at increased risk of harm. Some care plans had not been reviewed since our previous inspection and there were still a number of risks that had not been appropriately assessed. Staff did not have access to relevant information on how to minimise risk and keep people safe.

There was still a lack of management oversight in respect of infection control and cleaning of the home. As a result, people were still not sufficiently protected from the risk of infection.

The renovation of the premises had not been completed and as a result the environment was still unsafe in some areas.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 December 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and effective risk assessment. This inspection examined those risks.

We undertook this targeted inspection to check on a specific concern we had about risk management and premises safety. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mulroy’s Seaview Nursing Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mulroy’s Seaview Nursing Home is a residential care home providing personal and nursing care to up to 27 people in one adapted building. The service provides support to adults with mental health conditions. At the time of our inspection there were 26 people using the service.

People’s experience of using this service and what we found

People were exposed to risk as person-centred risk assessments were not always in place or up to date. Fire safety was not appropriately managed in the home. There were not enough staff on duty to ensure all management and administration tasks were completed. The management team did not have robust systems in place to safeguard people from the risk of abuse or to protect people from the risk of infection. Medicines were administered safely by staff who were appropriately trained and assessed as competent. However, medicines stock levels had not been correctly managed.

Safe recruitment processes had been followed when new staff commenced employment. The management team monitored accidents and incidents to ensure lessons were learned when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice. The registered manager had not ensured people’s capacity to make decisions about their care was always properly assessed or recorded.

Staff supported people to make day to day decisions and choices. Staff training was not fully up to date and not all staff had regular supervision. The premises needed renovation and redecoration. We observed staff providing care in a way which demonstrated skills and knowledge of the people they supported. People were supported to eat a healthy balanced diet that met their needs. People had access to health professionals when required.

The systems in place for checking on the quality and safety of the service were not always effective. Audits and quality monitoring had not been completed on a regular basis. Some documentation was out of date. There was a positive culture within the home. People we spoke with were generally happy with the care they received, and we had good feedback from relatives. Staff and management worked closely alongside other health and social care professionals to achieve good outcomes for people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection

The last rating for this service was good (published 17 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mulroy’s Seaview Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have made a recommendation about improving the management of medicines stock.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Good procedures were in place for professionals visiting the service. People had been supported to keep in touch with loved ones via video and telephone calls. Face to face visiting was due to start shortly and a visiting pod was planned.

People and staff understood the procedures in place to maintain social distancing. Small changes had taken place at the service to support social distancing. People were supported to go outside for short walks when they wanted to.

People had been admitted into the service safely. Good procedures had been followed to minimise the risks of cross infection. People had continued to attend and receive healthcare appointments.

There were good stocks of personal protective equipment (PPE) available. Staff were observed wearing PPE correctly. Refresher training in donning and doffing PPE correctly was due to be carried out.

People and staff had participated in regular testing. Vaccinations were underway. A range of resources were in place to support people and staff to take up vaccinations. Where COVID-19 cases had been identified, the right procedures had been followed.

The service was clean throughout. Cleaning regimes were in place across the service and this included increased cleaning of frequently touched areas. Updates to the environment were taking place across the service.

Staff had listened to feedback from professionals and made the necessary improvements. An updated IPC policy was in place.

People’s experience of using this service and what we found

People said they were very happy with the care and support provided to them. They said staff were supportive and they always felt safe. Staff were described as ‘Amazing.’

Staff understood the risks to people. They were responsive to people’s needs and made sure the right actions were taken to keep people safe. Lessons were learned when incidents took place. There were enough suitably trained staff on duty to support people. Medicines were safely managed.

Staff were supported to provide good care to people. Health professionals were in place to support people with their needs. Responsive plans were in place to meet people’s mental health needs. Records were updated as people’s needs changed. Continued improvements were taking place with the environment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People said they received good care. They said staff were kind and compassionate and were always available to them when they needed additional support. People were involved in their care and their opinions respected. Staff were dignified in their approach with people.

Care records demonstrated the individualised care which people received. Records showed how staff adapted care when people experienced a deterioration in their health and well-being. People spoke positively about the activities at the home. People said they always spoke with staff if they had a concern to raise and were listened to.

Staff worked together as a team to deliver good care to people. This meant they were able to support people with complex health conditions, where previous placements had been unsuccessful. Quality assurance processes were effective, and feedback was used to drive improvement.

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

Rating at last inspection (and update)

The last rating for this service was good (published 20 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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 performance of the service. The deputy manager had then developed a wide range of actions plans and ensured these were acted upon.

We found that the deputy manager had commenced this process immediately following the inspection in December 2015 and had completed at least two audits per area such as infection control, care plans, staff training and recruitment. They had produced and completed actions plans for each area and then redid the audit to ensure the work down had effectively addressed the issue. We found that they could now demonstrate that their governance systems were effective.

The audits had identified that the policies were not fit for purpose and care plans needed to be improved. The registered manager had made the decision to be responsible for making improvements in this area. They reviewed their policies and procedures and identified where improvements could be made. We found that the registered provider had created a large number of new policies and these clearly explained to staff what were the service expectations.

The registered provider had also overhauled the care records and introduced improved ways of recording. They were still in the process of completing this work but we found the work completed had made the care records easier to navigate and use.

The people we spoke with were extremely happy with the service and spoke highly of the staff and the registered manager. We observed staff worked with people in a sensitive and compassionate manner. The staff were able to clearly outline the needs of the people.

We found that the registered manager had critically reviewed the home and following this completed a refurbishment programme, which included upgrading the offices, the bedrooms and some of the communal areas. Also they had provided additional hours for the domestic staff to complete a full deep clean of the whole home.

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.

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.