Seaview Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Whilst improvements were seen and the breach of regulation met, there were areas of improvement that needed to be developed and embedded further to ensure continuous safe care. Care records and monitoring charts were not always consistent. Environmental risks and hazards were not always reported promptly in order for repairs to be promptly carried out. Medicine management had improved in the service, however there were further improvements required to the processes and recording of PRN (as required) medicines. Staff had received training regularly in a broad range of subjects that included specific health conditions. Recruitment processes were robust, which helped to ensure staff were suitably experienced, competent and able to carry out their role. Good infection control practices were followed by staff to reduce the risks of contamination.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives we spoke with told us they felt safe. One person said they felt safe due to “the friendliness of staff”. A relative said, “I know she is safe and being looked after”. Relatives said they would feel confident to raise concerns if they were worried. One relative told us, “I know how to make a Complaint but to be honest it’s easier to pop in and see either the nurse or manager.”

Staff knew how to recognise signs abuse may be occurring and knew what steps to take to raise those concerns. One staff member said, “We get safeguarding training, we get updates of any changes to the procedures,” One staff told us that the manager is easy to speak to if they have concerns, and regularly has discussions with the staff about safeguarding. Staff said they know where to find the safeguarding policy to guide them with the process and a senior member of staff would provide them with support if required. One told us, ‘I know about whistleblowing and am confident to use it.”

Safeguarding policies and procedures had been regularly reviewed, and they set out the process for staff to follow when raising a concern. Staff had been required to read the policies and attend training in safeguarding as part of their induction to the role, and had also received training in equality and diversity awareness to ensure they knew how to protect people from discrimination. Safeguarding concerns and allegations had been managed effectively by the provider and notifications had been submitted to CQC as required.

Relatives told us they felt involved in care planning discussions and in decisions relating to risk. One said, ‘I am involved in his care planning, they let me know he had a crackle on his chest, they had called the paramedics in and they gave him some antibiotics”. Another family member told us that their relative felt included in decisions about their support. They said the person, “feels involved with their care and is supported to go out to appointments.”

Staff were knowledgeable about the people they were supporting and what level of support they required to stay safe. Staff told us important information and updates are communicated to the care team regularly, one said, “We have handovers to ensure any changes are shared.” Staff we spoke with knew where to find information about risks and told us they had received training about people’s individual health needs so they understood how people’s needs may progress.

We saw some people had been provided with specialist equipment to reduce risks to their safety, however we observed an occasion where staff had not been following best practice when using it. This posed a safety risk to the person. We immediately raised this as a safety risk with management, and all staff on duty were provided with an immediate short training session in safe use of that piece of equipment. The care plan was subsequently reviewed and the risk assessment updated. Some other environmental safety concerns had not routinely been reported, or added to risk assessments.

Whilst improvements were seen to how risks were managed, there were areas that needed to be developed and embedded to ensure safe, continuous care. Care plans and risk assessments were comprehensive and were supported by decision specific mental capacity assessments. These included those for skin integrity, wounds, nutrition and mobility. However, the documentation regarding wounds and the care of wounds did not follow The National Institute for Health and Clinical Excellence (NICE) guidelines. We raised this with the provider during the assessment and action was immediately taken to review and update the documentation accordingly. There was no evidence the poor recording had impacted on the wound healing process but there was a potential of risk which was now mitigated. We were not assured food and fluid records were completed in a consistent way and in real time. Staff were not recording fluid intake consistently due to them having minimal access to a computer. During the inspection hand-held tablet devices were ordered, which would allow staff to consistently and accurately record care given. There were detailed fire risk assessments, which covered all areas in the home. People had Personal Emergency Evacuation Plans (PEEPs) to ensure they were supported in the event of a fire. These were specific to people and their needs. Premises risk assessments and health and safety assessments continued to be reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment. The risk assessments also included contingency plans in the event of a major incident such as fire, power loss or flood.

People and their families told us the environment was in need of some repair and redecoration, however they felt it was safe. Relatives told us equipment in their relatives rooms appeared to be well maintained. One relative said, “The décor and furnishings are tired.” We were told by relatives that their family members had been encouraged to bring their own items to personalise their rooms.

Staff told us they report any issues needing repair or maintenance work. One staff said, “Nothing gets used if it’s not working properly.” Another staff member told us how there is an ongoing programme to upgrade the environment and equipment. One staff confirmed this, saying, “A bit of TLC (tender loving care) is needed, but they have done lounges which look really good.”

The overall cleanliness of the home remains difficult for the housekeeping staff to manage as the older part of the building needed repair and renewal. There was also the added impact of not enough housekeepers to keep on top of the cleaning, particularly in relation to carpets and communal shower/ bathrooms. Communal areas however were clean and comfortable. We spoke with the registered manager and area manager regarding the rolling plan of renewal and repair, which we were told has been escalated. We received confirmation of 7 floors being replaced and the progression of shower room repairs. We have asked for an action plan to address this.

Although audits had been completed regularly to monitor the safety of the environment and equipment, it was not sufficiently detailed and had not identified the issues we found during our site visit.

People told us they would like to see more staff around to improve the frequency of social interactions. One person said, “I think more would benefit the residents.” People told us they felt safe and staff respond well when they call for assistance. One person said, “I think the staff levels are good, I certainly get all the care I need.” Another person told us, “When I need help, they come quickly,”

We received mixed feedback about staffing levels from the staff. One staff said, ‘We have enough. Some residents need more time but we are still ok.’ Other staff members told us there are not enough and they would benefit from another member of the team during the day.

We saw that people were responded to by staff when there was a need for support, however there was a lack of staff available to chat with people at times when they wanted company. We were told by the provider they are currently recruiting for additional activity staff, and this would alleviate some of the pressure from the care team who are also trying to carry out activity sessions.

Improvements had been made since the last inspection to the numbers of suitably qualified, competent, skilled and experienced staff on duty. However, we did continue to see they were not sufficiently deployed to meet people’s needs. This was addressed by management during our assessment by adding additional staff and was to be monitored by the management team. Staffing rotas we looked at confirmed that agency staff were used to cover unforeseen absence. We noted people were still receiving care and support to get up and dressed up to just before lunch, and that staff lacked time to update records as care was delivered. It was therefore difficult to follow people’s oral health, fluid intake and personal care due to the retrospective completion of daily records. We were not able to observe care for those in bedrooms being given consistently. This was fully discussed with the Registered manager and Operation manager. Following our feedback, an extra staff member was immediately deployed for each floor to meet people's care needs. The lack of domestic staff will be reflected under infection control quality statement. Staff had received the appropriate training to meet the needs of people currently living in the home. There were staff currently undertaking training but this had been considered when planning the rotas to ensure the skill mix was appropriate. The management team acknowledged staffing had continued to be challenging especially for activity roles, but felt positive with new staff joining the team, and they were in a good place now. Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

We spoke with some visitors to the service. Some felt the cleanliness of the service needed to improve. One relative said, “It is better now as there are more staff.”

Staff told us they are well resourced for cleaning and infection control. One said, “PPE is not an issue, we have loads, and also cleaning products and equipment.” Staff said there are ongoing discussions in staff meetings about planned work and upgrades to the service. One staff told us, “I don’t think it’s dirty but the carpets do look it.” They told us they had received training in infection control and had regular spot checks to ensure they are doing it properly.

We saw areas required improvement such as standards of cleaning of furniture surfaces, and window frames. In some cases, this was contributed to by these areas being in disrepair. We saw drinking cups had staining, and raised this with the manager who took them out of use immediately. There were some odours in several parts of the home, but this was whilst people were getting washed and dressed. Although audits had been carried out to identify issues, they lacked detail and were not robust enough to make timely improvements. We did see good practice was followed by staff in relation to infection control. Laundry was handled appropriately to avoid cross contamination and staff used PPE (personal protective equipment) in the correct way.

The overall cleanliness of the home remained difficult for the housekeeping staff to manage as the older part of the building needed repair and renewal. There was also the added impact of not enough housekeeping staff to keep on top of the cleaning, particularly in relation to carpets and communal shower/ bathrooms. Communal areas however were clean and comfortable. We spoke with the registered manager and area manager regarding the rolling plan of renewal and repair, which we were told has been escalated. We received confirmation of 7 floors being replaced and the progression of shower room repairs. We have asked for an action plan to address this. We were not fully assured that the provider was promoting safety through the layout and hygiene practices of the premises. The poor decor, furnishings and carpets and insufficient domestic staff deployed had not kept all areas of the service clean and hygienic. This was fully discussed during the assessment process and the hours of housekeeping staff were reviewed and increased. There were up to date infection control policies and procedures in place and staff confirmed they had read them and received regular updates. The training programme identified all staff had received the necessary training and competency assessments. We were assured the provider was using PPE effectively and safely. There had been a recent norovirus outbreak at the service, and it had been managed effectively following the national guidance. We were assured the provider’s infection prevention and control policy was up to date. During our assessment staff used gloves and aprons appropriately.

Relatives we spoke to told us they had no concerns about medicine management. One relative said, “Since [relative] has been at Seaview, [relative] has really improved, they have a good understanding of her needs, and her medicines are well managed.” One person we asked about medicines said, “I get my medicines every day. They come round and give me my medicines.”

Staff were knowledgeable about the medicines they administered, and the processes they needed to follow to ensure they were safe. Staff told us they had annual competency checks and refresher training to ensure their practice is up to date. Care staff told us they would speak with a nurse, if there were any concerns. One said, “The nurses are always around if we need them.” We received some feedback from health professionals about medicine management. They told us staff knew people well and they had themselves received very positive feedback from family members about the way the service managed medicines for people.

Enough improvements had been made at this inspection and the provider had met the breach of regulation in respect of using medicines safely (medicine optimisation). However, there were further improvements needed to the administration of ‘as required’ medicines (PRN), which was taken forward immediately. There were protocols for 'as required' (PRN) medicines such as pain relief medicines, however they were generic and did not describe the circumstances and symptoms when the person may require this medicine, this included just in case medication. There were no care plans or risk assessments in place for some who were receiving consistent pain relief medication, and not all had a pain chart in place to monitor effectiveness. However, we saw people had received pain relief when requested. Medicines were ordered in a timely way, this meant people received their prescribed medicines in a safe way. At Seaview Nursing Home, senior care staff as well as registered nurses gave people their medicines. Medicine givers were trained to handle medicines in a safe way and completed competency assessments. Medicines were stored, administered and disposed of safely. People's medication records confirmed they received their medicines as required.