Archived: Seahorses Nursing Home

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 the building upkeep, to ensure the premises were safe to use for their intended purpose. The provider had not replaced worn and damaged furniture as required to keep the premises and equipment appropriately maintained.

People were not protected from the risk of infections due to staff not adhering to safe infection control procedures. Many areas of the service were unclean, and equipment such as bed rail coverings and specialist wheelchairs could not be cleaned effectively due to the plastic coverings becoming worn and split.

Systems used to ensure the water system was safe from legionella bacteria were not robust.

People's medicines were not managed or administered safely. People did not always receive their medicines as prescribed. This included prescribed creams.

Care plans for people who had complex health care needs had not been developed to offer guidance to staff on how to maximise people’s health and keep them safe.

People did not receive any social activity or stimulation; staff did not have time to deliver this in addition to their caring duties. The provider had not followed our previous recommendation in order to improve this area of people’s care.

Following the inspection we urgently raised our concerns with the clinical commissioning group and local authority who responded swiftly to meet with the provider and discuss the concerns. People living in the service were subsequently moved to local nursing homes with the support of the local authority and this service is no longer operating.

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, respectful and professional manner. Systems were in place which safeguarded people from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe.

People and relatives said if they needed to make a complaint they would know how to. There was a complaints procedure in place for people to access if they needed to. The views of people, relatives and staff were sought via an annual survey. This was mainly positive, and action had been taken in certain areas as a result of feedback.

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.

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.