Seahaven

About the service

Seahaven is a residential care home providing personal care to up to 19 people who have a learning disability and or autism. The service was delivered in 2 adjoining houses, registered as a single location. At the time of our inspection, one house accommodated 11 people and 6 people lived in the other. Most people who used the service received support with personal care. This is help with tasks related to personal hygiene and eating. Where people receive this support, we also consider any wider social care provided.

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

Right Support:

Risks to people were identified and there was full guidance in place to mitigate the risks. However, staff did not always follow the guidance and failed to report to management when incidents occurred. This meant that appropriate actions were not taken to mitigate the risks.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. However, when people were prescribed 'as and when' medicines for when they were distressed there was no guidance in place to make sure these medicines were given consistently and safely. At night there were times when people might have to wait to receive their ‘as and when’ medicines as not all staff were trained to administer medicines.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. 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.

Staff were recruited safely and there was enough staff deployed to ensure people received the care and support they needed when they needed it.

People were assisted to achieve their aspirations and goals. Staff focused on people's strengths and abilities to learn and develop new skills. People pursued their chosen interests.

Right Culture:

Quality assurance systems were in place to monitor the service people received. However, they had not identified the shortfalls we found at this inspection regarding risk assessments and medicines.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff placed people's wishes, needs and rights at the heart of everything they did. The stable management and core staff team supported people to receive consistent care from staff who knew them well. People received compassionate and empowering care which was tailored to their needs. People and those important to them, were involved in planning their care. People's relatives felt that there was good communication, and they were kept informed of any changes to people's wellbeing.

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. All the relative we had contact with were complimentary and positive about the service and the care and support their loved ones received.

Right Care

People were treated with kindness and care. Staff showed genuine affection in their approach. Staff knew people well. Day to day choices were offered to people and staff demonstrated a good understanding of people. Some people were not always encouraged to take an active role with tasks such as making meals and helping around the service. At times staff did things for people and not with them. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. People indicated and said they felt safe living at Seahaven. We observed people to be relaxed in the company of staff. Safeguarding concerns had been responded to promptly. Staff had training on how to recognise and report abuse and they knew how to apply it.

Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

People's care, treatment and support promoted their wellbeing and enjoyment of life.

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 21 May 2021) and there were breaches of regulation. We served the provider with 3 Warning Notice under Section 29 of the Health and Social Care Act and 2 breaches of the regulations.

We undertook a targeted inspection (published 10 January 2022) to check the provider had taken action against the Warning Notices. The provider had taken action and the warning notices had been met. This did not change the previous rating of requires improvement because we only looked at part of the key questions. There were still 2 outstanding breaches of the regulations.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 11 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve fit and proper persons employed, and notifications of other incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.

The inspection was also prompted in part due to concerns received about safeguarding incidents. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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 see what action we have asked the provider to take at the end of this full report.

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 remains the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We will continue to monitor the service and will take further action if needed. We have identified a breach in relation to safe care and treatment and in relation to governance and oversight.

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.

Seahaven is a residential care home providing personal care to up to 19 people who have a learning disability and or autism. The service was delivered in two adjoining houses, registered as one location. At the time of our inspection, one house accommodated 12 people and five people lived in the other. Not everyone who used the service received personal care. This is help with tasks related to personal hygiene and eating. Where people receive this support, we also consider any wider social care provided.

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

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 the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection that considered the safety and management of the service. Based on our inspection of safeguarding, people's care and the management. The staff were able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting maximised people's choice, control and Independence.

Right care:

• Care was person-centred and promoted people's dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services could lead confident, inclusive and empowered lives.

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.

Potential risks to people's health, welfare and safety had been assessed. There was guidance in place for staff to mitigate the risks, however, some care plans required additional points to be more personalised. Accidents and incidents had been recorded and analysed to identify patterns and trends.

Risk assessments relating to people's care, medical conditions and behaviours that could be concerning had been transferred onto the new electronic system which made it easier for staff to ensure that they had all the information they need to support and care for people safely. Staff knew people well and they knew the risks associated with people's care and support.

People told us they felt safe living at Seahaven. When Incidents that had occurred, they had been reported to the local safeguarding team. The registered manager had taken action to make sure people were safe. Incidences involving people’s behaviour had reduced since the last inspection.

Infection was prevented and controlled including risks associated with COVID -19.

The registered manager had oversight and scrutiny of the service. Quality checks had been completed throughout the service. If any shortfalls were identified action was taken to rectify them.

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 requires improvement (11 March 2021).

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 improvements had been made and the provider was no longer in breach of regulations in relation to the warning notices we issued at the last inspection. This report covers our findings in relation to the breaches of regulation in Key Questions Safe and Well-led. The Key Questions Safe and well-led, were inspected but not rated as not all the domain was covered.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12, Regulation 13 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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 Seahaven on our website at www.cqc.org.uk.

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

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Intervention plans were in place to physically restrain three people, but processes had not been followed to ensure they were agreed or lawfully implemented. Some people could have behaviour which was challenging to others, staff and themselves resulting in incidents of potential abuse. Staff had failed to always notify relevant authorities of incidents of alleged abuse or update care plans to reflect risks and the support people required.

People were not protected from risks associated with allegations of abuse. When incidents occurred care plans and risk assessments had not been updated to reflect risks.

Where people were at risk from epilepsy or severe constipation, care plans were not robust and lacked guidance about how people should be supported safely and consistently. In one instance, health care professionals had made a recommendation about how a person’s condition should be managed, however, no action was taken to progress this.

Medicines were not always safely managed; staff did not follow procedures to ensure blood sugar monitoring equipment was calibrated when needed. During our inspection, staff administered insulin to one person, however, they had not signed the medicine administration record to show the dose had been given.

The registered manager failed to recognise and meet their regulatory requirements; multiple incidents that should have been notified to CQC were not.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not always maximise people's choice, control and Independence.

Right care:

• Care was not always person-centred and did not promote people's dignity, privacy and human Rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services could lead confident, inclusive and empowered lives.

This meant some people were subject to unauthorised restraint, impacting upon their choice and independence. The provider had not always acted to mitigate the risk of harm to people. Some people did not receive person centred care.

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 16 September 2019).

Why we inspected

There have been significant concerns identified at other locations run by the same provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Seahaven on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, fit and proper persons employed, good governance, and notifications of other incidents at this inspection.

We served warning notices against the provider and registered manager in relation to regulation 12, 13 and 17.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Seahaven is a residential care home providing personal care to 17 people who have a learning disability and or autism.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 19 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated. The service was delivered in two separate houses. One house accommodated five people and 12 people lived in the other when we inspected. The buildings fitting into the residential area and was surrounded by other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything which suggested they were care staff when coming and going with people.

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

Feedback from people, relatives and a health and social care professional was consistently positive about the service and staff. People told us they were happy with the report they received, and relatives said, “The staff are very professional”, and “They are very good and are really caring.”

People continued to be supported by staff who knew how to help them remain safe. They were protected from abuse and risks to their health and safety were well managed. Medicines were well managed, and people received these on time and as prescribed.

Staff continued to be recruited safely to make sure they were suitable to work with vulnerable people. Staff were well supported and supervised and had the skills and training they needed to support people.

People’s needs continued to be assessed in a holistic way. These assessments were used to develop support plans which included people’s preferences and goals.

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 were supported to access healthcare services including dental care when they needed to do so and there was information for people to take with them if they needed to be admitted to hospital. This information would assist hospital staff to support people and communicate with them.

Staff were caring, and people were treated with kindness. Staff knew people well and used their knowledge to assist people to communicate and express their views about their care and support. When people needed emotional support, this was provided. Staff respected people’s privacy and people were treated in a dignified manner.

People had keyworkers who led on their support and gave people the opportunity to feedback on their support and any concerns. People and their relatives knew how to complain if they choose to do so and were able to speak to the registered manager and deputy manager when they wanted to.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure people who use the service can live as full a life as possible and achieve the best possible outcomes which include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent. People were supported to make choices and were involved in planning their care.

There were systems in place to check and maintain the quality of the service to ensure people received a good standard of care. The service was well led and focused on providing people with personalised support.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of the thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 on 25 January 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.

Seahaven is registered to provide accommodation and personal care for up to 19 people. The service is split over two adjacent houses, with an inter-connecting door between them. One house was called Seahaven and the other house was called Kingsdown Lodge. There were five people living at Kingsdown Lodge and 11 people living at Seahaven. People living in both houses had a range of learning disabilities and mental health needs. Some people were living with autism and some people required support with behaviours that challenged.

The service was located in a rural location, overlooking the sea. Each house had its own kitchen and lounge areas. People were able to move between the two houses whenever they wished, to visit their friends and staff. Each person had their own bedroom.

The service had a registered manager in post. A registered manager is a person who is 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 registered manager also managed a smaller service for three people in Deal, Kent and shared their time between the two services.

Some people’s care plans and risk assessments required updating. The registered manager had already identified this and there was a plan in place to ensure this happened as soon as possible. When people’s care plans and risk assessments had been updated they were detailed and accurate. People told us that they were supported by the same staff, who knew them well and so they always received the support they needed.

Detailed assessments were carried out before people moved into the service. One person had recently moved in and they had visited the service and met staff several times so they were able to get to know everyone.

There were enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

People kept their medicines in a locked safe in their bedrooms and were supported to be as independent as possible when taking their medicines.

People were relaxed in the company of staff and their relatives told us that staff were kind and caring. Staff knew people well and offered people reassurance and support throughout our inspection. People were treated with dignity and respect. Some people needed support with their communication so staff used signs and symbols to help them make their needs known.

The registered manager documented and investigated any complaints.

People and staff told us they thought the service was well led. Staff told us they were well supported by the registered manager and there was an open and inclusive ethos within the service.

Staff completed incident forms when any accident or incident occurred. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

Staff had an induction and the training needed to carry out their roles. All staff had received training in how to manage people’s behaviours safely, and how to prevent behaviours from occurring. Staff met regularly with their line manager to discuss their training and development needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there were any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.

People were able to access their kitchen, whenever they wanted and were supported to prepare meals and drinks of their choosing. People were supported to eat a healthy and balanced diet.

Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. People were supported to manage unstable healthcare conditions such as diabetes.

The registered manager was experienced in working with people with learning disabilities and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

The registered manager regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. These were collated and analysed and the results were displayed within the service so everyone could read them. When areas of improvement were made, these were acted on and people’s views were listened to.

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, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because the manager had a good understanding of the risks and needs of the people using the service and had put appropriate measures in place. Risk assessments had been completed to make sure staff knew how best to support people to minimise potential risks to their wellbeing. People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. People told us that they felt safe. One person said, 'My life has improved since I've lived here. When I'm having a bad day the staff support me. They listen to me and give me time.' People were protected from infection because the provider had maintained appropriate standards of hygiene and had good systems in place to monitor and assess the quality of service.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialists including psychologists and speech and language therapists had been involved in people's care and to give staff training and advice. Staff had received the training they needed and there was an ongoing training programme to make sure staff had the skills they needed to support people appropriately.

Is the service caring?

The service was caring. Staff spent time with people and assisted them to do what they wanted. Staff had got to know the people using the service well and had developed ways to communicate with them. When people needed support this was given respectfully and in a relaxed way. Staff occupied people with activities and encouraged people to learn new skills.

Is the service responsive?

The service was responsive. People were given choices and staff were responsive to their needs. Sometimes people needed support with their behaviour and there were plans and systems in place to respond to this. The service had a development plan that addressed all areas of improvement needed and they had been responsive to concerns raised at the last inspection.

Is the service well-led?

The service was well-led. The service had a manager who was experienced in working with people with learning disabilities and had been registered as a manager with the Commission at a previous employment. There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs. The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

Prior to the visit we contacted other agencies including environmental health, social services and the police regarding the activity that had been reported to us. We were concerned that the activity was not appropriate for this service and that people were at risk of acquiring an infection should it continue. We made an unannounced visit to the service to check that this activity had ceased; which it had six days prior to our visit. People told us that there had been a bad smell for a few days when the activity was being carried out but that it had gone since the activity had ceased. One person told us 'That smell has gone, it was bad.'

People had their needs assessed and risks were identified in most cases. However we found that risks relating to an activity had not been identified, assessed and managed to an appropriate standard to ensure the health, safety and welfare of people staff and visitors.

We found that laundry was being separated appropriately and that special waste was being handled, segregated, stored and disposed of suitably.

Concerns had been raised with regard to people not having curtains up in their bedroom and that lights did not work in some of the bedrooms. We found that the curtains were being replaced at the time of our visit and that the lights worked in the rooms that we checked, with the exception of one of the lights in an upstairs bathroom that was not working, this had been reported for replacement.

We saw that the systems that were in place to assess and monitor the service had not been used effectively to ensure people's welfare and safety and that decisions about people's care in regard to the activity had not been made by appropriate staff.

We saw that people were offered choices and their independence was promoted. We saw some positive interactions between staff and the people who live at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the home and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said "I feel safe here, I am very comfortable". Another said "The staff are kind and always find time to chat with me".