Archived: Seton Hall

Updated 24 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection team consisted of an inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We spoke with 12 people who lived in the care home and one relative whose family member lived in Seton Hall.

We visited four people in their own homes. The expert by experience phoned five people who used the homecare service following our visits.

We spoke with the nominated individual. A Nominated Individual has responsibility for supervising the way that the regulated activity is managed. We consulted the registered manager; personalisation planner [care coordinator] for the homecare service; the recruitment and training assistant; two senior care workers;11 care workers; the administrative assistant; a member of the maintenance team and a volunteer from the Friends of Seton Hall service.

We conferred with the local authority safeguarding team and contracts and commissioning team. We also consulted with an infection control practitioner from the local NHS; two care managers from the local NHS and a challenging behaviour clinician from the local mental health trust; an environmental health officer from the local authority and a member of staff from the local Healthwatch organisation. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We looked at 12 care plans and a number of records relating to the management of the service.

Prior to carrying out the inspection, we reviewed all the information we held about the service. We did not request a provider information return (PIR) before we undertook the inspection, due to the late scheduling of the inspection. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Updated 24 April 2015

The inspection took place on the 7 January 2015 and was unannounced. We undertook a further three visits to the service to complete the inspection. These visits were announced and were carried out on the 8, 9 and 12 January 2015.

The service was inspected in October 2013 and we found the provider was not meeting regulation 20 (records). We judged that people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained. We carried out a follow up inspection in March 2014 and found that the provider was now meeting this regulation.

Seton Hall is registered to provide two services; a care home and homecare service. The care home is registered to provide accommodation and care for up to 47 older people, some of whom have dementia related conditions. Nursing care is not provided. There were 39 people living there at the time of our inspection. Seton Hall also provides day care; we did not inspect this aspect of the service since this was out of scope of the regulations.

The homecare service provides personal care to people living in their own homes in the Berwickshire area. The service was currently providing personal care for 38 people.

We have written our report under the headings Care Home and Homecare to ensure our specific findings for both services are clear.

Care Home

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.

There were safeguarding procedures in place. Staff were knowledgeable about the action they would take if abuse was suspected. There were no ongoing safeguarding concerns. This was confirmed by the local authority. We found that there were systems in place to manage medicines safely.

We observed that staff were caring. Many of the staff had worked there for a considerable period of time. This experience contributed to the efficiency and skill with which staff carried out their duties. One person told us, “The staff are all lovely, they know what I like.”

We checked the premises and found that some areas of the home were in need of refurbishment. In addition, the décor did not fully meet the needs of people who lived there such as those who lived with dementia. We noted that remedial work on the electrical installations had not been carried out in a timely manner.

We have made a recommendation that the premises is designed and arranged to promote people’s independence and wellbeing.

Improvements were required to ensure that infection control procedures followed best practice guidelines. Staff were using body sponges to clean people following any episodes of incontinence, because disposable wipes were not available. The infection control practitioner informed us however, that the use of sponges was not based on best practice guidelines because they could not be easily cleaned.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We found that staff were not fully aware of the principles behind the Act nor how it affected their practice. Certain procedures at the home were not in line with the MCA and DoLS.

Staff were knowledgeable about people’s needs. We read people’s care plans and noted that people had access to healthcare services.

We noted however, that care plans were sometimes generic. We have made a recommendation that care plans should be individualised and reflect people’s needs, choices and preferences.

People told us that they were happy with the meals at Seton Hall. One person told us, “The food is lovely, nothing fancy, it’s what I like.” The chefs were very knowledgeable about people’s needs. We observed the kitchen was well stocked with fruit, vegetables, meat, fish and home cooked cakes and puddings.

Surveys and audits were carried out to monitor the quality of the service provided. However, not all checks were documented and other audits did not highlight the concerns which we had found such as the electrical installations test.

Homecare Service

There was no registered manager in place. The registered manager for the care home told us that this had been an oversight and she completed her application to register with CQC as manager for the homecare service on the first day of our inspection. Following our inspection, the manager was waiting for an interview with a CQC registration inspector who will assess her ability to manage the service, according to the criteria outlined in the CQC registration regulations 2009.

We checked medicines management. We found that the medicines administration records did not accurately reflect the medicines which were administered.

There were safeguarding procedures in place. We found however, that certain financial procedures were not clear. The registered manager told us that she would look into this issue. In addition, there was no documented procedure for staff to follow in case of a missed call to ensure that staff took appropriate action.

Risk assessments were in place which documented actions for staff to take to minimise risk to both people and staff. Moving and handling was one such area covered. We found however, that not all areas of risk to staff had been assessed. The manager informed us that she would address this immediately.

Staff were caring and promoted people privacy and dignity.

A complaints process was in place. The manager informed us that no formal complaints had been received.

The personalisation planner [care coordinator of the homecare service] undertook checks of care plan documentation; financial procedures and MARs. We found however, that the checks did not always highlight concerns we found with medicines management.

Spot checks on staff were carried out. However, these did not monitor every aspect of their working practices such as communication skills; infection control procedures and medicines management. There was no opportunity to obtain feedback from people nor relatives during these checks.

We considered that insufficient time was allowed for the leadership and management of the service. Following our inspection, we spoke with the nominated individual about this issue. She told us that a further two staff had been deployed to work in the homecare service to ensure that more management time was available to monitor all aspects of the service.

During our inspection of the care home and homecare service we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to consent to care and treatment; management of medicines and assessing and monitoring the quality of service provision. These correspond with three breaches of the new regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment in relation to medicines; consent and governance. You can see what action we told the provider to take at the back of the full version of the report.