We carried out a review of the data available to us about Sefton Hall on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Sefton Hall, you can give feedback on this service.
We found the following examples of good practice.
People were supported to maintain relationships with their loved ones in creative ways. For example, in the early stages of the Covid-19 pandemic the home introduced ‘drive through’ visiting, an initiative which was reported by local media. The home also took part in a pilot using 30-minute lateral flow tests to enable people to have close contact visits in the safest way possible.
The staff made efforts to ensure people did not feel isolated by the lack of contact with family, friends and the community. For example, each year the staff and people living at Sefton Hall take part in the local community carnival. Because this had been cancelled staff recreated it within the grounds of the home by building a float, wearing fancy dress and holding games and competitions. Activities were risk assessed and a balance struck to endeavour to keep life stimulating for people, whilst minimising risk. The registered manger told us “staff have tried to replace family as much as they can”.
The provider used funding available to create an ‘isolation unit’ within the building. This included 11 en-suite bedrooms, a kitchen and a wet room. This was part of the homes contingency plans should people living with dementia, who would find it difficult to isolate in their own bedrooms in the main part of the home, test positive for Covid-19.
There was an experienced registered manager who was responsible for the home. 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, Southern Healthcare, also has another care home in Exeter.
People received outstanding person centred and individualised care from a motivated, skilled and
exceptionally well led staff team. The provider had strong visions and values focused on maximising people's quality of life and cultivated a caring and supportive culture. Staff had embraced these values which were evident in all interactions. Without exception people and relatives spoke in high praise of the registered manager, provider and all of the staff team. One person summed this up by saying staff were “interested” in the people they cared for, and said about their choice of Sefton Hall, “Every day I thank my lucky stars.”
Staff at all levels were described as exceptionally caring and the provider encouraged staff and people to be kind in everything they did. Helping to celebrate people’s lives and achievements
had resulted in a caring culture at the home. Staff understood the needs of each individual person and regularly went the ‘extra mile’ to ensure people lived their positive lives. There were numerous examples of people's everyday lives being enhanced by creative, compassionate care with an extremely varied diary of social events.
People benefited from a balanced and varied diet available in a variety of settings, including a pub within the home. Emphasis was placed on the social aspect of meals to encourage people to eat and drink more in a calm and unrushed atmosphere. Those with specific health needs were supported by knowledgeable staff and external health professional advice.
The passion and motivation of the registered manager and senior staff created a committed staff team. These key members of staff supported nursing and care staff to provide an outstanding level of care to people through regular reflection and learning.
There had been a significant investment in staff training and development in best practice innovations which had resulted in improved outcomes for people, particularly those living with dementia. The service was constantly being adapted to meet the needs of people well and staff encouraged people to maintain their independence and life skills.
There were systems in place and oversight for monitoring the quality of care provided; some improvements were made during the inspection linked to environmental checks and some aspects of fire training. The staff team were continuously learning, developing and shaping the service, involving people living at the home in making changes.
Medicines were managed safely and in line with best practice guidance. The internal and external
environment offered varied, safe and meaningful engagement opportunities for people. 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 acted as a foundation to this practice.
Rating at last inspection: The last rating for this service was outstanding (published August 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 reinspection programme. If we receive any concerning information we may inspect sooner.
Sefton Hall is registered to provide accommodation for up to 49 people needing personal and nursing care. People living at the home are older people, some of whom are living with dementia or a physical disability. Accommodation is provided in two areas of the home, a nursing care area which can support up to 30 people, and a more secure dementia care area which can support up to 19 people. There were 42 people living in the home at the time of our inspection.
The home had a registered manager. 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.
The registered manager and provider were committed to raising standards of care at Sefton Hall and ensure there was a strong and visible person centred culture in the home. There was a clear vision that was centred around the principles of Dementia Care Matters Butterfly Household Approach. This is a national scheme aimed at improving the lives of people living with dementia. The home was consistently praised by relatives and health professionals for the positive outcomes staff had achieved to ensure that people living with dementia received exceptional care. The ethos and values of the home created a caring and compassionate environment and ensured that the care delivered was truly focused on meeting the holistic needs of people.
People and their relatives were extremely satisfied with the service they received and told us the home was excellent. People and relatives consistently told us they felt cared for, valued and listened to and that their views mattered. There was a strong commitment to developing respectful, trusting relationships. Staff all demonstrated compassion and empathy. People's care was based upon best practice and was constantly reviewed. There was a strong person centred ethos, which was embedded throughout the home. This was to always treat people with dignity, as you would want to be treated. The ethos of the home was intended to make people feel valued, supported and included, with an aim to enhance quality of life. Interactions promoted wellbeing and showed staff knew people well. People were at the heart of care.
There were clear lines of accountability. The home had outstanding leadership and direction from the registered manager, provider and management team. Staff felt fully supported to undertake their roles. Staff were given regular training updates, supervision and development opportunities. For example, staff were encouraged and supported to develop lead roles, becoming ‘champions’ and gain additional skills in areas such as end of life care, quality of lifestyle, diabetes, infection control and health and wellbeing. Champions took on responsibility for attending additional training and then shared their knowledge within the staff team.
Not only was the provider committed to support and develop the staff team, staff achievements were also celebrated. For example, staff were nominated by people and their relatives as ‘employees of the month’ and newsletters contained information about staff such as important events in their lives and their interests. Staff told us this approach not only helped people relate to them but also made them feel valued, empowered and very motivated.
The home was exemplary in responding to people's needs and preferences. People were supported by staff that were devoted to getting to know people and their families. Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the home and were continually reviewed. This ensured that the staff knew about and responded to their particular needs and wishes when they moved in and during their stay.
Staff worked tirelessly and found creative ways to enable people to live full lives. People were encouraged to do things they enjoyed and found meaningful, and this included social activities based on people's interests. Staff continually encouraged and supported people to remain active and independent.
The environment had been designed, based on research evidence, to promote the independence and wellbeing of people who lived with dementia. People who liked to move around were positively encouraged to use communal areas throughout the building. The whole staff team were attuned to needs of people living with dementia, with a recognised and respected model of dementia care in use. The registered manager and provider kept up to date with best practice in dementia care and ensured this was adopted by the staff. Staff were skilled in communicating with people and supporting them to express their views, even where people had difficulties with communication.
There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff on duty at all times to meet people’s needs. When the provider employed new staff at the home they followed safe recruitment practices.
There were comprehensive quality assurance processes in place using formal audits and regular contact with people, relatives, professionals and staff. People told us they were given the opportunity to provide feedback about the culture and development of the home and all said they were extremely happy with the service provided. The provider was responsive to new ideas and had developed links with external organisations and professionals to enhance the staff's and their own knowledge of best practice and drive forward improvements.
CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. Not everyone in the dementia unit had someone who was able or legally authorised to act as an advocate for them, and staff ensured they contacted organisations who could act as advocates.
People were able to discuss their health needs with staff and had contact with the GP and other health professionals, as needed. People were protected from the risks associated with nutrition and hydration. People spoke positively about the choice and quality of food available. Where people were at risk of malnutrition, referrals had been made to the dietician for specialist advice.
The home had a strong commitment to supporting people and their relatives, before and after death. People had end of life care plans in place, which clearly stated how they wanted to be supported during the end stages of their life. A staff champion had been appointed taking a lead on promoting positive care for people nearing the end of their life to ensure a person’s end of life was as peaceful and pain free as possible.
This inspection took place on 14 and 15 April 2015 and the first day was unannounced.
Sefton Hall is a care home situated in Dawlish. The home is registered to provide nursing care for up to 52 people who may have dementia or a physical disability. Accommodation is provided in two areas of the home, a nursing care area which can support up to 39 people, and a more secure dementia care area which can support up to 13 people. There were 35 people living in the home at the time of our inspection.
At our last inspection of the home in August 2014 we had identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to obtaining people’s consent to care and treatment, care records that did not accurately reflect people’s care needs and the safety of the care provided to people.
We took enforcement action against the home in relation to the care and welfare of service users under Regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The registered provider sent us an action plan on 6 January 2015 telling us they had completed improvements to put these issues right.
At this inspection we saw the improvements needed had been made and sustained.
The service had 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.
People were supported in a home that was safe. Risks to people’s health and safety were clearly identified and managed. Staff understood people’s rights and how to protect them from potential abuse or harm. People told us they felt well cared for and supported by the staff. One person said “I had a good feel about the home as soon as I came” and another, “it’s lovely, always a lovely atmosphere.”
There were sufficient staff on duty to keep people safe and meet their needs and this was supported by comments received from people and relatives. One person said staff have time for her, “I feel I can always ask the staff”. Staff had received training in topics relating to people’s care needs such as dementia care and pressure ulcer prevention, as well as health and safety topics such as infection control. People’s medicines were managed safely.
Care staff were well organised and it was clear each day who they were responsible for. Staff told us they received good support at the home and Sefton Hall was a good place to work.
People had access to community healthcare support services. Health care professionals involved in providing support to the home confirmed their confidence in the home’s ability to care for people with complex mental health and nursing needs. Staff told us that they were proud of the care they delivered to people, particularly at the end of their lives, and felt it was something the home did very well. One member of staff said “it’s a privilege to care for them.”
People told us they enjoyed the meals at the home and were provided with a wide variety. People who needed support to eat were given this sensitively and in ways that respected their dignity.
Care planning was individual and personalised: staff had a good understanding of people’s backgrounds, needs and wishes. People’s capacity to consent to care was recorded, and where they could not do this, records and assessments showed decisions had been made in people’s best interests. For those people whose liberty was restricted to maintain their safety, such as with the use of coded locked doors, applications for authorisation had been made to the appropriate authority.
People had access to interesting activities that met their needs and wishes. The home’s activity organiser had used innovative and creative approaches, including the use of hand held computers, to support people to remain active and involved.
Communal areas of the home and people’s rooms were clean with no unpleasant odours.
The home managed any complaints or concerns well. People told us they felt able to raise any issues and be confident of a resolution without recrimination. The culture at Sefton Hall was open and the registered manager told us their door “is always open”.
Robust recruitment practices were in place which included appropriate pre-employment checks to ensure prospective staff had not been barred from working with vulnerable people.
Quality assurance and audit systems ensured people’s views were sought and learning took place to develop the service further. The home met its legal obligations to the Care Quality Commission, and was operating in accordance with their conditions of registration.
On the day of our visit we were told there were 41 people people living at Sefton Hall. We spoke with nine people living at the home, three relatives, three members of staff and the acting manager. We looked around the home, examined some records and observed staff providing assistance to people. Following the inspection visit we sought information from health and social care professionals. We spoke with a GP and specialists in tissue viability and the Mental Capacity Act 2005.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. Please note, the person described as the registered manager throughout the report was the acting manager during our visit but had been registered with the Care Quality Commission by the end of the inspection.
Is the service safe?
People's safety was compromised because records were not maintained in a way that protected them. Information was sometimes limited, conflicting, or unclear and confusing. For example, one person's fluid monitoring chart was incorrectly tallied.
Assessments were not always robust or adequately informative for staff. Additional information was not always sought which may have improved safety.
Care plans did not always provide enough information, or provide the clear steps required for staff to meet the person's needs and wishes.
Is the service effective?
The service was effective in that food and drink were offered on a regular basis. People told us they were happy with the care they received, with comments including, "It suits me. They are all very good. I've never had any complaints".
Health care professionals were involved in people's care where the home had identified this was necessary.
There was a lack of understanding how to maximise people's ability to make informed decisions when it was not known if they understood the consequences of their actions.
Is the service caring?
People using the service thought the staff were caring and we observed people being treated with kindness and dignity.
One staff told us 'We care. I talk to people in the way I would want to be spoken to'. One staff explained how they used a syringe to provide liquid to a person who was unable to drink from a cup. Another explained how a very sick person required additional care the day of our visit and the staff were attending to their needs.
Staff were improving people's lives through decorating a 'shop' for people to use within the home.
Is the service responsive?
Assessment and care planning was not robust and did not ensure person centred care. Some care plans provided detailed information about people's health and social care needs but others did not ensure people's needs and wishes were understood and met. For example, one person found comfort from their faith but there was no care plan as to how their faith needs might be met or contact details for their church.
Risk assessments and monitoring records did not always provide adequate information from which further decisions about people's health and care needs could be made. For example, one monitoring record stated the person was complying with their care plan when they had been at the home for only one day and they were already refusing that care.
Is the service well-led?
Staff told us about changes, which they said were improvements, at the home. They told us they felt the home was well-led.
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found '
Is the service safe?
There were enough staff on duty to meet the needs of the people living at the home. People felt safe and staff had been trained in safeguarding. Safeguarding policies were in place and relevant contact numbers were displayed for staff use.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to nursing homes. While no applications had needed to be submitted, proper policies and procedures were in place.
Is the service effective?
People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us 'They are very good at taking care of me. The nurses are very good.' Another person told us 'It's very good. I feel well looked after.'
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed. One person told us 'They're very caring. They look after you well, I love it here.' Another person said 'I'm very happy here, they meet my needs and all the staff are lovely.'
Is the service responsive?
Records showed that people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain as much independence as possible.
Is the service well-led?
Quality assurance processes were in place in the home. We saw that people had completed a survey asking for their feedback. We saw that issues identified had been acted upon by the home. Staff told us they felt listened to by the management and were often asked for their feedback and opinions.
We spoke with seven people who lived at the home and we observed the care of one other person as they were unable to verbally communicate with us. Many people at the home suffer from some form of dementia type illness.
One person told us the care was good. They said 'They are very nice, they look after me well' Another person said, "the staff are very nice". However, not everyone we spoke with was completely happy with the care they received. One person said 'it's awful you always have to wait, there are not enough people to help me'. We found that three of those seven people we saw were not having their basic care needs for personal hygiene, nutrition, continence and pressure area care met.
We spoke with four care workers throughout the morning, they were all kind and helpful. Care workers were seen to be very busy. People told us it was 'always like that'. One person said 'I always wait ages, sometimes they never come and I have to ring again'.
We found that staff with the appropriate skills had not been adequately deployed to meet peoples needs during this inspection.
Some parts of the home were clean and tidy but others were not.
Prior to this visit we had received two separate concerns about the care and welfare of two people who lived at the home. We found no evidence to support the concerns.
We found that people's privacy was protected. We observed staff knocked on people's doors and waited to be asked to enter.
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the care records for four of the people who lived in the home to find out how their health and personal care needs had been assessed, and how the home planned to meet those needs.
Appropriate arrangements were in place relating to the safe management of medicines. The medication systems allowed for a full audit trail to be completed recording the receipt, administration or return and disposal of prescribed medication.
We looked at four staff files which showed us there were effective recruitment procedures in place. For example we saw evidence that criminal record checks had been performed.
We saw that the home identified, assessed and managed risks relating to the health, welfare and safety of people who used the service.
We (CQC) visited the home on 26 and 28 September 2012. This was because the home was scheduled to receive a visit, but also because some concerns had been raised with us by the Devon County Council (DCC) Safeguarding Adults team. These concerns related to the poor care received by one person living at the home. These concerns had been dealt with by the home and procedures were in place to ensure the issues were not repeated. DCC also had concerns that two other people had not received the care they needed. We found no evidence to support these concerns.
On our visits to the home we spoke with the people who lived there about the ways in which they were involved in the services they receive. They told us that regular meetings were held where they could discuss any concerns or suggestions they had.
When we asked people if they felt safe at the home one person told us they felt "Very safe. Always someone there if you need them". They also told us that if they were unhappy about something they would talk to one of the staff.
People that we spoke with praised all the staff who worked at the home. One person told us that the staff treated them with respect and "Are really friendly". Another person said "They (staff) are always kind and I have a few jokes and a laugh with them". However, one person told us that they sometimes had to wait a long time for assistance.
We looked at four care plans for people living at the home. We saw some evidence that the individuals themselves had been consulted about these plans and there was some evidence that representatives had been consulted. One person told us that they were aware of their care plan and knew what was in it, but didn't want to be involved any further. We were told by the manager that care plans are continually being improved to help staff easily find the information they need.
We ate lunch with people in the main dining room and saw that the food served was well presented, nutritious and plentiful. We heard people being offered something else when they didn't want what they had ordered. We saw evidence that people who required high protein diets were given regular snacks. We also saw that people who required assistance with their food, received help in a respectful and dignified way.
Staff that we spoke with told us that they had received training on safeguarding people and they were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring.
During our visit we looked at the communal areas of the home and some bedrooms. Areas that we saw were generally clean and tidy and there were no unpleasant odours.
All medicines are stored appropriately in lockable cupboards and trolleys and records are generally well maintained. We saw the medication trolley being secured whenever staff moved away from it.
The provider has a continual programme of upgrading and maintaining the property. We saw some rooms that had been refurbished to a good standard with good quality furnishings and fittings.
People told us that the staff at the home were 'very good' and 'very caring'. There were no negative comments about any of the staff. Friendly banter and laughter was shared throughout the day between staff and people living in the home. Staff were able to communicate with people using different styles according to the behaviour, need or personality of the individual. We saw staff working with people, supporting them with their mobility, eating, drinking and general care. Staff supported people well, and the interactions we saw showed people were treated with respect and courtesy. We saw and heard people being offered choices and support when needed.
Regular 'get together' are held for people who live at the home and for their representatives to enable them to express their views on the quality of care provided.
Staff told us that they knew people well and were able to identify if they were unhappy about anything. They would then do what they could to alleviate any concerns or problems. They said that the manager was very approachable and would deal with any concerns anyone had.