We carried out a review of the data available to us about Seymour House (Hartlepool) Limited 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 Seymour House (Hartlepool) Limited, you can give feedback on this service.
Seymour House (Hartlepool) Limited is a care home which can provide nursing and personal care for up to 20 people who live with mental health conditions. At the time of this inspection there were 18 people living at the service.
People’s experience of using this service and what we found
People were protected from harm as risks had been assessed and plans put in place to mitigate these. Improvements had been made to the assessment and support plans. However, staff needed to ensure they clearly detailed any restrictions and the legal framework in place to support them. The registered manager needed to ensure staff fully understood and consistently applied the principles of the Mental Capacity Act 2005 and associated code of practice.
Care staff, in general, adhered to COVID-19 guidance on working in a care setting. We raised the need to ensure supplies of PPE were available at more points throughout the service. The deputy manager immediately ensured PPE was made at both entrances of the home.
There were enough staff on duty and staff were recruited safely. There had been some staff turnover recently and the provider was actively recruiting permanent staff.
People told us they were treated with kindness. People told us the care was safe and, overall, they were happy at Seymour House. Staff were dedicated and committed to providing an effective service.
People were protected from abuse by staff who understood how to identify and report any concerns. Medicines were managed safely.
Staff had received mandatory and condition specific training. Staff supervision sessions were completed.
People were receiving nutritious meals, but some people felt these could be a bit repetitive at times. Work is in progress to develop a more rehabilitation focus and a skills kitchen was being created.
Staff worked closely with local healthcare professionals and commissioners. These good working relationships ensured people received care and treatment in a timely manner.
The provider had ensured the governance arrangements were used to critically review practices within the service. We received positive feedback about how the service was managed.
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 6 December 2018).
Why we inspected
This was a planned inspection based on the rating at the last inspection.
This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.
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 Seymour House (Hartlepool) Limited on our website at www.cqc.org.uk.
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.
Seymour House (Hartlepool) Limited is a ‘care home.’ People in care homes receive accommodation, nursing and 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. Seymour House provides nursing care for up to 20 people who have mental health needs. At the time of this inspection there were 20 people used the service.
The registered manager has been in post for over 18 months. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.
At the last inspection in September 2017 we rated the service to be requires improvement in four domains. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to having safe care and treatment and having good governance systems in place.
We found during this inspection the provider had rectified these breaches of the regulations and the service had improved to a rating of good.
People were at the core of the service and included in all discussions. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, staff needed to ensure they consistently applied the principles of the Mental Capacity Act.
People and relatives told us the service was a safe place. The provider had reviewed the fire procedures and staffing levels to ensure there were sufficient staff should there be an emergency. Following this review, a small fire occurred in the laundry. This was contained and the night staff quickly evacuated the building. The attending fire officers had commended the staff efficiency.
People received their medicine safely. The provider was in the process of improving the treatment room and ensuring staff could call for assistance when in this room. In the interim the registered manager was ensuring staff had access to walkie-talkies so they could contact others, if needed. People were supported to access the support of health care professionals when needed.
People received a varied and nutritional diet that met their preferences. However, we discussed with the registered manager that they needed to ensure at least two healthy options were available each meal time and that those people at risk of under-nourishment were supported and encouraged to eat fortified meals.
People were protected from the risk of abuse because staff understood how to identify and report it. Accidents and incidents were analysed to identify trends and reduce risks. Lessons had been learned when incidents took place.
People spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well. People were engaged in activities and accessed the wider community.
Care records clearly detailed people’s needs. External visiting professionals had encouraged staff to produce a copious amount of risk assessments that often were not necessary, as this information was already contained in the care plan.
The registered manager and staff actively sought people’s views about the service.
New staff were appropriately vetted to make sure they were suitable and had the skills to work at the service. Staff were well supported and received the training and supervision they needed.
People told us they did not have any concerns about the service but knew how to raise a complaint if needed. Feedback on the service was encouraged in a range of ways and was positive.
The provider had commenced and full refurbishment of the service and we saw this had improved the environment. We found that staff adhered to infection control protocols.
The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement.
The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.
Further information is in the detailed findings below.
At the last inspection on 6 June 2016, which was brought forward because concerns had been raised about staffing levels overnight, we found sufficient staff were on duty but the service was in breach of relevant regulations relating to providing person-centred care. We also found improvements were needed in four key questions; is the service Safe?, Effective?, Responsive?, and Well led?, and the service was rated Requires Improvement overall.
After the last inspection, the provider wrote to us to say what they would do to ensure compliance with the regulation relating to person-centred care.
At the two inspections prior to the one in June 2016, the service had also been rated as Requires Improvement and breaches of regulation had been found in both cases.
Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people who have mental health needs. At the time of this inspection there were 19 people in receipt of care at Seymour House (Hartlepool) Limited.
The home had not had a registered manager since February 2017. 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. A manager was in post and told us they would be submitting an application to become the registered manager.
We found during this inspection the provider had rectified the breach of the regulations in relation to person centred care that we identified at our last inspection of the service. New care plans had been developed and were focused upon people’s individual needs. However, action was needed to ensure the current records were organised so immediate risks and changes in people’s presenting needs were not lost amongst the paperwork, and assessment information contained detailed information about people’s needs. The manager told us they were in the process of designing a new care record template and intended to introduce this during August 2017.
On the first day that we visited the service we found staff had not clearly identified risks and the action they were taking in the records. Also information about new risks did not provide specific details around how to address risks for people. When we revisited we saw staff had addressed this and ensured details about risk and other relevant information was contained in the care records.
The fire evacuation measures stated that the person in charge would be responsible for calling the fire brigade, liaising with them and checking that people had evacuated the building. The fire authority expects the provider to ensure sufficient staff are on duty to fully evacuate the building. Overnight a nurse and a carer were on duty, which was insufficient to ensure staff could adhere to the provider’s fire evacuation procedure and to meet people’s current needs. We asked the provider to immediately complete a comprehensive review of staffing levels and determine if these were adequate. Following our first visit the provider organised meetings with fire authority and commissioners to discuss staffing levels and they are in the process of determining how many staff are needed to support people safely overnight.
Medicines records supported the safe administration of medicines. Records were accurate and regular audits took place. These ensured any issues were dealt with. Medicines were stored safely and securely. However, we found that the treatment room was extremely small and did not have room for cupboards or a sink. Also it was located in an isolated part of the service and there was no means for staff to call for assistance should it be needed. We observed that people would go to this room to receive their medicine and at times could become upset about the need to take tablets, and only because of the skilled nursing inventions did their distress not escalate. There was a risk that if people’s distress could not be de-escalated, they may become physically aggressive and staff would not be able to call for assistance.
Many areas of the home needed to be refurbished and we heard there was a plan to complete a full refurbishment of the service over the next 20 months. However, immediate action was needed to ensure the flooring in the bathrooms, toilets and carpets were improved.
Staff not been trained in how to complete Mental Capacity Act assessments. Although staff were making ‘Best Interests’ decisions for people in relation to risk areas such as self-neglect or unstable diabetes they had not assessed if individuals had the capacity to make these decisions. Also this lack of assessment had led to Deprivation of Liberty Safeguards (DoLS) authorisations not being sought. But when we went back to the service we found action had been taken to ensure where people lacked capacity and were being deprived of their liberty DoLS authorisations were sought.
In general people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems supported this practice.
Systems were in place for auditing the quality of the service and for making improvements but these needed to be improved.
People told us they were happy being supported by the service and felt the staff were friendly and helpful. People were extremely independent and organised their day.
We found staff were caring and treated people with respect.
Each person’s dietary needs were fully understood and where appropriate people were supported to manage their health needs. Staff responded promptly to any changes in a person’s mental health or general demeanour and ensured advice was sought from individual’s healthcare professionals.
New staff were appropriately vetted to make sure they were suitable and had the skills to work at the service. Staff were given support by means of regular training, supervision and appraisal. The staff team had a good knowledge of people’s needs and preferences.
People told us they had no complaints about their care and were aware of the complaints procedure. Accidents and incidents were monitored and staff knew how to recognise and report any abuse.
We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.
We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 entitled, Notification of other incidents, which we are dealing with outside of the inspection process.
Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people. The home provides care and support for people with mental health needs. At the time of this inspection there were 20 people living at Seymour House (Hartlepool) Limited.
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 2008 and associated Regulations about how the service is run.
We found during this inspection the provider had breached the regulations in relation to person centred care. New care plans had been developed but these lacked detailed information about the care people needed.
You can see what action we have asked the provider to take at the back of the full version of this report.
We found the provider had made progress with the actions identified following the last inspection. Health and safety checks were mostly up to date following the employment of an external professional. Action had been taken to improve the signage to inform people oxygen was being used in the building. Individual emergency evacuation plans required further development. Work commenced on developing these on the day of the inspection. No new care workers had been employed since the last inspection so no new recruitment checks had been required.
Additional audits had been introduced but the quality assurance process lacked a structured approach to ensure issues were identified and dealt with in a timely manner. We have made a recommendation about this.
The gas safety certificate check for the service was overdue. The registered manager arranged for this check to be completed during this inspection. The electrical installation certificate was unavailable to view, although other records confirmed the installation was satisfactory.
The required training outstanding from the last inspection had been completed. However, moving and handling training had lapsed and not been updated in a timely manner.
People gave positive feedback about their care. One person told us, “They look after me well”. Another person said, “Staff are champion. I have got used to it now. It’s alright, not bad. It is a room over my head.” We observed care workers were kind and caring.
People and care workers said the service was a safe place to live and work. One person said, “Oh yes I am safe here, the staff look after me so well.” One care worker told us, “People come and talk to us if they have concerns.”
Medicines records supported the safe administration of medicines. Records were accurate and regular audits took place. These ensured any issues were dealt with. Medicines were stored safely and securely.
Care workers knew about safeguarding adults and whistle blowing. This included how to report any concerns. One care worker commented, “We are open here, we do talk to each other. I would go straight to the nurse in charge or the manager. [Registered manager] is on the ball.” No concerns had been raised since we last inspected the service in November 2015.
Staffing levels were sufficient to provide the support people needed in a timely manner. One person told us, “There are no concerns with staffing.” Care workers told us also felt there were enough care workers on duty to support people. One support worker said, “Yes, I think there is enough staff.” Night staff did not raise any concerns about people's safety at night time.
Accidents and incidents were logged and details recorded of the action taken to help keep people safe.
Care workers told us they were well supported. One care worker said, “I can go to the [registered manager] if I am not happy. The [registered manager] will talk me through things.” Another care worker commented, “I am very well supported.” Records confirmed one to one supervision took place regularly and appraisals had been planned in.
The registered manager and care workers said people were not deprived of their liberty. People confirmed there were no restrictions placed on them. People regularly accessed the local community if they chose to. People were supported to make their own decisions and choices. One care worker commented, “People make decisions for themselves. We promote decision making.”
People were supported to have enough to eat and drink. One person said, “Meals are very good, cereal for breakfast. At one time we had bacon and egg but people wasted it. Usually a sandwich for lunch with a piece of fruit. The menu had been updated following suggestions from people.
People had access to a range of external health care professionals, as their needs required. One person told us, “If I need a doctor they are quick to get one, I just ask.”
Since our last inspection people’s needs had been re-assessed. Staff had spent time with people gathering information about their life history and their preferences.
People could take part in their chosen activities if they wanted, such as bingo, dominoes and entertainers.
People could express their view in a suggestion box or by attending ‘service user’ meetings.
People told us they knew how to complain if need be. There had been no complaints made about the service.
Quality assurance questionnaires had been issued. However, feedback from people and professionals was limited.
Care workers felt the home was managed well. One care worker commented, “We have a brilliant manager. Anything you go with he is always open and honest. If you have concerns and need somebody he is there.” Care workers were able to attend regular meetings.
Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people. The home provides care and support for people with mental health needs. At the time of this inspection there were 20 people living at Seymour House (Hartlepool) Limited.
The home did not have a registered manager. Although a new manager had been appointed, they had not yet applied to register with the Care Quality Commission to become the 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 2008 and associated Regulations about how the service is run.
The registered provider had breached regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008. This was because checks to protect the health and safety of people using the service were overdue. The registered provider did not have personalised guidance to support people in an emergency. The registered provider lacked a structured and effective approach to quality assurance to improve the quality of the service. Quality audits had not been completed recently.
Staff had not completed all of the training they needed to effectively carry out their caring role, such safeguarding, Mental Capacity Act and fire safety training. References were not available for some staff to confirm they were suitable to work with vulnerable adults.
You can see what action we told the provider to take at the back of the full version of the report.
People gave us consistently positive feedback about the service. They said they were treated with dignity and respect by staff who knew their needs well. One person told us, “The girls keep looking after me. I have been here a long time so they know me very well.” Another person said, “Staff call me by my name and always knock on my door, they treat me very well.” People confirmed they felt safe.
People were independent and had no restriction placed on them in terms of access to and from the service. Deprivation of Liberty Safeguards (DoLS) authorisations were not required for people currently using the service. People told us they could come and go as they liked, and were not restricted at all.
People told us they were free to make their own choices and decisions. One person said, “I can come and go when I want to, I do my own thing.” Another person told us, “I like it here; I can come and go when I want.” People described how staff had supported them to meet their religious needs by arranging for a local to priest to visit them at the home. Other people described how staff supported them to dress how they chose and to help them lose weight.
Risk assessments were in place to help keep people safe. Assessments identified control measures to help keep people safe, including accessing specialist medical support.
Staff knew how to raise concerns about people’s safety. One staff member said, “I would go straight to my line manager and voice my concerns.” Another staff member said, “I have not seen anything. Concerns would be dealt with very professionally and quickly, straightaway.” Safeguarding concerns had been reported to the local authority for further investigation.
There were enough staff to meet people’s needs in a timely manner. One person told us, “They are always about, in and out of here [lounge area].”
Medicines were managed appropriately. Medicines records confirmed people had received their medicines correctly from trained staff. Medicines were securely stored and locked away.
The registered provider had systems to log and investigate incidents and accidents. Records confirmed action had been taken following falls to help keep people safe.
Staff had a good understanding of how to support people when they displayed behaviours that challenged. Strategies used included distraction and diversion techniques, such as playing games. One staff member said, “We try to stop a situation before it starts.”
People were independent with eating and drinking. They told us they enjoyed their meals. One person told us, “We have lovely homemade meals, I enjoy all my food.”
People were supported to access health care when required, including a range of professionals, such as community nurses, specialist nurses and GPs. One person told us, “I can go to the doctors on my own but someone will go with me if I want it’s no trouble to them. They make sure I get my flu jab.”
People had their needs assessed, including their social needs. There was no record people’s needs assessments had been reviewed, however up to date care plans were in place and had clear goals identified for people to aim towards. The language used within care plans was written from a medical perspective which might be difficult for people to understand. A new format for care plans was to be introduced from January 2016.
People were involved in a range of activities, such as playing games, going to the gym, walking along the seafront and cycling.
People knew how to complain if they were unhappy with the service. One person said, “I have never needed to complain but I know to speak with [manager], and he would listen.” There had been no complaints received about the service.
There were opportunities for people to give their views, through key worker meetings, regular service user meetings and a suggestion box.
We also found two statutory notifications relating to safeguarding concerns had not been submitted to the Care Quality Commission. We are dealing with this outside of the inspection process.
Staff gave us positive feedback about the new manager and said they were approachable. One staff member said, “The manager is approachable and easy to talk to. I can always approach him if I need anything.”
Staff had opportunities to give their views, through attending regular staff meetings. One staff member said, “Staff are listened to, staff get on.” There was a positive atmosphere in the home. One staff member described the atmosphere as, “Nice, a really lovely service.”
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people. The home provides care and support for people with mental health needs. At the time of this inspection there were 20 people living at Seymour House (Hartlepool) Limited.
This was an unannounced inspection. During this inspection we looked at all 23 key lines of enquiry (KLOEs). We spoke with nine people who lived in the home, four staff and the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
We spoke with nine people, looked at the care records for six people and looked at records that related to how the home was managed.
We last inspected Seymour House (Hartlepool) Limited in May 2013. At that inspection we found the service was meeting all the regulations that we inspected.
People’s needs had not been fully assessed following their admission into the home. We also found that care plans were not written in a person-centred way and used language that people would find difficult to understand. Care plans did not evidence that people had been involved in developing them. The registered manager told us that they were already implementing a new format for care planning which would be more person centred.
Care plans we viewed contained limited information to guide staff about the most effective care to meet people’s needs. For example, to ‘liaise with health professionals’ and ‘give medications.’ Progress towards achieving outcomes was difficult to measure due to the way care plans had been written. People’s care records were not recorded in line with recognised best practice.
The home’s approach to managing on-going risks was unclear. The provider had access to referral information about each person, including any potential risks. However, we found no evidence of a risk assessment tool that Seymour House staff would use to assess risks from the point of admission onwards.
We found that the service had clear expectations about how people should be treated. These had been documented into an ‘Expectation Card’ and made available to people who used the service. People said they felt safe living at the home and felt comfortable approaching staff if they had any worries or concerns. People told us they were treated equally and fairly.
Staff we spoke with had a good understanding of the needs of the people they were caring for. They also had a good understanding of how to keep people safe and knew how to respond to safeguarding concerns and behaviours that challenge. Staff told us they were well supported to carry out their caring role and could approach the manager with any concerns they had.
Staff told us that people in the home were currently able to make their own decisions. They understood when the Mental Capacity Act 2005 (MCA) may apply to people and how to respond should there be doubts about a person’s capacity to make decisions. Following the Supreme Court judgement about what constitutes a Deprivation of Liberty, the registered manager was in the process of assessing each person to determine whether a DoLS application to the local authority was required. So far no DoLS applications had been needed.
Most people who used the service felt there were enough staff to meet their needs in a timely manner. The registered manager told us that staffing levels were flexible and determined by people’s needs. The registered manager reviewed staffing levels as part of a six monthly quality assurance programme.
The provider had policies and procedures to ensure people received their medication from trained staff and in a timely manner. However, the service did not have an effective system to identify and investigate gaps in medication records. The registered manager carried out a range of checks to make sure the premises were safe, well maintained and clean.
People told us they felt the staff providing their care had the appropriate experience and skills. They said staff looked like they knew what they were doing.
Staff carried out routine checks of people’s health and supported them to attend appointments or if they needed to go to hospital. One person confirmed that staff supported them to attend the hospital every few months. However, we found no evidence that planned therapeutic interventions were taking place, such as group work, relaxation therapy and anxiety management.
People were supported to meet their nutritional needs. People were assessed for the risk of poor nutrition. Staff said that there was currently nobody identified as at risk. Staff had a good understanding of people’s food likes and dislikes and ensured that they were offered things they liked to encourage them to eat. People were happy with the food they received and gave us only positive comments.
People said they were well cared for and that staff treated them well. They also said they were treated with dignity and respect. Staff described how they maintained people’s privacy and dignity and gave us practical examples of how they delivered care to achieve this aim. We observed that there were positive interactions and a good rapport between staff and people. Staff told us that they spent one to one time with people sitting and chatting, looking through newspapers, shopping or sorting out clothes and toiletries.
People were supported to maintain their independence. We saw that people accessed the local community independently and were encouraged to do things for themselves.
People had opportunities to give their views about the service through regular meetings and questionnaires. We found staff listened to people’s views and responded to their suggestions.
People were asked for their consent before receiving any care and support. They had the opportunity to be involved in a range of activities, such as trips out, the walking club, visiting family, card games, board games and entertainers.
There had been no complaints made about the service. However, there were systems in place to deal with any complaints received. People told us they were happy with their care and nobody raised any concerns or complaints with us during our inspection.
The values of the service were not fully embedded into service delivery as staff were unable to confidently tell us what they were. The service had an over-arching five year plan, which included specific objectives which included providing a well-trained, skilled staff team and promoting excellence in care practices.
There was a clear management structure in the home and people and staff knew who to go to if they had any concerns. Staff had the opportunity to give their views about the service including any suggestions they had to improve the service.
People made mostly positive comments about the atmosphere in the home. One person told us that there could sometimes be a bit of tension between some of the people who used the service.
The provider carried out a range of checks and audits as part of a six monthly quality assurance programme. The registered manager was a visible presence around the home observing care delivery and speaking with people to encourage them to give feedback.
The provider had policies and procedures in place to respond to any whistle blowing concerns and staff were aware of their responsibilities. Staff said the manager would act immediately on any concerns. There were systems to log any incidents and accidents that happened at the service. We found from viewing the log that action had been taken following any incidents or accidents to keep people safe.
We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. We found that people were encouraged to be independent. One person told us, 'I try to go out every day, I go to the shops on my own.' Another person told us 'I go to church every Saturday.' This contributed to maintaining people's welfare and promoting their wellbeing.
We found that people who used the service had a choice of food and drink and this was readily available. One person told us, 'The cooks are good, you get a variety. I had a lovely dinner yesterday.' Another person said, 'We always talk about food at the 'residents' meetings.' We found that there was a choice of suitable and nutritious food and hydration to meet the needs of people who used the service.
We found that people were supported by suitably qualified, skilled and experienced staff.
We found there was an effective complaints system in place at the home.
People told us that the service was run well and that the manager also owned the home so was very committed to making sure everything operated smoothly. We were told that recent work had been completed in the home to make sure all the rooms were single and that it was all redecorated. People said that they felt that all the staff were competent and supportive and 'The staff have supported me to deal with my worries', 'I'm helped to deal with things in such a good way' and 'The staff sit down with me and go through my plans to see how what needs to be done'.