Archived: Seymour Care Home

Seymour Care Home is residential care home located in East Manchester. The home is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 27 people over the age of 65, including people living with dementia. At the time of the inspection there was 21 people living at the service.

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

People were not supported safely. Risks to people were not always robustly assessed and mitigated. Medicines were not safely managed. Staff were not recruited and deployed safely and effectively.

People were not always treated with dignity and respect. We observed one person who became very distressed being left by 3 members of staff. Support around mealtimes was sometimes undignified, with some meals returning to the kitchen uneaten. There were times, the communal areas were very loud and not always favourable for people living with dementia, on one occasion a person had their fingers in their ears as it was so loud. People were not always involved in planning and reviewing their care.

The providers internal governance processes did not highlight the concerns we found at this inspection. We found training was ineffective at the service. There were concerns in relation to the culture at the service.

Mental capacity assessments were ineffective and some in some cases not decision specific. They were not detailed and did not cover how the service had assessed people’s capacity. Some people’s capacity assessments had not been reviewed for some time.

Records in relation to safeguarding were not robust enough. We have made recommendation about this.

The service worked well with external agencies including district nursing and primary care.

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 CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Rating at last inspection and update

The last rating for this service was requires improvement (Published 04 April 2022)

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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk, staffing, recruitment, and training. This inspection examined those risks.

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.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, dignity and respect, need for consent, safe care and treatment, governance and oversight of the service, staffing and fit and proper persons employed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Seymour Care Home is residential care home located in East Manchester. The home is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 27 people over the age of 65, including people living with dementia.

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

At this inspection we identified three breaches of regulations in relation to safe care and treated, dignity and respect, and good governance. We have also made two recommendations in relation to medicines management and responsibilities around duty of candour.

We reviewed the care records for eight people who were identified to us as having additional needs in relation to eating and drinking. We found risks associated with eating and drinking were not always managed safely. This placed people at risk of harm.

Staff were not organised, supervised and deployed effectively. There was an absence of visible leadership and management 'out on the floor'. This meant there were lost opportunities to challenge poor practice and to lead by example.

The management of people’s medicines was not consistent and failed to follow national best practice guidance. A variety of issues were identified in relation to Medicines Administration Records (MAR), medicines prescribed to be given ‘as and when required’ and for medicines that were given to people covertly in food or drink.

We completed several formal periods of observation in communal areas and saw that staff did not always interact with people in a caring or compassionate manner. We also found care and support provided to people had become task-and-time oriented with no meaningful effort made by staff to positively engage with people other than when delivering care related tasks.

There had been a deterioration in systems and processes which previously had enabled lessons to be learned and practice changed to improve care. This is evident from the deterioration in quality and safety found at this inspection and a failure to sustain previous improvements.

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 overall rating for this service at the last inspection was Good (published 16 July 2021). At this inspection the overall rating has deteriorated to Requires Improvement.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a resident of the care home died. This incident is subject to an ongoing investigation. As a result, this inspection did not examine the specific circumstances of the incident.

We also 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.

Enforcement

We have identified three breaches of regulations in relation to safe care and treated, dignity and respect, and good governance. Please see the action we have told the provider to take at the end of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the 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.

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.

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

In October 2020 we carried out a targeted inspection in response to concerns. At that inspection we recommended the provider should consult national guidance around creating an environment where people could freely 'speak up' to raise concerns. Progress had been made in this area but there was more work for the provider to do in ensuring this learning was fully embedded in every aspect of service delivery.

Staffing levels had improved to ensure a safe and responsive level of care and supervision was maintained. Systems were in place to ensure people were protected from the risk of abuse. Medicines were managed safely. We were assured staff followed safe infection prevention and control procedures. Current government guidance was being followed to support visitors into the home, and to enable people to participate in visits outside the home.

Staff were caring and sought to ensure people were treated in a dignified and respectful way. Improvements had been made, and were ongoing, to create a more inclusive and supportive environment for everyone. People living in the home benefited from a team of staff who knew them well. Staff were knowledgeable about peoples likes, dislikes, interests and hobbies.

The registered manager understood the importance of not only sustaining recent improvements, but the need for continuous service improvement, centred around evidenced based best practice. Systems for audit, quality assurance and questioning of practice were operated effectively.

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 11 September 2019) with one breach of regulation. 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.

Why we inspected

We undertook this focused inspection to check the provider 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 of safe, caring and well-led.

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. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We also 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

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 Care Home is a residential care home that is registered with the Care Quality Commission (CQC) to provide personal care and support for up to 27 people over the age of 65, including those living with a diagnosis of dementia. On the day of the inspection there were 21 people living at the home.

Why we inspected

CQC have introduced targeted inspections 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.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about safeguarding. A decision was made for us to inspect and examine those risks.

We also 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.

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

We acknowledge the provider responded swiftly upon being made aware of the safeguarding concerns. The matter was still subject to an ongoing police investigation at the time of the inspection. As a result, this inspection did not examine the specific circumstances of the concerns. However, we did review overarching systems and processes that sought to safeguard people from the risk of abuse. We also looked at the culture and ethos within the care home.

Policies and procedures for safeguarding were in place, and staff we spoke with were aware of their responsibilities in relation to safeguarding. However, the culture within Seymour Care Home did not always create an environment where staff felt able speak up, and to challenge and report poor practice.

There was no dedicated safeguarding or ‘speak up’ champion within the home. Staff who take on additional responsibilities through champion roles can help to ensure current best practice guidance is shared with the wider staff team and embedded into everyday practice.

We have made a recommendations about these issues within the well-led section of this report.

Despite our findings outlined above, we found no evidence of wider systemic safeguarding issues within Seymour Care Home.

We found people were protected from the risk of acquiring infections and the service was visibly clean. Personal protective equipment was readily available to staff and all staff were following the latest guidance.

Rating at last inspection

The last rating for this service was requires improvement (published 11 September 2019).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Seymour Care Home 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 Care Home is a large extended house situated in the Clayton area of Manchester, accommodating people in one adapted building, with a large garden to the rear of the home.

People’s experience of using this service:

Staff rotas we looked at on the day of the inspection accurately reflected the numbers of staff on duty. During the inspection we had concerns that staffing levels were not always sufficient to provide safe care and treatment for people at all times. Staff knew how to keep people safe from harm from abuse and people told us they felt safe. Staff were aware of risks specific to individuals and risks posed by the environment and were guided with information and instruction on how to reduce these to keep people safe.

The meal time experience was not a good one for some people on the second day of our inspection, partly due to the layout of the dining room. We discussed this with the registered manager during our feedback.

People spoken with said they were well cared for. People were supported to have choice and control of their lives and staff supported this in the least restrictive way possible. Policies and procedures were in place to support this practice. People received a healthy diet in line with their assessed needs. People had access to health care as required.

Care plans and assessments were in place which identified the areas of support people wanted and needed. People’s views and opinions were sought on the service. This was done informally as the service was a small one. The service had a complaints policy and people we spoke with knew how to make a complaint. Suitable arrangements were in place to respond to any complaints and concerns.

Systems and procedures were in place to monitor the quality and effectiveness of the service. At our last inspection the registered manager had introduced and completed a variety of audits to identity areas of good practice and issues for improvement. We saw that audits of the service had been sustained and indicated that the registered manager had oversight of the service. People, and their relatives were consulted to provide feedback on the service, but the number of responses were low. Professionals and staff had not been asked for feedback. The registered manager was dealing with staffing issues and trying to improve staff morale.

At this inspection we found improvements continued to be made in some areas. We will continue to monitor information and intelligence about this service to ensure these are sustained.

Rating at last inspection: Requires Improvement (report published on 24 July 2018).

The last inspection of Seymour Care Home took place on 05 and 06 June 2018. The last rating for this service was requires improvement (published 24 July 2018). The service remains rated requires improvement. This service has been rated requires improvement or worse for the last four consecutive inspections.

Why we inspected:

An unannounced comprehensive inspection was undertaken on 10 and 11 July 2019 in line with our inspection schedule and to ensure that previous improvements made by the provider had been sustained.

Enforcement: Please see the ‘action we have told the provider to take’ section at the end of the report.

Follow up: We have asked the provider to complete an action plan detailing how they will make improvements to ensure the regulations are met. We will work with our partner agencies, including the local authority, to review the progress made by the provider. We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We last inspected Seymour Care Home in October 2017. At that inspection, we found multiple breaches of regulations, the service was rated Inadequate and placed in special measures. At this inspection, we found no regulatory breaches and improvements had been made in each of the five key questions of safe, effective, caring, responsive and well-led. As a result of this, Seymour Care Home was removed from the special measures framework.

This service is a ‘care home’. People in care homes receive accommodation and/or nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Seymour Care Home is situated in the Clayton area of East Manchester and is registered with CQC to accommodate a maximum of 27 people. Care and support is provided to adults aged over 65, including those living with dementia. Accommodation is provided over two floors and there is a passenger lift.

At the time of this inspection, 19 people were accommodated at the service. This was because following our last inspection, the local authority had imposed an embargo on new admissions. However, at the time of publication of this report, the embargo had been lifted.

There was a registered manager in post at Seymour Care Home. A registered manager is a person who has registered with CQC 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 improvements had been made to ensure medicines were managed safely. This included systems for ordering, storage, administration and disposal. However at the time of our inspection we found there had been a lapse in the checking of medication stocks to ensure actual quantities in stock reflected the amount staff had recorded as being administered.

Based on the current number of residents, we were satisfied that staffing levels were sufficient to meet people’s needs. We highlighted with the registered manager the need to ensure a managed process for accepting any new admissions and that there were sufficient staff to meet people’s needs. The home had implemented a new dependency tool provided by the local authority and we were assured this tool would be used to assist in measuring dependency levels versus staffing establishment.

New and improved systems and processes had been introduced for the reporting and recording of issues related to safeguarding, protecting vulnerable adults and whistle-blowing. The management team and wider staff group fully understood their individual and collective responsibilities in this area. The registered manager was able to provide examples of good practice where the service had been proactive and acted decisively concerning safeguarding issues. The registered manager emphasised that safeguarding was now 'everybody's business'.

Risks to people at the home were regularly assessed and reviewed. General environmental and specific risk assessments were completed. We found risk assessments in place in the care files we reviewed around choking, falls, moving and handling, infection control, oral health and other aspects of personal care.

We checked the systems in place to protect people in the event of an emergency. We found that personal emergency evacuation plans (PEEPs) were in place for all people who used the service and a copy was kept in the staff office.

Significant improvements had been made which sought to ensure the service was working within the principles of the Mental Capacity Act (MCA) 2005. For example, new care planning documentation had been introduced, a robust framework for best interest’s decisions and the involvement of ‘relevant persons’ had been established and the registered manager and wider staff group had completed specific MCA training.

Since our last inspection we found the annual training plan had been reviewed and staff now received specific training for dementia and challenging behaviour. The registered manager and a senior carer had also completed an enhanced level of training with regards to dementia and the management of distressing behaviours.

We observed the mealtime experience and found this to be relaxed and well organised. People received any help, support and encouragement they required to eat and drink promptly.

Before a person moved into Seymour Care Home a pre-admission assessment would be completed. The registered manager described the process to us and we were told a pre-admission assessment was important for both the potential new resident and for the existing people living in the home.

People continued to be supported to maintain good health and we saw that people had access to their GP, district nurses and other specialist services.

Through our observations of staff interacting with people and from conversations with the staff, it was clear that they knew the people they provided care for well. They understood people's preferences, likes and dislikes. They also had a good understanding of people's past lives, which enabled them to participate in meaningful conversations with people.

Care plans were person-centred and comprehensive yet easy to navigate and information was readily accessible. Each care plan also contained a one-page profile that provided key information about the person.

Staff at Seymour Care Home continued to provide a responsive level of care and support to those people who were nearing the end of life. Staff had completed end of life training to nationally recognised standards.

It was clear to the inspection team the registered manager demonstrated a renewed commitment and willingness to improving the quality and safety of care provided at Seymour Care Home. The registered manager also demonstrated a greater breadth and depth of understanding in respect of their role and legal responsibilities.

Throughout the inspection, it was also evident that the deputy manager and wider staff team had invested much time and effort in supporting the registered manager drive improvements across every aspect of the service.

This unannounced inspection took place on 30 and 31 October 2017. The inspection was prompted in part following information of serious concern received from two whistle-blowers. The whistle-blower alleged physical, psychological and emotional abuse to seven people living at the home. Whistleblowing is when a person tells someone they have concerns about the service they work for.

We last inspected Seymour Care Home on 26 September 2016 when we rated the home ‘Requires Improvement’ overall. At that inspection we found a breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Need for consent. We issued a requirement notice to the provider to formally inform them of the reasons they were in breach of the regulations and to tell them improvements must be made.

At this inspection we identified ongoing concerns and breaches of the regulations. We found breaches of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care, good governance, recruitment, training and premises and equipment.

You can see what action we have told the provider to take at the back of the full version of this report. We are currently considering our options in relation to enforcement and will update this section once any enforcement action has concluded. As a result of our concerns, we requested and received an urgent action plan from the provider that detailed the immediate actions they would take ensure the safety of people living at the home. Furthermore, Manchester City Council Commissioning team have temporarily suspended all new admissions to Seymour Care Home until further notice.

Seymour care home is situated in the Clayton area of Manchester and provides residential care for up to 27 people. The vast majority of people are living with dementia. Accommodation is based over two floors and there is a passenger lift between the floors. At the time of our inspection there were 24 people living at the home.

At the time of our inspection the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 looked at the concerns raised and found the provider had not protected people from the risk of harm and abuse as some people were being unlawfully restrained as a means of managing their behaviour.

People within the service were not always safe. It was standard practice for sluice and laundry rooms in the home to be left unlocked, placing people at risk of harm by potentially coming into contact with hazardous materials. On the first day we noted a hoist had been stored on the ground floor corridor; this posed a potential trip hazard. We found no evidence to show the home’s passenger lift had been examined to ensure it was safe to use under the ‘Lifting Operations and Lifting Equipment Regulations’ 1998 (LOLER) .

People's medicines were not being managed effectively and we found a number of shortfalls. For example, we found the clinic room was warm and no room temperature recordings had been completed. The provider could not be assured medicines stored in the clinic room had not been compromised due to fluctuating room temperatures. We found that practices around administering medicines were also not robust and not safe and important information about people's medicines was missing. People were in danger of not receiving the right dose of the right medicine at the right time, as prescribed.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to people's needs.

There was a lack of leadership and governance at the home and effective systems to seek feedback of the experience of people was not in place. There was a lack of support and coaching for staff and this was reflected in the care they provided. Auditing systems were not robust enough to ensure that the service was compliant with the Health and Social Care Act 2008 and as a result these had not identified the concerns that we found during our inspection. Where audits had identified improvements that were required, these had not always been actioned. The provider had also failed to notify CQC of important incidents and events.

Risks to people's health, safety and wellbeing were not consistently identified, managed and reviewed. This impacted on people's well-being and they were at high risk of receiving inappropriate care that did not meet their needs and reflect their preferences.

The culture within the home did not promote a holistic approach to people's care to ensure that their physical, mental and emotional needs were being met. Care plans were incomplete, inconsistent and task led. We found two care plans had not been updated to reflect people's current care needs. Opportunities to participate in activities were limited and activities provided were not personalised or tailored to meet people's level of ability, choice or preference.

Staff had received a training session on the Mental Capacity Act 2005 (MCA), however the staff we spoke with had limited understanding of this legislation. As a result we found care plans failed to address people’s abilities to make decisions about care and support, or evidence where decisions had been made in a person's best interest.

Complaints were not clearly recorded and did not provide assurances that people’s complaints were responded to appropriately.

There was not an effective system in place to ensure there were sufficient numbers of staff on duty to support people and meet their needs. There were not enough staff to provide adequate supervision, nutritional support, stimulation and meaningful activity. This had a direct impact on people's safety and welfare.

Staff received supervision and appraisals. Staff told us the training they received was good, however a course intended to enable staff to help people manage their behaviours had not been reviewed in over five years. This led to staff not having the confidence or skills to support people safely when people’s behaviours challenged others.

Staff reported accidents and incidents to the office however; the management team did not always review them to ensure appropriate action had been taken and to reduce the risk of incidents happening again.

The home environment was not dementia-friendly, in that adjustments had not been made to help people living with the condition to maintain their independence and navigate around the home. We recommend that the home investigates and implements good practice in modern dementia care to improve people's quality of life.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration, the service will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five questions it will no longer be in special measures.

Seymour care home is situated in the Clayton area of Manchester and provides residential care for up to 26 people.

At the time of our inspection the service 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 there were systems in place to protect people from risk of harm. There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA). Where people did not have the capacity to consent, the provider did not always act in accordance with the legal requirements of the MCA 2005.

We looked at records relating to the personal care the service was providing and found care was well planned and reviews involved the people receiving care and their families. Care was personalised and people were well supported. People received good support to make sure their nutritional and health needs were appropriately met.

At this inspection we found the provider had systems in place to protect people from the risk of harm. Staff understood how to keep people safe and knew the people they were supporting very well.

There was enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff were skilled and experienced to meet people’s needs because they received appropriate training, supervision and appraisal.

We observed some good interactions between staff and people who used the service and the atmosphere was relaxed. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People we spoke with told us they were aware of the complaints procedure and would have no hesitation in making a formal complaint if they had any concerns about the standard of care provided.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines.

Records we looked at showed there were systems in place to assess and monitor the quality of the service and the focus was on continuous improvement. However these were not always effective in relation to assessing people’s capacity. There was good leadership at the service by the registered manager which promoted an open culture.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

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?

We saw people were being cared for in an environment that was safe and clean.

The people we spoke with who used the service told us they felt safe. One person said 'I am well looked after.'

We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This meant the people who used the service were supported by staff who had the necessary skills and experience.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

We saw quality assurance questionnaires had been circulated to professional visitors. One had commented 'They are professional, approachable and friendly.'

The home had received a food hygiene rating of 5 on 18th November 2013. This reflects the standard of food hygiene found on the date of inspection by the local authority, on a scale of 1-5.

Is the service effective?

People's health, social and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly every month.

From the training records we viewed we found staff had received training to enable them to meet the needs of the people who used the service. Discussion with staff and examination of records confirmed a programme of training was in place so all members of staff were kept up to date with current practice.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the care they received and the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included 'I am happy living here' and 'I am very satisfied.'

Feedback we saw in a thank you card from a family member said 'Thank you for all the care you gave her.'

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

Is the service responsive?

People's needs had been assessed before they moved into the home. The records we saw confirmed 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 which were important to them and had been supported to maintain relationships with their friends and relatives.

We saw people's rooms were spacious, light and clean. People had personalised their rooms with their belongings and furniture. There was a dining area and two lounges. All of these were clean, spacious and light. The gardens were large and we were told there were plans to make them more inviting. There were ramped entrances for easy access.

We saw large print and picture signage on all doors to communal areas, so that people who used the service could easily identify the rooms.

Is the service well-led?

We saw documentary evidence that the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home's values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, satisfaction questionnaires had been completed by people who used the service and their families and by professional visitors. We saw collated results for previous questionnaires but this had not yet been done for the most recently completed.

People living at the home (who were able to) told us that the quality of care provided was good. Comments made included:

'I am very happy here. I am well looked after and the staff are all very kind.'

'They (staff) help me with the things I can't do.'

'The doctor comes to see me when I am unwell.'

Medicines were being stored securely in appropriate cupboards or the designated medicines fridge where appropriate to do so. However it was noted that security needed to be improved in respect of the two mobile medicine cabinets and the lock fitted to the door of the medicines storage room.

We found that people were being cared for in a suitable environment by adequate numbers of appropriately trained staff.

'All the staff have been very nice and kind.'

'The staff speak to me politely and with respect.'

'I decide what time I go to bed, when I get up and how I spend my time.'

'They (staff) are all very good. They knock on my door before they come in, ask me what I would like to eat, and ask me my views on about how I am being looked after.'

'I have been looked after superbly since I came here.'

We found that suitable arrangements were in place to keep people safe, ensure that staffing provision was adequate and appropriate and deal effectively with any complaints.