Seymour House

Seymour House is a residential care home providing personal care to a maximum of 11 adults with a learning disability and adults on the autism spectrum. The care home accommodates people in two adjoined and one detached domestic premises. At the time of our visit five people were supported in the adjoined premises and the detached premises was vacant due to refurbishment work.

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

People benefitted from systems which were established and embedded by the service to reduce the risk of abuse and ensure people’s welfare. Staff understood risks to people and took action to mitigate the risk of harm. Relatives told us their family members experienced a safe service, with comments such as, “[Staff] have got everything for [family member’s] safety” and “I feel that there’s adequate staffing. [Staff are] aware of [family member’s] needs.”

Staff supported people to access a range of healthcare services in response to their needs. The environment was adapted to improve people’s access to facilities. Staff received mandatory training and specific training to meet people’s needs such as autism awareness and positive behaviour support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care planning was person-centred and focused on people’s individual needs and preferences. Records showed that people and their relatives were involved in reviewing their care plans. The service risk assessed and enabled people to visit their relatives where this benefitted their well-being, during the pandemic. Regular contact was maintained between people and relatives through video calls.

The service had changed its management and staffing structure. This had improved the registered manager’s ability to develop and monitor systems and policies and procedure to ensure safe, quality care. Relatives and staff consistently told us the management team were approachable and listened to any concerns or ideas they had to continuously develop the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right culture. We did not look at the component of right care as part of this inspection.

We found the premises had signage in the window which suggested the service was a care home and was not in line with the principles of national guidance for this.

Right support:

• The model of care and setting maximises people’s choice, control and independence. We found the premises had signage in the window which indicated the service was a care home. The registered manager immediately took this down to ensure they were fully in line with the principles of registering the right support.

Right care:

• We did not inspect the Caring domain as part of this inspection and did not look at all the components in relation to right care.

Right culture:

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

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 inadequate (published 3 June 2020). This service has been in Special Measures since 20 April 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive 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. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Seymour House 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 - 21, 23 & 25 Seymour Road is a residential care home for up 11 people with a learning disability and or autism. The care home is located across three semi-detached properties in Slough. One of the properties has two annexe buildings in the garden which two people have on-suite bedrooms. The home is within easy walking distance of the local shops. Each property has a mixture of private bedrooms and communal areas. At the time of our inspection the service was supporting nine people.

Not all aspects of the service have been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. For example activity schedules and menu plans were not consistently available to people.

The service is registered to support up to 11 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design. People were supported in three domestic properties and two annexe buildings in the garden. There was no signage to indicate it was a care home and staff did not wear uniform that suggested they were care staff when coming and going with people.

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

Systems or processes were not established and operated effectively to ensure compliance with regulations or to monitor and assess the quality safety of the service or welfare of people. The lack of robust management and staffing structure meant there was not consistent oversight of the service from service leaders. Systems were not implemented to report serious incidents to all relevant people so we have made a recommendation about the duty of candour requirement.

Systems were not always implemented to ensure the effective management of medicines. For example, medicines were not stored securely. Health and safety checks for legionella were not completed and fire safety actions were not progressed in a timely manner. Substances hazardous to health were not secured safely. The service did not always take appropriate action to prevent or respond to the risk of abuse or improper treatment towards people. Incidents were not always escalated appropriately by the registered manager or reported to the safeguarding authority.

The service monitored people's weight and made referrals to the dietitian where there were concerns. Monitoring templates did not refer to and were not adapted to include nationally recognised malnutrition assessments. We have made a recommendation about this.

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; however, the systems in the service did not always support this practice. For example, documentation did not always follow the mental capacity code of conduct. We have made a recommendation about the Mental Capacity Act 2005.

Interactions from staff towards people were generally caring. However, we reported one member of staff to the registered manager for speaking to a person disrespectfully. We have made a recommendation about human rights training for staff. We received mixed feedback from relatives about their involvement in decision about their family member's care. Two relatives were dissatisfied because the service did not always inform them of incidents or health related concerns, whilst other relatives were happy with the level of inclusion.

In general people's privacy and dignity were upheld by staff. CCTV was in use at the exterior entrance of people's home without an impact assessment on their privacy and we have made a recommendation about this.

The service did not act upon relative’s complaints in accordance with their complaints policy and procedure. Some relatives were unhappy about the way the manager dealt with their concerns about the service.

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; People did not always receive information to support them to prepare, plan and make choices about their day. For example, information about people's activities and menus were not available or communicated to all people using the service.

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 (March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, incidents and allegations of abuse not reported or investigated, poor management of the service and low staff morale, medicines management, nutrition and access to food, staff training and induction. A decision was made for us to inspect and examine those risks.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained an injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of accidents and incidents.

We have found evidence that the provider needs to make improvements. Please see the all sections of this full report for further information.

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment, acting upon complaints, governance of the service, deployment of suitable staff, staff recruitment checks and notifying the Commission of events such as allegations of abuse.

We have issued the provider with warning notices in relation to safe care and treatment and governance of the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service 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.

Seymour House - 21, 23 & 25 Seymour Road is a residential care home for 11 people with a learning disability and or autism. The care home is located across three semi-detached properties in Slough. One of the properties has two annexe buildings in the garden which two people have on- suite bedrooms. The home is within easy walking distance of the local shops. Each property has a mixture of private bedrooms and communal areas.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People were supported with their prescribed medicines. We received positive feedback from people about how staff did this safely. However the records relating to medicine management did not always follow safe practice. We have made a recommendation about this in the report.

People were treated with kindness and compassion by staff who were supported in their role. The service ensured staff with the rights skills and attributes were employed. People told us there was enough staff to support them on a daily basis.

Risks posed to people were identified and systems were in place to minimise the risk of harm to people.

People were supported to achieve their potential and maintain independence living skills. The service regularly monitored changes in people’s health and behaviour to enable them to have a better quality of life.

Where people had expressed an interest in work, the service helped them access support to obtain work. Other people were supported to attend social and support groups.

People were supported to maintain a healthy lifestyle and diet. People had access to specialist external healthcare professionals when needed.

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 in the service supported this practice.

Systems were in place to monitor the quality of the service and the registered manager had a clear vision to help improve people’s experiences.

Seymour House is a care home for adults who have a learning disability or autism. It is registered to provide accommodation for nine people. At the time of our inspection seven people lived at Seymour House.

We previously inspected the service on 30 October 2013. The service was meeting the requirements of the regulations at that time.

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.

The home had a relaxed atmosphere and staff supported people in a respectful and friendly way. Staff understood the needs of people they supported and independence was encouraged.

People told us they felt at home at Seymour House. They felt safe and had confidence in management to deal with any concerns. Relatives told us they were very happy with the service their family member received. They had confidence that people were supported in a dignified manner.

People who could go out independently did so frequently. People were supported to have meaningful activities, one person attended college another was supported with voluntary work.

Risks to people were clearly documented. Risk assessments were comprehensive and reviewed at regular intervals. Staff were knowledgeable on actions to mitigate risk.

Medicines were managed in safe way. There was clear guidance about the use of medicines prescribed for occasional use. This meant that staff were consistent in when these medicines were administered to people.

Staff had a good understanding of what constitutes abuse. People using the service had access to information on how to raise concerns about safety.

Staff had a good understanding of the implications for them and their practice of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make specific decisions at a given time. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after them safely.

The service was managed well. The registered manager supported staff to develop themselves and the service. Each staff member had a role within the home.

We have made a recommendation about staff training on the subject of manual handling.

We have made a recommendation about supporting all staff in particular one to one meetings and annual appraisals.

We spoke with two care staff who told us that they supported people to be as independent as possible and helped them to work towards and achieve personal leisure activities or social goals. We looked at a range of care files that demonstrated the personalised approach that was in place and this supported comment made by the staff. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training and support that enabled them to provide a high quality of care.

We spoke with one parent who told us that they were happy with the service provided and that they felt the staff were friendly and always behaved in a professional manner. This person told us they had been made aware of the complaints procedure but that they had never had cause needed to use it.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who used the service. We observed staff assessing people's needs and ensuring that care was provided in line with individual care plans. We were able to see that people were comfortable and that there was adequate numbers of staff available to provide the individualised support needed.

People told us that if they were upset or fed up they would go and talk to a member of staff. One person told us they were happy living at Seymour House. People told us they felt safe. One person said 'If we do something wrong we get told off'. We asked if all the staff told them off and they said 'No, just one or two'. We followed that matter up with staff and the manager. Both staff and the manager took the matter seriously. The manager told us she would look into the matter after our visit.

We found people's needs were assessed and care was provided in line with their care plan. People's nutritional needs were met. The service had satisfactory arrangements in place for the control of medicines. There were appropriate pre-employment checks on staff involved in supporting people. There were sufficient staff to support people. Complaints by people were investigated.