Seymour House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.The service was in breach of legal regulations in relation to people’s dignity and respect, lack of oversight, monitoring and good governance at the service.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.Staff and leaders did not always listen to information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.The service did not evidence they worked in partnership with people and provided person-centred care to achieve set outcomes. This did not ensure people’s care was tailored to their individual needs, requirements and ambitions. We reviewed 4 people’s care records. We noted 2 people did not have any outcomes or goals recorded, and other people’s goals had long exceeded the target dates without recent review. People were not supported to set and achieve goals in accordance with their individual needs and aspirations. This did not ensure people’s skills and independence were promoted.

Staff did not ensure all people were engaged with meaningful activities in line with their individual needs and preferences to ensure equality in experience and outcomes. We observed staff did not always initiate or encourage people to make independent choices and decisions about activities. Staff did not acknowledge when or why people did not wish to participate in activities led by the service. Staff did not promote or demonstrate a culture of inclusivity, equity and care.The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We reviewed people’s care records and found they would be best supported through communication tools such as Makaton, or easy read formats of information. We observed people did not have easy read menus to choose their meals from, and we did not observe staff using Makaton to promote and empower people to communicate how they felt most effective. This did not ensure information was always provided in an accessible way according to people’s individual needs.

The provider did not always demonstrate they understood the context in which they delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. They did not ensure the staff team were also equipped with required skills to care for people according to their needs and wishes.We observed the staff were supporting people to meet their basic needs. However, they did not always demonstrate they understood when people needed support regulating their emotions.For example, we observed one person approached 2 staff members. One staff told the person they were “too busy at the moment”, the second staff member told the person to “go sit down”. This did not demonstrate staff were skilled in engaging with people with kindness and compassion. The person did not want to engage in an activity and was becoming upset. Staff did not ensure they always acknowledged people’s concerns or needs. This person’s care plan stated “being ignored and being dismissed when trying to express [themself]” would cause distress. Staff did not demonstrate they could identify this person’s needs, ensuring they listened and involved the person in line with their care plan to avoid the risk of avoidable harm to them. The same person then asked the inspector for support including to take them home.

Some people were regularly approaching staff, walking, shouting, pacing or repeatedly talking about a few different topics. Some of these actions could indicate they were getting more upset as described in the plans of care. However, we did not always observe the staff recognised this and engaged with people in some meaningful activities or conversations. The service had an area with plenty of different activities and that was not used at all during our visit.We observed one staff telling a person they would inform the manager about their lack of participation in an activity. But the management was not present to oversee staff’s practices so they could advise and model staff’s actions. This could have ensured they provided better support to people and prevent them getting more upset or distressed, ensuring people had choices over their activities.

The provider did not demonstrate they have been fostering a positive culture where people felt they could speak up and their voice would be heard. People were not always given opportunity or support with communication so they could speak up and that their voice would be heard.The provider did not always promote people’s independence, so people did not always know their rights or had a choice and control over their own care, treatment and wellbeing.For example, we observed people were frequently told to go to their bedrooms rather engaging with them to do some tasks together or activities. Staff did not always empower people to maximise their independence, choice and control of choosing where they wanted to spend their time. Directing people to their bedrooms so frequently did not promote people’s wellbeing and social needs. This also did not reflect staff used the plans of care or considered reflections in the analysis of incidents and accidents.The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.Staff felt they could approach the management team with any concerns or queries. They felt the staff team worked well together. Relatives agreed they could contact the service or the management team if they had any queries or issues.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by managing equality and equity for people who worked for them.The deputy manager told us about their support to staff including respecting and celebrating diversity; responding to staff’s needs and any issues.Staff felt positive about the managers and working at the service and were confident that their concerns and ideas would be taken on board. They felt supported, treated fairly and looked after by the managers. Staff confirmed they had some staff team meetings to discuss the service and any other items related to the people.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.The provider’s quality assurance systems did not identify concerns we found during this assessment which are described throughout this report.The provider did not maintain an effective oversight of the quality of care being provided, risk management and mitigation, staff practices, knowledge and competency to support people.The provider did not always monitor recruitment checks were appropriately carried out to ensure all required information was gathered to ensure there were suitable staff to work with people.The people were not consistently safeguarded from the risk of harm. Staff were not always adequately trained and competent prior to providing care and treatment. The provider could not demonstrate how they proactively looked at trends or themes in the incidents, accidents and complaints that occurred so that were able to identify areas of concern, different strategies for emotional support and take action to prevent reoccurrence and safeguard people.The provider did not always ensure management of medicine and records was safe and proper.

The provider gathered some feedback from people about their experiences in the service. The information collated had no date noted to show how current it was. The report noted findings and areas for improvement. However, we did not observe this was working or that staff took the findings into consideration to ensure better experience for people.We reviewed 2 sets of meeting minutes for people however there was no evidence to show people were involved, supported to understand the purpose of meeting and communicate their wishes, worries or any other matters important to them.The provider carried out a staff survey, but again there was no date noted. The findings noted some improvements, but we did not receive further information on the progress.The provider could not show how they gathered and used the feedback from various stakeholders to develop the service and drive improvements.

The provider did not always ensure accurate, complete and legible records were maintained or updated when necessary to support effective management of people’s care and treatment, staffing and the service. The provider did not demonstrate they were aware of people’s individual needs to ensure safety from the risk of harm or improper treatment. There was limited effective oversight to identify if risk assessments and care plans in place were followed and reflected in people’s daily notes. This meant they were not able to demonstrate how they identified and worked on the areas where improvements were needed.Some assessments or care records did not always contain the most accurate information. For example, one person’s weight had change in the last 5 months. However, the relevant assessments were not updated to reflect the current situation to ensure the record was till current for effective care provision.We found some people’s care notes contained details of other residents. This did not ensure people’s information was always kept clear and accurate. The management team did not ensure good governance of people’s records to ensure their needs and wellbeing were always correctly entered.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.Some people received support from a few health professionals to look after their health and wellbeing which had positive effect on them. However, we also identified people did not consistently experience positive outcomes. We found effective approaches were not always used to monitor people’s care and treatment to ensure continuous improvements were made. For example, some people had been assessed by external healthcare professionals such as SALT. They recommended for one person to be monitored for any incidents of coughing or choking and for the service to record these incidents and to “refer to SALT if required”. We noted this person had a nutritional risk assessment which stated “any episodes of choking/coughing/gurgling.... SALT should be notified immediately”. We found in a separate risk assessment for this person, staff noted the person had been ‘coughing’ and ‘gurgling’; yet no information was noted in the further comments box, and the review date was set for 6 months later. This did not evidence the provider acknowledged the requirement to refer this person to SALT for further guidance, and to safely monitor and manage the risk of harm. Staff did not evidence they always monitored this person’s mealtime experience to identify any risks, patterns or trends.This did not evidence the service monitored people’s care and treatment to ensure positive outcomes which were in line with clinical expectations.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.The provider did not have a clear process and did not use their policies to focus on continuous effective learning and improvement from incidents, reportable events, audits and information gathered at the service. For example, the provider did not always ensure incidents and accidents were thoroughly reviewed to help identify themes, triggers or trends that would require further action to be taken. It was not evident how such information was used to adjust support to people, reduce the risk of recurrence and more stress to people.The provider did not always demonstrate how they actively contributed to safe, effective practice and research that could also encourage reflection and collective problem-solving with staff and people. Staff and leaders did not ensure people using the service, their families and staff were involved in developing and evaluating improvement and innovation initiatives.The deputy manager provided us with some positive achievements for people and how staff supported them to have good outcomes. However, the provider did not use their policies and procedures to support the process of continued learning, measuring outcomes and impact or the services provided. Where we identified shortfalls during this assessment, the provider was not always responsive to our findings to start working on areas of improvements.