OSJCT Seymour House

We found the following during our visit:

Most people living on the first floor of the home had a positive diagnosis of COVID-19. We found areas where best practice guidance for the control of infections was not being followed. These included a clinical waste bag on the floor of a person’s bedroom, with the contents on their carpet. Also, a staff member was observed not following safe waste disposal procedures.

We reported our concerns to the management team of the home. We were advised of appropriate bins being ordered, to support safe clinical waste disposal. The staff member observed also had their practice addressed in-line with the home’s policies and procedures. The management team were also provided with guidance and supportive feedback from the visiting public health nurse, to improve their infection control practice.

Cleaning schedules were in place and we were advised the house-keeping team were supported by the care and maintenance staff. The cleaning completion checks did not always match with the tasks set on the cleaning schedule. These included cleaning light switches and call bells in people's bedrooms once daily, rather than twice daily, which was identified as the requirement on the provider’s cleaning schedule.

At the time of our inspection, the home was operating on low staffing numbers, which had been risk assessed as being safe operating practice. Care and maintenance staff were supporting the housekeeping team to clean 'touch points' in the communal areas, such as light switches and lift controls.

Visitors to the home were required to change their clothing, have their temperature checked, wash their hands and put on personal protective equipment (PPE). There were well-stocked supplies of PPE, including gloves, aprons and face coverings. There were well established supply chains and ordering processes for PPE.

People were supported to maintain contact with relatives with phone calls and video calls. Before the COVID-19 outbreak, people were supported to see their relatives in the visitors' room.

We observed staff wearing the correct PPE. Staff cleaned mobility equipment such as hoists and stand-aids after each use and this was clearly identified with signage. Festive decorations had been installed safely, to reduce the number of people who came into contact with them, but still allowing the displays to be enjoyed.

Further information is in the detailed findings below.

OSJCT Seymour House is a residential care home providing personal care without nursing for up to 42 older people. At the time of the inspection 39 people were living at the home. Some people had limited verbal communication, so we captured some of their experiences through observations.

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

People told us they were happy living at the home and they felt safe. All people were comfortable in the presence of staff. People and relatives were positive about how safe their family members were. Medicines were administered and managed safely. Risks had been identified with ways to mitigate them in place.

Systems were in place to audit the service and when issues were identified they had been resolved. The management strove to be open and continually develop and improve the support people were receiving. They were aware of their responsibility to notify the Care Quality Commission of certain events in line with their statutory obligations.

People were supported by enough staff to meet their needs. Although staff levels had not always been good, so the management were working hard to resolve this. Staff had received a range of training and good induction when they started.

People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. There were good links with other health and social care professionals to meet the needs of people living at the home.

Staff were kind and caring and knew the people living at the home well. Staff respected privacy and dignity throughout the inspection. Although one practice observed at the beginning of meal times could be improved. Links had been developed within the wider community which had a positive impact for people. Independence was promoted, as were the values of treating each person as an individual.

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.

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 14 December 2018). There were multiple breaches of regulation in relation to medicine management, risk assessing, notifying the Care Quality Commission and quality assurance of the service. Concerns were also raised about how personalised care plans were.

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

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 11 October 2018 and was unannounced. We returned on 17 and 18 October 2018 to complete the inspection.

The service did not have 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. There was a manager in post who had submitted an application to be registered manager of the service. We will monitor this to ensure the provider meets the conditions of their registration.

Systems to assess and manage risks people faced were not effective. When plans were reviewed following incidents, staff did not always consider whether other actions were necessary to keep people safe. Reviews did not always include an assessment of why risk management plans had not worked or whether other measures were necessary to reduce the risks to the person.

Action had not been taken to manage the risks people faced from other people who used the service during periods of distress. Support plans for people had not been updated with information about the incidents or strategies for preventing similar incidents in the future.

People were not always supported to take the medicines they had been prescribed.

People had care plans in place, however, they were not always kept up to date as people’s needs changed. One person had a plan in which some sections had not been completed and one person’s plan contained contradictory information.

There were quality assurance systems in place. However, they were not effective and had not ensured improvements were made to the quality and safety of the service being provided.

The provider had not ensured they had always notified the Care Quality Commission of significant incidents in the home.

People said they felt safe living at Seymour House. We observed people interacting with staff in a confident and friendly way. People appeared relaxed in the company of staff and requested assistance when they needed it.

People told us they were treated well and staff were caring. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for support.

Staff received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training relevant to their role.

There were group and individual meetings for people to provide feedback about their care. People were confident any complaints would be investigated and responded to.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 7 and 8 September 2016. The first day of the inspection was unannounced.

The service had a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection in July 2015 we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because necessary records of assessments of capacity and best interest decisions were not in place for people who lacked capacity to decide on the care provided to them by the service. The service had not made all necessary applications to the local authority for Deprivation of Liberty Safeguards authorisations to protect people from being deprived of their liberty without lawful authority. The service did not always provide care in a safe way by taking all reasonably practicable measures to mitigate risks.

At this inspection we found the provider had taken action to address the issues highlighted in the action plan. There was evidence people consented to their care and treatment at OSJCT Seymour House and where people lacked capacity to consent, the necessary mental capacity assessments and best interest decisions were completed. Where needed deprivation of liberty safeguards applications had been made to the local authority. The service had taken actions to reduce risks where people had more complex needs, for example implementing food and fluid charts, making referrals to health colleagues and introducing assistive technology.

People’s medicines were not consistently managed safely. This was due to a new system in place which increased the risk of medicines errors occurring. The registered manager was aware of the concerns and was reviewing the new administering system. They had already been in discussions with the Order of St. John’s Trust before our inspection.

People and relatives spoke positively about the care and support they received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection, with people using the service not hesitating to seek assistance where required and sharing jokes with staff.

People spoke positively about the food choices and were supported to have sufficient food and fluids. People were offered a choice at meal times and where people did not want what was on the menu alternatives were available. There were plenty of drinks and snacks available during the day and night.

People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest other activities they would like to complete. In addition to group activities people were able to maintain hobbies and interests, staff provided support as required.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People told us they were regularly consulted about their care and they attended six monthly care review meetings.

Risk assessments were in place to support people to be as independent as possible. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place. There were enough staff on duty to meet people’s care and support needs safely.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role. The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support. Training was regularly updated, with staff attending a range of core training such as infection control and safeguarding, as well as training specific to the needs of people using the service, for example dementia awareness.

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence. The management operated an on call system to enable staff to seek advice in an emergency. This showed leadership advice was present 24 hours a day to manage and address any concerns raised.

The building was easily accessible for people living with dementia as well as people with a visual impairment. There were coloured walls, pictorial signage on bathroom and toilet areas and clearly named room doors to help people find their way around independently.

' 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?

During the day we spoke with seven people who used the service and one relative. We observed staff interaction with people and saw that staff and people had developed trusting relationships. People told us that staff treated them 'very well'.

The home had been newly decorated and attention had been given to ensure that the walkways were light and airy and were not obstructed. We saw that people moved freely around the home independently and safely.

People's safety was promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively. Staff had attended safeguarding training and knew how to recognise and report abuse. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications have been submitted, appropriate policies and procedures were in place. All care staff had received training in the Mental Capacity Act and the application of DoLS.

Is the service effective?

People's needs were assessed and they told us that they were involved in planning their care. People told us that they were 'very happy' with the care and support they received. We saw from the care records kept in their home that people were involved in making decisions about their care and that these were respected by staff.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were identified and the support they received was meaningful and person centred. The daily records did not fully describe people's emotional well-being. We asked the provider to note that recording the person's emotional well-being was one indicator of the person's physical health.

Is the service caring?

We observed that all staff treated people respectfully and were attentive and caring. All of the comments we received were of a positive nature and confirmed that people and relatives were happy with the support received. Support workers had sufficient information about people's needs and how they should be cared for. This included their preferences and the things that were important to them. The care records we looked at demonstrated that people were consulted about their care needs and that the service offered had been tailored to the individual.

Is the service responsive?

People's care had been reviewed regularly. Other agencies were consulted when there were changes to people's care. All those involved in the person's care were aware of changes so they could respond appropriately and consistently. The home had developed strategies to ensure that staff had the appropriate training in order to offer people the support they required.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service. The service had quality assurance systems in place so that the quality of service could be maintained and shortfalls could be identified.

The home had a clear staffing structure in place. Staff we spoke with were clear on their roles and responsibilities and there were defined reporting lines so all staff knew who to report to. Staff received appropriate support and development to enable them to competently carry out their role.

We returned to check whether improvements had been made in these areas. A new manager had been appointed in November 2013 and had been tasked with addressing the failings in the home. There had been no further admissions to the home since our last visit in November 2013 and the home had eleven vacant rooms. Staffing levels had been maintained and, with reduced occupancy, the provider was focussing on team building and staff training. Staff and people who used the service told us that they were much happier.

Record keeping had also improved. A comprehensive review of all care plans was almost complete. Further coaching and training was to be given to staff. Records were mostly completed to a higher standard and were accurate and up-to-date. Daily records were less task orientated and provided a greater sense of people's physical and emotional well being.

Staff told us they enjoyed working at Seymour House and felt well supported with training. Additional resources had been identified to provide training in a range of subjects. However records showed that there remained a significant number of training shortfalls and staff had not been receiving adequate regular supervision. We recognised that the frequent changes in management may have impacted on the home's progress in this area and acknowledged that efforts were now being made to address this.

We spoke with staff, managers, people who used the service and their relatives. We looked at records, including people's personal records, audits and minutes of meetings.

Staff told us that staffing levels had improved and that absences were more consistently covered. However, they felt that staffing levels did not take into account the level of dependency of some of the people they supported and they were concerned that they were not able to consistently meet people's needs. People who used the service talked of loneliness and some complained that they were not supported to have regular baths or showers because there were insufficient staff. This had been a concern at our last visit. We were concerned that the provider was not using up-to-date and accurate information to assess people's dependency and they had not undertaken a time and motion study as they had committed to do. They had also failed to listen to the views of staff. Managers disputed that there were insufficient staff; they told us there were concerns about the culture in the home and the attitude of staff, which they were trying to address.

We saw some improvements in record keeping. Staff had received further coaching and training and care leaders were tasked with reviewing care plans to ensure that they remained accurate and up-to-date. However, we found a significant number of record keeping deficiencies and we could not be assured that records reflected people's current needs or that people consistently received the care they required.

In July 2013 we were contacted by three members of staff from Seymour House. They told us the home continued to be under staffed, staff were exhausted and morale was still poor. They were concerned that they were not able to meet people's needs. One staff member told us that they had forgotten to provide a meal to three people the day before because they were so busy.

We visited the home in response to these concerns. We spoke with seven care staff; they were all concerned about staffing levels. One staff member said "Residents are being neglected; some people have not had a bath for weeks."

We spoke with four people who lived at Seymour House and a relative, who also commented on staffing levels. One person said "there are not enough staff to look after the people here; another person said "the home is always short staffed so we have to wait."

We found no evidence that the home's manager had listened to staff concerns. Staff felt demoralised and exhausted. Despite assurances from the manager that the home was consistently fully staffed, we found this was regularly not the case.

We returned to the home to check whether improvements had been made in these areas. We had also been contacted by a whistle blower who told us that the home was regularly under staffed. They said that people were not receiving adequate support with their continence and other needs and that people who were confined to, or chose to stay in their rooms were not checked on a regular basis. They told us that staff did not have adequate skills or training to care for people with dementia. They also said that people were "calmed down with medication and they are now sleeping all day and night".

We did not find evidence to support the claim that people did not receive the care and support they needed but record keeping remained poor so we could not be assured that people's needs were consistently met. We found no evidence that people had been over medicated with the intention of 'calming them down', although our investigation of this highlighted some further record keeping concerns. Improvements had been made in training but there remained some shortfall in some essential subjects. Many staff felt that the home was under staffed and this had led to poor staff morale.