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Archived: Seabrooke Manor Care Home Requires improvement

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Reports


Inspection carried out on 2 February 2016

During a routine inspection

This inspection took place on 2 and 8 February 2016 and was unannounced. At the last comprehensive inspection in October 2015 this service was placed into special measures by CQC as it was rated inadequate in the “safe” and “well-led” domains. This inspection found that there was enough improvement to take the service out of special measures. However, we will continue to monitor to ensure that improvements made are sustained as there were still some regulation breaches.

Seabrooke Manor is a 120 bed care home providing residential and nursing care. The service is divided into four units. Norman House and Belgae House provide nursing and residential care. Saxon House provides residential dementia care and Roman House provides nursing dementia care. On the day of our visit there were 90 people living at Seabrooke Manor.

On the days of our inspection there was 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 and associated Regulations about how the service is run.

During this inspection we found that improvements had been made. Although continence risk assessments had improved, risk assessments for behaviours that challenged were still not specific enough to enable staff to manage the risks appropriately. Care records we looked at were up to date with the exception of one aspect of care. Future decisions care planning was in progress but was still falling short as most plans were either not completed properly or just said, “not willing to discuss.” We recommend further guidance is sought on having difficult conversations.

Staffing levels were reviewed regularly. On the day of our visit call bells were answered in a timely manner. However prior and after our inspection we were told of incidents on Belgae Unit where non- permanent staff were not responding to people in a timely manner. We recommend that action be taken to ensure consistent skills mix is achieved on Belgae unit in order to deliver consistent, safe care delivery.

Improvements had also been made to the activities provided to ensure that people cared for in their rooms and people living with dementia had appropriate activities. Although significant progress had been made with further training for the staff on dementia care, time was needed to ensure all staff had attended the training, and were confident in effectively managing certain behaviours. Staff also needed further training to use the various resources available within the service to engage with people.

Improvements had been made to ensure equipment such as pressure relieving mattresses, hoists and slings were checked regularly to ensure they were safe to use. Topical medicines were now managed safely and there were completed “as required” medicines protocols on three of the four units. In addition units audited each other’s medicine management monthly using a generic audit tool to ensure that safe medicine management guidelines were followed.

People told us they were treated with dignity and respect and that they could receive visitors at any time. They told us most staff listened to their wishes and respected them as individuals by delivering care where possible according to their preferences. Staff had attended equality and diversity training and were able to explain how they applied this in their daily practice by promoting people’s individual choice.

Before care was delivered consent was sought. Staff understood how the MCA applied to their practice and were aware of the people with a current deprivation of liberty authorisation.

People were supported to eat sufficient amounts that met their needs. Where required input from other healthcare professionals was sought and acted upon to ensure people’s health was maintained.

There were appropriat

Inspection carried out on 8 and 9 October

During an inspection to make sure that the improvements required had been made

This inspection took place on 8 and 9 October 2015 and was unannounced. At our last inspection in January 2015, the service had not met legal requirements relating to consent to care and treatment, care planning, infection control, medicines management, nutrition, and privacy and dignity. At this inspection they now met requirements relating to infection control, and had improved but were still not meeting some legal requirements relating to maintaining accurate records, aspects of medicine management, nutrition and mental capacity.

Seabrooke Manor is a 120 bed care home providing residential and nursing care. The service is divided into four units. Norman House and Belgae House provide nursing and residential care. Saxon House provides residential dementia care and Roman House provides nursing dementia care. On the day of our visit there were 102 people living at Seabrooke Manor.

There was 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 and associated Regulations about how the service is run.

People were cared for in a clean and hygienic environment. Infection control guidelines such as handwashing, single use of hoist slings and syringes were adhered to.

Pain assessments were not always reassessed and did not always explain how the identified risk could be minimized in order to protect people using the service. Similarly continence assessments were not always specific and did not always identify individualized toileting patterns.

Medicines were not always handled and administered safely as topical medicine prescriptions were not always specific and not always signed for. Systems for as required medicine were inconsistent as some were on the MARs sheet and others were not increasing the risk of missing some necessary medicines.

People were treated with dignity and respect most times. However, there were occasions where people were rushed by staff and where staff did not always wait for people’s responses.

We saw inconsistencies in leadership styles. Some units were very task oriented whereas other units were more person centered in the way staff supported people.

Staff had attended appropriate training with the exception of how to respond to behaviours that challenged and different aspects of dementia. Although senior staff were knowledgeable about how to respond appropriately to certain behaviours junior staff were not always able to respond. They were sometimes less confident in dealing with repetitive requests and refusal to eat.

There were safer recruitment practices in place which included appropriate checks to ensure staff were suitable to work with vulnerable adults. Regular supervision including group supervision and annual appraisals were completed in order to ensure that staff were supported to provide care to people using the service.

The registered manager and staff had attended training, and showed an awareness of how to lawfully deprive people of their liberty where this was in the person’s best interests. However we identified shortfalls in the capacity assessments, communication care plans, and knowledge of some staff in caring for people with dementia. We recommend that best practice guidance be sought on how to effectively engage with people living with dementia. We found several breaches to 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.

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 of 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. This will lead to cancelling their registration or to varying the terms of their 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.

Inspection carried out on 30 January and 9 March 2015

During a routine inspection

This inspection took place on 30 January 2015 and was unannounced. A second visit took place on 9 March 2015. At our last inspection in September 2014, the service had not met legal requirements relating to consent to care and treatment and care and welfare of people using this service. At this inspection there was no improvement and they were still not meeting these requirements.

Seabrooke Manor is a 120 bed care home providing residential and nursing care. The service is divided into four units. Norman House and Belgae House provide nursing and residential care. Saxon House provides residential dementia care and Roman House provides nursing dementia care. On the day of our visit there were 113 people living at Seabrooke Manor.

There was 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 and associated Regulations about how the service is run.

During this inspection we found the provider was not meeting some of the legal requirements relating to consent to care and treatment, care and welfare, record keeping, information and involvement, cleanliness and infection control. You can see what action we told the provider to take at the back of the full version of this report.

People were not always cared for in a clean and hygienic environment. People were at risk of contracting infections as appropriate guidance was not always followed. Infection control guidelines such as handwashing, single use of hoist slings and syringes were not always adhered to. Some staff had visibly dirty uniforms.

Risk assessments were not always completed and did not always explain how the identified risk could be minimised in order to protect people using the service. Enteral nutrition was not always managed appropriately in accordance with enteral nutrition best practice guidance. This could put people at risk of aspiration and infections.

People were not always treated with dignity and respect. We saw people with their undergarments exposed. Although care was assessed, care plans were not always individualised or reviewed to reflect the current needs of people using the service.

We saw inconsistencies in leadership styles. Some units were very task oriented whereas other units were more person centred. However, on the second visit when all unit leaders were present all units were better organised.

Staff had attended appropriate training. Regular supervision including group supervision and annual appraisals were completed in order to ensure that staff were supported to provide care to people using the service.

There were safer recruitment practices in place which included appropriate checks to ensure staff were suitable to work with vulnerable adults. Medicines were handled and administered safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). There had been several applications for Deprivation of Liberty Safeguards (DoLS) for people using the service. The registered manager and staff had recently attended training, and showed an awareness of how to lawfully deprive people of their liberty where this was in the person’s best interests.

Inspection carried out on 17, 18 September 2014

During a routine inspection

Two inspectors carried out this 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 spent time in all four units and observed how people were supported by the staff. We saw that staff treated people with respect and were kind to them. Relatives told us that they felt people were safe. One relative told us, “I think about [my relative] all the time but I know they are safe here. The care is great.” Another said, “I’m confident she is very safe here.” However, for some people, we found that their care and treatment did not reflect relevant research and guidance. It was not planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). When there were concerns about a person's ability to make a decision affecting their safety and welfare a mental capacity assessment had been carried out and a DoLS put in place. However, specific aspects of decision making had not been explored and some aspects of people’s care and support may have been provided without appropriate consents.

We found that the provider had effective recruitment and selection procedures in place. Hence, staff were appropriately recruited to ensure that they were suitable to work with vulnerable adults.

Is the service effective?

People were supported to receive the healthcare that they needed. Records showed that people saw the relevant healthcare professionals. For example, we saw that referrals were made to the dietician when there were concerns about people’s weight. The GP, dietician and tissue viability nurse were all involved in peoples’ care when needed.

People's care needs were assessed and plans of care developed from these. Staff had a good understanding of people's individual and assessed needs and of individual preferences. However, updates to care plans did not always reflect relevant changes in the person’s health and/or wellbeing.

Is the service caring?

Relatives and people who used the service were positive about the care provided by the staff team. One relative told us, “They do look after her well.” A person who used the service told us “The attitude of staff towards residents is very good.”

We observed that staff supported people where required and were respectful of their privacy.

Is the service responsive?

Care staff were able to tell us about peoples’ needs and how they supported and cared for them. The service was responsive to their changing needs. For example, we saw that timely referrals were made to the GP when there were concerns about a person refusing their medication.

Is the service well led?

The service had a registered manager in post and a clear management structure that included a clinical lead and a lead person for each of the four units. Staff we spoke with said they felt that they received the support and guidance they needed to carry out their duties and to meet people’s needs. We observed a daily meeting held by the manager with the heads of each unit and of ancillary services. At this meeting information was shared about issues, what was happening on each unit as well as any concerns with regard to ancillary services. This enabled the management team to monitor the service provided.

Inspection carried out on 30 October 2013

During a routine inspection

At the time of our visit there were 91 people using the service. This included people having respite care and one admission for permanent placement due on the day of our inspection. People told us they were happy at the home and relatives thought their family member’s needs were met.

People were supported in being as independent as possible. One resident said, “the staff help me, but sometimes I can do it myself.” Staff were described as being “compassionate”, “caring” and “professional”. One person commented in a letter to the home, “staff spent time talking to my relative. It was a very hard time for the family but eased by the way we were all treated.”

Some relatives told us that residents can be left waiting for a while before they got support from staff. Several people thought that the home felt short staffed. However no one said that people’s care and welfare was affected. The staff rota accurately reflected the staff members present on the day of the inspection. However we were unable to ascertain whether alternative staff were on duty to cover staff absences or extra tasks.

Staff were qualified, skilled and had the relevant experience to meet people’s needs. They all received appropriate support and training.

There were suitable arrangements in place to ensure people using the service were safeguarded against the risks of abuse.

There were quality monitoring processes in place. The people using the service and their representatives were asked for their opinion of the home through meetings and a yearly survey. The people understood how to complain and any complaints were addressed appropriately.

Inspection carried out on 24 July 2012

During a routine inspection

Overall people told us that they were happy living at Seabrooke and were happy with the staff who they felt were nice. People felt cared for. One person told us “If you ring the bell, usually they come in quick time”. Another person told us “you can ask for a cup of tea anytime”.

We also spoke to relatives who were visiting. We were told that they felt people were being well looked after and that the home kept them informed about what was going on for their relatives.

Reports under our old system of regulation (including those from before CQC was created)