The Seaton

We found the following examples of good practice.

The provider was following best practice guidance in terms of ensuring visitors to the home did not introduce and spread Covid19 providing good information and support for all.

Staff were adhering to Personal Protective Equipment (PPE) and social distancing guidance. People were supported to see their visitors in the specially designed pod in one of the lounges with direct access to outside, or when this was not possible people were supported to speak to their families on the phone or via video call.

The provider had a clear policy designed for people who were admitted to the home from the community or from hospital.

Staff were well trained and have undertaken onsite IPC training and undergone regular spot checks and competency checks. Staff were trained and knew how to immediately isolate individuals with COVID 19 symptoms to avoid the virus spreading to other people. All staff in high risk groups have been risk assessed, and adjustments have been made. Plans were in place to protect vulnerable staff in the event of an outbreak.

Staff had devised a full and interesting activities programme to keep people entertained day to day. Relatives were kept up to date via a monthly newsletter and by a virtual relatives’ meetings which were held on a monthly basis.

People’s experience of using this service:

Staff developed exceptionally positive caring and compassionate relationships with people. People and relatives consistently spoke about the "family atmosphere" at The Seaton. People and relatives said; “Staff are caring,” “They treat [my relative] and all other residents with compassion and kindness.” A staff member captured the ethos of the home when they said; “People’s illness is secondary, their care is not time or task led, we do what we can to make a great day for each person.”

People experienced a level of care and support that promoted their physical and mental wellbeing and enhanced their quality of life. Staff focused on people's wellbeing, they knew about people's lives, talents and importance of having a sense of purpose. The service recently started a weekly nursery group at the home with a local children’s nursery. People joined in and helped with the children. These were enjoyed by all and invoked happy memories of nurturing and parenting.

People mattered and they received care personalised to their needs. People were encouraged to socialise, pursue their interests and hobbies and try new things in a wide variety of inspiring and innovative ways. People received effective care, based on best practice evidence by staff with excellent communication skills. Staff had an in-depth knowledge of people’s care and treatment needs and used best practice evidence to improve people’s lives.

People’s nutrition and hydration and mealtime experience had improved their enjoyment of food.

People's privacy, dignity and independence was promoted and their rights and choices respected. Staff 'went that extra mile' to meet people’s needs and wishes.

People received a consistently high standard of care because the provider and registered manager led by example and set high expectations of staff about the standards of care expected.

People were asked for their consent before they received any care and treatment. People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

People were supported to have a peaceful, comfortable and dignified end of life care in line with national best practice guidance. Relatives commented on the kind words, reassurance and compassion of staff towards them and their loved ones.

Rating at last inspection: Good. (report published 10 November 2016)

Why we inspected: This was a planned inspection based on the rating at the last

comprehensive inspection. At this inspection, the rating for the service improved to Outstanding.

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

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

The Seaton Nursing Home is registered to provide nursing care for up to 31 people. On the day of the visit, there were 24 people at the home.

There was a registered manager for the service. 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.

Staff techniques when engaged in moving and handling activities were not always carried out in a way that minimised risks to people and staff. Staff did not always position themselves in a safe position when helping people who were in wheelchairs. Nor did some staff always assess if the way they were going to assist a person with their mobility needs was the most safe and suitable way. Audits carried out by the registered manager had picked up a need for more training for some staff in safe moving and handling techniques.

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Six people told us that one staff member allegedly spoke in a manner that could seem abrupt and abrasive. This was bought to the attention of the registered manager. The registered manager said they would be taking appropriate action. The registered manager contacted us after our visit and told us they were addressing the concerns.

When health and safety risks to people were identified, suitable actions were put in place and followed by staff. This was to minimise the risk of people being harmed when receiving care. The risks of abuse to people were minimised, as staff were competent in their understanding of abuse. The team were trained to know how to report concerns correctly. People told us they felt safe and secure at the home. They said that staff were kind and respectful towards them.

People had their needs met by enough suitably qualified staff. Staff provided people with care that met their needs. The numbers and skill mix of staff deployed at any time of the day or night meant peoples’ needs were met in a timely manner.

When people had the capacity to, they were encouraged to be included in making decision deciding how they wanted to be cared for. There were effective systems in place that helped ensure staff obtained consent to care and treatment in line with legislation and guidance. When people did not have capacity to consent, their care needs were assessed in line with The Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and the how to act in someone’s best interests.

People said that they liked the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs.

People who lived at the home and the staff had built up positive and caring relationships. This also extended to include relatives and friends.

People told us how much they liked the programme of regular one to one and group activities that took place in the home. People told us they liked the entertainers who performed at the home on a regular basis.

The provider had recently introduced a new system for staff to record all care activities on their own data protected individual i-pads. This was proving to be a very effective way to monitor the delivery of care. For example, the amount of fluids, when a person had been assisted to be moved , and what activities they had taken part in could all be easily monitored on the system . Trends were spotted by the recording system as well. For example, falls people may experience and the times they happened could all be easily seen on the electronic system.

Care plans were informative and guided staff so that they knew what actions to follow to meet people’s range of care and nursing needs. Staff knew what was written in each person’s care records. They knew how to provide care that was flexible to each individual and met their needs. Care plans were produced with people. The plans were kept under review to ensure they were up to date and reflected people’s current needs.

People were supported by a team of well trained staff. The staff had attended regular training and were developed and supported in their work. This helped them to improve and develop their skills and competencies. Staff received supervision that helped to ensure they were competent in their work. Staff spoke positively about working as a team and about the good moral that existed among them. Nurses were able to go on regular clinical training and updating of their skills. This was to help them know how to provide nursing care based on up to date practice.

People knew how to complain and make their views known .The provider actively sought the views of people and their families. Suggestions were acted upon and changes were made to the services when needed. Feedback about the home from people and others involved in their care was positive. Regular reviews were undertaken to see where improvements were needed and the service could be further developed. There were systems in place to monitor the service to ensure people always received care that was personalised to their needs.

Staff spoke positively of the management structure of the organisation they worked for. They said that the senior managers and the registered manager provided strong and supportive leadership. The staff team told us they were particularly well supported by the registered manager, who spoke positively about their role. Staff said they saw them every day and they were always there and helped them whenever they needed support and guidance.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence which supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and homely. There were enough staff on duty to meet the needs of the people living at the home. The care staff were supported by a team of registered nurses, one of whom was on duty at all times. The manager was available on call when she was not present at the home. The manager was supported by a director of nursing and staff told us that should the manager be unavailable at any time they would contact the director of nursing.

We saw the corridors were quite narrow for wheelchair use and there were small flights of steps throughout the building. These steps had lifts beside them to facilitate wheelchair users. The home benefited from two lounges. The larger lounge had a television on the wall and the chairs were arranged to facilitate conversations. The smaller lounge was furnished like a coffee-shop and there was a small shop selling chocolates, crisps and toiletries in the corner. Off the dining room was an inner court-yard. This was where people could smoke if they wished. It was sunny on the day of our visit and several people were enjoying the sunshine in the court-yard. There was decking that made it easy for wheelchair users to access the area. Above there was a large net suspended across the whole court-yard we were told that this was to stop the seagulls from entering and scaring people by trying to steal their food or 'bombing' them.

Is the service effective?

We found the service was effective because staff understood the needs of people and care and support was well planned. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. For example a member of staff told us that they knew one person liked to match their jewellery with their outfits. One person told us "I am very happy here." They went on to say that they had been living in a different care home and that they had been unhappy there. Another person told us that they had chosen The Seaton because of the home's "good ambiance."

We spoke with three professionals. One of them told us that they could "Leave people at The Seaton and go away knowing that they are well cared for and treated as individuals." Another said "I have confidence that The Seaton gives good care. One of my clients is physically better than they've been for years."

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us that they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person was unable to decide what they wanted to do. Staff helped them to walk to the court-yard and then back into the dining room. This was repeated several times. After lunch the chef chose to sit with some people to play a game of cards. It was a hot day and we saw staff making sure that people had enough to drink.

We spoke with one relative who said that the staff were "patient and caring." They went on to explain that their relative had settled into the home and had "become attached to the carers." Another relative told us "They are very caring, they care for (my relative) very well, they do everything for them. They are very welcoming to us". Another visitor explained that their relative had settled in very well and they commented that "there is always a lot of interaction between the staff and people."

Is the service responsive?

We found the service was responsive because records confirmed people's preferences and interests had been recorded and support had been provided that met their wishes. One person had a dog and the home had taken steps to enable the dog to remain with them. We saw evidence that people's spiritual needs were supported. We heard that complaints were made about a member of staff and we saw that the member of staff no longer worked for the home.

One visiting spouse told us that the home had made a cake for their birthday. The home had enabled them to celebrate with their spouse. One person had chosen to leave the home and move to another in order to be closer to family. They were just about to leave when we arrived. They told us that the home had helped and facilitated their move.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We found the service was well led because we saw staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us that they were asked for their feedback on the service they received and we saw that their comments had been displayed pictorially on one wall and in a report that was on a notice board outside the dining room. This showed that the home listened to what people told them and informed them what actions they were planning to take to address the issues raised.

One person living at the home, and one member of staff told us about a member of staff who did not have the right attitude to the work. We saw that the management had addressed the issue and when it could not be resolved the person had left their employment. Senior members of staff carried out regular verbal surveys of what people wanted and we saw that some of the suggestions were being implemented.

One visiting professional told us "I have a good relationship with the management. When I give advice they always do it. They always follow through. Good communication." They went onto say "I would put my mother here. I can talk to the management and we work well together."

One person who lived at the home commented that the home was "well run".

People told us they liked living at the home and felt well cared for. One person said, 'staff are very nice', another person said, 'The staff are very good here'. A third person said, 'I've settled in well here, they make everybody welcome'. Most people said they enjoyed the food at the home and their individual tastes and preferences were catered for. Health professionals said staff worked well with them and contacted them appropriately about people's health care needs.

We found people's care needs and risks were assessed. Care plans we looked at showed people were well supported with their care and treatment. We observed that staff interacted well with people, and were caring and compassionate. Staff responded to people's care needs at a pace that suited each person. Staff we spoke with knew about people's needs and how to meet them. People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard by undertaking regular training and updating.

Outcome 2 - Consent to treatment

Outcome 4 - People's care and welfare

Since that visit, we undertook another visit to the home on 17 July 2012, and observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services. However, we did not review these two outstanding compliance actions at that visit. This was because that inspection was part of a themed inspection programme to assess whether older were treated with dignity and respect and whether their nutritional needs were met.

We reviewed the information sent by the provider about the improvements made. We did not visit the home or speak to any people. We concluded from the information sent that the home was compliant with those outcome standards.