Seymour House

Seymour House is a care home providing accommodation for up to 50 people older people. At the time of the inspection there were 34 people living at the home.

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

At the last inspection, the service was failing to ensure people’s safety was promoted, did not have effective governance systems and did not send the required notifications. As a result, there were found to be multiple breaches of regulations and was put into special measures.

At this inspection we found that the required improvements had been made and systems implemented to address the shortfalls had been effective. Therefore, the service is no longer in breach of regulations and will be taken out of special measures.

People felt safe and told us the staff were kind and helpful. Relatives felt the staff team were very good and they were happy with the care and support people received. People’s safety and welfare was monitored. The management team identified and resolved any incident or concern whenever they arose. Incident, events and unexplained injuries were recorded and investigated. Where needed, incidents were reported appropriately.

People were treated with dignity and respect. People and staff had good relationships and staff knew people well. Care plans had been updated giving staff the information to meet people’s needs. Records were reviewed to help ensure people’s needs had been met. Staffing was monitored and call bells audited to ensure staffing numbers were effective. Feedback from people and staff was that there was enough staff available to meet people’s needs.

Staff felt they had enough training and support to do their role and found the leadership of the management team to be good. Training relating to infection control and COVID-19 had been delivered. Staff knew how to reduce the risk of transmission of and worked safely in relation to COVID-19.

The recruitment process was robust, including all required checks to help ensure staff employed were fit to work in a care setting. Medicines were now managed safely and these were checked through an audit system. Governance systems needed to monitor and identify concerns had been developed and these had been effective in driving improvements.

Rating at last inspection

The last rating for this service was Inadequate (8 and 22 June 2021) and there were multiple breaches of regulation. The provider sent us an action plan stating how they would make the required improvements.

Why we inspected

We carried out an unannounced focused inspection of this service on 8 June 2021 and 22 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when. This was to improve Governance, safe care and treatment, duty of candour, Notifications of other incidents and safeguarding service users from abuse and improper treatment.

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 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.

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.

Please see the safe and well led section of this full report. 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 is a residential care home providing personal care to 45 people aged 65 and over at the time of the inspection. The service can support up to 50 people.

Seymour House accommodates up to 50 people across three separate floors, with shared washing facilities. On the ground floor there are three separate living and dining areas, an additional lounge, Kitchen and laundry room. The office is situated on the ground floor.

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

People were put at harm and were at risk of harm due to lack of safeguarding processes and effective systems in place to identify risks for people. Care plans and risk assessment did not identify fundamental information to ensure people were supported in a safe way.

Staff lacked knowledge in what their responsibilities were under safeguarding processes and as a result people were exposed to continuous risk of harm, For example, staff were unable to identify when people needs health care input for people who are at risk of pressure sores. Staff skills were not assessed and there were gaps in training for staff. People were subjected to unjustified restrictions and the registered manager had not ensured they considered the legal requirements to do this.

When people’s health needs changed staff were not equipped with the skills and confidence to know when health professionals needed to be referred to. We observed staff not being proactive in supporting people when they expressed, they were in pain or discomfort.

People were not always shown respect and dignity when being supported by staff and there was a lack of meaningful activities that people would enjoy. Some people’s bedrooms were not decorated or personalised.

Infection prevention control measures were not effective, and practices meant that people were at risk of infections. Staff did not use safe practices when using personal protective equipment. There was equipment including hoists, standing stools, pressure relieving equipment that was not safe to use.

Quality assurance systems were not effective and did not identify the issues we found. We were not confident there was an open and honest culture in the home.

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 (published 19 April 2019).

Why we inspected

We received a safeguarding concerns in relating to how people were being supported with wound management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service and it was decided to not inspect any other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection. We found evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people being harmed and at continuous risk of harm due to lack of processes and skilled staff. We identified a number of safeguarding concerns and the governance system was not robust to pick up where there were significant failings. The registered manager had not notified CQC where there were incidents of harm to people at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 is a care home. People in care homes receive accommodation and personal care under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Seymour House provides a service for up to 40 older people, some of whom may be living with dementia. At the time of the inspection there were 39 people living at the service. Accommodation is provided over three floors and people have access to communal areas.

People’s experience of using this service:

• Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people's medicines safely and to reduce the risks associated with the spread of infection.

• Sufficient numbers of staff were employed to meet people's needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet the specific needs of people using the service.

• People were supported to maintain good health. Staff made referrals to health professionals when required.

• People were provided with the care, support and equipment they needed to stay independent. Staff were kind and caring and had developed good relationships with people using the service.

• People were supported to maintain their health and had access food and drink based on their individual choice and preferences. People had access to a wide range of activities in the community and within the service, that reflected their specific needs and interests.

• Care plans were in place which guided staff to provide support that met people's needs which were in line with their preferences.

• People's privacy, dignity and rights were respected and upheld. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible

• Systems were in place to monitor the service, which ensured that people's risks were mitigated and lessons were learnt when things went wrong. There was an open culture within the service, where people and staff could approach the registered manager who acted on concerns raised to make improvements to people's care.

Rating at last inspection:

Good (report published 9 September 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

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

The service provides care and support to older people with a range of support needs, including chronic health conditions, physical disabilities, and those living with dementia. At the time of the inspection, 39 people were being supported by the service.

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 2008 and associated Regulations about how the service is run.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from avoidable harm. The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People’s medicines were managed safely.

Staff had regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. Where people did not have capacity to consent to their care or make decisions about some aspects of their care, this was managed in line with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives. People had adequate food and drinks to maintain their health and wellbeing. They were also supported to access other health services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. They were involved in reviewing their care plans. People had been provided with enjoyable activities and some had been supported to pursue their hobbies and interests outside of the home.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives other professionals and staff, and they acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements. Staff said that the manager provided stable leadership and effective support, and they also promoted a caring and culture within the service.

We found that the provider was meeting the standards we had inspected. People and their relatives had given their consent to received care and treatment that were safe and appropriate. There were suitable arrangements in place for the management and safe administration of medicines and all the required checks had been carried out before staff had been employed to work at Seymour House.There was a system for assessing and monitoring of the quality of service.

The provider and staff demonstrated they were aware of people's cultural needs and for ensuring equality and valuing diversity.

People told us that the quality of care was very good, and that there was always plenty of staff around to assist them. There was a variety of activities provided each day and activities were planned around people's individual abilities. This meant that everyone who wanted to be involved could be.

In each of the lounges there was a trolley laid with drinks and snacks and people were able to help themselves when required. A visiting relative said that they were happy that they had chosen this home, and that everything had met with their expectations and exceeded them.

On arrival we found most of the people who lived at Seymour house were in bed. We observed those people to be asleep in rooms that were appropriately lit and of a reasonable temperature. In some cases we noted that there was a light on to assist people with orientation if they were to wake. We noted that people were appropriately dressed for bed and had clean linen on their beds.

Several people were still awake and sitting in their rooms with a hot drink and a snack.

We looked at pressure care records for two people and noted they were required to be checked on a two hourly basis and these records had been completed appropriately. We observed that there were four members of staff on duty including a senior shift leader.

The home was warm, welcoming and well lit up for the time of night. Two people who lived at Seymour House told us they were well looked after and the staff were lovely.

We observed that in all the corridors, doors were labelled and had a picture to assist people with identifying where they were going. We noted staff were replenishing the snack trolleys in the lounges. The staff told us these were available at all times for people to help themselves when required.