Archived: Seely Hirst House

The care home accommodates up to 38 older people, including some people who were living with dementia, in one adapted building. At the time of our inspection 27 people lived there.

People’s experience of using this service:

¿The provider had made improvements to the management of risk for falls and behaviours that challenge, fluid intake, infection prevention and control and cleanliness and the application of topical medicines.

¿This meant the provider was no longer in breach of Regulation 9, 12 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

¿However, the provider had failed to ensure equipment used to help people move had been inspected as required. Not all staff who administered medicines had had their competency checked in line with good practice recommendations and we found topical creams were not always stored securely in people’s bedrooms. They had also failed to ensure their systems and processes to assess and monitor the quality and safety of services and investigate complaints were effective. In addition, the provider had not always worked effectively with other professionals to ensure continuous learning.

¿This meant they were still in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

¿Risks in the environment, such as from legionella were monitored and checked. Risks associated with people’s healthcare conditions were identified and managed. Procedures were in place and followed by staff, to ensure infection protection and control practices were effective.

¿Sufficient staff were available to meet people’s needs and staff were deployed to ensure people received support in communal areas. Staff understood what actions to take to protect people from harm and abuse. The registered manager looked to learn from incidents and make improvements when things went wrong.

¿People’s needs were assessed and monitored and people’s diverse needs were supported. Policies and procedures helped to ensure care was delivered in line with current standards.

¿Staff received support and supervision to help them work effectively in their roles, although not all staff were up to date with the areas the provider had identified they required for their job role.

¿Staff made referrals to other professionals for their advice and guidance regarding people’s care when needed. People had access to other healthcare services as required.

¿People had choices of food and drink to help them maintain a balanced diet. Staff supported people with their meals and drinks when needed.

¿People liked their home and the premises had been adapted to meet their needs.

¿People felt cared for by staff. People’s views were taken into account when their care was planned. Staff took steps to ensure people’s privacy and dignity was respected. People’s independence was promoted.

¿People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿People received personalised and responsive care and enjoyed how they spent their time at the service.

¿People had experienced a variable quality of experience when they had made a complaint; plans were in place to ensure people received a consistent and robust response to any complaint made. Information was available on how to complain. People’s communication needs were identified and met.

¿ The registered manager was keen to ensure care promoted positive outcomes for people. The registered manager was considered to be open and approachable. People and staff felt listened to and had opportunities to be involved in the service; more information is in the full report.

Rating at last inspection:

At our last inspection, the service was rated as 'Requires Improvement' overall and 'Safe' was rated as 'inadequate.' (Published 12 September 2018). At this inspection we found the service had made some improvements and some improvements were still required. The overall rating for this service is ‘Requires Improvement’. This is the third inspection where the service has been rated 'Requires Improvement' overall.

Why we inspected:

This is a scheduled inspection based on the previous rating. The previous inspection found four breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. These were Regulation 9 (Person-centred care), Regulation12 (Safe care and treatment), Regulation 18, (Staffing) and Regulation 17 (Good governance).

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

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

Seely Hirst House was rated as requires improvement at our last inspection in August 2017. During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing, person centred care and governance. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was no registered manager in post at the time of our inspection. 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. The registered manager had been absence since March 2018 and left their post in June 2018. There was an acting manager in place and they told us plans were underway to recruit to the post of registered manager. We will monitor this.

During this inspection we found concerns about the safety of people living at the home. People were not always protected from risks associated with their care and support, such as falls. Risks associated with people’s behaviour had not always been effectively assessed or managed. Some areas of the home and equipment used in people’s care and support was not always sufficiently clean and hygienic. There were not always enough staff to ensure people’s safety. This had resulted in some staff using unsafe moving and handling techniques.

Overall, medicines were stored and managed safely and people received their medicines as required. However, topical creams were not always applied as prescribed. Systems were in place to protect people from improper treatment and abuse, at the time of our inspection several concerns were being investigated by the local authority safeguarding adults team. Safe recruitment practices were followed.

People were at risk of poor fluid intake or dehydration. Mealtimes experiences were not always positive and people were not always served the correct diet. Improvements were needed to ensure people were supported to have maximum choice and control of their lives. Staff had adequate training and supervision. People had access to healthcare and their health needs were monitored and responded to, there was detailed information about people’s health needs in their care plans. There were systems to share information between services to ensure care was person centred. The environment was adapted to meet people’s needs.

People did not always receive consistent, person centred support. Staff did not always respond to people’s distress and discomfort and did not always treat people in a respectful and dignified manner. Despite this, people told us staff were kind and caring in their approach. People were involved in day to day decisions about their care and support. There were links with local advocacy services to enable people to express their views if needed. People’s right to privacy was respected and their independence was promoted.

The home was not consistently well led. Systems to monitor and improve the quality and safety of the service were not always effective. Action was not taken to improve practice based on learning from incidents and care plans were not always updated as a result of incidents. Accurate and up to date records were not kept of people’s care and support and sensitive personal information was not always stored securely. Staff did not always feel valued or involved in the running of the home. Whistleblowing on poor practice was not promoted or supported by the provider. People and their relatives were involved in giving their views on how the service was run. The management team told us they were committed to addressing the issues found at this inspection.

The service had a registered manager in place at the time of our inspection. 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.

During this inspection we found that effective action had not always been taken to protect people from the risk of harm resulting from other people’s behaviour. The majority of risks associated with people’s care and support were managed effectively. However, we found that equipment was not always used correctly, but swift action was taken to address this.

People’s medicines were stored and managed safely and people received their medicines as prescribed. There were enough staff to provide care and support to people when they needed it and safe recruitment practices were followed.

Improvements were required to ensure that people’s rights under the Mental Capacity Act 2005 were respected at all times. Where people had capacity they were encouraged to make decisions about their care and support. People were supported by staff who had not always received adequate training. However, we did not see any impact of this during our inspection and staff we were competent and knowledgeable. Staff were provided with regular supervision and support.

People’s day to day health needs were met and they had access to specialist nursing advice. However, there was a risk that people may not receive appropriate support with specific health conditions as care plans did not consistently contain sufficient detail of people’s health conditions. People were supported to eat and drink enough and were offered choice, but we found that some improvements were needed to ensure staff provided people with assistance to eat in a timely manner.

Staff understood how people who used the service communicated and supported them to maintain their independence. People had access to advocacy services if they required this to express their views. Staff understood the importance of treating people with kindness, dignity and respect and we observed this in practice. People and their families were supported with care and compassion at the end of their lives.

Staff had a good knowledge of people’s need and people told us they received the support they required. People were provided with opportunities for social activity and were supported to access the local community. People’s diverse needs were recognised and accommodated. There were systems in place to gain feedback from people who used the service and to respond to and investigate complaints.

There were systems and processes in place to ensure the safe and effective running of the service. Staff felt supported in their roles and were confident to raise concerns or make suggestions about how to improve the service. Feedback and suggestions from people and their families was used to drive development and improvement at the service.