Seeleys House Short Breaks Centre

Seeleys House Short Breaks Centre is a residential care home offering a respite care service for people with a learning disability and or physical disability. The service is registered to provide support to a maximum of 12 people. At the time of the inspection 4 people were staying overnight. Each person had their own room and access to communal toilet and bathroom facilities. There was access to an enclosed garden.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

People used their own communication system to show us and we understood from the actions or gestures that we saw from people they enjoyed staying at Seeleys House Short Breaks Centre. We observed lots of appropriate, professional interaction between staff and people. People were observed to be smiling, laughing and relaxed in the home.

Relatives described the staff as “excellent,” “approachable, caring, efficient, interested in who they are looking after,” “Professional and friendly”.

Right Support: The service gave people care and support in a safe, clean, well-equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

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.

Right Care: Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right Culture: People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

The staff and management team worked hard to create an inclusive, supportive and caring environment for people. The service was providing personalised care which promoted independence in people. Staff told us they enjoyed working at the service. Comments included, “Everyone who works at Seeleys is so passionate about care and constantly looking for ways for us to improve our client’s overall experience” and "I love working at Seeleys, I like that we get the opportunity to get to know our clients and spend quality time with them, they get to choose what they would like to do with us on a weekend and we have fun." A third member of staff told us "I like the fact that we have a diverse team and that each individual staff member brings something different, and we all help each other out. Any issues are dealt with in a timely manner through staff meetings and are usually easily resolved."

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 29 July 2019 ) and there were breaches of regulation. 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

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, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of 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 COVID-19 and other infection outbreaks effectively

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Seeleys House Short Breaks Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Seeleys House Short Breaks Centre is a residential care home offering a respite care service for people with a learning disability and or physical disability. People typically stay at the home between one and 14 nights. The service is registered to provide support to a maximum of 12 people. However, the service has decommissioned some rooms and had eight rooms available per night.

People’s experience of using this service:

We observed some positive and engaging interactions between people and staff. Relatives were complimentary about the improvements within the service. One relative told us “It is the best it has ever been”. Other comments included “My son has complex needs and is looked after very well”, “We are very pleased with the care he receives” and “We’ve always been pleased, absolutely” and “I know she is treated with kindness.”

People were not routinely protected from avoidable harm. One person, who was at high risk of choking, had been left unsupervised in the dining area. Risk assessments were not written or routinely available to staff to advise them on how they should support people safely.

The provider did not robustly ensure people’s human rights were upheld. The service did not always carry out mental capacity assessments or best interest assessment for restrictive practice.

The provider had put measures in place to monitor and improve the quality of the service. This included weekly improvement meeting with bi-weekly attendance by a director of the provider. Prior to each person being admitted to the service a pre-admission checklist was completed. This was to identify if there had been any changes to the person’s level of need. We found the processes in place did not always ensure people’s records were updated in a timely manner.

Improvements had been made to the environment and people’s experience of the service.

People were supported by staff who had been recruited safely and were provided with opportunities to keep their skills up to date.

People were protected from abuse as staff had received training and were confident to raise concerns to the local authority.

People were treated with dignity and respect. Staff were knowledgeable about people’s likes and dislikes.

People were supported to engage in meaningful activities. People went on visits to the local area, shops and cinema.

The provider facilitated coffee mornings for relatives to meet up and engage with peers. Systems were in place to seek feedback from people.

Rating at last inspection:

The service was rated Requires Improvement at the last inspection on 19 February 2018 20 February 2018 21 February 2018 (Published 30 May 2018).

Why we inspected:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

We found areas of practice where the provider was not meeting the regulations. These were in relation to the management of risk, quality assurance processes and ensuring people were supported in line with the Mental Capacity Act 2005. We found ongoing improvements were required to ensure the service had good governance.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will follow up with a further inspection of this location to check that the provider has achieved compliance in those areas in which this report highlights significant concerns. We have also asked the provider to submit an action plan which outlines what they will do to improve the service and by when.

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

Seeleys House Short Breaks Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides respite care. This means people often stay one or two nights. The numbers of people staying at the home during the course of inspection ranged from four to five. Seeleys House Short Breaks Centre is registered to care for up to 12 people and supports people with a learning disability and or physical disability.

We previously inspected the service on the 27 and 28 June 2017. We found breaches of the Health and Social Care Act 2008 (HSCA). We found people who used the service were not protected against the risk of unsafe or inappropriate care in regards to management of risks. We found people were at risk from the management of their medical condition, fire and medicine management. This was because records relating to the care and treatment were not accurate and up to date. We also found people were not supported in line with the Mental Capacity Act 2005 (MCA), as the service did not always assess people’s ability to consent to care. We took enforcement action to ensure people’s safety and ensure improvement occurred at the service. We served two warning notices to the provider following the inspection. A warning notice gives a date the service must be compliant by. The date the service needed to be compliant was 02 October 2017.

We found the service had complied with the warning notice in respect of the MCA. However we found on-going concerns about records management. We found a number of records were not accurate; there was a potential people could come to harm because of this. We found the provider had not made sufficient improvement in regards to record keeping.

We also served the provider with requirement notices for beaches of a further five regulations of the HSCA. We had concerns about people’s safety, as risk assessments did not always provide staff with sufficient information on how to minimise risks to people. There was a lack of systems in place to manage situations where potential abuse was identified. We found equipment was not always safe to use. We found the provider was not always operating in an open and transparent way. We asked the provider to send us an action plan detailing how they intended to improve the key questions safe and well-led to at least good.

At this inspection we found improvements had been made in safeguarding people from abuse, the use and maintenance of equipment, and the openness and transparency of the provider. For instance, the provider ensured they notified CQC of certain events when they were legally required to do so. However we found on-going concerns about the risk management within the home. We found potential risks to people were not always identified and managed. For instance there had been fire doors that had not closed routinely since November 2017. Although this had been reported and some work carried out to rectify the problem. On the inspection we found some fire doors were still not shutting fully.

The service did not always recognise practise that had the potential to restrict people’s freedom. We have made a recommendation about this in the report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘ Seeleys House Short Breaks Centre’ on our website at www.cqc.org.uk.

The service had 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.

We observed positive interactions between staff and people. We saw people were smiling and laughing with staff. Staff were able to share people’s likes and dislikes with us. It was clear the staff had developed a good working relationship with people.

We noted there had been an improvement in the access people had to activities of their choice. Relatives told us people had been to the seaside for a day trip, for picnics and had been supported to go to the local shops.

The service worked well with external health and social care professionals to ensure people’s needs were met.

The new management had stabilised the staff team and had developed accountability and professionalism to the home. They had sought feedback from people and their relatives on how the service could develop. The provider’s senior management team demonstrated a commitment to improving the service.

This is the second consecutive time the service has been rated Requires Improvement.

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.

This was the first inspection of the service since the provider registered with the Care Quality Commission (CQC) on the 5 May 2017 to provide accommodation and personal care. However, the service is not new. Previous providers managed Seeleys House Short Breaks Centre when it was called Seeleys House Respite Centre. The previous provider was supported by the current provider (Buckinghamshire County Council) to improve and then a decision was made for Buckinghamshire County Council to manage the service fulltime. We had concerns about the service under the previous provider.

Seeleys House Short Breaks Centre is a care home for adults living with a learning disability and or physical disability. The home provides respite care. This means people often stay one or two nights. On day one of our inspection eight people were staying overnight and on day two, seven people were staying overnight.

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. A manager was in post who had been seconded from another service until a new manager was appointed. They had submitted an application to become registered with CQC and at the time of the inspection the application was being progressed.

At this inspection we found the service was not well-led. Quality audits did not routinely highlight failings. The service did not have a current fire risk assessment. Buckinghamshire Fire and Rescue visited the service and had issued the provider with a deficiency notice. The provider had not ensured the building was safe to be used as routine maintenance was not carried out. No Legionella risk assessment was on site to review and no water sampling had been undertaken. Water temperatures recorded highlighted there was a growth risk of Legionella. However no remedial action had been taken. The provider has since commissioned urgent testing and has provided us with a copy of their risk assessment.

Risks to people were not always assessed, mitigated and prevented. This was because pressure sore risks and risks around the use of bed rails were not considered. Care plans did not always contain information about risks posed to people as a result of their medical condition or support required. For instance one person was a diabetic and staff had not received training or had any guidance on how to provide safe care to them. Other people were at risk of choking but the risk assessment did not provide a detailed management plan to ensure staff were consistent in managing that risk. The provider responded to our concerns and after the inspection we received confirmation of training and actions planned to improve risk management.

People’s human rights were not protected as staff did not fully understand the Mental Capacity Act 2005 (MCA). Staff did not always refer people who had restrictive measures in place to protect them from harm to the local authority (Supervisory Body) for an assessment of deprivation.

People were not supported to provide consent to care and treatment in line with the code of practice of the MCA. This was because consent was sought from family members who did not have legal authority to act on the person’s behalf. Where a person did not have a legal representative, decisions about their care should be made with relatives or professionals in the person’s best interest. There was a lack of understanding of the ‘best interest’ process.

People were at risk of not receiving person centred care. This was because care plans did not always refer to the person. A number of care plans we looked at referred to the person as X. Care plans provided an outline of people’s needs but some care plans lacked the detail as to how staff were to support them.

Records were not suitably maintained, up to date or fit for purpose. Some records were kept in a generic communication book, which made it difficult to have a full overview of what support people had received. People’s records were not always named, dated and we found information within two care files viewed related to another person.

Accident and incidents were not properly managed and filed appropriately. This meant accidents and incidents were not reviewed and action taken to prevent reoccurrence. Staff told us they had spoken with external agencies about incidents and accidents; however they could not demonstrate where that conversation had been recorded. This meant we could not confirm incidents or accidents had been managed appropriately.

There was a lack of managerial oversight and management of the service. Staff had been delegated tasks without adequate support and training to support them. For instance, staff had not received training on risk assessments or their keyworker role. Staff acting in a senior role had not received staff management training.

Staff were committed to providing a quality service and we recognised the work which had been undertaken to make improvements to the service. Staff spoke passionately about their work. We observed good team work throughout our inspection.

Staff had good knowledge of people’s needs, likes, dislikes and preferences. People had developed close relationships with staff. People appeared relaxed and happy in the company of staff. We observed mixed practice from staff and communication with people could be improved.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.