Archived: Seabourne House Care Home

Seabourne House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Seabourne House Care Home is registered for 48 people. There were 37 older people living in the home at the start of our inspection. People had a variety of care and support needs related to their physical and mental health. The majority of the people living in the home had needs associated with the impact of dementia on their health and well-being.

There was not a registered manager in post, which is a requirement of the service’s registration. 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 provider had acted to recruit to this role. The last registered manager had left the service in November 2018. An interim manager was in post and a new manager had been appointed.

We received concerns and allegations in relation to whether people’s needs were being effectively met and how well-led the home was. We reviewed this information and planned to carry out an inspection focusing on the questions, is the service safe? and is the service well led? During the inspection, we also identified that there were some issues related to oversight so we looked at all the domains to check the experience of care people were receiving.

Overall people’s rights were protected, however staff had mixed understanding of the application of consent and best interests decisions. The provider acknowledged this and had put measures in place to support staff.

Recording relating to some risks was not always robust. This meant the monitoring of people’s wellbeing and the risks they faced could not be achieved. This was addressed during our inspection.

People were supported to eat enough to obtain a balanced diet. People’s dietary needs were met although preferences were not always respected.

There were sufficient staff to meet people’s needs. Feedback from people and observations indicated that deployment needed to be reviewed and the provider committed to undertake this work.

Overall, people and relative’s complaints were taken seriously and used as an opportunity for learning and improvement. However, one complaint had not been fully responded to and one person’s concerns had not been fully addressed. The provider acted on this.

People’s needs were assessed and their needs planned for. Care plans had not all been updated to reflect changes to people’s needs and this impacted on meeting DoLS conditions. This had not impacted on care and staff were consistent in their understanding of people’s needs.

People were supported by staff who felt supported and valued their training. Staff had the support and training they needed to meet people’s identified needs.

People were supported by staff who promoted their independence and respected their dignity. People's independence and wellbeing was also enhanced by the design and environment of the home.

People received the care and support they needed and in the ways they preferred. Staff took the time to get to know people and their life and social histories. They used this information to help them understand the person and to provide appropriate care and support.

People were engaged with, and enjoyed, activities including individual and group activities. Most people and relatives felt that they were listened to and their views were considered and acted upon.

The environment was clean and well maintained.

There was a programme of quality checks and audits to monitor and improve the quality and safety of the service. The provider reviewed their processes in light of concerns identified and were transparent in their acknowledgement of learning. The registered provider took immediate action in response to the shortfalls identified.

Seabourne House Care Home is a care home without nursing for up to 48 people. It specialises in the care of people who are living with dementia. At the time of the inspection, there were 43 people using the service. It is located in a residential area of Bournemouth near the seafront. There are 45 bedrooms, which are situated on the ground, first and second floors; three of these rooms can accommodate two people. Most have ensuite toilet and shower facilities. The main lounge and dining areas are on the ground floor, but there are quieter lounges and a dining area on the second floor, and a seating area on the first floor. There is an enclosed garden to the rear of the property, with a small onsite parking area to the side.

Seabourne House Care Home is owned by the managing director of the Luxurycare Group, which owns three care homes in Poole, Dorset. Although not part of the group legally, it is treated as part of the group, overseen by the same senior management team and run in the same manner.

The service did not have a registered manager. However, the home manager had been in post since October 2016 and their application to register as manager was under assessment. This had been held up by some administrative issues and the registration was confirmed following the 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.

Staff and visitors spoke about the service having a family feel. There was a happy, friendly, welcoming atmosphere. Staff did not wear uniforms, which gave a sense of being homely rather than clinical. Staff and managers had got to know people well and to understand them. They greeted them with evident warmth and affection. Staff used information about people’s lives to inform how they provided care and to organise activities that were enjoyable and relevant. This information helped staff and managers to understand why some people who used to work in an office liked to spend time with what they perceived as paperwork, and why someone who had been a nurse needed reassurance that everything had been done and that people were comfortable.

The service was exceptional at helping people express their views so they understood things from their points of view. The way staff worked was underpinned by a recognised model of dementia care that sees people’s behaviours, including the way they communicate, as having meaning. In line with this model, staff were attentive to what and how people were communicating, even if people were not using words, and responded in a way that validated them. Staff spent time with people, making an effort to listen and understand them. For example, someone liked to sit in reception near the front door and the member of staff on reception spent time in conversation with them, as did other passing staff, even though the person’s words were not always clear.

The arrangements for social activities were innovative and met people’s individual needs. Meaningful activity was key. People and relatives spoke highly of the activities they were involved in, both at Seabourne House and in the local area. Group activities regularly included minibus trips to local attractions, such as garden centres and local beauty spots. There were special events from time to time, such as the Luxurycare Olympics. More recently there had been a Caribbean-themed day involving food, music, decorations and a local drummer, who brought in instruments for people to play. Three activities staff organised and ran individual and group activities based on people’s interests. They also kept track of what activities people had found particular benefit from.

The service played a strong part in the local community, where the manager was well known and was actively involved in building further links. People were encouraged and supported to engage with services and events outside of the service. For example, people and their relatives attended a dementia café held at a nearby care home. People often went to the local pub for drinks and meals. They had also gone to the nearby cliff top to watch the Bournemouth Air Show displays, and space had been made for residents to attend the turning on of the Southbourne Christmas lights in 2016. There were links with a theatre that held dementia-friendly film screenings and tea dances. Raffle prizes for special events were sourced from local businesses and local residents attended the service’s events, such as the summer fete. A local resident had completed a volunteer DBS check and they and their dog visited the service each week.

The vision and values of the service were person-centred, with people at the heart of the service. These were owned by all and underpinned practice. This was evident in the way people, their visitors and staff spoke about the service and the manner in which staff interacted with people. All of the staff and managers we met were positive about their work. A member of staff remarked on the “the ethics that come through the company, values – they really care”.

There was an emphasis on striving for improvement through reflective practice. The manager and director of care services reflected on accidents, incidents, complaints, safeguarding investigations, audits and inspections to consider how practice could be improved. This reflection and learning was recorded on ‘opportunity for improvement’ forms, introduced across the Luxurycare services to demonstrate and reinforce the provider’s ethos of continuous learning and improvement. Learning from this service and the other Luxurycare services was shared between the services.

The service provided outstanding end of life care. Staff took steps to ensure people who were at the end of their life experienced a comfortable and dignified death, involving GPs and district nurses as necessary. They supported families and friends of people who were dying, with empathy and understanding. The chaplain employed by the provider had run a course for staff and families about the bereavement process and how families could be supported. Staff designated as end of life champions had devised a ‘comfort box’. This contained items the person and their visitors might find comforting and helpful in the person’s final days. The idea had come about after staff needed to source these items quickly earlier in the year when someone had been approaching the end of their life. A locked cupboard had been set up in a quiet room for visitors who were spending time with someone at the end of their life. They were given the key so they could access snacks and drink making facilities as they wished, without having to locate staff.

The service was flexible and responsive to people’s individual needs and preferences, and people’s rights were protected because managers and staff acted in accordance with the Mental Capacity Act 2005. People and their relatives praised highly the care they and their loved ones received. The manager and director of care services kept up to date with best practice in dementia care and ensured this was adopted by the staff. The building and garden were adapted for people living with dementia, based on recognised good practice guidance.

People were protected from abuse and avoidable harm. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. People involved in accidents and incidents were supported to stay safe and robust action was taken to prevent further injury or harm. Medicines were managed and administered safely. Risks to people’s personal safety had been assessed and plans were in place to manage these in the least restrictive way possible. There were also risk assessments and action plans in relation to the premises, which were maintained in good repair.

Two inspectors carried out this inspection, arriving at the home at 5.07am. We found three care staff employed by the home and two agency staff on duty. One of these staff members was allocated to work one-to-one with an individual. The registered manager was present from around 7.20am and the provider and other members of the home's management team arrived later in the morning. There were 43 people living at the home on the day of our inspection.

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 that supports our summary please read the full report.

We considered our inspection findings to answer 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?

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. We found that one person's risk of malnutrition had been calculated incorrectly. This meant that the person had not been receiving all the interventions they needed, such as a fortified diet. It also meant that the air mattress on their bed had been adjusted incorrectly. Staff did not always assist people to reposition themselves at the intervals specified in their care plans.

Two people's cream administration records for June 2014 had gaps for several days. This meant that either the individuals had not had their creams applied or that staff had applied the creams but had not recorded this. This increased the risk of people developing pressure sores or their skin otherwise breaking down.

People had access to sufficient, suitable incontinence products, where they needed these.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People who use the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements. The provider responded appropriately to any allegation of abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS), which apply to care homes. The home met the legal requirements relating to DOLS. The management team were aware of a March 2014 Supreme Court judgement about DOLS. This judgement requires that people who are unable to consent to living in a care home have DOLS in place if they require continuous supervision and control and are not free to leave. People living at the home were subject to continuous monitoring of their wellbeing. Prior to the inspection, the home's management had notified us that DOLS had been authorised for one individual in April. One person's care file we looked at showed a recent application to the local authority to authorise DOLS for them.

People were protected from unsafe or unsuitable equipment. There was enough equipment to promote the independence and comfort of people who use the service. During the inspection, the owner placed an order for adjustable beds to replace beds with fixed metal frames that were too small for the mattresses. People were protected from unsafe or unsuitable equipment because the provider ensured that equipment was properly maintained. There were plans in operation to replace broken equipment.

There were enough qualified, skilled and experienced staff to meet people's needs. Prior to 8am, we heard call bells sounding frequently. One person rang their bell repeatedly and staff told them they would be with them shortly, resetting their bell on each occasion. We heard this person calling for assistance. They told us they thought they received good care but there were not always enough staff to help them. They said they did not feel that night staffing levels were sufficient to enable them to manage the challenging behaviours that people displayed. However, incident records and care records contained no indication that people displayed challenging behaviours that night staff were unable to manage. Managers had taken steps to ensure that staffing at night was sufficient to meet people's needs.

Staff received the training they needed to perform their roles safely and had opportunities to gain qualifications in health and social care.

Is the service effective?

People had access to meaningful activities during the day. We saw noticeboards with information about daily activities, such as visiting animals and trips out. During the inspection a visiting ordained minister conducted a church service and we observed that people participated as they were able; the minister told us that they visited the home regularly for similar services. The home employed two activities organisers and we observed that they spent time talking with people.

Is the service caring?

During the day staff addressed people respectfully and assisted them sensitively. We observed staff supporting people for a 45 minute period before and during lunch in the garden; all the interactions we saw were positive. This contrasted with some negative interactions we observed from staff during the night. For example, we saw a member of night staff take away the book a person had been looking at without asking, when they brought the individual a drink. Another person had a plaster cast on their broken wrist. We observed a member of staff holding the hand with the plaster cast as they led the person into the lounge. The staff member had failed to consider the individual's injury and that this might cause the person pain.

Is the service responsive?

Care and treatment was not always delivered in line with people's individual care plans. We saw an entry in one person's night care records that stated staff had applied cream to their skin. However, their care plan and medicines administration record made no reference to them having any creams prescribed. The registered manager informed us that the individual's skin was in very good condition. This meant that either the person had received treatment that was not prescribed or that staff had made an inaccurate recording.

Is the service well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. The provider took account of complaints and comments to improve the service. We saw that the registered manager had investigated complaints thoroughly and promptly. They had addressed the issues raised. Managers regularly sought the views of staff to monitor the quality of service that people received.

People that we spoke with were positive about the way the home was run and managed. People told us that staff were "nice" and the food was good and there were organised activities to keep them occupied. One person told us "The staff are very good, I would talk to the manager if there were problems".

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected from the risk of infection because appropriate guidance had been followed.

The provider had suitable quality assurance procedures in place to manage the health and welfare of people living in the home. People were able to comment on the service provided.

People living at Seabourne House were very positive about their experience of living at the home. No one had any complaints or concerns about how the home was run and managed.

We used a number of different methods to help us understand the experiences of people using the service. This was because they had complex needs which meant they were unable to tell us about their experience.

We used the Short Observational Framework for Inspection (SOFI). It is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We observed that people were in positive or neutral moods and frequently smiled with each other and staff. People freely approached staff and had good relationships with them.

Staff gently reassured and supported people when they became unsettled.

People who lived at Seabourne House benefited from thorough processes and procedures being followed when new staff were recruited, which meant they were protected from harm.

Medicines were prescribed and given to people appropriately.

We saw the home had a robust quality assurance system in place to ensure standards in the home were maintained.