Sebright House Care Home

Sebright House Care Home is registered to provide nursing care for up to 40 elderly people whose primary care needs stem from dementia. The home has five beds contracted for 'discharge to assess' (D2A). People live in the home for six weeks under the D2A scheme and within that period they are either discharged home with a care package or to a more appropriate care setting. There were 34 people living in the home at the time of our inspection visit.

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

Since our last inspection there had been changes in the management of the home. Staff spoke positively about the impact of the new manager and how the recruitment of new staff meant they had time to carry out their role and responsibilities. Staff told us they took pride in caring for people, and relatives spoke positively about the standards of care provided. However, audits needed to be improved to ensure they were effectively assuring the cleanliness, safety and quality of the environment.

Some people living at Seabright had dementia which required very careful and considered care planning to minimise the likelihood of distress. Staffing levels meant staff were able to be attentive to people’s needs and respond proactively when needed. Staff understood their safeguarding responsibilities and people appeared relaxed around them.

Individual risks to people had been assessed and risk management plans were regularly reviewed to ensure they were up to date. Medicines were stored, managed and administered in line with good practice guidelines.

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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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 requires improvement (published 18 April 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sebright House Care Home 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.

Sebright House Care Home is registered to provide nursing care for up to 40 elderly people whose primary care needs stem from dementia. The home has five beds contracted for 'discharge to assess' (D2A). People are placed in the home for six weeks under the D2A scheme and within that period they are either discharged home with a care package or discharged to a more appropriate care setting. There were 33 people living in the home at the time of our inspection visit.

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

Since our last inspection the registered manager had focussed on improving the home and quality of care provided. More robust auditing and checking systems had driven improvements in many areas, but audits of the environment had not identified some issues which could impact on people’s safety. The registered manager was responsive to feedback to improve service provision and was working towards an action plan to maintain the momentum for improvement.

The management of individual risks associated with people's care had improved but needed to be consistently reflected in risk management plans. There were enough staff with the appropriate skills, knowledge and experience to effectively and safely meet people’s needs. Staff had a good understanding of abuse and how to keep people safe. Medicines were managed in a safe way and staff followed good hygiene practices to minimise the risks of infections spreading.

Staff received training and support which helped them keep up to date with current practice and were encouraged to complete external qualifications to enhance their confidence. People's nutritional and hydration needs had been identified and assessed and they were encouraged to eat and drink enough to maintain their health. People’s healthcare was monitored, and health professionals were involved where necessary.

Relatives spoke of a supportive and caring staff team who took time to understand people’s individual needs. Staff had a caring approach which was patient and non-discriminatory. 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.

Improvements had been made in care plans to ensure they were more reflective of people’s individual needs, preferences and lifestyle choices. Staff had a better understanding of their role in meeting people’s social needs. They engaged people in activities they had an interest in, to make them as meaningful and stimulating as possible.

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 21 March 2019) and there were two 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

This was a planned inspection based on the previous rating.

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.

Sebright House Care Home is registered to provide nursing care for up to 40 elderly people whose primary care needs stem from dementia. The home has five beds contracted for ‘discharge to assess’ (D2A). People are placed in the home for six weeks under the D2A scheme and within that period they are either discharged home with a care package or discharged to a more appropriate care setting. There were 28 permanent residents and four D2A people living in the home at the time of our inspection visit.

People’s experience of using this service:

•The provider’s quality assurance processes had not identified shortfalls in the safety and quality of the service provided.

•Risk assessments were in place to manage risks within people’s lives, but there were gaps in the records staff completed to demonstrate how they minimised risks.

•There were risks in the environment, that the provider and manager had not identified or minimised.

•Whilst we were confident people received their medicines as prescribed, some practices around the management of medicines needed to be improved.

•Improvements were needed in making the environment suitable for the needs of people living with dementia, ensuring privacy was maintained and providing a homely place for people to spend their time.

•There were sufficient numbers of nursing and care staff on duty to keep people safe and monitor the communal areas of the home.

•Staff felt well-prepared for their role, because they had training in relevant subjects and spent time observing experienced staff before they worked independently.

• Staff understood their safeguarding responsibilities.

•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’s dietary needs, preferences and nutritional needs were assessed and known by staff.

•People were referred to other professionals to support their healthcare, but this was not always done in a timely way.

•Staff were warm, respectful and responsive towards people. They understood people’s concerns and anxieties and were quick to offer reassurance.

•Improvements were needed to ensure people were given opportunities to engage in activities and interests that were meaningful to them.

•The provider had appointed a new manager who was open and honest about the challenges within the service.

•The new manager had identified areas where improvements were needed and was working with other organisations and healthcare professionals to improve outcomes for people.

The registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Rating at last inspection:

Good overall with a rating of requires improvement in ‘well-led’. The last report for Sebright House Care Home was published on 17 September 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had not remained consistent. At this inspection the rating has now changed to Requires Improvement overall.

Enforcement:

Action provider needs to take (refer to end of report).

Follow up:

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

Sebright House is a nursing home providing care and accommodation for up to a maximum of 40 people. On the day of our inspection there were 39 people living in the home. Eight of those people were living in the home on a ‘discharge to assess’ basis. Those people would be in the home for a six week period prior to discharge to a more suitable place of care. Most people living in the home have complex dementia care needs.

People’s bedrooms are situated on the ground and first floor of the building. There are three communal lounge areas and large conservatory.

This service was last inspected on 7 January 2015 and we found one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008. A breach was found because people who had their liberty deprived had not been appropriately assessed to determine whether the restriction was lawful under the Deprivation of Liberty Safeguards. At this inspection we looked to see if the provider had responded to make the required improvements in the standard of care to meet the regulations. We found they had and they were no longer in breach of the regulations.

This service had a 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 and associated Regulations about how the service is run.

There were sufficient numbers of staff to provide the individual support people needed, and to manage the requirements of people with complex needs living together as a group. Staff were observant of people and communicated well to intervene and distract people when they became anxious, distressed or frustrated. Staff worked as a team to ensure people’s safety and promote their emotional well-being.

Staff were aware of their responsibilities for protecting people against the risk of avoidable harm and abuse. Staff knew about risks to people's health and wellbeing and followed plans to reduce those risks. Risk management did not impact on people’s wishes and choices.

People’s medicines were managed safely and only administered by qualified nurses or staff who had been trained and assessed as competent to do so. Staff followed best practice when giving people their medicines.

The registered manager and staff worked within the principles of the Mental Capacity Act 2005. They encouraged people to make as many of their own decisions as possible about their care and treatment, and understood the need to gain people’s consent before providing care and support. Where deprivations on people’s liberty had been identified, the appropriate authorisations had been submitted to the local authority.

Care staff received training which enabled them to confidently carry out their roles and nurses received on-going training to maintain and develop their clinical skills. Staff felt supported in their roles and said they received regular support and guidance. Staff were given opportunities to develop their careers and gain further qualifications to support their development.

Staff were kind, caring and respectful when they engaged with people. Staff knew people well, they had a good understanding of people's needs and were aware of changes in people's moods and behaviour that could indicate they may be unwell or upset. Staff provided verbal and physical reassurance to people when they became upset or distressed. Staff worked together to develop strategies to promote people’s health and wellbeing. Care plans were well structured and presented with easily accessible information. Plans were detailed and promoted personalised care.

There was a programme of activities which was displayed in the entrance to the home. However, the registered manager had identified that further work needed to be done to improve the range of activities provided and give more one to one time for people who were unable or chose not to engage as part of a group.

The registered manager and deputy manager both demonstrated a detailed understanding of the people who lived in the home and their individual mental and physical health needs. Staff had regular meetings where they talked about the service and information was shared. The registered manager valued staff and acknowledged their commitment to providing good quality care at the meetings.

The registered manager followed a monthly audit schedule to check that people received the care they needed. These checks had not identified some maintenance issues that needed to be addressed to ensure people's well-being and safety.

Records to show cleaning regimes in the kitchen had not been completed and the provider was not adhering to the Hazard Analysis Critical Control Point plan (HACCP).

Concerns had been raised to us about the management of people’s money. The provider had not been able to produce financial records for people who lived at Sebright House for 2012 during our visit.

In August 2013, at our request, the provider sent us an action plan telling us how they were going to improve. They told us they had a relative’s meeting planned in September and had conducted a survey with people’s relatives to obtain their views about the running of the home. During this inspection we found a survey had been undertaken and the results had been analysed to see where any improvements could be made to the service.

We saw the manager had involved people’s families in decisions about the changes in the home and they had involved relative’s in the review of people’s care.

Kitchen records were up to date and audit’s had taken place to ensure all documentation was available for people to review regarding people’s personal monies.

We found that people and their relatives were not always consulted about changes in the home.

We saw staff were kind and attentive when they delivered care to people.

We looked at three people’s care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw people were offered food and drink to maintain their nutrition. We saw people were supported at mealtimes by staff if they needed assistance to eat their meal.

We spoke with two staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Staff told us they were well supported by the provider and had received a good induction programme.

We saw the home had systems in place to manage complaints.

We saw records were incomplete for cleaning regimes in the kitchen. The home was not able to provide us with expenditure details of people’s money for 2012.

People’s care plans did not reflect the care, treatment and support to meet their needs.

We found safeguarding incidents were not recorded and training had not been provided to all staff in safeguarding vulnerable people.

We found care staff had not received the relevant training in the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLs), continence care or whistle blowing.

We asked the provider to make the necessary improvements. In November 2012, at our request, the provider sent us an action plan telling us how they were going to improve.

When we visited on 22 January 2013 we saw people were being treated with dignity and respect and care plans had been updated to reflect people’s current care needs.

We saw records had been maintained of safeguarding incidents by the home.

We also saw training had been delivered or had been arranged for safeguarding vulnerable people, MCA, DoLs, whistle blowing and continence care.

People who lived at the home were not always able to tell us about their experiences of living at Sebright House and we therefore spoke with relatives to obtain their views on the service.

Relatives told us they were involved in the care and treatment of their family member. They told us their relative received care when they wanted it and made positive comments about the service and the care staff.

When we visited we observed poor practice of dignity and respect to two people who lived at Sebright House. We saw people's dignity was not protected when they were being moved around the home.

We saw some care plans had not been updated with changes to people's health or risks to people's care needs.

We saw that safeguarding incidents were being reported but they were not being investigated to identify ways of preventing further instances of abuse. Not all staff had received training in safeguarding, Deprivation of Liberties (DoLs) or how to care for people with challenging behaviour.

We saw the training records for care staff showed there was a lack of training provision. For example, training on how to deal with complaints or whistle blowing procedures.

We saw there were quality assurance systems in place which measured people's satisfaction with the service provided by the home.