Seabank House

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

We found the following examples of good practice:

There was a programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks and a negative lateral flow test.

Staff used personal protective equipment (PPE) and followed good guidance and practices. There was ample PPE available to the people living at the home and staff.

Staff were trained on how to manage the spread of COVID-19. People were encouraged to maintain social distancing and use face masks in the community where required.

Daily cleaning schedules were implemented by the care staff.

Staff supported people to access healthcare services.

Seabank House is residential care home providing personal care to eight people at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance.

This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was a period domestic style property. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other larger domestic homes of a similar size.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good.

People living at the home benefitted from individualised care and support. Seabank House had a relaxed and friendly atmosphere. People told us they truly thought of it as their home. There were no set routines and people’s choices dictated the course of the day.

The philosophy of the service was to empower people to develop their standing in their community. People were supported and encouraged by staff to be a part of both their local and wider community. The home was situated close to public transport links and good local amenities, meaning it was easier for people to access their community.

People received care and support from staff who were genuinely caring and compassionate and were supported by staff who were familiar to them. Many staff had worked at the home for a long time and had formed strong relationships with the people they supported.

Staff provided care and support in a dignified way and with consideration. Staff took care to encourage and maintain people’s independence as far as possible.

People were supported in such a way that allowed them 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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff were well supported in their role with appropriate training and supervision. Staff had also received additional training to meet the specific needs of the people they were caring for.

Checks and audits were carried out to determine the quality and safety of the care and support being provided. Risk to people was appropriately assessed and measures were put in place to support people safely, whilst still respecting their freedom.

Feedback about the management of the service from people, their relatives and staff was positive.

The registered manager and registered provider had met their legal requirements with the Care Quality Commission (CQC). They promoted person centred care and transparency within the service.

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

Rating at last inspection

At our last inspection, the service was rated "Good." (Report published June 2017).

Why we inspected

This was a planned inspection based on the rating of the last inspection.

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.

We undertook a focused inspection on 31 October 2016 to check that the provider had met our

requirements and completed the actions identified in the home's action plan. We saw that repairs had been undertaken that improved the safety of the environment and improvements had been made to the systems used to monitor the quality of care and services provided.

This inspection took place on 16 and 18 May 2017.

The home is a three storey detached building on the main road between Birkenhead and New Brighton. There is a bus stop outside. At the time of our inspection seven people lived at the home and another person sometimes had respite stays at Seabank House. The manager told us there were no plans to have any more people living at the home.

The home had a registered manager who was also the registered provider. 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.

It was evident during our visits that people were comfortable living at Seabank House and regarded it as their home. Two relatives we contacted were very positive about the home.

The manager ensured a homely environment and a relaxed atmosphere. The interactions we observed between staff and the people who lived at the home were respectful and positive. People were supported to be as independent as possible and to explore their interests and hobbies. They received support to make choices about their lives.

New staff members had been recruited safely. Training and supervision plans were in place.

People’s medication was managed safely and daily medication checks were carried out.

People’s care plans were individualised and provided guidance to staff to ensure people received the care and support they needed and were kept safe.

Monthly monitoring checklists were completed by the deputy manager and signed off by the manager. These identified areas needing attention.

This was a follow up to our unannounced comprehensive inspection on 1 and 8 April 2016. At that inspection we had found breaches of legal requirements.

This was because the registered provider had failed to ensure that the premises used were safe for the purpose of providing social care. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider had also failed to have effective quality assurance systems in place to monitor the quality of care and services provided to people. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We issued the provider with a warning notice in relation to the breach of Regulation 17. A warning notice is an enforcement action used by the Care Quality Commission to direct a provider to improve their service to meet requirements of a specific regulation within a set time period. We gave the provider until the 16 September 2016 to meet their legal requirements in relation to monitoring the quality of care and services provided to people.

We undertook a focused inspection on the 31 October 2016 to check that the service had met the requirements in the warning notice, completed the actions identified in the home’s action plan and had made the necessary improvements to meet their legal requirements. This report only covers our findings in relation to these topics. You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for ‘Seabank House’ on our website at www.cqc.org.uk’

Seabank House is registered to provide accommodation and personal care for a maximum of nine people who have a physical and or learning disability. The home is in a detached building in a residential area of Wallasey and has accommodation on the ground and first floors.

The home had a registered manager in place who was in attendance during 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 saw that actions had been taken and completed following our previous report and feedback from the local authority. Repairs had been undertaken that improved the safety of the environment at the home. Discarded items on the stairs between the first and second floors had been removed, the top floor had been taken out of use.

There had been improvements in the availability of equipment for personal hygiene and areas of the laundry had been refurbished.

There had been improvements made in the effectiveness of the systems at the home that the manager used to monitor the quality of care and services provided to people.

Seabank House is a residential care home for people who may have learning disabilities and autism. The home is in a three storey detached building. The home provides personal care and accommodation for up to nine people, with bedrooms on the ground and first floors. The first and second floors were accessible by stairs, the second floor was unoccupied. At the time of our inspection seven people lived at the home.

There was 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. The registered manager was also the owner of the registered provider. She told us she had been working as the manager of the home for 19 years.

From our observations and the care plans we looked at we saw that the registered manager had a person centred ethos and good relationships with people who lived at the home. We found that the registered manager’s approach to care was to ensure a homely environment for people and they had achieved this. The home had a laid back atmosphere; it was clear that people were comfortable living at Seabank House and treated it as their home.

People we spoke with either told us or indicated that they liked living at Seabank House. People were supported to be as independent as possible and to explore their interests and hobbies. We saw that people’s care plans were individualised and at times aspirational. They guided staff to listen to the person being supported and provided appropriate guidance to staff to ensure people were involved in and made decisions about their care.

However, we found breaches relating to; regulation 12 safe care and treatment and regulation 17 good 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 any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There had been concerns raised with the registered manager of Seabank House by the local authority environmental health and community infection control teams. These were concerns with regard to the maintenance of the home, the standard of cleanliness and the availability of appropriate equipment for cleaning and personal hygiene. At our inspection we found that improvements had been made in the standard of cleanliness at the home and the availability of personal hygiene equipment. There was evidence that further improvements were underway, such as painting and plastering and the home had taken recent deliveries of further hygiene equipment.

We identified a number of concerns with regard to the safety of the homes environment, some areas of the home required maintenance to make sure those areas were safe. Also the registered manager was unsure if recommendations they had received on recent health and safety checks had been looked at and the gas safety check did not cover all gas appliances. This meant the registered manager could not be sure the home’s environment was safe.

New staff members had not always been recruited safely. Background checks in respect of previous employer references had not been robust. There were also no systems in place to assess the training needs of staff or for documenting the training completed. We also found that there was no effective system in place to ensure that staff received appropriate support in the form of supervision and appraisal so that they were able to carry out their duties effectively.

Medication was administered safely. When medication was received by the home, we observed it was checked in safely. Medication administration records (MAR) were complete. However medication checks at the home were not effective. They did not record the stocks of medication, assess if the stocks of medication were sufficient or check if medication administration records (MAR) had been completed correctly. The checks had no way of showing what correct medication stocks should be. This meant that there were no adequate systems in place to check that medication had been given to people correctly.

One person required support with nutrition and hydration. Whilst it was evident that the person had received sufficient food during the eight day period of time that we looked at. There was no evidence that staff had oversight with regard to monitoring the person’s food and fluid intake to ensure it was within the guidelines set by health professionals.

Seabank House had quality audits which had been completed regularly by a senior member of staff. The registered manager had not signed off the most recent six audits. These audits had not identified the issues with infection control, cleanliness, health and safety, record keeping and medication concerns that this inspection and other outside organisations had picked up on. This meant that the system in place to assess and manage these risks was not effective. There was also no evidence of the registered manager using any information gained from these audits or any other checks to come to an informed view of the quality and safety of the service provided.

The support people received at the home promoted them making choices about their lives. The registered manager had arranged for people to be supported by independent advocates when they needed to make specific decisions in their lives. The registered manager had also recently put plans in place to assess the capacity of some people to consent to their care and had completed one capacity assessment. This needed expanding and further development to meet their responsibilities under the Mental Health Act (2005).

It was clear from our observations that people were relaxed living at the home and treated it as their own home. People didn’t ask permission or seek the approval of staff before doing things. People did as they chose and came and went around the home as they pleased, either deciding to have the privacy of their room or relax in the lounge downstairs. We observed that people were involved in day to day decision making at the home. We noticed this in regard to the food shopping, what was to be bought and who was going to go with the staff to the shops. The interactions we observed between staff and the people supported were respectful and positive which contributed to the friendly atmosphere.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

People were cared for in an environment that was safe, however there were areas that required attention including the d'cor in certain parts of the home. There was also a need for the home to have a thorough cleaning programme. There were enough staff on duty to meet the needs of the people living at the home and the manager was always available on call in case of emergencies.

Staff personnel records we looked at for training, supervision and appraisal informed us that staff required up dated training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of DoLS and had attended training. Looking at the policies and procedures the manager needs to ensure they are up to date. Staff were aware and understood when an application should be made, however they did require up to date training.

Is the service effective?

People told us that they were happy with the care and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. One person told us. "The staff are great here. I'm happy". Staff required up to date refresher training in moving and handling, infection control, safeguarding vulnerable adults and medication training to enable them to safely meet the needs of the people living at the home.

Is the service caring?

We spent time in all areas of the home where we observed staff to be kind and patient to the people who lived there. We saw that staff asked people living at the home what they wanted did not tell them but encouraged them in the right direction. One person told us "It's a good home and I like it here'. A member of staff told us 'We provide really good care and support to the people living here'.

Is the service responsive?

People's needs were assessed before they moved into the home. People told us that all staff were very attentive and understood what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs were recorded and care and support provided in accordance with people's wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they had completed customer satisfaction surveys, and if they were unhappy with anything staff would always listen. Staff told us they were clear about their roles and responsibilities. They said the manager always consulted with them before implementing changes to the management of the home and their views were taken into consideration. One member of staff said "We work together as a team so all of the people living here have a good quality of life; we provide good care and would not tolerate bad practice".

"It is great here, this is my family"

"I love it here, the staff are lovely; they look after us and help us"

"I'm very excited we are going to a party tonight"

"We've all got our own rooms and we get to do nice things; last week we went bowling"

When asked, both people responded that they felt safe and comfortable with staff and one person said "We have a new person, he's nice, I like him".

Staff we spoke with told us that they enjoyed working at Seabank House and felt like it was "one big family". We saw people being treated with respect at all times and they were included in decision making and encouraged to live as independently as possible. Staff had learned and understood how to communicate with everyone and everyone's views were sought at all times.

We saw evidence that the health and wellbeing of people living at the home was supported by all health professionals. People were taken to GP and outpatient appointments and other health professionals visited the home when necessary. There were systems in place to ensure that staff were employed and trained appropriately and a complaints procedure which encouraged complaints to be made and brought them to a satisfactory conclusion.

The training record for the staff team showed all staff had completed training around safeguarding vulnerable adults from abuse in the last 12 months. All staff interacted with the people in a manner that promoted their dignity and privacy.

A training schedule had been drawn up and implemented to ensure all staff received appropriate training to meet the needs of the people they supported.

We spoke with two people who used the service they raised no issues of concern about how they were supported or cared for.

We looked at team meetings, resident meetings and staff supervision records and found a range of issues were discussed. This was to ensure people's views and opinions were sought and acted upon.

The records held by the service about how the quality and safety of the service was monitored and reviewed were disorganised. This meant people may have been placed at risk of living in an environment where environmental risk were not being effectively monitored and supported.