This unannounced inspection took place on 14 and 16 February 2018. 2 Seymour Terrace was previously inspected in August 2015 and was found to be meeting the regulations inspected at that time.2 Seymour Terrace is a small care home that provides accommodation, personal care and support to a maximum of four people of working age who are experiencing severe and enduring mental health conditions. 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. At the time of the inspection there were four people living at the home.
There was a registered manager in post at the time the inspection they were also overseeing another home owned by the same provider. An interim manager had recently been appointed by the provider to oversee the home in the registered managers’ absence and is referred to throughout the report as the house manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
The home’s quality assurance and governance systems were not always effective. Although some systems were working well others had not identified the concerns we found during this inspection.
Risks to people’s health and wellbeing were not always managed safely and the systems in place to minimise risks to people’s health and safety were not always understood by staff. For example, where guidance had been provided to reduce the risk posed by people smoking, it was not always known to staff or followed. This potentially placed people at increased risk of harm.
People did not have personal emergency evacuation plans (PEEP) in place. The purpose of a PEEP is to ensure staff know how to assist each person to leave the building safely in the event of an emergency. This meant staff did not have all the key information they needed to assist people to leave the building in the case of an emergency. Records showed that routine checks on fire equipment and premises safety were being completed
People’s rights were not always protected. Records for one person showed there were various restrictions in place, which prevented this person from leaving the home when they wished to do so. Records showed these restrictions were discussed with external professionals every three months as part of this person’s formal discharge arrangements. We found there was no legal basis or framework in place to support these restrictions.
We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found the home was not taking appropriate action to protect people's rights. For example, where the home held or managed people’s monies and/or bankcards, there were no mental capacity assessments to show that people did not have capacity to manage their own finances. There were no records to show the rationale for these decisions, or whether this was being carried out in their best interests.
We looked at the care records for people living at the home and found some people’s records were not written in a person centred way, contained outdated/ misleading terminology and did not always provide staff with sufficient detail to support the person’s needs. For example, people’s records contain references to ‘unescorted leave’. This would imply that there were times when people living at the home were not able to go out without some level of supervision or were restricted in some way. We discussed this with the registered manager who assured this was not the case.
People told us there was enough staff to meet their needs and keep them safe. We saw staff had time to spend with people on a one to one basis and support them to attend appointments, go shopping and socialise.
We have however made a recommendation that the provider uses a suitable tool to determine people’s level of dependency to ensure that staffing levels are sufficient to meet people’s assessed needs. There was no tool in place and staff told us the ‘Community’ had been slow to recognise the need for extra staffing when people’s support needs had increased.
People were encouraged and supported to engage with a range of healthcare services and staff supported people to attend appointments. People's support plans included details of their appointments and staff we spoke with knew people well. People received their medicines when they needed them and in a safe way. People were cared for and supported by staff who knew them well. Staff were kind, caring and treated people with dignity and respect. The registered manager and staff understood their roles and responsibilities to keep people safe from harm and protect people from discrimination.
People told us they had confidence in the staff supporting them and felt staff were well trained. Newly appointed staff undertook an induction programme and there was a comprehensive staff-training programme in place. Staff confirmed they received regular training, supervision and annual appraisals.
People told us they felt they had control over their lives. Staff explained how they empowered people to manage their own needs independently and supported them. People were encouraged to be as independent as possible with the planning, shopping and cooking their own meals. A large kitchen was freely accessible and well stocked with Tea, coffee and soft drinks.
People were encouraged and supported to maintain links with the community to help ensure they were not socially isolated. People’s support plans contained detailed information about people’s hobbies and interests. People had many different opportunities to socialise and take part in activities if they wished to do so.
People were aware of how to make a complaint and felt able to raise concerns if something was not right. People told us they were encouraged to share their views and senior managers regularly carried out unannounced spot checks and audits of the home. These included speaking with people who lived at the home in order seek their views, and auditing all aspects of health and safety.
People, relatives and staff told us the home was well managed, and described the management team as open, honest and approachable. Staff were positive about the support they received and told us they felt supported and valued by both managers.
The registered manager was aware of their responsibilities in ensuring the Care Quality Commission (CQC) and other agencies were made aware of incidents, which affected the safety and welfare of people supported by the home.
The home was clean, well maintained, and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations
2014. You can see what action we told the provider to take at the back of the full version of the report.