OSJCT Seymour House 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. Seymour House accommodates up to 42 people in one adapted building.

This inspection took place on 11 October 2018 and was unannounced. We returned on 17 and 18 October 2018 to complete the inspection.

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. There was a manager in post who had submitted an application to be registered manager of the service. We will monitor this to ensure the provider meets the conditions of their registration.

Systems to assess and manage risks people faced were not effective. When plans were reviewed following incidents, staff did not always consider whether other actions were necessary to keep people safe. Reviews did not always include an assessment of why risk management plans had not worked or whether other measures were necessary to reduce the risks to the person.

Action had not been taken to manage the risks people faced from other people who used the service during periods of distress. Support plans for people had not been updated with information about the incidents or strategies for preventing similar incidents in the future.

People were not always supported to take the medicines they had been prescribed.

People had care plans in place, however, they were not always kept up to date as people’s needs changed. One person had a plan in which some sections had not been completed and one person’s plan contained contradictory information.

There were quality assurance systems in place. However, they were not effective and had not ensured improvements were made to the quality and safety of the service being provided.

The provider had not ensured they had always notified the Care Quality Commission of significant incidents in the home.

People said they felt safe living at Seymour House. We observed people interacting with staff in a confident and friendly way. People appeared relaxed in the company of staff and requested assistance when they needed it.

People told us they were treated well and staff were caring. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for support.

Staff received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training relevant to their role.

There were group and individual meetings for people to provide feedback about their care. People were confident any complaints would be investigated and responded to.

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

OSJCT Seymour House provides accommodation and personal care for up to 42 older people some of who are living with dementia. At the time of our inspection there were 42 people living at the Home.

The inspection took place on the 7 and 8 September 2016. The first day of the inspection was unannounced.

The service had a registered manager in post at the home. 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.

At the last comprehensive inspection in July 2015 we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because necessary records of assessments of capacity and best interest decisions were not in place for people who lacked capacity to decide on the care provided to them by the service. The service had not made all necessary applications to the local authority for Deprivation of Liberty Safeguards authorisations to protect people from being deprived of their liberty without lawful authority. The service did not always provide care in a safe way by taking all reasonably practicable measures to mitigate risks.

At this inspection we found the provider had taken action to address the issues highlighted in the action plan. There was evidence people consented to their care and treatment at OSJCT Seymour House and where people lacked capacity to consent, the necessary mental capacity assessments and best interest decisions were completed. Where needed deprivation of liberty safeguards applications had been made to the local authority. The service had taken actions to reduce risks where people had more complex needs, for example implementing food and fluid charts, making referrals to health colleagues and introducing assistive technology.

People’s medicines were not consistently managed safely. This was due to a new system in place which increased the risk of medicines errors occurring. The registered manager was aware of the concerns and was reviewing the new administering system. They had already been in discussions with the Order of St. John’s Trust before our inspection.

People and relatives spoke positively about the care and support they received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection, with people using the service not hesitating to seek assistance where required and sharing jokes with staff.

People spoke positively about the food choices and were supported to have sufficient food and fluids. People were offered a choice at meal times and where people did not want what was on the menu alternatives were available. There were plenty of drinks and snacks available during the day and night.

People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest other activities they would like to complete. In addition to group activities people were able to maintain hobbies and interests, staff provided support as required.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People told us they were regularly consulted about their care and they attended six monthly care review meetings.

Risk assessments were in place to s

At the time of the inspection there were forty-one people who used the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

During the day we spoke with seven people who used the service and one relative. We observed staff interaction with people and saw that staff and people had developed trusting relationships. People told us that staff treated them ‘very well’.

The home had been newly decorated and attention had been given to ensure that the walkways were light and airy and were not obstructed. We saw that people moved freely around the home independently and safely.

People's safety was promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively. Staff had attended safeguarding training and knew how to recognise and report abuse. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications have been submitted, appropriate policies and procedures were in place. All care staff had received training in the Mental Capacity Act and the application of DoLS.

Is the service effective?

People's needs were assessed and they told us that they were involved in planning their care. People told us that they were ‘very happy’ with the care and support they received. We saw from the care records kept in their home that people were involved in making decisions about their care and that these were respected by staff.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were identified and the support they received was meaningful and person centred. The daily records did not fully describe people’s emotional well-being. We asked the provider to note that recording the person’s emotional well-being was one indicator of the person’s physical health.

Is the service caring?

We observed that all staff treated people respectfully and were attentive and caring. All of the comments we received were of a positive nature and confirmed that people and relatives were happy with the support received. Support workers had sufficient information about people's needs and how they should be cared for. This included their preferences and the things that were important to them. The care records we looked at demonstrated that people were consulted about their care needs and that the service offered had been tailored to the individual.

Is the service responsive?

People's care had been reviewed regularly. Other agencies were consulted when there were changes to people's care. All those involved in the person's care were aware of changes so they could respond appropriately and consistently. The home had developed strategies to ensure that staff had the appropriate training in order to offer people the support they required.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service. The service had quality assurance systems in place so that the quality of service could be maintained and shortfalls could be identified.

The home had a clear staffing structure in place. Staff we spoke with were clear on their roles and responsibilities and there were defined reporting lines so all staff knew who to report to. Staff received appropriate support and development to enable them to competently carry out their role.

We had visited this home four times between October 2012 and November 2013 because we had continuing concerns about some standards of quality and safety. We were concerned that the home was not always adequately staffed to meet the needs of the people living there because the systems used to assess staffing levels were not effective. Record keeping did not provide assurance that people's needs were consistently assessed and met. Staff did not receive adequate training in essential subjects.

We returned to check whether improvements had been made in these areas. A new manager had been appointed in November 2013 and had been tasked with addressing the failings in the home. There had been no further admissions to the home since our last visit in November 2013 and the home had eleven vacant rooms. Staffing levels had been maintained and, with reduced occupancy, the provider was focussing on team building and staff training. Staff and people who used the service told us that they were much happier.

Record keeping had also improved. A comprehensive review of all care plans was almost complete. Further coaching and training was to be given to staff. Records were mostly completed to a higher standard and were accurate and up-to-date. Daily records were less task orientated and provided a greater sense of people's physical and emotional well being.

Staff told us they enjoyed working at Seymour House and felt well supported with training. Additional resources had been identified to provide training in a range of subjects. However records showed that there remained a significant number of training shortfalls and staff had not been receiving adequate regular supervision. We recognised that the frequent changes in management may have impacted on the home's progress in this area and acknowledged that efforts were now being made to address this.

We previously visited this home in April 2013. At that time staff told us the home was regularly under staffed and people did not always receive the care and support they needed. Staff morale was poor because they felt that their concerns were not listened to. We did not find evidence to corroborate these concerns but we asked the provider to investigate this.

In July 2013 we were contacted by three members of staff from Seymour House. They told us the home continued to be under staffed, staff were exhausted and morale was still poor. They were concerned that they were not able to meet people's needs. One staff member told us that they had forgotten to provide a meal to three people the day before because they were so busy.

We visited the home in response to these concerns. We spoke with seven care staff; they were all concerned about staffing levels. One staff member said "Residents are being neglected; some people have not had a bath for weeks."

We spoke with four people who lived at Seymour House and a relative, who also commented on staffing levels. One person said "there are not enough staff to look after the people here; another person said "the home is always short staffed so we have to wait."

We found no evidence that the home's manager had listened to staff concerns. Staff felt demoralised and exhausted. Despite assurances from the manager that the home was consistently fully staffed, we found this was regularly not the case.

We visited this home in October 2012. At that time we had concerns that some staff were not up-to-date with training in essential subjects. We also had concerns about the standard of record keeping. We could not be assured that people's needs were consistently met because records were not always complete.

We returned to the home to check whether improvements had been made in these areas. We had also been contacted by a whistle blower who told us that the home was regularly under staffed. They said that people were not receiving adequate support with their continence and other needs and that people who were confined to, or chose to stay in their rooms were not checked on a regular basis. They told us that staff did not have adequate skills or training to care for people with dementia. They also said that people were "calmed down with medication and they are now sleeping all day and night".

We did not find evidence to support the claim that people did not receive the care and support they needed but record keeping remained poor so we could not be assured that people's needs were consistently met. We found no evidence that people had been over medicated with the intention of 'calming them down', although our investigation of this highlighted some further record keeping concerns. Improvements had been made in training but there remained some shortfall in some essential subjects. Many staff felt that the home was under staffed and this had led to poor staff morale.

We spoke with five people who lived at the home. They told us they enjoyed living at Seymour House. They all spoke positively about the staff, who were described as “caring” and “hard working”. They told us that they were treated with courtesy and respect. They said they were able to make choices about how they lived their lives. They chose what wear, what to eat and when they went to bed or got up in the morning. Most people told us that they enjoyed their meals and that there was always enough to eat and drink. They said they could always ask for an alternative if they did not like what was on the menu. Some people participated in regular activities organised in the home.

People told us that when they used their call bells to summon assistance, the staff usually responded quickly. People told us that they felt safe and well cared for at Seymour House. They said they felt able to raise any concerns with staff and confident that concerns would be acted upon.

We looked at care plans and records. people's needs had been individually assessed and detailed care plans described how people's needs were to be met. However we could not be assured that people's needs were consistently met because records were not always complete.

We spoke with staff and looked at staff records. They told us they felt well supported and enjoyed working at Seymour House. However training records identified that a significant number of staff had not received recent training in mandatory subjects.

Seymour House is a purpose built care home service, registered to provide personal care for up to 42 older people. The home is situated in a quiet area with a pleasant secure garden. The service is part of The Orders of St John Care Trust; a large provider of care services.

The first day of the inspection was unannounced and took place over the 28, 29 and 30 July 2015.

The service had a registered manager who was responsible for the day to day running of the home and had been in post for approximately 18 months. 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 found that the service obtained people’s consent before care and accommodation were provided. However, the service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA) when people lacked the capacity to give consent to living and receiving care at Seymour House. This was in breach of Regulation 11 of the Health and Social Care Act (2008) Regulations 2014.

The MCA sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected in relation to consent or refusal of care or treatment. CQC is required by law to monitor the application of the MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require care home providers to submit applications to a ‘Supervisory Body’; the appropriate local authority, for authority to do so.

We found that the service had not made  approximately seven applications to the local authority for DoLS authorisations to protect people from being deprived of their liberty without lawful authority. This was in breach of regulation 13 of the Health and Social Care Act (2008) Regulations 2014. The process of making these applications was started by the service during the second day of the inspection.

Most of the risks to people receiving care at Seymour House were assessed by the service, and for the great majority of the time all reasonable steps were taken to keep risks as low as possible. However, we noted that for people who had more complex needs there were some areas where all reasonable actions to reduce risks had not taken place. This was in breach of regulation 12 of the Health and Social Care Act (2008) Regulations 2014. The service took immediate action in these areas for example: implementing a record of a person’s food and fluid intake, making referrals to health colleagues and introducing assistive technology.

You can see what action we told the provider to take about the breaches of the Health and Social Care Act (2008) Regulations 2014 at the back of the full version of the report.

People said they felt safe living at the home. Staff were aware of their safeguarding responsibilities and showed positive attitude to this, and also to whistleblowing.

The premises were safe, clean, homely and well maintained. There was an on-going programme of refurbishment and improvement for the home. Recent improvements included the redecoration of some people’s bedrooms and provision of kitchens for people and their friends and families to use. One family member had complimented the home on this, “The addition of coffee making facilities have made a great improvement as you feel you are able to be entertained by your relative as you would be in their own home.”

Checks of records indicated that reporting and recording of incidents and accidents took place. There was an effective system for auditing incidents and accidents that was used to improve the quality and safety of the service.

There were effective management systems in the home that provided staff with clear lines of responsibility and accountability. The service had systems in place to keep staff up to date with best practice and to drive improvement and promote safety. The service had effective systems in place to listen to people and respond to their requests. We have made a recommendation about more specific auditing of the service’s activities and compliance with the MCA which can be found in the well-led section of this report.

There was a complaints procedure in place; the service had received approximately three comments or complaints and many compliments this year. One relative wrote they were, “…impressed by the team’s compassionate knowledge of my mother’s minute to minute condition and ready smiles and humour.”

Staff acted in a caring manner; we observed they treated people with respect and asked before carrying out care. People who use the service were helped to make choices and decisions about how their care was provided. One person said, “They are lovely people and will do anything they can for you.”

Each person who uses the service had their own personalised care plan which promoted their individual choices and preferences. People were assisted to go out into the community to enjoy leisure time and also to attend health appointments.