About the service: Seale Pastures is a residential care home that provides personal care for up to 40 older people who may also be living with dementia. At the time of our inspection there were 23 people receiving a service.

People’s experience of using this service:

On our last inspection we identified improvements were needed with how the provider identified improvements, recognised and reported safeguarding concerns, managed medicines safely and made suitable applications to ensure restrictions were lawful.

On this inspection we saw improvements had been made in these areas. Further improvements were needed to ensure it was clear how capacity was assessed and to ensure people on respite care had a suitable care plan in place.

• People could make decisions about how they wanted to be supported. Where people lacked capacity, assessments had been completed, although clearer information needed to be recorded about how capacity had been assessed.

• Where people received respite care, a comprehensive plan had not always been developed to record how they wanted to be supported.

• Quality monitoring systems were now in place to ensure the quality of the service was monitored and improvements were made.

• People felt they were safe and had the right support and care from staff. Staff now knew how to raise concerns if they suspected people were being harmed or at risk of abuse. Staff were confident their concerns would be acted upon.

• Improvements had been made with how medicines were managed. There were safe systems in place to ensure people had their medicines as prescribed.

• People enjoyed their meals and their dietary needs had been catered for. Additional support was given to people who needed help or a had a specialist diet.

• Infection control measures were in place to protect people from the risk of infections.

• People could pursue their hobbies and interests. There were opportunities to take part in activities within the home.

• People felt there were enough staff to meet their needs and who treated them with respect and dignity.

• People felt that staff knew how to support them safely and had received training to develop their skills and knowledge.

• People received regular check-ups to maintain their health and when unwell, staff liaised with health care professionals to address their health care needs.

• People could raise concerns about the quality of the service and felt confident these would be addressed.

• The registered manager worked in partnership with health and care professionals to bring about improvements within the service.

• The registered manager notified us of significant events which helped us the monitor the action they had taken.

Rating at last inspection: Requires Improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection the service had improved their rating to Good overall.

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

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

The inspection took place on 22 January 2018 and was unannounced. Seale Pastures is a care home that provides accommodation with personal care and is registered to accommodate 40 people. The service provides support to older people who may be living with dementia. The accommodation at Seale Pastures is on the ground and first floor and there are three lounge areas and a dining room for people to use. A new small private lounge was being completed and the garden area was being landscaped with raised beds and a new seating area. The home is in a rural location and has a car park for visitors to use. There are no public facilities or public transport services within easy reach of the home.

Seale Pastures 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. At the time of the inspection there were 33 people using the service.

The service had a manager who had submitted their application to register with us. 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.

Seale Pastures was last inspected on 28 April 2016 and the service was rated as Good. On this inspection we found the service was now rated as Requires Improvement. This is the first time the service has been rated Requires Improvement. This was because people were not always protected from harm as staff had not always recognised where people may have been harmed and what actions to take to keep people safe. Medicines were not always managed safely; safe systems had not been developed to ensure people received their medicines as prescribed in case of any system failure of the electronic medicines system. Improvements were needed with how information was accessible for people.

We also found people were not always supported to have maximum choice and control of their lives as some applications to restrict people of their liberty had been made without ensuring that the person did not have the capacity to make this choice. The provider had identified that improvements were needed and further time and support was needed to implement these changes. We have made a recommendation about involving people in decisions about their care.

People felt the staff and manager were caring and treated them with respect and dignity. Staff understood the importance of treating people with kindness and compassion and enjoyed spending time with people. The staff knew people well and respected their privacy and dignity. People were confident that staff supported them in the way they wanted.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. People were happy with the standards of hygiene in the service.

People were supported to eat and drink and there was a choice of foods available. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed assistance, this was done in a caring and supportive way.

People knew how to make complaints. They were confident that the staff and the new manager would respond to any concern and they could approach them at any time. Complaints were managed in line with the provider’s complaints procedure and people were informed of any investigation and actions.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the prov

This inspection took place on 28 April 2016. The inspection was unannounced. Our last inspection took place in June 2014 and at that time we found the provider was meeting the regulations we looked at.

Seale Pastures provides residential care for up to 40 older people. On the day of our inspection 26 people were using the service.

The service had a registered manager. 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.

People were protected from the risks of abuse because staff understood where harm may be caused and took action to keep people safe. Where people were concerned about their safety they knew who to speak with. Staff supported people to understand any risks and enabled people to remain independent in a safe environment.

People’s medicines were managed to ensure they received their prescribed treatments safely. There were sufficient staff available to care for people and meet their needs and staff had training and support to improve their knowledge and enhance their skills. People ate food and drink that they liked and specialist diets were catered for. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. People had opportunities to be involved with a variety of activities and could choose what to be involved with and were treated with kindness, compassion and respect. People liked the staff who supported them and had developed good relationships with them. People maintained relationships with their families and friends and they were invited to join in activities with them.

Staff listened to people’s views about their care and people were able to influence the development of the service. People knew how to complain and concerns were responded to. The provider and manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us informed us of information that we needed to know.

As part of our inspection we spoke to two visiting families and five people who used the service. We also spoke to one visiting healthcare professional and three members of staff.

At the time of our inspection visit the home was being refurbished and was not at full capacity. On the day of the inspection 26 people were living at Seale Pastures House.

We considered all the evidence we gathered under the outcomes we inspected. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Recruitment practice is safe and thorough. All the necessary recruitment checks had been completed prior to staff commencing their employment at the home.

Medicines used at the home were stored and administered safely. We found a small number of recording errors for when medicines were administered and we bought these to the attention of the manager for further investigation.

Staff treated people living at Seale Pastures House with consideration, dignity and respect. One family member we spoke with told us, “I know staff treat my relative with dignity.”

Is the service effective?

People’s health care needs had been assessed and care plans were in place. Care plans and risk assessments had been reviewed regularly.

Plans had been made to deal with foreseeable emergencies and staff we spoke with told us they felt confident in following emergency procedures if needed.

Is the service caring?

Staff paid individual attention to people living at the service during any support given. One person using the service told the staff member supporting them, “You’ve been an absolute angel to me today, thank you for all you do.”

The manager had used the views of people using the service, their relatives, staff and other professionals to plan improvements to the service.

Is the service responsive?

Staff had a good knowledge of people’s care needs and we observed staff providing care in line with people’s care plans and risk assessments. We found any changes to people’s care needs had been identified and recorded.

When people living at Seale Pastures House requested help staff responded immediately.

Is the service well-led?

The manager used regular audits to check for any shortfalls in the service and to identify improvements.

We spoke with a number of people at the service and their visitors. They all told us they were pleased with the standards of the care provided. People told us they were included in choices made about them.

We saw people were well presented and appeared to be happy in their surroundings when receiving care.

One person told us “there are no bossy staff here everyone gets on well and staff are very helpful to me”.

One visitor told us “I am happy with the care provided for my parent. I find staff are very helpful when you ask them a question about the care provided”.

People commented on how they felt about the home. One person told us “I am well cared for and I could not ask for nicer staff”. Another person told us “I feel safe here”.

We spoke with a health care professional who told us they found staff to be very helpful and able to follow instructions. They told us they were regular visitors to the home and worked well with all the staff.

We saw the domestic staff not only kept the home clean and free from odours they also helped to make the beds as part of their duties to maintain the overall presentation of the home. We saw 2 people going out shopping with 2 staff. We were told they would have lunch out. On their return they told us they had “a lovely time”. We saw the preparation for a special anniversary being made by staff and by visitors for a special celebration later in the evening. People told us staff always made an effort to make them happy at the home.

We visited at different times of the day to ensure people’s choices were being considered at all times. We had received information of concern that people were not being given choices as to when they got up in the morning or went to bed. We visited the home in the afternoon and evening followed by and unannounced return early morning visit the next day.

Before leaving the home in the evening, we saw many people were still up for the evening. Some people were having a light snack of sandwiches and biscuits with a hot drink. One person told us they went to bed around 8.30pm and sometimes they would get up early. Two people told us they liked to get up early. On arrival at the home the next day around 6.20am we found six people seated in the lounge. Four other people joined them as part of their daily routine. They all looked comfortable.

One person told us they felt safe at the home. They said they made choices about what they wore as the staff helped them select their clothes. They were able to decide when they got up or went to bed and found staff supported them in doing so. They told us staff were polite and caring and regular care workers attended to them. They were not aware of agency staff being asked to provide cover.

We asked a visitor to the home if they felt people’s respect and choice was promoted. They said “the care workers are lovely, I am very pleased with the care provided and if I have any concerns I would go to the manager, she is always helpful”.