About the service:

Seton Care Home is a care home. People in care homes receive accommodation and personal care under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Seton Care Home provides a service for up to 12 older people. At the time of the inspection there were 8 people living at the service. Accommodation is provided over one floor and people have access to communal areas.

People’s experience of using this service:

• People told us they were very happy living at Seton Care Home, they felt safe. Staff were kind, caring and compassionate and knew each person well. They enjoyed working at the service and felt the registered manager was supportive and had an open-door policy.

• There continued to be systems in place to manage risks and keep people safe from avoidable harm. Staff gave people their medicines safely, followed good practice guidelines to help prevent the spread of infection and ensured health and safety was a priority.

• Staff respected people’s privacy and dignity and encouraged independence wherever possible There were enough staff on duty to provide support to each person in the way they wanted. Staff continued to receive training, supervision, guidance and support so that they could do their job well.

• People chose their meals and staff provided support in the serving of those meals. External healthcare professionals helped people maintain their health.

• People made decisions in all aspects of their lives and were fully involved in planning what they wanted to do.

• People were provided with opportunities to put forward their views on the running of the service. Staff understood the provider’s ethos and values and made sure that people’s lives were as comfortable and fulfilling as possible.

• The registered manager and staff team strove for continuous improvement, worked well with external professionals and ensured that people were part of their local community.

Rating at last inspection:

Good (report published 26 July 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

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

The inspection took place on Friday 11th June 2016 and was unannounced. The service was previously inspected on 15 June 2015 at which time it was found to be in breach of Regulation 12 because people who used the services were not protected against the risks associated with safe management of their medicines. We asked the provider to draw up an action plan setting out how it would address the concerns. At this inspection we found that the provider had made the necessary improvements and the service was no longer in breach of this regulation.

Seton Care Home is registered to provide accommodation for 12 older people who require personal care. On the day of inspection there were 10 people living at the service.

A registered manager was 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.’

People were safe as the service had comprehensive systems in place for monitoring and managing risks to promote people’s health and wellbeing.

There were suitable arrangements in place for medicines to be stored and administered safely.

There were sufficient numbers of staff with the relevant skills and knowledge to effectively meet people’s needs.

People were encouraged to exercise choice and control in their daily lives and were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported appropriately in accordance with current legislation.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Appropriate mental capacity assessments and best interest decisions had been undertaken. This ensured that any decisions taken on behalf of people were in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated codes of practice.

A choice of food and drink was available that reflected peoples nutritional needs and took into account their preferences and any health requirements. People were supported to maintain their health as had regular access to wide range of healthcare professionals.

Staff were caring and had good relationships with people and were attentive to their needs. People’s privacy and dignity was respected at all times.

People were treated with kindness and respect by staff who knew them well and who listened to them, respecting their views and preferences.

People were encouraged to follow their interests including religious practices and beliefs and were supported to keep in contact with their family and friends.

Staff enjoyed working at the service and were included in the running of the home.

The registered manager had robust systems in place to ensure the quality and safety of the service and to drive improvements and respond appropriately to complaints and feedback.

This inspection took place on 11 June 2015.

Seton Care Home is registered to provide accommodation for 12 older people who require personal care. There were 11 people living at the service on the day of our inspection.

A registered manager was not 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.’ A new manager had recently been appointed and told us they would be making an application to the commission to be the registered manager, as required.

Medicines were not always safely managed to ensure people received their prescribed medicines to meet their needs. The provider’s systems to check on the quality and safety of the service provided were not always effective in identifying areas where improvements were needed.

People were involved in planning their care. Care plans were regularly reviewed and included people’s preferences. However, improvements were needed to some areas of care planning so that staff had clear information on how to give people the care that they needed. The provider had a clear complaints procedure in place.

Staff had attended training on safeguarding people. They were knowledgeable about identifying abuse and how to report it. Recruitment procedures were thorough. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage any risks in relation to the running of the home.

People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People’s dignity and privacy was respected. Visitors were welcomed and people were supported to maintain relationships and participate in social activities and outings.

People were cared for by staff who were being provided with improving opportunities for support and training. Improvements were planned to the way people’s ability to make decisions was considered so the provider fully met the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People told us that they received the care they needed and this was provided in a kind and caring way by people working in the service. People had regular access to healthcare professionals. A wide choice of food and drinks was available to people that reflected their nutritional needs, and took into account their personal preferences.

People knew the manager and found them to be approachable and available in the home. People living and working in the service had opportunity to say how they felt about the home and the service it provided.

Our inspection team was made up of one inspector and answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. All people who used the service had received an assessment of their capacity and staff recognised the importance of choice and consent.

Staff recognised the importance of risk assessment and management with full involvement of the people who used the service and how this helped the service to continually improve.

The service was safe, clean and hygienic. Equipment was well maintained and audited regularly therefore not putting people at unnecessary risk.

The manager ensured the staff rotas were appropriately set to provide a safe and good quality service, taking people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs are always met. Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

The provider had ensured additional specialist staff were in post to ensure that people's pastoral and spiritual needs were met.

People’s health and care needs were assessed with their involvement, including writing of their plans of care. People said that they had been involved in writing their care plan and that they reflected their current needs.

People’s needs were taken into account at all times including enabling people to move around freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people while preserving their dignity. People commented; “I could not be in a better place, there is so much kindness here, the staff take the time and trouble to find out what we need and want, I really have no complaints."

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly and these were offered in keeping with the people's specific cultural and spiritual needs.

People knew how to make a complaint and told us they would have no hesitation to raise a concern.

Staff and people who used the service spoke with confidence at having their points for service improvements taken on board by the provider.

Is the service well-led?

The service had a regular auditing system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with four people who used the service and looked at two people’s records. We found that people’s right to make decisions and choice in their daily lives was considered and respected.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person said, “We could not ask for more or better. The care is great. The staff are excellent. They make the place really. You can ask them for anything and they will do anything for you.”

People told us they were provided with appropriate support in a safe way in line with their plan of care. Equipment was in place to promote people’s comfort and safety.

People were provided with a good choice of food and drinks. One person said, “We get gorgeous meals every day. Really you have no idea. It is beautiful and there are always fresh vegetables, fruit and salads. There is so much of it.” Another person said, “The food is very good. Yesterday, we had beef in red wine and it just melted in your mouth.”

A complaints procedure was available. People who used the service confirmed that they would feel able to voice any concerns and felt sure they would be listened to.

We met with all the people using the service during our visit of 11 July 2012. They told us that they were able to make decisions and choices about their everyday care and routines and that staff encouraged them to be independent. One person said, “They let me do what I can. I want to do that while I can, but if I need help they are there. They are great.”

People said that they felt safe and that they always had someone to talk to. They told us that they felt listened to and that staff respected their privacy and lifestyle preferences. They spoke in a complimentary way about staff and the way they did their job describing them as “wonderful” and “great”. People told us that they considered that there were enough staff to meet their needs. They said that staff responded quickly to requests for support.

People told us that they found the home comfortable and that they were happy with the quality of the care and service provided to them at the home. One person said, “We are very spoilt. We could not ask for better care.”

People with whom we spoke were satisfied with the standard of care they received at Seton Unit. They told us that this included their physical care as well as their emotional and spiritual well-being. Comments included "The care here is marvellous" and "We could not be better looked after" and "There is plenty to keep us busy" and "I enjoy the company and it is nice to look around and see others who are of the same vintage as myself.”

People using the service said that they had opportunity to express their views, be listened to and influence the service. They felt their choices and independence were respected such as in whether to continue to manage their own medicines. One person told us that a representative of the owner comes to the home every month and talked with them to ensure that they are satisfied with the service.

People told us they felt safe at Seton Unit. One person said "I do feel safe, both during the day and at night, and the staff have so much patience and are so kind." Another person said "We could say if we were not happy with anything and they would listen."

People with whom we spoke were very complimentary about the staff who work at Seton Unit. One person said "They are outstanding, they are always there and nothing is any bother." Another person said "I am enamoured by the quality of the staff and the quality of the care they give us." Another person added "That includes all the staff including the night staff, we could not ask for better."