The inspection took place from 30 October to 1 November 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Seymour House (Hartlepool) Limited is a ‘care home.’ People in care homes receive accommodation, nursing and 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 provides nursing care for up to 20 people who have mental health needs. At the time of this inspection there were 20 people used the service.

The registered manager has been in post for over 18 months. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 inspection in September 2017 we rated the service to be requires improvement in four domains. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to having safe care and treatment and having good governance systems in place.

We found during this inspection the provider had rectified these breaches of the regulations and the service had improved to a rating of good.

People were at the core of the service and included in all discussions. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, staff needed to ensure they consistently applied the principles of the Mental Capacity Act.

People and relatives told us the service was a safe place. The provider had reviewed the fire procedures and staffing levels to ensure there were sufficient staff should there be an emergency. Following this review, a small fire occurred in the laundry. This was contained and the night staff quickly evacuated the building. The attending fire officers had commended the staff efficiency.

People received their medicine safely. The provider was in the process of improving the treatment room and ensuring staff could call for assistance when in this room. In the interim the registered manager was ensuring staff had access to walkie-talkies so they could contact others, if needed. People were supported to access the support of health care professionals when needed.

People received a varied and nutritional diet that met their preferences. However, we discussed with the registered manager that they needed to ensure at least two healthy options were available each meal time and that those people at risk of under-nourishment were supported and encouraged to eat fortified meals.

People were protected from the risk of abuse because staff understood how to identify and report it. Accidents and incidents were analysed to identify trends and reduce risks. Lessons had been learned when incidents took place.

People spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well. People were engaged in activities and accessed the wider community.

Care records clearly detailed people’s needs. External visiting professionals had encouraged staff to produce a copious amount of risk assessments that often were not necessary, as this information was already contained in the care plan.

The registered manager and staff actively sought people’s views about the service.

New staff were appropriately vetted to make sure they were suitable and had the skills to work at the service. Staff were well supported and received the training and supervision they needed.

People told us they did not have any concerns about the service but knew how to raise a complaint if needed

The inspection took place on 7 August 2017 and was unannounced. Prior to this inspection we had received anonymous concerns related to night time staffing levels. We visited the service at 6am so that we could speak with the night staff. We visited the service for a second day on 7 September 2017, as when we first visited the new manager had been in the process of completing a full review of the service and was making changes so we wanted to see the impact.

At the last inspection on 6 June 2016, which was brought forward because concerns had been raised about staffing levels overnight, we found sufficient staff were on duty but the service was in breach of relevant regulations relating to providing person-centred care. We also found improvements were needed in four key questions; is the service Safe?, Effective?, Responsive?, and Well led?, and the service was rated Requires Improvement overall.

After the last inspection, the provider wrote to us to say what they would do to ensure compliance with the regulation relating to person-centred care.

At the two inspections prior to the one in June 2016, the service had also been rated as Requires Improvement and breaches of regulation had been found in both cases.

Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people who have mental health needs. At the time of this inspection there were 19 people in receipt of care at Seymour House (Hartlepool) Limited.

The home had not had a registered manager since February 2017. 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 manager was in post and told us they would be submitting an application to become the registered manager.

We found during this inspection the provider had rectified the breach of the regulations in relation to person centred care that we identified at our last inspection of the service. New care plans had been developed and were focused upon people’s individual needs. However, action was needed to ensure the current records were organised so immediate risks and changes in people’s presenting needs were not lost amongst the paperwork, and assessment information contained detailed information about people’s needs. The manager told us they were in the process of designing a new care record template and intended to introduce this during August 2017.

On the first day that we visited the service we found staff had not clearly identified risks and the action they were taking in the records. Also information about new risks did not provide specific details around how to address risks for people. When we revisited we saw staff had addressed this and ensured details about risk and other relevant information was contained in the care records.

The fire evacuation measures stated that the person in charge would be responsible for calling the fire brigade, liaising with them and checking that people had evacuated the building. The fire authority expects the provider to ensure sufficient staff are on duty to fully evacuate the building. Overnight a nurse and a carer were on duty, which was insufficient to ensure staff could adhere to the provider’s fire evacuation procedure and to meet people’s current needs. We asked the provider to immediately complete a comprehensive review of staffing levels and determine if these were adequate. Following our first visit the provider organised meetings with fire authority and commissioners to discuss staffing levels and they are in the process of determining how many staff are needed to support people safely overnight.

Medicines records supported the safe administration of medicines. Records were accurate and regular audits took place. These ensured any issues were dea

The inspection took place on 6 June 2016 and was unannounced. We brought this inspection forward as we had also received anonymous concerns related to night time staffing levels. We visited the service at 6am so that we could speak with the night staff. At the last inspection on 30 November 2015, we asked the provider to take action to make improvements to health and safety, recruitment for new care workers, training and quality assurance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to the provision of essential training for care workers.

Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people. The home provides care and support for people with mental health needs. At the time of this inspection there were 20 people living at Seymour House (Hartlepool) Limited.

The home 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.

We found during this inspection the provider had breached the regulations in relation to person centred care. New care plans had been developed but these lacked detailed information about the care people needed.

You can see what action we have asked the provider to take at the back of the full version of this report.

We found the provider had made progress with the actions identified following the last inspection. Health and safety checks were mostly up to date following the employment of an external professional. Action had been taken to improve the signage to inform people oxygen was being used in the building. Individual emergency evacuation plans required further development. Work commenced on developing these on the day of the inspection. No new care workers had been employed since the last inspection so no new recruitment checks had been required.

Additional audits had been introduced but the quality assurance process lacked a structured approach to ensure issues were identified and dealt with in a timely manner. We have made a recommendation about this.

The gas safety certificate check for the service was overdue. The registered manager arranged for this check to be completed during this inspection. The electrical installation certificate was unavailable to view, although other records confirmed the installation was satisfactory.

The required training outstanding from the last inspection had been completed. However, moving and handling training had lapsed and not been updated in a timely manner.

People gave positive feedback about their care. One person told us, “They look after me well”. Another person said, “Staff are champion. I have got used to it now. It’s alright, not bad. It is a room over my head.” We observed care workers were kind and caring.

People and care workers said the service was a safe place to live and work. One person said, “Oh yes I am safe here, the staff look after me so well.” One care worker told us, “People come and talk to us if they have concerns.”

Medicines records supported the safe administration of medicines. Records were accurate and regular audits took place. These ensured any issues were dealt with. Medicines were stored safely and securely.

Care workers knew about safeguarding adults and whistle blowing. This included how to report any concerns. One care worker commented, “We are open here, we do talk to each other. I would go straight to the nurse in charge or the manager. [Registered manager] is on the ball.” No concerns had been raised since we last inspected the service in November 2015.

Staffing levels were sufficient to provide the support people needed in a timely manner. One

The inspection took place on 30 November 2015 and was unannounced. We last inspected Seymour House (Hartlepool) Limited in August 2014. At that inspection we found the service was meeting all the regulations we inspected.

Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people. The home provides care and support for people with mental health needs. At the time of this inspection there were 20 people living at Seymour House (Hartlepool) Limited.

The home did not have a registered manager. Although a new manager had been appointed, they had not yet applied to register with the Care Quality Commission to become the 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.

The registered provider had breached regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008. This was because checks to protect the health and safety of people using the service were overdue. The registered provider did not have personalised guidance to support people in an emergency. The registered provider lacked a structured and effective approach to quality assurance to improve the quality of the service. Quality audits had not been completed recently.

Staff had not completed all of the training they needed to effectively carry out their caring role, such safeguarding, Mental Capacity Act and fire safety training. References were not available for some staff to confirm they were suitable to work with vulnerable adults.

You can see what action we told the provider to take at the back of the full version of the report.

People gave us consistently positive feedback about the service. They said they were treated with dignity and respect by staff who knew their needs well. One person told us, “The girls keep looking after me. I have been here a long time so they know me very well.” Another person said, “Staff call me by my name and always knock on my door, they treat me very well.” People confirmed they felt safe.

People were independent and had no restriction placed on them in terms of access to and from the service. Deprivation of Liberty Safeguards (DoLS) authorisations were not required for people currently using the service. People told us they could come and go as they liked, and were not restricted at all.

People told us they were free to make their own choices and decisions. One person said, “I can come and go when I want to, I do my own thing.” Another person told us, “I like it here; I can come and go when I want.” People described how staff had supported them to meet their religious needs by arranging for a local to priest to visit them at the home. Other people described how staff supported them to dress how they chose and to help them lose weight.

Risk assessments were in place to help keep people safe. Assessments identified control measures to help keep people safe, including accessing specialist medical support.

Staff knew how to raise concerns about people’s safety. One staff member said, “I would go straight to my line manager and voice my concerns.” Another staff member said, “I have not seen anything. Concerns would be dealt with very professionally and quickly, straightaway.” Safeguarding concerns had been reported to the local authority for further investigation.

There were enough staff to meet people’s needs in a timely manner. One person told us, “They are always about, in and out of here [lounge area].”

Medicines were managed appropriately. Medicines records confirmed people had received their medicines correctly from trained staff. Medicines were securely stored and locked away.

The registered provider had systems to log and investigate incidents and accident

We spoke with three people who used the service. They told us they were treated well, the staff were good and they had no complaints. One person said, “The staff are lovely, you do get to do what you want.” Another person told us, “I love it here, the staff are great.”

We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. We found that people were encouraged to be independent. One person told us, “I try to go out every day, I go to the shops on my own.” Another person told us “I go to church every Saturday.” This contributed to maintaining people's welfare and promoting their wellbeing.

We found that people who used the service had a choice of food and drink and this was readily available. One person told us, “The cooks are good, you get a variety. I had a lovely dinner yesterday.” Another person said, “We always talk about food at the ‘residents’ meetings.” We found that there was a choice of suitable and nutritious food and hydration to meet the needs of people who used the service.

We found that people were supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the home.

During the visit, we spoke with eight people who used the service. As this was a routine visit we asked people about the choices on offer; what the care was like; and what people thought about the staff. People told us that they really liked living at the home, thought the staff were good at their jobs and felt they could lead fairly independent lives. People said ‘’I go out everyday and the staff are excellent, as they even put a minibus on for me to go to the Post Office’’, ‘‘The staff are very easy to talk to and will always make sure I’m alright’’ and ‘’I have found that it is very pleasant and peaceful here, which has been such a positive for me’’ and ‘’The staff are excellent and know what’s what’’.

People told us that the service was run well and that the manager also owned the home so was very committed to making sure everything operated smoothly. We were told that recent work had been completed in the home to make sure all the rooms were single and that it was all redecorated. People said that they felt that all the staff were competent and supportive and ‘’The staff have supported me to deal with my worries’’, ‘’I’m helped to deal with things in such a good way’’ and ‘’The staff sit down with me and go through my plans to see how what needs to be done’’.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Seymour House (Hartlepool) Limited provides nursing and residential care for up to 20 people. The home provides care and support for people with mental health needs. At the time of this inspection there were 20 people living at Seymour House (Hartlepool) Limited.

This was an unannounced inspection. During this inspection we looked at all 23 key lines of enquiry (KLOEs). We spoke with nine people who lived in the home, four staff and the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We spoke with nine people, looked at the care records for six people and looked at records that related to how the home was managed.

We last inspected Seymour House (Hartlepool) Limited in May 2013. At that inspection we found the service was meeting all the regulations that we inspected.

People’s needs had not been fully assessed following their admission into the home. We also found that care plans were not written in a person-centred way and used language that people would find difficult to understand. Care plans did not evidence that people had been involved in developing them. The registered manager told us that they were already implementing a new format for care planning which would be more person centred.  

Care plans we viewed contained limited information to guide staff about the most effective care to meet people’s needs. For example, to ‘liaise with health professionals’ and ‘give medications.’ Progress towards achieving outcomes was difficult to measure due to the way care plans had been written. People’s care records were not recorded in line with recognised best practice.

The home’s approach to managing on-going risks was unclear. The provider had access to referral information about each person, including any potential risks. However, we found no evidence of a risk assessment tool that Seymour House staff would use to assess risks from the point of admission onwards.

We found that the service had clear expectations about how people should be treated. These had been documented into an ‘Expectation Card’ and made available to people who used the service. People said they felt safe living at the home and felt comfortable approaching staff if they had any worries or concerns. People told us they were treated equally and fairly.

Staff we spoke with had a good understanding of the needs of the people they were caring for. They also had a good understanding of how to keep people safe and knew how to respond to safeguarding concerns and behaviours that challenge. Staff told us they were well supported to carry out their caring role and could approach the manager with any concerns they had.

Staff told us that people in the home were currently able to make their own decisions. They understood when the Mental Capacity Act 2005 (MCA) may apply to people and how to respond should there be doubts about a person’s capacity to make decisions. Following the Supreme Court judgement about what constitutes a Deprivation of Liberty, the registered manager was in the process of assessing each person to determine whether a DoLS application to the local authority was required. So far no DoLS applications had been needed.

Most people who used the service felt there were enough staff to meet their needs in a timely manner. The registered manager told us that staffing levels were flexible and determined by people’s needs. The registered manager reviewed staffing levels as part of a six monthly quality assurance programme.

The provider had policies and procedures to ensure people received their medication from trained staff and in a timely manner. However, the service did not have an effective system to identify and investigate gaps in medication records. The registered manager carried out a range of checks to make sure the premises were safe, well maintained and clean.

People told us they felt the staff providing their care had the appropriate experience and skills. They said staff looked like they knew what they were doing.

Staff carried out routine checks of people’s health and supported them to attend appointments or if they needed to go to hospital. One person confirmed that staff supported them to attend the hospital every few months. However, we found no evidence that planned therapeutic interventions were taking place, such as group work, relaxation therapy and anxiety management. 

People were supported to meet their nutritional needs. People were assessed for the risk of poor nutrition. Staff said that there was currently nobody identified as at risk. Staff had a good understanding of people’s food likes and dislikes and ensured that they were offered things they liked to encourage them to eat. People were happy with the food they received and gave us only positive comments.

People said they were well cared for and that staff treated them well. They also said they were treated with dignity and respect. Staff described how they maintained people’s privacy and dignity and gave us practical examples of how they delivered care to achieve this aim. We observed that there were positive interactions and a good rapport between staff and people. Staff told us that they spent one to one time with people sitting and chatting, looking through newspapers, shopping or sorting out clothes and toiletries.

People were supported to maintain their independence. We saw that people accessed the local community independently and were encouraged to do things for themselves.

People had opportunities to give their views about the service through regular meetings and questionnaires. We found staff listened to people’s views and responded to their suggestions.

People were asked for their consent before receiving any care and support. They had the opportunity to be involved in a range of activities, such as trips out, the walking club, visiting family, card games, board games and entertainers.

There had been no complaints made about the service. However, there were systems in place to deal with any complaints received. People told us they were happy with their care and nobody raised any concerns or complaints with us during our inspection.

The values of the service were not fully embedded into service delivery as staff were unable to confidently tell us what they were. The service had an over-arching five year plan, which included specific objectives which included providing a well-trained, skilled staff team and promoting excellence in care practices.

There was a clear management structure in the home and people and staff knew who to go to if they had any concerns. Staff had the opportunity to give their views about the service including any suggestions they had to improve the service.   

People made mostly positive comments about the atmosphere in the home. One person told us that there could sometimes be a bit of tension between some of the people who used the service.

The provider carried out a range of checks and audits as part of a six monthly quality assurance programme. The registered manager was a visible presence around the home observing care delivery and speaking with people to encourage them to give feedback.   

The provider had policies and procedures in place to respond to any whistle blowing concerns and staff were aware of their responsibilities. Staff said the manager would act immediately on any concerns. There were systems to log any incidents and accidents that happened at the service. We found from viewing the log that action had been taken following any incidents or accidents to keep people safe.