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.