Archived: Seabrooke Manor Care Home

Seabrooke Manor is a 120 bed care home providing residential and nursing care. The service is divided into four units. Norman House and Belgae House provide nursing and residential care. Saxon House provides residential dementia care and Roman House provides nursing dementia care. On the day of our visit there were 90 people living at Seabrooke Manor.

On the days of our inspection there was 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 and associated Regulations about how the service is run.

During this inspection we found that improvements had been made. Although continence risk assessments had improved, risk assessments for behaviours that challenged were still not specific enough to enable staff to manage the risks appropriately. Care records we looked at were up to date with the exception of one aspect of care. Future decisions care planning was in progress but was still falling short as most plans were either not completed properly or just said, “not willing to discuss.” We recommend further guidance is sought on having difficult conversations.

Staffing levels were reviewed regularly. On the day of our visit call bells were answered in a timely manner. However prior and after our inspection we were told of incidents on Belgae Unit where non- permanent staff were not responding to people in a timely manner. We recommend that action be taken to ensure consistent skills mix is achieved on Belgae unit in order to deliver consistent, safe care delivery.

Improvements had also been made to the activities provided to ensure that people cared for in their rooms and people living with dementia had appropriate activities. Although significant progress had been made with further training for the staff on dementia care, time was needed to ensure all staff had attended the training, and were confident in effectively managing certain behaviours. Staff also needed further training to use the various resources available within the service to engage with people.

Improvements had been made to ensure equipment such as pressure relieving mattresses, hoists and slings were checked regularly to ensure they were safe to use. Topical medicines were now managed safely and there were completed “as required” medicines protocols on three of the four units. In addition units audited each other’s medicine management monthly using a generic audit tool to ensure that safe medicine management guidelines were followed.

People told us they were treated with dignity and respect and that they could receive visitors at any time. They told us most staff listened to their wishes and respected them as individuals by delivering care where possible according to their preferences. Staff had attended equality and diversity training and were able to explain how they applied this in their daily practice by promoting people’s individual choice.

Before care was delivered consent was sought. Staff understood how the MCA applied to their practice and were aware of the people with a current deprivation of liberty authorisation.

People were supported to eat sufficient amounts that met their needs. Where required input from other healthcare professionals was sought and acted upon to ensure people’s health was maintained.

There were appropriate recruitment checks in place to ensure that only staff who had undergone the necessary identity, occupational health, reference and disclosure and barring checks (checks to see if the applicant has a criminal record) were employed.

Staff attended training regularly and were supported by means of regular supervision and yearly appraisals.

There was a registered manager in place at the time of the visit. Staff were aware of their roles and responsibilities. There were still variable leadership styles on each unit, however staff from two units where we identified concerns at the previous inspection were moving away from task allocation towards person-centred care in order to support people effectively.

Quality assurance was monitored as feedback was sought regularly from people, their relatives and staff and acted upon. We saw action plans with specified timelines in place in order to improve the quality of care delivered.

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

' 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?

We spent time in all four units and observed how people were supported by the staff. We saw that staff treated people with respect and were kind to them. Relatives told us that they felt people were safe. One relative told us, 'I think about [my relative] all the time but I know they are safe here. The care is great.' Another said, 'I'm confident she is very safe here.' However, for some people, we found that their care and treatment did not reflect relevant research and guidance. It was not planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). When there were concerns about a person's ability to make a decision affecting their safety and welfare a mental capacity assessment had been carried out and a DoLS put in place. However, specific aspects of decision making had not been explored and some aspects of people's care and support may have been provided without appropriate consents.

We found that the provider had effective recruitment and selection procedures in place. Hence, staff were appropriately recruited to ensure that they were suitable to work with vulnerable adults.

Is the service effective?

People were supported to receive the healthcare that they needed. Records showed that people saw the relevant healthcare professionals. For example, we saw that referrals were made to the dietician when there were concerns about people's weight. The GP, dietician and tissue viability nurse were all involved in peoples' care when needed.

People's care needs were assessed and plans of care developed from these. Staff had a good understanding of people's individual and assessed needs and of individual preferences. However, updates to care plans did not always reflect relevant changes in the person's health and/or wellbeing.

Is the service caring?

Relatives and people who used the service were positive about the care provided by the staff team. One relative told us, 'They do look after her well.' A person who used the service told us 'The attitude of staff towards residents is very good.'

We observed that staff supported people where required and were respectful of their privacy.

Is the service responsive?

Care staff were able to tell us about peoples' needs and how they supported and cared for them. The service was responsive to their changing needs. For example, we saw that timely referrals were made to the GP when there were concerns about a person refusing their medication.

Is the service well led?

The service had a registered manager in post and a clear management structure that included a clinical lead and a lead person for each of the four units. Staff we spoke with said they felt that they received the support and guidance they needed to carry out their duties and to meet people's needs. We observed a daily meeting held by the manager with the heads of each unit and of ancillary services. At this meeting information was shared about issues, what was happening on each unit as well as any concerns with regard to ancillary services. This enabled the management team to monitor the service provided.

People were supported in being as independent as possible. One resident said, 'the staff help me, but sometimes I can do it myself.' Staff were described as being 'compassionate', 'caring' and 'professional'. One person commented in a letter to the home, 'staff spent time talking to my relative. It was a very hard time for the family but eased by the way we were all treated.'

Some relatives told us that residents can be left waiting for a while before they got support from staff. Several people thought that the home felt short staffed. However no one said that people's care and welfare was affected. The staff rota accurately reflected the staff members present on the day of the inspection. However we were unable to ascertain whether alternative staff were on duty to cover staff absences or extra tasks.

Staff were qualified, skilled and had the relevant experience to meet people's needs. They all received appropriate support and training.

There were suitable arrangements in place to ensure people using the service were safeguarded against the risks of abuse.

There were quality monitoring processes in place. The people using the service and their representatives were asked for their opinion of the home through meetings and a yearly survey. The people understood how to complain and any complaints were addressed appropriately.