Seagrave House Care Home is a residential care home for 84 older people living with dementia or physical disabilities. 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. The home is able to support people on a respite or permanent basis.

At our last inspection in May 2016 we rated the service good. This inspection took place on 8 May 2018 and was unannounced. At this inspection we found that the evidence supported an overall rating of good with improvements to the well led domain required.

We found that improvements were required to the way in which records were maintained, reviewed and actioned. We found that people regularly received good standards of care however, people’s records did not reflect the care that had been provided. Minor improvements were also required to ensure that auditing procedures adequately reviewed people’s care records to ensure they received care in accordance with their preferences.

This home is required to have a registered manager in post. At the time of inspection, the home had 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 2008 and associated Regulations about how the service is run.

People received their medicines safely and there were adequate numbers of staff available to support people with the care they required. Staff were knowledgeable about safeguarding procedures and these were reported and investigated appropriately. Infection control practices were in place and accidents and incidents were reviewed to ensure learning was implemented to prevent similar incidents occurring where possible.

People’s care needs were appropriately assessed and people’s nutritional and healthcare needs were effectively supported. People were supported to receive good support from other services and staff made efforts to ensure this was a fluid process for people who required additional support. Staff received regular training relevant to people’s care needs, and were adequately supervised and supported in their roles.

People were supported by kind and compassionate staff who took time to build positive and trusting relationships with people. People were encouraged to make their own choices and decisions and these were respected by staff. People’s dignity was maintained and people were supported to maintain relationships with people that were important to them.

People had care plans in place which accurately reflected their care needs and these were updated when people’s needs changed. Staff were knowledgeable about people’s preferences and encouraged people to join activities if they wished. People’s end of life care plans were discussed with people and their relatives to ensure this would be in accordance with their wishes. Complaints were investigated and outcomes were communicated to people.

Procedures were in place to receive feedback from people and their relatives and this was considered and actioned where necessary. People and their relatives were happy they could approach the registered manager and their feedback was listened to. Appropriate notifications were submitted to the CQC and the home’s rating was clearly displayed within the home.

Further information is in the detailed findings below.

This unannounced inspection took place on 23 May 2016. This residential care home is registered to provide accommodation and personal care for up to 84 people. At the time of our inspection there were 79 people living at the home.

There was not 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 2008 and associated Regulations about how the service is run. A registered manager had recently left the service, and an interim manager was in place supporting the home. A new permanent manager had been appointed and was in the process of having their background checks completed.

People felt safe in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times it was needed. There were sufficient staff to meet the needs of people who lived there and recruitment procedures protected people from receiving unsafe care from unsuitable staff.

People received care from staff that had adequate supervision and support from senior staff. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained risk assessments and risk management plans to protect people from harm. Individual plans of care provided staff with information on the measures required to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Care plans were written in a person centred manner and focussed on empowering people; personal choice, ownership for decisions and people being in control of their life. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

The home had an extensive quality monitoring system in place which reviewed the quality of care that people received. People at the home reacted positively to the manager and the culture within the home focussed upon supporting people’s health and well-being and for people to participate in activities that enhanced their quality of life. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

This unannounced inspection took place on 16 April 2015. Seagrave House is registered to provide accommodation and personal care for up to 84 people and there were 75 people living at the home at the time of this inspection.

There was not 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 2008 and associated regulations about how the service is run.

The registered manager had resigned in October 2014 and a permanent manager had up taking

up post in January 2015. In the interim temporary managements arrangements had been in place and the management systems needed to be re-established for the service to be fully operational.

Systems were in place for the obtaining, storing, administration and disposal of medicines. People generally received the medicines they were prescribed however there was a need to improve associated record keeping.

Risks to individuals due to behaviours that placed them and others at risk were not always appropriately assessed and managed. There was also need for the provider to consider the Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DoLS) to protect people from being unlawfully restricted.

People at risk of poor nutrition and hydration had their food and fluid intake closely monitored, however there was a need to improve the associated record keeping.

There was sufficient staff available to provide people’s care and support needs. Robust staff recruitment practices protected people against the risk of people being cared for by staff unsuitable to work in a care home.

Staff were provided with induction training and supported to keep up to date with changes in care practice through regular training updates.

The provider had reported safeguarding concerns and carried out investigations appropriately. The staff where knowledgeable about the safeguarding procedures and knew how to report abuse.

The staff treated people dignity and respect and ensured their rights were upheld and the care plans reflected people’s needs and choices. People were supported to engage in occupational and recreational activities according to their preferences.

The service listened to people’s experiences, concerns and complaints; they were taken seriously and responded to appropriately.

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.

The inspection was unannounced, which meant the provider did not know that we were coming. Our last inspection took place in December 2013, at that inspection there was no breaches in the regulations.

Seagrave House provides a service for up to 84 people who have care needs and who may be living with dementia. At the time of the inspection there were 84 people living at the home.

The home had a registered manager in post. ‘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.’

During this inspection we observed staff showing people respect and preserving their dignity. Staff were seen and heard knocking on people’s doors and waiting for an answer before they enter or saying who they were as they entered if no response was given on knocking.

Care plans we looked at showed that staff were provided with detailed information on how people’s care and support needs were to be met. This ensured that care and support was provided in a consistent manner to people.

We saw that people’s complaints had been responded to in line with the provider’s policy and that learning from them had taken place to improve the quality of the service for people living at Seagrave House Care Home.

Records showed that appropriate recruitment checks had been carried out to ensure that only suitable staff were employed to work with vulnerable people.

We found that the manager had taken appropriate action to ensure that people who could not make decisions for themselves were protected.

To ensure the quality of the service we saw a number of audits had been carried out and action had been identified and followed up and when required. Health and safety checks were carried out to ensure the environment remained safe for people who lived in the home.

A person who used the service told us, "This is an excellent home and I love it here.’’ Another person told us, "I like it here otherwise I wouldn't stay." One relative we spoke with told us, "The home is aesthetically beautiful, it's always clean. I am very happy with the quality of care and the staff. I have no concerns. If you are going to have a template for a home this is it." A relative of another person had a similar view. They told us, "The home is very impressive. The quality of care lives up to the appearance of the home."

We found from looking at care plans that people and their relatives or representatives had been involved in decisions about their care. People's care had been planned and delivered in a way that met people's individual needs and preferences. Our observations of staff were that staff were attentive to people's needs and treated people with dignity and respect. People had been supported to lead active lives through a wide range of home and community based activities.

Staff had been trained to understand the needs of the people they supported. Some staff had on occasions worked in excess of their contracted hours but they understood that the service had "put resident's needs first." Only staff who had been trained to handle and administer medications had done so. The service had effective arrangements for management of medicines.

The service had robust arrangements for assessing and monitoring the quality of care people received.