The service:

Sebright House Care Home is registered to provide nursing care for up to 40 elderly people whose primary care needs stem from dementia. The home has five beds contracted for ‘discharge to assess’ (D2A). People are placed in the home for six weeks under the D2A scheme and within that period they are either discharged home with a care package or discharged to a more appropriate care setting. There were 28 permanent residents and four D2A people living in the home at the time of our inspection visit.

People’s experience of using this service:

•The provider’s quality assurance processes had not identified shortfalls in the safety and quality of the service provided.

•Risk assessments were in place to manage risks within people’s lives, but there were gaps in the records staff completed to demonstrate how they minimised risks.

•There were risks in the environment, that the provider and manager had not identified or minimised.

•Whilst we were confident people received their medicines as prescribed, some practices around the management of medicines needed to be improved.

•Improvements were needed in making the environment suitable for the needs of people living with dementia, ensuring privacy was maintained and providing a homely place for people to spend their time.

•There were sufficient numbers of nursing and care staff on duty to keep people safe and monitor the communal areas of the home.

•Staff felt well-prepared for their role, because they had training in relevant subjects and spent time observing experienced staff before they worked independently.

• Staff understood their safeguarding responsibilities.

•People 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.

•People’s dietary needs, preferences and nutritional needs were assessed and known by staff.

•People were referred to other professionals to support their healthcare, but this was not always done in a timely way.

•Staff were warm, respectful and responsive towards people. They understood people’s concerns and anxieties and were quick to offer reassurance.

•Improvements were needed to ensure people were given opportunities to engage in activities and interests that were meaningful to them.

•The provider had appointed a new manager who was open and honest about the challenges within the service.

•The new manager had identified areas where improvements were needed and was working with other organisations and healthcare professionals to improve outcomes for people.

The registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Rating at last inspection:

Good overall with a rating of requires improvement in ‘well-led’. The last report for Sebright House Care Home was published on 17 September 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had not remained consistent. At this inspection the rating has now changed to Requires Improvement overall.

Enforcement:

Action provider needs to take (refer to end of report).

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 9 August 2016 and was unannounced.

Sebright House is a nursing home providing care and accommodation for up to a maximum of 40 people. On the day of our inspection there were 39 people living in the home. Eight of those people were living in the home on a ‘discharge to assess’ basis. Those people would be in the home for a six week period prior to discharge to a more suitable place of care. Most people living in the home have complex dementia care needs.

People’s bedrooms are situated on the ground and first floor of the building. There are three communal lounge areas and large conservatory.

This service was last inspected on 7 January 2015 and we found one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008. A breach was found because people who had their liberty deprived had not been appropriately assessed to determine whether the restriction was lawful under the Deprivation of Liberty Safeguards. At this inspection we looked to see if the provider had responded to make the required improvements in the standard of care to meet the regulations. We found they had and they were no longer in breach of the regulations.

This service had a registered manager in post at the time of our inspection. 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.

There were sufficient numbers of staff to provide the individual support people needed, and to manage the requirements of people with complex needs living together as a group. Staff were observant of people and communicated well to intervene and distract people when they became anxious, distressed or frustrated. Staff worked as a team to ensure people’s safety and promote their emotional well-being.

Staff were aware of their responsibilities for protecting people against the risk of avoidable harm and abuse. Staff knew about risks to people's health and wellbeing and followed plans to reduce those risks. Risk management did not impact on people’s wishes and choices.

People’s medicines were managed safely and only administered by qualified nurses or staff who had been trained and assessed as competent to do so. Staff followed best practice when giving people their medicines.

The registered manager and staff worked within the principles of the Mental Capacity Act 2005. They encouraged people to make as many of their own decisions as possible about their care and treatment, and understood the need to gain people’s consent before providing care and support. Where deprivations on people’s liberty had been identified, the appropriate authorisations had been submitted to the local authority.

Care staff received training which enabled them to confidently carry out their roles and nurses received on-going training to maintain and develop their clinical skills. Staff felt supported in their roles and said they received regular support and guidance. Staff were given opportunities to develop their careers and gain further qualifications to support their development.

Staff were kind, caring and respectful when they engaged with people. Staff knew people well, they had a good understanding of people's needs and were aware of changes in people's moods and behaviour that could indicate they may be unwell or upset. Staff provided verbal and physical reassurance to people when they became upset or distressed. Staff worked together to develop strategies to promote people’s health and wellbeing. Care plans were well structured and presented with easily accessible information. Plans were detailed and promoted personalised care.

There was a programme of activities which was displayed in the entrance to the home. However, the registered m

We visited Sebright House on 23 July 2013. During our visit we looked at how family members were involved in people’s choices in the home. We found that the provider had not consulted people or their relatives about significant changes within the home. People’s representative’s told us they were not always involved in the review of their relatives care and treatment.

Records to show cleaning regimes in the kitchen had not been completed and the provider was not adhering to the Hazard Analysis Critical Control Point plan (HACCP).

Concerns had been raised to us about the management of people’s money. The provider had not been able to produce financial records for people who lived at Sebright House for 2012 during our visit.

In August 2013, at our request, the provider sent us an action plan telling us how they were going to improve. They told us they had a relative’s meeting planned in September and had conducted a survey with people’s relatives to obtain their views about the running of the home. During this inspection we found a survey had been undertaken and the results had been analysed to see where any improvements could be made to the service.

We saw the manager had involved people’s families in decisions about the changes in the home and they had involved relative’s in the review of people’s care.

Kitchen records were up to date and audit’s had taken place to ensure all documentation was available for people to review regarding people’s personal monies.

People who lived at Sebright House were not always able to express their views of what it was like to live there. We spoke with three relatives to obtain their views on the care, welfare and treatment received by people at the home. We also spoke with the manager, managing director, operations director, catering manager, two care workers and a kitchen assistant.

We found that people and their relatives were not always consulted about changes in the home.

We saw staff were kind and attentive when they delivered care to people.

We looked at three people’s care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw people were offered food and drink to maintain their nutrition. We saw people were supported at mealtimes by staff if they needed assistance to eat their meal.

We spoke with two staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Staff told us they were well supported by the provider and had received a good induction programme.

We saw the home had systems in place to manage complaints.

We saw records were incomplete for cleaning regimes in the kitchen. The home was not able to provide us with expenditure details of people’s money for 2012.

We last inspected the service on 28 September 2012 and we found people’s dignity was not always being respected.

People’s care plans did not reflect the care, treatment and support to meet their needs.

We found safeguarding incidents were not recorded and training had not been provided to all staff in safeguarding vulnerable people.

We found care staff had not received the relevant training in the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLs), continence care or whistle blowing.

We asked the provider to make the necessary improvements. In November 2012, at our request, the provider sent us an action plan telling us how they were going to improve.

When we visited on 22 January 2013 we saw people were being treated with dignity and respect and care plans had been updated to reflect people’s current care needs.

We saw records had been maintained of safeguarding incidents by the home.

We also saw training had been delivered or had been arranged for safeguarding vulnerable people, MCA, DoLs, whistle blowing and continence care.

On the day of our visit we met with four relatives of people who used the service, spoke with three staff members and a senior manager.

People who lived at the home were not always able to tell us about their experiences of living at Sebright House and we therefore spoke with relatives to obtain their views on the service.

Relatives told us they were involved in the care and treatment of their family member. They told us their relative received care when they wanted it and made positive comments about the service and the care staff.

When we visited we observed poor practice of dignity and respect to two people who lived at Sebright House. We saw people's dignity was not protected when they were being moved around the home.

We saw some care plans had not been updated with changes to people’s health or risks to people’s care needs.

We saw that safeguarding incidents were being reported but they were not being investigated to identify ways of preventing further instances of abuse. Not all staff had received training in safeguarding, Deprivation of Liberties (DoLs) or how to care for people with challenging behaviour.

We saw the training records for care staff showed there was a lack of training provision. For example, training on how to deal with complaints or whistle blowing procedures.

We saw there were quality assurance systems in place which measured people’s satisfaction with the service provided by the home.

All the people living at Sebright House have dementia and were generally unable to give informed comments on the care and support offered at the home. However, the general demeanour of the people at the home indicated they were comfortable in their surroundings. There were lots of smiles and pleasantries from people. Where there were negative remarks, these were generally caused by the close proximity of someone else who was making a noise or noisy comments for reasons they could not fully understand. For example, one lady was unhappy at the noises being made by a person next to her, but was fine once this person was accompanied by staff elsewhere and both became more settled.

We spoke to the relatives of six people at the home during our visit. One person had concerns about aspects of their parent's care, but all other responses were generally extremely positive, with people feeling that their relatives were very well looked after.

Typical comments included; ‘first class care’, ‘a good crew’, ‘always tidy, well-presented’, and ‘no concerns, people wonderful’.

Overall, there was a positive and busy atmosphere prevailing in this home for forty people with advanced dementia and associated physical frailties.

The inspection took place on 7 January 2015. It was an unannounced inspection.

Sebright House is a nursing home providing care and accommodation for up to a maximum of 40 people. On the day of our inspection there were 31 people living in the home. There was one person who had been receiving respite care and was due to leave on the day of our visit.

People’s rooms are situated on the ground and first floor of the building. There are three communal lounge areas and a conservatory on the ground floor. There is a lift for people to access the first floor rooms including the bathroom/shower rooms although the bathroom was not in use at the time of this visit.

The home has 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.

The registered manager was not fully complying with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Records we looked at showed there were concerns about people’s capacity to make decisions. Although people had been assessed to determine how decisions could be made in their best interests, applications for DoLS were not always being made when they should be. We found two people were being deprived of their liberties without formal agreements in place which meant they were not meeting the requirements of the law.

We found the registered manager had not sent all the statutory notifications required to the Care Quality Commission relating to safeguarding people. These notifications inform us about incidents that affect the health, safety and welfare of people who live at the home.

People living at Sebright told us they felt safe. Care staff understood their responsibility to be observant at all times to keep people safe. They knew how to recognise abuse or poor practice and told us they would report abuse if they observed this happening. There was a risk assessment process in place to manage risks to people and help protect people from the risk of harm. This included plans for staff to follow in the event of an emergency such as a fire to make sure people were kept safe. These were not easily accessible to the emergency services if required.

People were provided with food that met their identified health needs. Some people needed to have their food and fluid intake monitored by staff due to their health condition. Records showed increased calorie diets were provided to those losing weight and at risk of poor nutrition.

People were supported to maintain their health and wellbeing through access to healthcare professionals. Care records and assessments contained detailed information to support staff in meeting people’s needs in a way they preferred.

There were suitable numbers of trained staff on duty to meet people’s needs. Everyone spoken with considered staff to be kind, caring and respectful towards them. We observed staff to be caring and supportive to people throughout our visit. We saw staff respecting people’s privacy and dignity when providing their care such as when they supported people to transfer from a wheelchair to a chair.

Visitors spoken with said they felt listened to and would feel comfortable raising any concerns they may have with the registered manager or other staff members. The provider obtained feedback from people and their relatives about the service to identify where improvements were needed to the quality of service provision. The resulting actions to be taken were not always clearly communicated to people and their relatives so that they knew their issues had been taken seriously.

The provider carried out checks on the quality of care and services to identify areas that required improvement. Some of the areas identified for improvement have been ongoing for some time.

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