This inspection took place on 05 and 06 June 2018. The first day was unannounced, which meant the service did not know we were coming. The second day was by arrangement.

We last inspected Seymour Care Home in October 2017. At that inspection, we found multiple breaches of regulations, the service was rated Inadequate and placed in special measures. At this inspection, we found no regulatory breaches and improvements had been made in each of the five key questions of safe, effective, caring, responsive and well-led. As a result of this, Seymour Care Home was removed from the special measures framework.

This service is a ‘care home’. People in care homes receive accommodation and/or nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Seymour Care Home is situated in the Clayton area of East Manchester and is registered with CQC to accommodate a maximum of 27 people. Care and support is provided to adults aged over 65, including those living with dementia. Accommodation is provided over two floors and there is a passenger lift.

At the time of this inspection, 19 people were accommodated at the service. This was because following our last inspection, the local authority had imposed an embargo on new admissions. However, at the time of publication of this report, the embargo had been lifted.

There was a registered manager in post at Seymour Care Home. A registered manager is a person who has registered with CQC 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 improvements had been made to ensure medicines were managed safely. This included systems for ordering, storage, administration and disposal. However at the time of our inspection we found there had been a lapse in the checking of medication stocks to ensure actual quantities in stock reflected the amount staff had recorded as being administered.

Based on the current number of residents, we were satisfied that staffing levels were sufficient to meet people’s needs. We highlighted with the registered manager the need to ensure a managed process for accepting any new admissions and that there were sufficient staff to meet people’s needs. The home had implemented a new dependency tool provided by the local authority and we were assured this tool would be used to assist in measuring dependency levels versus staffing establishment.

New and improved systems and processes had been introduced for the reporting and recording of issues related to safeguarding, protecting vulnerable adults and whistle-blowing. The management team and wider staff group fully understood their individual and collective responsibilities in this area. The registered manager was able to provide examples of good practice where the service had been proactive and acted decisively concerning safeguarding issues. The registered manager emphasised that safeguarding was now 'everybody's business'.

Risks to people at the home were regularly assessed and reviewed. General environmental and specific risk assessments were completed. We found risk assessments in place in the care files we reviewed around choking, falls, moving and handling, infection control, oral health and other aspects of personal care.

We checked the systems in place to protect people in the event of an emergency. We found that personal emergency evacuation plans (PEEPs) were in place for all people who used the service and a copy was kept in the staff office.

Significant improvements had been made which sought to ensure the service was working within the principles of the Mental Capacity Act (MCA) 2005. For example, new care planning documentation had been introduced, a ro

This unannounced inspection took place on 30 and 31 October 2017. The inspection was prompted in part following information of serious concern received from two whistle-blowers. The whistle-blower alleged physical, psychological and emotional abuse to seven people living at the home. Whistleblowing is when a person tells someone they have concerns about the service they work for.

We last inspected Seymour Care Home on 26 September 2016 when we rated the home ‘Requires Improvement’ overall. At that inspection we found a breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Need for consent. We issued a requirement notice to the provider to formally inform them of the reasons they were in breach of the regulations and to tell them improvements must be made.

At this inspection we identified ongoing concerns and breaches of the regulations. We found breaches of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care, good governance, recruitment, training and premises and equipment.

You can see what action we have told the provider to take at the back of the full version of this report. We are currently considering our options in relation to enforcement and will update this section once any enforcement action has concluded. As a result of our concerns, we requested and received an urgent action plan from the provider that detailed the immediate actions they would take ensure the safety of people living at the home. Furthermore, Manchester City Council Commissioning team have temporarily suspended all new admissions to Seymour Care Home until further notice.

Seymour care home is situated in the Clayton area of Manchester and provides residential care for up to 27 people. The vast majority of people are living with dementia. Accommodation is based over two floors and there is a passenger lift between the floors. At the time of our inspection there were 24 people living at the home.

At the time of our inspection the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 looked at the concerns raised and found the provider had not protected people from the risk of harm and abuse as some people were being unlawfully restrained as a means of managing their behaviour.

People within the service were not always safe. It was standard practice for sluice and laundry rooms in the home to be left unlocked, placing people at risk of harm by potentially coming into contact with hazardous materials. On the first day we noted a hoist had been stored on the ground floor corridor; this posed a potential trip hazard. We found no evidence to show the home’s passenger lift had been examined to ensure it was safe to use under the ‘Lifting Operations and Lifting Equipment Regulations’ 1998 (LOLER) .

People's medicines were not being managed effectively and we found a number of shortfalls. For example, we found the clinic room was warm and no room temperature recordings had been completed. The provider could not be assured medicines stored in the clinic room had not been compromised due to fluctuating room temperatures. We found that practices around administering medicines were also not robust and not safe and important information about people's medicines was missing. People were in danger of not receiving the right dose of the right medicine at the right time, as prescribed.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, th

This inspection took place on 26 September 2016 and was unannounced. At the last inspection in June 2014, we found the provider was meeting all the regulations we inspected.

Seymour care home is situated in the Clayton area of Manchester and provides residential care for up to 26 people.

At the time of our inspection the service 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 there were systems in place to protect people from risk of harm. There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA). Where people did not have the capacity to consent, the provider did not always act in accordance with the legal requirements of the MCA 2005.

We looked at records relating to the personal care the service was providing and found care was well planned and reviews involved the people receiving care and their families. Care was personalised and people were well supported. People received good support to make sure their nutritional and health needs were appropriately met.

At this inspection we found the provider had systems in place to protect people from the risk of harm. Staff understood how to keep people safe and knew the people they were supporting very well.

There was enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff were skilled and experienced to meet people’s needs because they received appropriate training, supervision and appraisal.

We observed some good interactions between staff and people who used the service and the atmosphere was relaxed. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People we spoke with told us they were aware of the complaints procedure and would have no hesitation in making a formal complaint if they had any concerns about the standard of care provided.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines.

Records we looked at showed there were systems in place to assess and monitor the quality of the service and the focus was on continuous improvement. However these were not always effective in relation to assessing people’s capacity. There was good leadership at the service by the registered manager which promoted an open culture.

We found a breach of 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.

During our visit, we spoke with three of the twenty one people who used the service. They shared some of their experiences at the home. Due to medical conditions, some people who used the service were not able to speak with us. We also spoke with two care workers, the provider, the manager and the deputy manager, the cook and one family member.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

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 saw people were being cared for in an environment that was safe and clean.

The people we spoke with who used the service told us they felt safe. One person said “I am well looked after.”

We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This meant the people who used the service were supported by staff who had the necessary skills and experience.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

We saw quality assurance questionnaires had been circulated to professional visitors. One had commented “They are professional, approachable and friendly.”

The home had received a food hygiene rating of 5 on 18th November 2013. This reflects the standard of food hygiene found on the date of inspection by the local authority, on a scale of 1-5.

Is the service effective?

People’s health, social and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly every month.

From the training records we viewed we found staff had received training to enable them to meet the needs of the people who used the service. Discussion with staff and examination of records confirmed a programme of training was in place so all members of staff were kept up to date with current practice.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the care they received and the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included “I am happy living here” and “I am very satisfied.”

Feedback we saw in a thank you card from a family member said “Thank you for all the care you gave her.”

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

Is the service responsive?

People’s needs had been assessed before they moved into the home. The records we saw confirmed people’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

We saw people’s rooms were spacious, light and clean. People had personalised their rooms with their belongings and furniture. There was a dining area and two lounges. All of these were clean, spacious and light. The gardens were large and we were told there were plans to make them more inviting. There were ramped entrances for easy access.

We saw large print and picture signage on all doors to communal areas, so that people who used the service could easily identify the rooms.

Is the service well-led?

We saw documentary evidence that the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, satisfaction questionnaires had been completed by people who used the service and their families and by professional visitors. We saw collated results for previous questionnaires but this had not yet been done for the most recently completed.

We did not speak with people using the service on this occasion. Following our inspection in August 2013 we required that the provider take action to ensure the security of medicines at the home. The provider subsequently submitted details of the actions they had taken to achieve this. The purpose of this inspection visit was to check how effective the actions taken were. We discussed the security improvements with the deputy manager and looked at the arrangements for storing medicines within Seymour Care Home. We observed that the actions taken meant that medicines were now being securely stored.

Those who were able told us they were supported to make informed choices in their daily lives and that they were respected by staff. However many of the people using the service were unable to make informed choices and decisions in their daily lives due to the impact of dementia type illnesses. Where people using the service did not have capacity to make their own decisions best interest meetings were held with people who knew and understood the person.

People living at the home (who were able to) told us that the quality of care provided was good. Comments made included:

“I am very happy here. I am well looked after and the staff are all very kind.”

“They (staff) help me with the things I can’t do.”

“The doctor comes to see me when I am unwell.”

Medicines were being stored securely in appropriate cupboards or the designated medicines fridge where appropriate to do so. However it was noted that security needed to be improved in respect of the two mobile medicine cabinets and the lock fitted to the door of the medicines storage room.

We found that people were being cared for in a suitable environment by adequate numbers of appropriately trained staff.

People using the services of the Seymour Care Home told us that they were treated well and were respected. They also said they were supported and cared for properly. Comments made included;

“All the staff have been very nice and kind.”

“The staff speak to me politely and with respect.”

“I decide what time I go to bed, when I get up and how I spend my time.”

“They (staff) are all very good. They knock on my door before they come in, ask me what I would like to eat, and ask me my views on about how I am being looked after.”

“I have been looked after superbly since I came here.”

We found that suitable arrangements were in place to keep people safe, ensure that staffing provision was adequate and appropriate and deal effectively with any complaints.

People using the service told us that they were they were being cared for and supported well by staff who spoke to them politely and respected their privacy and dignity. They also said that they were comfortable and happy at the home and that they enjoyed the food.