The inspection took place on 11 December 2018, and was unannounced.

The last comprehensive inspection of the service was on 16 November 2017, when we rated the service requires improvement. We carried out a focussed inspection of the service on 21 June 2018 because we had received concerns about the service. We continued to rate the service requires improvement because we found it was not always safe or well-led.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of 'is the service safe?' and 'is the service well-led?' to at least ‘good’.

At this inspection of 11 December 2018, we found improvements had been made.

Seymour House-Northwood is a care home for up to 35 older people, some of whom may be living with the experience of dementia. 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. At the time of our inspection 32 people were living at the service.

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.

People living at the service, as well as their friends and relatives, were happy living there. They commented about the ''family atmosphere'' and told us they were well cared for. They said the staff were kind and caring. They had access to the health services they need, a range of different activities and told us their needs were being met. People were able to make choices about their care and the provider had acted within the principles of the Mental Capacity Act 2005 to make sure people consented to their care and treatment. People liked the food they were provided with, had a choice of what they wanted to eat and had enough to eat and drink.

The staff felt well supported. They liked the manager and told us they were invited to contribute their views about the service and felt listened to. The staff had access to a range of training and had regular meetings with their manager. There were effective systems to monitor staff performance and make sure they had the information they needed about their roles and responsibilities.

People were supported to meet their cultural and religious needs. The staff had not received training or information about how to provide an LGBT+ (Lesbian, Gay, Bisexual or Transgender) inclusive environment. The registered manager agreed that they would look into ways they could provide support for people to feel included.

The environment was appropriately designed, accessible and safe. There were checks on the building and equipment being used to make sure it remained safe. People had their own rooms with en-suite facilities. There was information for people on display, such as menus and when activities would take place.

People received their medicines in a safe way and as prescribed. There were procedures designed to safeguard them from the risks of abuse. People knew how to make a complaint and felt confident these would be responded to appropriately. Incidents and accidents were recorded and the management team analysed these to help prevent similar incidents from occurring in the future.

There were effective systems for monitoring the quality of the service and making improvements. The views of people using the service and other stakeholders were sought and used to help with improving the service.

This focused unannounced inspection took place on 21 June 2018.

We carried out an unannounced comprehensive inspection of this service on 16 and 21 November 2017 where we rated the key questions, is the service effective, is the service caring and is the service responsive as good. We also inspected the two key questions, is the service safe? and is the service well led? And rated these as requires improvement and overall.

This inspection was carried out to check that improvements to meet the legal requirement planned by the provider after our November 2017 inspection had been made. Their action plan had stated improvements would be made by 2 February 2018. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Seymour House Northwood on our website at www.cqc.org.uk.

We also carried out this inspection because we had received concerns relating to the recruitment and training of staff and the overall management of the service. This report includes our findings in relation to these topics.

Seymour House- Northwood is a ‘care home’. 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.

Seymour House- Northwood accommodates 36 older people in one adapted building. At the time of our visit there were 35 people using the service. Some people were living with the experience of dementia. The service did not provide nursing care.

On the 21 June 2018 we inspected the service against two of the five questions we ask about services: is the service safe? and is the service well led? This was because these two domains had been requires improvement at the November 2017 inspection and these were also linked with the concerns we received about the service. At this inspection we found that the service remained requires improvement.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this 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 2008 and associated Regulations about how the service is run.

Systems and procedures had not been put in place to ensure safe management of medicines to reflect current legislation and national guidance.

There were some systems in place to monitor and assess the quality of the service. However, these needed to expand to cover more aspects of the service and identify what was working well and where improvements needed to be made.

Risk assessments for individuals were in place to mitigate risks. There was no clear system for reviewing people’s risk assessments and this led to one assessment not being checked by the provider since August 2017. The registered manager confirmed they would re-check all risk assessments to make sure they were detailed and reviewed on a regular basis.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Overall people and staff felt supported by the registered manager, however, there had been the issues raised to us and some of the feedback from staff was less positive about how the service was managed.

There was a process in place for the recording of incidents but this information was not always reviewed

This comprehensive inspection of the service took place on 16 and 21 November 2017. The visit on 16 November was unannounced and we arranged with the registered manager to return on 21 November to complete the inspection.

Seymour House Northwood is a care home. 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 care home does not provide nursing care and accommodates up to 36 older people in one purpose-built property. Most of the people using the service are living with the experience of dementia. When we inspected, 33 people were using the service and three people were in hospital.

The service 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 provider had systems in place to keep people safe but some care staff did not fully understand these. This was because some care staff had difficulty reading and writing English. The provider and registered manager had taken action to identify English language classes for care staff and made arrangements for staff to support each other with the recording of the care they provided to people.

There were enough staff to meet people’s care and support needs and the provider carried out checks on new staff to make sure they were suitable to work with people using the service. However, they did not assess applicants' ability to communicate orally and in writing in English as part of their recruitment processes.

People received the medicines they needed safely and as prescribed. The provider assessed people’s healthcare needs and gave staff guidance on how to meet these. The service had good links with health care professionals and referred people to specialist services when needed.

The provider carried out checks on health and safety in the home and took action when they identified areas they needed to address.

Staff had the training and support they needed to care for people using the service.

The registered manager had a good understanding of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The provider did not deprive people of their liberty unlawfully.

People told us they enjoyed the food provided in the service. There was a varied choice of nutritious food and drinks.

People using the service and their relatives told us the care staff who looked after them were kind and caring. We saw staff were kind, caring and gentle with the people they supported. We saw they allowed people time to make decisions and offered them choices. People using the service told us that staff respected their privacy.

The provider assessed people’s care and support needs and developed person-centred care plans to meet these.

People told us they had access to and enjoyed the activities provided in the service.

People using the service and their relatives knew how to raise concerns and they told us they were confident the provider would take these seriously.

The provider had appointed a qualified and experienced manager who was registered with the Care Quality Commission. Staff told us they found the manager accessible and supportive.

The provider carried out regular monitoring visits to the service and developed an action plan to address issues they identified. The registered manager and staff carried out regular checks on quality in the service and identified improvements they needed to make.