This unannounced inspection took place on 14 and 16 February 2018. 2 Seymour Terrace was previously inspected in August 2015 and was found to be meeting the regulations inspected at that time.

2 Seymour Terrace is a small care home that provides accommodation, personal care and support to a maximum of four people of working age who are experiencing severe and enduring mental health conditions. 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 the inspection there were four people living at the home.

There was a registered manager in post at the time the inspection they were also overseeing another home owned by the same provider. An interim manager had recently been appointed by the provider to oversee the home in the registered managers’ absence and is referred to throughout the report as the house manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The home’s quality assurance and governance systems were not always effective. Although some systems were working well others had not identified the concerns we found during this inspection.

Risks to people’s health and wellbeing were not always managed safely and the systems in place to minimise risks to people’s health and safety were not always understood by staff. For example, where guidance had been provided to reduce the risk posed by people smoking, it was not always known to staff or followed. This potentially placed people at increased risk of harm.

People did not have personal emergency evacuation plans (PEEP) in place. The purpose of a PEEP is to ensure staff know how to assist each person to leave the building safely in the event of an emergency. This meant staff did not have all the key information they needed to assist people to leave the building in the case of an emergency. Records showed that routine checks on fire equipment and premises safety were being completed

People’s rights were not always protected. Records for one person showed there were various restrictions in place, which prevented this person from leaving the home when they wished to do so. Records showed these restrictions were discussed with external professionals every three months as part of this person’s formal discharge arrangements. We found there was no legal basis or framework in place to support these restrictions.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found the home was not taking appropriate action to protect people's rights. For example, where the home held or managed people’s monies and/or bankcards, there were no mental capacity assessments to show that people did not have capacity to manage their own finances. There were no records to show the rationale for these decisions, or whether this was being carried out in their best interests.

We looked at the care records for people living at the home and found some people’s records were not written in a person centred way, contained outdated/ misleading terminology and did not always provide staff with sufficient detail to support the person’s needs. For example, people’s records contain references to ‘unescorted leave’. This would imply that there were times when people living at the home were not able to go out without some level of supervision or were restricted in some way. We discussed this with the registered manager who assured this was not the case.

People told us there was enough staff to meet their needs and keep them safe. We saw staff had time to spend with people on a one to one ba

2 Seymour Terrace is a small care home for people of working age who are experiencing severe and enduring mental health conditions. The home provides accommodation, personal care and support to a maximum of four people. The home only offers placements to men. The home belongs to a group of homes owned by The Community of St Antony and St Elias. The homes all act as a community with group activities and group management meetings and oversight.

This inspection took place on 18 August 2015 and was unannounced. There were four people living in the home at the time of our inspection. People had a range of needs. All people had freedoms but some were restricted under the Mental Health Act. The service was last inspected in August 2013 and was found to be meeting all the regulations.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who lived in 2 Seymour Terrace were supported towards independent living with care, dedication and understanding. People spoke very highly of the home and described how living there met their individual needs. People who lived in the home had complex mental health and emotional needs. Staff ensured a great deal of planning and preparation was involved in their care. Staff had liaised and coordinated with people, their relatives, healthcare and social care professionals as well as relevant authorities in order to provide a support package and an environment which reflected people’s individual needs and preferences.

People’s relatives also praised the home, they said “It’s brilliant, I wish there were more homes like this in the country” and “I cannot praise them enough”. Healthcare professionals said “They are not like other providers, I find it excellent”, “I cannot fault anything that they do”, “There are very few settings that could manage as well as they do” and “They are an amazing place”.

People were confident about being safe and were comfortable about raising any concerns they may have to the management team. One person said “I feel very safe here. I have been in lots of other homes but wanted to be more independent”. People’s relatives also stated they felt people were safe. One relative said “I have absolutely 100% confidence in the place and the manager, I have complete confidence (my relative) is in a safe place”. People were protected from risks and comprehensive risk assessments had been carried out. These had been highly personalised and extensive thought had gone in to identifying all potential risks and actions to avoid them happening. There was clear evidence that people’s safety was paramount and that staff spent a lot of time understanding people. People were supported to be as independent as possible, working towards taking responsibility for their medicines, finances and learning new skills. The staff ensured people were physically safe and that their mental wellbeing was prioritised. There were very detailed assessments of the risks to people’s mental health, the triggers that could lead to a relapse in their mental health, the signs that their health was deteriorating and the actions staff were to take. Steps were taken to minimise the risks of people suffering abuse and the home had a very open culture around complaints and raising concerns. People were protected against risks relating to medicines as very specific protocols and training were in place.

Staff were equipped with the skills, knowledge and understanding to be able to support people with diverse and complex needs. Staff told us they were happy with the training they had received and felt skilled to meet the needs of the people in their care. Staff told us people came first and their wellbeing was paramount to the work staff undertook. Staff were supported to develop individually and to share their thoughts and opinions in order to improve the home. Prior to staff being recruited, candidates were invited to spend a ‘taster day’ at the home. This involved the candidate spending a day in the home getting to know the people who lived there and ensure people living at the home felt comfortable with them.

Staff sought advice from health and social care agencies and acted on their recommendations and guidance in people’s best interests. One healthcare professional said “They worked very closely with us before (the resident) got offered a place there”. One person who used the service said “I had meetings with them before I moved here. It made me feel much more comfortable that they knew how I communicate”. One relative described how the registered manager had travelled some distance to see their relative on two separate occasions in order to spend time with them. Their relative was non communicative but according to them the registered manager “Didn’t give up, they tried again and again. They got (my relative) to talk because they didn’t give up”. One healthcare professional said “They work very closely with us in order to manage very complex issues. Their key strengths are good communication between staff and with us”. A relative said “They involve the right people; they keep the right people informed”.

People’s experience of their care and support was positive. People were involved in all aspects of their care, including planning and reviews, and took pride in being able to direct their care. People discussed and shaped the activities programme they wished to take part in and their feedback was listened to and their ideas were implemented. The home had a very comprehensive activities programme in place which people took advantage of. The service was well known and respected within the local town which helped people feel part of the local community. People who lived in the service undertook voluntary work in local charity shops and were involved in other community projects. People took part in local social events as well as more individualised activities that met their needs and preferences. Staff supported people make choices and decisions about their care and lifestyle. People’s care records were detailed and were written in a personalised way. It was clear people were consulted during the writing of their care records and were involved in reviewing these. People were included in decisions about their care and where people lacked capacity to make certain decisions at a certain time staff had involved people’s relatives and professionals in making those decisions. People confirmed their wishes and preferences were respected.

The service had a strong person centred culture which helped people to express their views and share their points of view. People told us they were supported in a caring way which promoted their well-being and helped them to increase their self- esteem. For example, one person told us about a recent loss they had suffered, they described how the staff had supported them in different ways. They told us staff tried to cheer them up but also took the time to sit with them and chat when they were feeling upset. They told us staff had encouraged them to plant a rose bush in the garden in memory of the person they had lost and this had brought them comfort. Another person exhibited rituals in relation to their communication. They told us staff knew how to communicate with them in order to avoid increasing their paranoia. During our inspection we observed staff responding to this person in a way that calmed them and relaxed their anxiety.

Staff treated people with kindness, compassion, dignity and respect. People and relatives praised the staff at the home. People said “All the staff are really nice. If staff weren’t kind they wouldn’t be here” and “The staff here just see the best in people. They’re always praising how nice everyone is”. Relatives said “All of them walk the extra mile for the residents, the human input is there”, “They love him like family, it’s brilliant” and “They truly care about him”. Steps were taken to improve people’s relationships with their relatives and relatives felt the staff not only supported their relative but them also. One relative told us “I’m being looked after as well, they support me and my wellbeing”. People were always treated with dignity and respect. One healthcare professional said “They’re very honest, upfront and treated him with great dignity and respect”, “They go over and above in relation to dignity and respect” and “They are very sensitive”.

The community’s visions and values were embedded in every aspect of the home. People were treated as equals and were encouraged to take control of their lives as far as possible. Staff competence and behaviours were continuously monitored by management to ensure they were displaying the values of the community and the high level of competence expected.

The provider had a robust quality assurance system in place and regularly sought feedback from people, their relatives and health and social care professionals. The provider continually strived to deliver a very high quality service and always sought to improve. The management structure offered staff support and demonstrated a culture of openness. There was an out of hours management rota which ensured there was always a senior member of staff to contact for support and advice. People told us they felt comfortable sharing their feedback and complaints with the registered manager and the deputy manager and these were acted on.

When we visited the home we met all four people that lived there and spent time talking with three of them. People told us that they were very happy with the staff and the manager. One person said “I get on well with all of the staff. We have a good laugh and a joke”.

Staff obtained people’s consent before assisting them with their care and welfare needs. We saw that people’s' choices about their care were considered and this was supported by what people told us and what we saw in care records. We saw detailed daily records kept for each person. The records related to the person centred and individualised care plans. During our visit we saw staff respected people's privacy and dignity.

The organisation provided an activity programme that was available to all the people that used its services. On the day of our visit three people had attended an archery competition. People were supported to use community facilities and pursue their hobbies and interests.

Medications were managed safely by the service. Systems were in place to protect people from unsafe medicines management.

People were protected from the risks associated with care workers who may be unsuitable to work with vulnerable people. This was because the provider had effective recruitment procedures in place.

The provider had systems in place to assess and monitor the quality of the service provided.

When we visited the home we met two people that lived there and spent time talking with them. One person living at the home told us that they were very happy with the staff that were supporting them and also with the manager. They said the service was supportive and understanding. One person told us that the staff supported and encourage them.

We saw that peoples' choices about their care were considered and this was supported by what people told us and what we saw in care records. We saw detailed daily records kept for each person. The records related to the person centred and individualised care plans. During our visit we saw staff respected people's privacy and dignity.

The organisation provided an activity programme that was available to all the people that used its services throughout South Devon. We saw an activity programme which included a wide range of activities and events. People living at the home could plan ahead and decide what activity or event they would like to attend. People that used the service were supported to use community facilities and pursue their hobbies and interests.

We saw that the home had been monitoring the quality of the service. However it was difficult to see what direct action had been taken in relation to specific identified trends or questionnaire responses because this information was kept at the head office. The Registered Manager was able to explain how they monitor and manage incidents and accidents.