The inspection took place on 25 and 26 July 2016 and was unannounced. The service was last inspected in September 2014. There were no breaches of the legal requirements at that time.

The Seaton Nursing Home is registered to provide nursing care for up to 31 people. On the day of the visit, there were 24 people at the home.

There was a registered manager for the service. 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.

Staff techniques when engaged in moving and handling activities were not always carried out in a way that minimised risks to people and staff. Staff did not always position themselves in a safe position when helping people who were in wheelchairs. Nor did some staff always assess if the way they were going to assist a person with their mobility needs was the most safe and suitable way. Audits carried out by the registered manager had picked up a need for more training for some staff in safe moving and handling techniques.

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Six people told us that one staff member allegedly spoke in a manner that could seem abrupt and abrasive. This was bought to the attention of the registered manager. The registered manager said they would be taking appropriate action. The registered manager contacted us after our visit and told us they were addressing the concerns.

When health and safety risks to people were identified, suitable actions were put in place and followed by staff. This was to minimise the risk of people being harmed when receiving care. The risks of abuse to people were minimised, as staff were competent in their understanding of abuse. The team were trained to know how to report concerns correctly. People told us they felt safe and secure at the home. They said that staff were kind and respectful towards them.

People had their needs met by enough suitably qualified staff. Staff provided people with care that met their needs. The numbers and skill mix of staff deployed at any time of the day or night meant peoples’ needs were met in a timely manner.

When people had the capacity to, they were encouraged to be included in making decision deciding how they wanted to be cared for. There were effective systems in place that helped ensure staff obtained consent to care and treatment in line with legislation and guidance. When people did not have capacity to consent, their care needs were assessed in line with The Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and the how to act in someone’s best interests.

People said that they liked the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs.

People who lived at the home and the staff had built up positive and caring relationships. This also extended to include relatives and friends.

People told us how much they liked the programme of regular one to one and group activities that took place in the home. People told us they liked the entertainers who performed at the home on a regular basis.

The provider had recently introduced a new system for staff to record all care activities on their own data protected individual i-pads. This was proving to be a very effective way to monitor the delivery of care. For example, the amount of fluids, when a person had been assisted to be moved , and what activities they had taken part in could all be easily monitored on the system . Trends were spotted by the recording system as well. For example, falls people may experience and the times they happened could all be easily seen on the electronic system.

Care plans were informative and guided staff so that they knew what actions to follow t

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence which supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and homely. There were enough staff on duty to meet the needs of the people living at the home. The care staff were supported by a team of registered nurses, one of whom was on duty at all times. The manager was available on call when she was not present at the home. The manager was supported by a director of nursing and staff told us that should the manager be unavailable at any time they would contact the director of nursing.

We saw the corridors were quite narrow for wheelchair use and there were small flights of steps throughout the building. These steps had lifts beside them to facilitate wheelchair users. The home benefited from two lounges. The larger lounge had a television on the wall and the chairs were arranged to facilitate conversations. The smaller lounge was furnished like a coffee-shop and there was a small shop selling chocolates, crisps and toiletries in the corner. Off the dining room was an inner court-yard. This was where people could smoke if they wished. It was sunny on the day of our visit and several people were enjoying the sunshine in the court-yard. There was decking that made it easy for wheelchair users to access the area. Above there was a large net suspended across the whole court-yard we were told that this was to stop the seagulls from entering and scaring people by trying to steal their food or “bombing” them.

Is the service effective?

We found the service was effective because staff understood the needs of people and care and support was well planned. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. For example a member of staff told us that they knew one person liked to match their jewellery with their outfits. One person told us "I am very happy here." They went on to say that they had been living in a different care home and that they had been unhappy there. Another person told us that they had chosen The Seaton because of the home's "good ambiance."

We spoke with three professionals. One of them told us that they could "Leave people at The Seaton and go away knowing that they are well cared for and treated as individuals." Another said "I have confidence that The Seaton gives good care. One of my clients is physically better than they've been for years."

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us that they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person was unable to decide what they wanted to do. Staff helped them to walk to the court-yard and then back into the dining room. This was repeated several times. After lunch the chef chose to sit with some people to play a game of cards. It was a hot day and we saw staff making sure that people had enough to drink.

We spoke with one relative who said that the staff were "patient and caring." They went on to explain that their relative had settled into the home and had "become attached to the carers." Another relative told us "They are very caring, they care for (my relative) very well, they do everything for them. They are very welcoming to us". Another visitor explained that their relative had settled in very well and they commented that "there is always a lot of interaction between the staff and people."

Is the service responsive?

We found the service was responsive because records confirmed people's preferences and interests had been recorded and support had been provided that met their wishes. One person had a dog and the home had taken steps to enable the dog to remain with them. We saw evidence that people's spiritual needs were supported. We heard that complaints were made about a member of staff and we saw that the member of staff no longer worked for the home.

One visiting spouse told us that the home had made a cake for their birthday. The home had enabled them to celebrate with their spouse. One person had chosen to leave the home and move to another in order to be closer to family. They were just about to leave when we arrived. They told us that the home had helped and facilitated their move.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We found the service was well led because we saw staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us that they were asked for their feedback on the service they received and we saw that their comments had been displayed pictorially on one wall and in a report that was on a notice board outside the dining room. This showed that the home listened to what people told them and informed them what actions they were planning to take to address the issues raised.

One person living at the home, and one member of staff told us about a member of staff who did not have the right attitude to the work. We saw that the management had addressed the issue and when it could not be resolved the person had left their employment. Senior members of staff carried out regular verbal surveys of what people wanted and we saw that some of the suggestions were being implemented.

One visiting professional told us "I have a good relationship with the management. When I give advice they always do it. They always follow through. Good communication." They went onto say "I would put my mother here. I can talk to the management and we work well together."

One person who lived at the home commented that the home was "well run".

There were 23 people living at the home when we visited. We spoke with seven people and asked them about their experiences of living at the home and looked at four people's care records. We spoke with eight staff which included the registered manager, nursing and care staff as well as administration and housekeeping staff. We spoke with three health professionals who regularly visited the home.

People told us they liked living at the home and felt well cared for. One person said, “staff are very nice”, another person said, “The staff are very good here”. A third person said, “I’ve settled in well here, they make everybody welcome”. Most people said they enjoyed the food at the home and their individual tastes and preferences were catered for. Health professionals said staff worked well with them and contacted them appropriately about people’s health care needs.

We found people's care needs and risks were assessed. Care plans we looked at showed people were well supported with their care and treatment. We observed that staff interacted well with people, and were caring and compassionate. Staff responded to people's care needs at a pace that suited each person. Staff we spoke with knew about people's needs and how to meet them. People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard by undertaking regular training and updating.

We asked the provider to submit evidence of the improvements made in relation to the two outstanding compliance actions from a previous inspection undertaken in April 2011. These related to:

Outcome 2 - Consent to treatment

Outcome 4 - People’s care and welfare

Since that visit, we undertook another visit to the home on 17 July 2012, and observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services. However, we did not review these two outstanding compliance actions at that visit. This was because that inspection was part of a themed inspection programme to assess whether older were treated with dignity and respect and whether their nutritional needs were met.

We reviewed the information sent by the provider about the improvements made. We did not visit the home or speak to any people. We concluded from the information sent that the home was compliant with those outcome standards.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part

of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We talked with eight of the people who lived in the home, four staff and one relative and observed the care and support provided to others who were unable to communicate verbally with us. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who lived in the home told us that they were happy with the way they were looked after. We were told “I like it so much here that I asked if ‘they’ will put up with me for the rest of my life” and “This is like a five star hotel”. People told us that the staff were good at meeting their health and welfare needs. The atmosphere was one of peace and tranquillity with the staff going about their tasks calmly. They interacted meaningfully with people living at the home, maintaining their dignity and being respectful.

People we talked with told us that they enjoyed the meals provided. One person said, “I was asked what my favourite meal would be and I was able to have it”. Others mentioned that the variety seemed to have increased over the past four weeks.

People who lived in the home told us they felt safe. They said they knew how to raise concerns and felt comfortable about doing so. We spoke with one person’s relative who was visiting them on the day of our inspection. They told us they were included in decisions about their relative's care and were kept informed of changes in their relative's condition.

People using this service told us that they are treated with respect and have their privacy protected. We saw staff using screening to protect one person’s dignity and saw that they provided personal care in private. We saw that people are helped to remain well by for example seeing the doctor, dentist, chiropodist and specialists as needed. People enjoy flexible routines and care is delivered in a way that suits people. Risks to people’s health and welfare are identified and actions are taken to address these risks. However, practice in relation to moving and handling is not always as safe as it could be. One practice described to us puts the person at risk of developing pressure damage and practice we observed put the staff member and the person being assisted at risk of injury.

People say they feel they have as much independence and involvement as they choose. We saw an example of good practice where staff helped one person to have a consultation with the doctor by phone when they had declined to see the doctor in person. However, processes in place to help people to be involved in decision making are not always being used in a way that supports this. For example it is recorded that one person has been assessed as not having capacity to be involved in decisions about hair care or bathing, however staff say this person is capable of making these decisions but does need some support and encouragement. Another person has been assessed as not having capacity although they and their relative say they do have capacity despite having communication problems.

The system for determining capacity points staff towards ensuring that people are supported to make decisions and be involved through the provision of information given in a way that suits the person and we found this was not happening.

Some people told us that they had given consent to treatments, however records relating to consent are confusing. For example, it is recorded that one person must give consent to the use of a particular type of equipment, however they have been assessed as not having capacity to give consent. Another person has received treatments without it being recorded how these decisions were made as this person has been assessed as not having capacity. Some records are not signed by the person who obtained consent and are not dated.

Some records relating to care planning have not been reviewed and important information in daily records is not always used when reviews take place.

People enjoy the food served at The Seaton and specialist diets are catered for. People who need support to maintain their nutrition and/or to eat receive this. Meals are served in a sociable setting for those who prefer this, although people can also choose to eat alone if they so wish. Some people were not completed satisfied with the limited choices for lunch as the second choice is always a salad.

People feel safe and well cared for. Staff demonstrate a good knowledge about keeping people safe from abuse and know what to do if they saw potentially abusive behaviours. The manager is less familiar with procedures to follow if abuse were alleged.