Stallcombe House

Updated 11 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Stallcombe House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced on 9 March 2022 and announced on 11 March 2022.

What we did before inspection

The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We reviewed information we had received about the service. We also reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with seven people who used the service about their experience of the care provided. People who used the service who were unable to talk with us used different ways of communicating including using Makaton, pictures, photos, symbols, objects and their body language. We spent time observing the interactions between them and staff.

We spoke with 10 members of staff including the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed four people’s care files, three staff files, staff training records and a selection of policies, procedures and records relating to the management of the service.

We reviewed a range of records. We looked at a variety of records relating to the care and support provided, three staff files in relation to recruitment and various audits/reports relating to the quality and safety of the service to ensure people received safe care and support specific to their individual needs. We requested a variety of records were sent to us relating to staff training and regards the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We sought feedback from relatives, staff and health and social care professionals to obtain their views of the service provided to people. We received feedback from five staff, six relatives, and one health and social care professional. We continued to seek clarification from the provider to validate evidence found. We provided initial feedback to the service on 12 April 2022.

Updated 11 May 2022

About the service

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Stallcombe House provides accommodation for up to 33 people. The service is situated in the village of Woodbury near Exeter in Devon. The service consists of the main Stallcombe House which looks after 27 people with a learning disability, within four 'zones' within the house. The Willows is a separate unit which looks after six autistic people with complex needs. At the time of our inspection there were 32 people living at the service.

The care service had not originally been developed and designed in line with the values that underpin the principles and guidance of ‘Right support, right care, right culture.’ It would be unlikely that we would register this model of services now when considering applications for services for people with a learning disability and autistic people. This was because the home was situated in a rural area and supported 33 people.

However, the service had mitigated some of these areas, because the main house had been divided into four areas, so people could live in smaller groups of six or eight. Whilst there was a bustling atmosphere it was not evident that there were 27 people living at Stallcombe House due to each area having their own dining area, kitchenette and lounge areas. This location may not be ideal for some people who would want to access the local community independently. However, people were given plenty of choices and their independence and participation within the local community was encouraged and promoted.

People’s experience of using this service and what we found

Concerns were raised with regards to how many regular staff had left who had a lot of experience and knew people very well. Staff said they remained in post because of their love for their job and their relationship with the people living at the home. Staff and relatives’ comments and three staff exit interviews showed that staff had left for various reasons, but consistently stated that it was due to staff feeling unsupported and undervalued which had impacted on staff morale. Staff leaving statistics showed that 23 staff had left within the last 6 months. How long they had worked at Stallcombe House ranged from over 12 years to four weeks.

10 out of the 15 staff we spoke with, did not feel listened to and felt communication was poor between the home and the provider. Staff felt there was a 'void' between the home and the provider, they said they felt unable to go to the provider with a problem. This did not demonstrate a positive culture which was open and inclusive, despite the service' whistleblowing policy encouraging this.

Staff surveys showed evidence of staff feeling a lack of fairness, feeling undervalued and communication being poor. This demonstrated that the concerns raised impacting on high staff turnover had been raised by staff as part of the gathering of their views in May 2021. The provider commented, “Once the staff survey (and other surveys) had been completed and the results collated we held feedback sessions for staff as part of the team building event where we shared the results and discussed what people felt had contributed to their view of things.” However, these concerns remained and still needed to be addressed to improve staff retention.

We found no evidence that people had been harmed however, staff did not feel valued and supported by the provider which did not demonstrate a positive culture which was open and inclusive.

We did receive positive comments from staff about their experience of the management of the service. A new management structure had been agreed and started to be implemented. The aim to establish clear lines of accountability, with the aim of helping to improve communication at all levels within the service. The provider commented, “The employment of new heads of department has also been a direct attempt to improve our structure, listening capacity and communications.”

Concerns were voiced by staff and relatives about the staff turnover at the service, with regular staff leaving who knew people really well as they had supported them for many years and were knowledgeable about their individual needs. However, despite regular staff leaving, staff confirmed that people’s care and support needs were met, which we observed during our visit when people needed support or wanted to participate in particular activities.

The provider was actively recruiting for staff on an ongoing process via various advertising sources and had been successful in recruiting appropriate care staff. There were effective staff recruitment and selection processes in place.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The service’s vision and values centred around the people they supported. The organisation’s statement of purpose documented a philosophy of maximising people’s life choices, encouraging independence and people having a sense of worth and value. Our inspection found that people were constantly encouraged to lead rich and meaningful lives.

A total communication approach had been adopted to maximise people’s choices and independence regards to things which were important to them. Staff were passionate about this approach when supporting people. For example, regards to activities, holidays and meal choices. Total communication is about finding and using the right combination of communication methods for each person. This approach helps an individual to form connections, ensures successful interactions and supports information exchanges and conversations.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. Comments from people living at the service and relatives included, “I am happy here”; “Thumbs up”; “People are kept safe” and “I have no concerns about the safety of (relative), they are very well supported to lead a fulfilled life.”

Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf. The home was clean, and staff adopted good infection control measures linked to Covid-19.

Systems were in place to monitor the quality and safety of the service. Audits were completed on a regular basis as part of monitoring the service provided. Policies and procedures were in place and the service worked in line with them to ensure a safe service. The service worked with other health and social care professionals in line with people’s specific needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 26 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about a high turnover of staff due to issues around the management and leadership of the service and how this could be impacting on consistency when providing care and support to people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found that people’s needs were being met consistently in line with their care and support needs. However, concerns about staff support at provider level was having an impact of staff retention and staff morale.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed from good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stallcombe House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.