Angels (Stratton House) Limited

Angels (Stratton House) Limited is a nursing home providing personal and nursing care for up to 24 older people, some who are living with dementia. At the time of the inspection there were 16 people living at the service. The service is laid out over two floors that can be accessed by stairs and a lift. There are two communal lounges, a dining room and level access to an open front garden.

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

This inspection has shown the provider has made significant steps towards meeting all areas of the Warning Notice. Whilst further work was needed, we were satisfied with the progress made. We will continue to monitor the location to ensure all areas of the warning notice are met within an achievable agreed timescale.

The provider had made improvements to the monitoring, recording and oversight of people’s care and risk management. This included, skin integrity, accidents and incidents, safeguarding, choking and care plans. There was improved provider oversight of the service. Governance systems had been improved but required further work.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 June 2023). There were continued breaches in Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance) identified. Following the inspection (published 14 June 2023), a warning notice for Regulation 17 was issued.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Angels (Stratton House) Limited is a nursing home providing personal and nursing care for up to 24 older people, some who are living with dementia. At the time of the inspection there were 21 people living at the service. The service is laid out over two floors that can be accessed by stairs and a lift. There are two communal lounges, a dining room and level access to front gardens.

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

Governance systems continued to not be fully effective and meant repeated shortfalls at the service were found in relation to record keeping and risks to people. There was a lack of provider oversight. The service was reliant on the local authority identifying areas of improvement and directing changes.

Improvements had been made to ensure a stable, consistent staff team who knew people well. There was a friendly and positive atmosphere at the service. We received positive feedback about the support people received from staff, who were caring and responsive to people’s needs.

Staff now received regular supervision and training. Recruitment procedures were now fully followed. Improvements had been made to the environment and décor. People’s rooms were homely. The service was clean and tidy. Infection prevention control measures were in place and adhered to.

Care plans continued to need development to ensure they were person centred and accurate. People’s capacity was assessed in relation to specific decisions. However, improvements were needed to ensure capacity assessments and best interest decisions fully followed the Mental Capacity Act 2005 guidance. The recording and management of complaints had improved. However, the provider needed to ensure if complaints were escalated the complaints procedures could be effectively followed.

Medicines were managed safely. People enjoyed the food at the service and different diets were catered for. Activities were provided. We received positive feedback about the registered manager and how the service was being led. Staff were supported.

Accidents and incidents were reported and recorded. Safeguarding systems were in place to protect people from abuse. However, potential safeguarding concerns were not always identified as the records were not followed through.

Communication had improved both internally and externally, which supported lessons being learnt. Regular meetings occurred with staff and comprehensive handover information. Relatives were kept updated and informed. Relatives were involved in reviews of people’s care. People, relatives and staff were asked for feedback through surveys.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 May 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that provider reviewed documentation around consent to specific areas of people's care in line with The Mental Capacity Act 2005 (MCA). At this inspection we found that the provider had met this recommendation but improvements were still needed in fully following MCA guidance.

The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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 remained requires improvement.

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

Enforcement and Recommendations

We have identified repeated breaches in relation to Regulations 12 (Safe care and treatment) and 17 (Good Governance).

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Angels (Stratton House) Limited is a nursing home providing personal and nursing care for up to 24 older people, some who are living with dementia. At the time of the inspection there were 17 people living at the service. The service is laid out over two floors that can be accessed by stairs and a lift. There are two communal lounges, a dining room and level access to front gardens.

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

The provider had worked with the local authority to make improvements across the service, which were seen at this inspection. There were further improvements to be made which the provider acknowledged and an action plan had been implemented to address these areas.

Care plans and risk assessment were being reviewed by the service to ensure they were accurate and reflected people’s current needs. The service needed to ensure infection prevention control procedures were being adhered to and risks to people were identified and managed. Staff had not received regular supervision to support and develop their performance.

Staff had completed training. Safeguarding systems were in place to protect people from abuse. Medicines were managed safely. Improvements in food provision had been noted.

People were supported by staff who were kind and caring. There was enough staff to meet peoples’ needs. Staff were responsive and knew people well. People were supported to engage in activities of their choice. People and relatives felt comfortable raising concerns with the service.

Progress at the service had not been rapid. There had been recent management changes. Whilst improvements were noted, further developments were needed to ensure there was learning from accidents and incidents, complaints and safeguarding. Governance systems were being changed. Medicines, training and safeguarding were being monitored well. Areas such as recruitment, infection control, risk assessments and the environment needed to ensure actions were identified by audits and action taken promptly to address shortfalls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we made a recommendation in relation to ensuring documentation around capacity to consent to care was in line with guidance.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 13 July 2021). We found breaches of Regulation 12, 13, 17, 18 and 19. The provider was placed in special measures. Three warning notices were issued for Regulation 12, 13 and 17. These were followed up in a targeted inspection (published 15 October 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 10 (identified in 2019), 13, 18 and 19.

This service has been in Special Measures since 13 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to Regulation 12 and 17. Improvements were still required to ensure governance systems were effective and embedded and all risks to people were identified and managed.

We made a recommendation in relation to documentation around consent to care being in line with guidance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were cared for by staff who had received some training in infection prevention and control. This helped to promote good practice.

People were being supported by staff who were mostly wearing Personal Protective Equipment (PPE) appropriately. Staff knew what to wear for different tasks and how to safely put on and take off their PPE.

People lived in a home which was clean and fresh. Completed cleaning schedules showed that additional cleaning had been put in place to minimise the risks of COVID-19 and other infections.

Most people who lived at the home were unable to share their experience with us verbally due to their dementia. However, people looked comfortable and relaxed with staff. One person told us, “Everything is fine here.” Where people were being cared for in bed, they looked warm and comfortable. Where people were physically supported with their meals in their rooms, staff wore the correct PPE and chatted to the person they were supporting.

Staff and people living at the home were taking part in a regular COVID-19 testing programme. We observed a person being asked if they were happy to be tested and this was done with their consent.

Angels (Stratton House) Ltd is a nursing home and was providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 24 people. The building is a former domestic property and accommodation is laid out over two floors. Bedrooms can be found on both floors, most with en-suite facilities and people have shared access to one bathroom and one shower room. The ground floor provides two communal lounges and dining room, there is level access to front and back gardens. The manager’s office is found on the first floor.

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

This was a targeted inspection to follow up Warning Notices we issued in relation to Regulations 12 (Safe Care and Treatment), 13 (Safeguarding) and 17 (Good Governance). The management team and provider had made improvements to the service and we found the Warning Notices had been met.

Improvements had been made to infection prevention and control practices, including improved monitoring and staff training. All staff had either completed, or were in the process of completing, safeguarding and Infection Prevention Control (IPC) training. People were at reduced risk of their skin deteriorating because skin care assessments were accurate and specialist mattresses, to prevent skin breakdown, were correctly set. The management team had worked with an external fire safety organisation to undertake a fire risk assessment.

Systems to monitor the quality of care provision in the service had been updated and new systems had been introduced. The provider was more involved with running the service and visited weekly. There was improved oversight of safeguarding.

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

Rating at last inspection and update. The last rating for this service was inadequate (published 15 July 2021) and there were multiple breaches of regulation.

We served three Warning Notices in relation to Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities), Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) and Regulation 13 (Safeguarding). At this inspection we found improvements had been made.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) and Regulation 17 (Good governance) Regulations 2014 had been met and Regulation 13 (Safeguarding) of the Health and Social Care Act 2008 (Regulated Activities). The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Angels (Stratton House) Ltd is a nursing home and was providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 24 people. Accommodation is laid out over two floors that can be accessed by stairs and a lift. Each floor provides bedroom accommodation, most with en-suite facilities and people have shared access to one bathroom and one shower room. To the ground-floor there are two communal lounges, dining room, and level access to front and rear gardens. The registered manager's office can be found on the first floor.

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

There was a lack of provider oversight of the service and the quality of care provision. Governance systems

either did not exist or were not used effectively to identify the concerns, errors and omissions we identified during our inspection. The staffing structure did not always promote effective communication and staff did

not always speak about people in a person-centred way. We found one statutory notification had not been submitted in line with requirements. There was no oversight of safeguarding in the service. The systems in

place failed to support staff to recognise and identify that unexplained bruising may indicate potential abuse or neglect.

People were at risk from the spread of infection because staff had not received suitable training in relation to the application and management of personal protective equipment (PPE). When risks were identified,

they were not always managed in line with assessments. Staff were not recruited safely, and we received mixed comments about staffing levels in the home. Staff were not always undertaking training relevant to the needs of people they were supporting, and some

training was overdue.

The manager was working with a recognised training provider to implement a new training programme.

People were supported to eat and drink enough, however alternative meal choices were not always available.

The recently appointed manager was in the process of implementing changes, including introducing new ways to engage with stakeholders. Staff said they felt part of a team, and relatives spoke positively about

staff.

People were supported to access healthcare and external services.

The manager had identified that the premises were not always suited to people living with dementia and was working to improve this.

Routine health and safety checks were being completed. Improvements had been made in relation to the management of medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 25 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show

what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to food provision and staffing levels in the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Angels

(Stratton House) Ltd on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people, infection prevention and control and risk assessment and management. Additional breaches relating to recruitment and staff training and the service's quality assurance systems were also identified.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will

return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration,

we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than

12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Stratton House is a care home that provides personal and nursing care for up to 24 older people. The service is provided in accommodation over two floors. At the time of the inspection, 22 people were living at the home.

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

Since the last inspection the provider and registered manager had failed to assess and monitor the quality and safety of some of the services provided. This included the environment, infection control, safe medication management and accident incident analysis. This had a potential impact on people’s safety and quality of care. Some practices around dignity and respect could be improved.

Despite these shortfalls people were happy living at the home and told us they were cared for well and felt safe. We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from relatives was good. Staff we met and spoke with were happy and proud of the care they provided.

Some aspects of the service were safe. People were supported to take risks and promote their independence. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support. Checks were carried out on staff before they started work to assess their suitability to support people in a care setting.

The service was effective in meeting people’s needs. Staff received regular supervision and training. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People were provided a healthy, nutritious, balanced diet whilst promoting and respecting choice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Everyone we spoke with agreed that staff were caring and kind. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. People were supported to maintain relationships that were important to them and participate in a range of activities.

The service was responsive to people’s health and social needs. People received person-centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing. People were encouraged to make their views known and the service responded by making changes.

Although improvements were required in many ways the service was well led and it was unfortunate that some areas had deteriorated. The registered manager felt this was attributed to her increased presence required at another of the providers homes that she managed. Although there was a deputy at the home in the registered managers absence, improved strategies were required to ensure a stronger management oversight.

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 (report published December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected the service in November 2014, at that inspection the service was meeting all of the regulations inspected. However we made two recommendations to the provider regarding reviewing the Mental Capacity Act 2005 to make sure best interests decisions were being carried out and recorded appropriately. Also to explore the relevant guidance on how to make communication systems used by people living with dementia more ‘dementia friendly’. At this inspection we found the provider had taken action to improve these areas significantly.

There was 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 registered manager is also registered as the registered manager at a second location under a different legal entity. They delegated day to day clinical responsibility to two deputy managers who were nurses.

Relatives and staff gave us positive feedback about the management team. They said they were open, friendly and welcoming. They were happy to approach them if they had a concern and were confident that actions would be taken if required. The registered manager was very visible at the service and had an open door policy. They promoted a strong, caring and supportive approach to staff and put a high emphasis on staff training and increasing their knowledge.

The registered manager ensured there were sufficient numbers of suitable staff to keep people safe and meet their needs.

The provider demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. They had made appropriate applications for people they had assessed that required to be deprived of their liberty to the local authority DoLS team.

People were supported by staff who had the required recruitment checks in place and were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

People were supported to eat and drink enough and maintain a balanced diet. People and visitors were positive about the food at the service. People were seen to be enjoying the food they received during the inspection.

People received their prescribed medicines on time and in a safe way. Visitors said staff treated their relative with dignity and respect at all times in a caring and compassionate way.

People were supported to follow their interests and take part in social activities. A designated activities coordinator was employed by the provider. They ensured each person at the service had the opportunity to take part in activities and social events which were of an interest to them.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. Care plans were person centred and people where able and their families had been involved in their development. Staff were very good at ensuring people where able were involved in making decisions and planning their own care on a day to day basis. People were referred promptly to health care services when required and received on-going healthcare support.

The premises were well managed to keep people safe. There were emergency plans in place to protect people in the event of a fire or emergency.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives and staff through staff and residents meetings, surveys and questionnaires to continuously improve the service. There was a complaints procedure in place. There had been no formal complaints received in 2016.

We spoke with two relatives who told us that they could visit when they liked, nothing was too much trouble and the manager kept them up to date with changes to their relative's welfare.

We saw that best interests meetings had been called when relevant and also the Deprivation of Liberties procedure had been used properly when it was needed. This meant that decisions about peoples care, treatment and support were taken by people who knew them well.

We observed the medication administration system which was very clear and accurate. This meant that people had received the right medication at the right time.

We spoke with staff about the support they received and they told us that they thought that management were very supportive to them. We saw records which showed us that supervision and training occurred on a regular basis.

We saw a monthly auditing system which showed us that people's views were taken into account when delivering care, treatment and support. This system also reassured us that matters such as health and safety and case files were well managed.

This inspection took place from late afternoon until late evening. During our visit we spoke with both day and night staff including three nurses, two carers and one of the cooks. We also reviewed three care records that described people's individual needs in the home.

We were told all people who lived in the home had some form of memory loss or dementia. We carried out a short observation to help us understand whether people's needs were being met. This was because some people were unable to tell us their full experience of what it was like to live in the home. This showed interaction from staff towards people who lived in the home was positive. We noted that when staff had assisted a person, this was done respectfully and at a comfortable pace for the person.

One person spoken with told us they thought 'staff were very kind, helpful in everyway, they help me to wash and dress myself'.