Stafford Hall

Stafford Hall is a residential care home providing personal care and support for up to 40 older people some of whom may be living with dementia. At the time of our inspection 26 people were using the service. The service is set in an adapted building over two floors.

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

There was not always enough staff on duty to meet people’s needs. Contingency plans for replacing staff when they were undertaking training had not been put in place. People did not always receive personalised care to access meaningful activities of their choice and to have a good mealtime experience.

The provider had made improvements to their processes for monitoring the quality and safety of the service since the last inspection. However, these systems were still not robust in addressing the staffing requirements to meet people’s needs.

Safeguarding systems were in place to protect people from harm. People were given their medicines in the right way and at the right time. They were well managed by staff who were competent in their role.

Infection prevention and control measures were in place to prevent the spread of infection. Some lessons had been learnt when things had gone wrong. Staff were safely recruited in line with legal requirements and the provider had completed the appropriate checks prior to them starting work.

Risks to people’s health and wellbeing had been assessed and were recorded and monitored. Care plans provided details of people’s care and support needs.

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.

The provider worked alongside other healthcare professionals in order to support people’s health needs, making referrals and seeking additional support where appropriate.

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 19 August 2021). The service remains rated requires improvement.

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

Why we inspected:

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 safe care and treatment 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 carried out this unannounced inspection on 10 October 2022 to review the key questions of safe and well led only. This was to follow up breaches of the regulations from the last inspection. We had also received concerns in relation to levels of staffing at the service.

At this inspection enough improvement had not been made and the provider was still in breach of the regulations. They sent us information to show improvements made to the service during the inspection.

We carried out a further unannounced inspection on 7 November 2022 to see if improvements the provider said they were taking had been made.

Some improvements had been made to mealtimes and activities, but the provider was still in breach of the regulations and staffing at the service had not been increased to ensure that peoples identified physical, social and emotional needs could be met.

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.

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

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stafford Hall 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 breaches in relation to staffing and oversight at the service. 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.

Stafford Hall is a residential care home providing personal care and support for up to 40 older people some of whom may be living with dementia. At the time of our inspection 27 people were using the service. The service is set in an adapted building over two floors.

Risk assessments needed to be clear and identify the support people required to keep them safe. Clear guidance on how best to support people needed to be implemented for staff to follow.

Safeguarding concerns are required to be raised with the local authority and fully investigated, so lessons learned can be shared in a meaningful way with staff. Better systems needed to be implemented to ensure this happened.

Staffing requirements need to match the needs of the service and people living there. Contingencies needed to be put in place when staffing numbers reduced at short notice, to ensure there continued to be enough staff present to support people safely day and night.

Governance at the service needed to improve to ensure this was meaningful and reflected an accurate oversight of the service to manage and mitigate risks.

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

We had a mixed response of views from people and their relatives, concerns were mostly voiced over staff shortages. However, people and relatives were complimentary of the staff team.

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

Rating at last inspection: The rating at the last inspection was Good (published 17 March 2020).

Why we inspected: The inspection was prompted in part due to concerns received around safeguarding and risks to people. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

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

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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 Infection Prevention and Control, staff training and governance.

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 for 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.

accommodation for up to 40 people who may need assistance with personal care and may have care needs

associated with living with dementia. The service has two floors and there is access to these via a small

staircase. On the day of our inspection the service was caring for 27 people.

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

People felt safe living in the service and had their belongings protected. There were processes in place to ensure that staff knew how to protect people from abuse and where to escalate concerns if they needed to. People had their health and wellbeing assessed and risk assessments were individual to each person and based on their needs. Medicines were managed safely.

Staff received training and development to be able to support people safely which included learning more about specific conditions related to the needs of the people who used the service. Staff were supported to develop within the service and to achieve additional qualifications. People were supported to maintain a balanced diet and were given choices about what they ate and drank. People were supported to maintain their health and wellbeing in line with recommended guidance.

Staff were kind and caring when they supported people and gave emotional support when needed. People were comfortable with staff. Staff knew people well and were able to communicate with people individually based on their abilities. People and their relatives were involved in making decisions about their care. People had their privacy and dignity protected. People’s relatives felt welcome at the service.

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.

People, their relatives and staff spoke highly of the registered manager and found them to be approachable. People and their relatives said that they were listened to and felt involved in the service. There were systems in place which supported monitoring the quality of the service provided to drive improvement. The registered manager was actively involved in initiatives to improve the quality of care that people received.

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 7 June 2017).

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.

The service had 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. The registered manager of the service had been in post for two years.

The service was remarkably responsive. Since out last inspection the service had continued to make further improvements that had a positive impact on people’s lives. Staff, relatives, professionals and people living at the service all felt the care at the service was exceptional and people were enabled to have a good quality life. Staff cared for people in a very kind and compassionate way, they knew them well and people were happy and relaxed at all times. Relatives were very positive about the care provided at the service and complimentary about staff and management.

The service was safe. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty and these were regularly reviewed. People’s medication was well managed and they received their medication as prescribed.

The service was effective. Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker. They also received regular support and felt well supported by management. Management and staff had a good understanding of the Mental Capacity Act 205 and Deprivation of Liberty and protected people’s rights and freedoms.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus. People were supported to maintain good healthcare and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

The service was caring. People had agreed to their care and had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Meetings had been held for the people living at the service, relatives and people felt listened too and that their views and opinions had been sought and the service had made appropriate improvements.

Detailed assessments had been carried out and care plans were developed around people’s individual needs and preferences. People were seen to receive very personalised care which was unique to them and their care records were person centred. People’s daily lives included activities and hobbies that interested them and their involvement in participating in activities they liked was seen to be important and that they enjoyed their days. The service was decorated and set out in a way that meant that all the people living there had a space that they enjoyed. The environment full of unique areas and ideas to keep people engaged.

People told us that they knew how to complain. The service had a complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response. We saw that complaints had been recorded and action taken included any lessons learnt and how to reduce the chance of it occurring again.

The service was well-led. It was evident from the responses we received from people and relatives, staff and volunteers, health and social care professionals that this was a well-led service.

There were systems in place to regularly assess the quality of the service and that people were kept safe. People were able to share their views at regular resident meetings or during the regular surveys. Relatives were positive about the care provided and had been given opportunities to give feedback and make suggestions to improve the experience for people who used the service.

Stafford Hall provides services for up to 40 people who need assistance due to old age or for people who may need care due to living with some form of dementia. It does not provide nursing care. On the day of our inspection the service had three vacancies.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager 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 showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. During our inspection there were sufficient numbers of staff on duty.

People’s medication was well managed and people received their medication as prescribed.

Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker.

We found there were policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of what these meant and the implications for people living at the service. Where people had been deprived of their liberty, applications had been submitted to the local authority for a DoLs authorisation.

Suitable arrangements were in place that ensured people received good nutrition and hydration. People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus.

People were supported to maintain good healthcare. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

Meetings had been held for the people living at the service and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.

People were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Detailed assessments had been carried out and care plans were developed around people’s needs and preferences.

The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response.

There was a strong emphasis on promoting and sustaining the improvements already made at the service. The registered manager continually strived to improve the service and demonstrated that they knew which areas of the service needed attention. Since being in post they had introduced a number of systems to improve the quality of care and had enhanced people’s lives.

Staff were observed speaking with people with dignity and respect and involving them in their care. People appeared relaxed and staff were viewed helping them to make choices on how they wanted their care provided. During our visit at no time were people seen waiting for staff to support them. Staff were observed interacting with people and there was generally a homely atmosphere.

People and relatives spoken with were complimentary about the care they received at Stafford Hall. Some people had lived at the home for a number of years and stated they were happy with the staff and that they were friendly and helpful. Others who were unable to verbally communicate were observed with staff and they appeared relaxed in their company. Those staff spoken with were aware of people's needs.

The manager had kept a compliment book and comments included, 'Thank you for all you did to make 'X's' stay at Stafford Hall comfortable and caring' and 'Many thanks for looking after me when I was with you, and making my time a happy one. I know how busy you are and you still made time to look after me to see if I was alright.' Other comments received included 'Staff are friendly, they can't do enough for you,' 'This is a happy place' and 'They always let you know if there is a problem.'