Stapely Residential and Nursing Home

Stapeley Residential and Nursing Home is a residential care home providing personal and nursing care for up to 97 people of Jewish and non-Jewish faith. The service is provided over three large houses, all of which are connected. Two houses provided residential personal care and one house provided nursing care. At the time of this inspection 45 people were using the service.

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

Aspects of governance and oversight of the environment needed improving. The provider took immediate actions to carry out updated repairs and refurbishment.

Suitable numbers of staff were provided. The manager advised she would review how she managers and calculates staffing numbers so she can share this information with everyone at the service.

Staff were aware of the procedures to follow to prevent and control the spread of infection and received specific guidance about the COVID-19 pandemic. We signposted the manager to further guidance to ensure equipment was replaced and safely maintained. Risks associated with individual's needs were assessed and regularly reviewed with measures in place to mitigate risks.

People were happy with the care and support they received. People had access to services and facilities that met their cultural needs.

People received their medicines from trained and competent staff. People were protected from abuse and the risk of abuse. People and their family members told us that the service was safe.

Safe recruitment practices were in place to help ensure that only suitable staff were employed at the service.

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 17 Feb 2020.)

Why we inspected

This was a planned focused inspection based on the previous rating. It was undertaken in part to check whether the manager had applied for registration with CQC.

This report only covers our findings in relation to the Key Questions Safe and Well-led.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stapely Residential and Nursing Home on our website at www.cqc.org.uk.

The overall rating for the service has remained good. This is based on the findings at this inspection.

Stapley Residential and Nursing Home is a residential care home providing personal and nursing care for up to 97 people of Jewish and non-Jewish faith. The service is provided over three large houses, all of which are connected. Two houses provided residential personal care and one house provided nursing care. At the time of this inspection 67 people were using the service.

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

We have made three recommendations about the current system in place for reviewing the quality and safety of the service; the reviewing of the quality and content of care planning document and the implementation of the Mental Capacity Act.

People were happy with the care and support they received.

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 did not always support this practice.

People felt safe using the service and received their medicines when they needed them. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service.

Systems were in place to monitor the quality of the service that people received. People were able to voice their views and felt they were listened to. People had access to services and facilities that met their cultural needs both within the service and the local community.

People's needs and wishes were assessed prior to moving into the service. People received care and support from experienced staff who were supported in their role. People were offered a nutritious and balanced diet that met their cultural needs and wishes. Systems were in place to ensure that people’s healthcare needs were understood and met.

People were protected from abuse and the risk of abuse. People and their family members told us that the service was safe. Infection control practices were followed to minimise the risk of the spread of infection.

People had access to a programme of activities and events. Staff knew people well and were knowledgeable about individual's needs and wishes and how they were to be met. People and their family members had access to information as to how to raise a concern or complaint about the service.

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 2 January 2019) and there were two 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

At the last inspection there was no effective management and oversight of the service. The three separate units operated in isolation and there were no systems in place for managers and staff to work together to share good practice and learn from mistakes. Although some checks were being completed by some managers, there were no formal systems in place to assess the overall quality of the service. Therefore, shortfalls on some units in relation to the completion of care records, medication administration records (MARS), staff recruitment files, staff supervision, staff appraisals, health and safety checks and the business continuity plan had not been identified.

At this inspection we found that a lot of work had taken place and improvements to the way the home is managed and effective systems implemented to ensure the health and safety and wellbeing of the people living there. There is a plan of ongoing improvements that we were shown and discussed throughout the three-day inspection.

Following the last inspection in April 2018 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well led to achieve a Good rating. We received an action plan and a business continuity plan.

Stapley Residential and Nursing Home is a care home. People in care homes receive accommodation and 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.

Stapely Residential and Nursing Home consists of three large Victorian Houses, two of which have been extended at the back. It is set in extensive gardens. The home was originally provided specifically for people of the Jewish community, however it now also accommodates people who are not of the Jewish faith. The first building was known as the nursing unit, the second building as the residential unit and the third building as Fernlea. The home is registered to accommodate up to 97 people at the time of the inspection 63 people were living there of whom 28 were receiving nursing care.

There was no registered manager in place, however a manager who had been working at the home for over 20 years has applied with the Care Quality Commission to become the 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.

We toured the home and visited all areas. There is still a lot of work taking place internally to link the home directly with the Fernlea building. A plan was provided with regular cyclical works and continuing works to be completed by early 2019. Time was spent with the electrician who completed all fire safety alarms throughout and ensured the home was safe under the fire regulations and we were provided with the official correspondence by the provider from the Merseyside Fire and Rescue Authority that stated they had withdrawn the enforcement notice as works had been carried out.

The medication procedure for safe storage and temperature records was not being followed in two of the units and medication was not being sent back to the pharmacy for surplus stocks. There were gaps in medication records that when checked however showed that the relevant medicine had been administered but staff had omitted to sign the medication record.

People received support with their health care. Care plans and risk assessments had been updated accurately and contained guidance to be followed by staff to ensure their health and safety. Monitoring records including food and fluid charts and, repositioning records that had been completed fully by staff to inform that the care and support had been provided as required in the care plans.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. We saw that mental capacity had been assessed appropriately, consent had been sought, DoLS conditions that were being applied by the home for people that required updating had been applied for by the manager.

Accidents, incidents and complaints had been managed appropriately with records in place to show actions were taken.

Infection control standards at the home we observed were good. Audits of the service were effective and were carried out on a monthly basis and sent to the monitoring infection prevention and control nurse.

We saw evidence of an induction process into Stapley Residential and Nursing Home and the staff training we were provided with informed us that staff had started a programme of relevant training or required updated training. Supervisions and appraisals were taking place with a programme of meetings for all staff working at the home.

The rotas we were provided with and observations and discussion with people, relatives, staff and the manager indicated there were sufficient staffing levels in all areas of the home.

People we spoke with told us they felt safe at the home and they had no worries or concerns. People’s relatives and friends also told us they felt people were safe. The staff at the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful towards people.

The activities arranged at the home not only gave people the opportunity to pursue their interests and hobbies they also provided a sense of purpose for people as they continued to remain part of and contribute to their wider community.

People’s personal emergency evacuation plans did match their risk assessments and gave the relevant information required.

At our last inspection on 13 and 14 February 2017 the service was rated Requires Improvement overall. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 12 and17. This was because the registered provider had failed to ensure a there was a robust system to monitor and assess the effectiveness and safety of the service and that people were fully protected from the risk of unsafe premises and equipment. After that inspection the provider wrote to us to say what they would do to meet it legal requirements. At this inspection we identified that improvements had not been made, regulations continued to be breached and additional breaches were identified.

We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

Stapley Residential and Nursing Home is a care home. People in care homes receive accommodation and 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.

Stapley Residential and Nursing Home accommodates up to 97 people in two separate buildings. One building contains the nursing and resident units and one houses a unit called Fernlea. At the time of this inspection 73 people were living at the service 29 of whom were accommodated in the nursing unit and receiving nursing care.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In addition to the registered manager there were four unit managers. One was based in Fernlea unit, one on the residential unit and two in the nursing unit. Following our inspection the provider wrote to us to inform us the registered manager was no longer working for them.

There was no effective management and oversight of the service. The three separate units operated in isolation and there were no systems in place for managers and staff to work together to share good practice and learn from mistakes. Although some checks were being completed by some managers, there were no formal systems in place to assess the overall quality of the service. Therefore shortfalls on some units in relation to the completion of care records, medication administration records (MARS), staff recruitment files, staff supervision, staff appraisals, health and safety checks and the business continuity plan had not been identified. Some of these shortfalls had been brought to the attention of the registered manager by the local authority as part of a quality monitoring visit of the service in October 2017 but had not been addressed.

Recruitment practices were not safe. Appropriate identity and security checks had not always been completed before staff started work. Although some staff received regular training and supervision from their line manager others had not.

The fire authority identified serious concerns in relation to the safety of the premises in the event of a fire. Immediate action was taken to mitigate these risks and further improvements were being made, however the providers own systems had failed to identify these concerns.

Records containing people’s personal information and other records relating to the on-going management of the service were not always stored securely.

People told us that they enjoyed the food that was available to them at meal times but people on the nursing unit were not always treated with dignity and respect at mealtimes. All meals were prepared and served in line with kosher requirements and specialised dietary requirements and preferences were catered for.

People’s needs had been assessed before they moved into the service and people had been consulted about their preferences for how they wanted their care delivered. People’s ability to consent to their care and treatment had been assessed and support had been provided to safeguard people who lacked the ability to consent. People received the support they needed with their personal and health care and received their medication as prescribed.

People felt staff knew them well and treated them with kindness. Visiting health and social care professionals felt that staff had a good understanding of people’s needs and had no concerns about the care people were receiving. Staff responded quickly to people’s requests for assistance and there were enough staff on duty to meet people’s needs.

A wide range of activities were provided that people enjoyed. We saw people participating in Tia chi, a ‘knit and natter’ group, trips out into the city, poetry reading and arts and crafts. The provider had bought a piano for people to play and was also taking delivery of exercise bikes for people to use. There were plans in place for more activities to be provided for people who spent time in their rooms.

Systems were in place and followed for dealing with concerns, complaints and potential incidents of abuse. However the CQC had not always been notified of significant events as required. People and their relatives felt safe living there and were confident to raise any concerns they had.

People spoke highly of the chairman of the board of trustees who they felt was approachable. The provider had strong links with the local Jewish community and other organisations involved in people’s care. Building works were underway to join the two main buildings together and provide a new kitchen and cinema.

We found six breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Stapely Care Home consists of three large Victorian Houses, two of which have been extended at the back. It is set in extensive gardens. The home was originally provided specifically for people of the Jewish community, however it now also accommodates people who are not of the Jewish faith. The first building was known as the nursing unit, the second building as the residential unit and the third building as Fernlea.

The home is registered to accommodate up to 97 people at the time of the inspection 72 people were living there of whom 33 were receiving nursing care.

The home has 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.

We spoke individually with ten of the people living there. We spoke with nine relatives or visitors and with 12 members of staff who held different roles in the home. We examined a variety of records relating to people living at the home and the staff team. We also looked at systems for checking the quality and safety of the service.

We found breaches of regulations relating to the safety of the premises and systems for assessing and improving the quality of the service provided. You can see what action we told the provider to take at the back of the full version of the report.

Parts of the environment at Stapely were unsafe. This included fire doors that did not close correctly and windows that were unrestricted.

Work on refurbishing and improving the premises was on-going with recent work including replacing the boilers. Some parts of the home were of a high standard and other parts were shabby. A full refurbishment of the remainder of the home was planned to take place in phases with an eventual goal of the whole home being of a consistently high standard.

Systems for formally obtaining the views of people using the service and assessing the quality of the service were not always followed or effective at obtaining people’s views and ensuring the building was safe.

There were enough staff working at the home to meet people’s needs. Staff knew people well and had built good relationships with them. People living at the home and their relatives liked and trusted the staff team. They found them responsive and caring.

People received the support they needed with their personal and health care. They also received their medication as prescribed. People’s care needs were assessed and care plans were in place to guide staff on how to support people.

All meals were prepared and served to ensure they met kosher requirements. People liked the meals and received support to eat and drink when they needed it. Snacks and drinks were served regularly throughout the day.

Systems were in place and followed for dealing with concerns, complaints and potential incidents of abuse. People living at Stapely and their relatives felt safe living there and were confident to raise any concerns they had.

People’s ability to consent to their care and treatment had been assessed and support had been provided to safeguard people who lacked the ability to consent.

A number of activities took place at the home however some people living there would like to see these increased.

The home had a manager who was registered with CQC. The manager and the representative of the trustees had a detailed knowledge of the people living there and were a visible presence within the home. As the home has recently increased in size additional support for the registered manager would be beneficial in ensuring paperwork remained up to date and records were completed in a timely manner.

At our last inspection in August 2014 we identified breaches of legal requirements. We issued the provider with compliance actions to meet the breaches. The breaches related to care and welfare and quality monitoring. At this inspection we found that the provider had improved quality monitoring systems.

The manager was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

The home is registered to provide accommodation and care for up to 60 people, there were 60 people living at the home at the time of this inspection. The building is split into two units. The ground floor is for people who require nursing care. The first floor is for people requiring residential care.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded. We spent time conducting a full tour of the home; the basement area was not safe. It was used as a storage space for food freezers. The basement was also used as an office for the maintenance person.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided had been checked. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs; however two records checked were not fully completed to inform staff of the required food and fluid intakes consumed at the end of the day.

Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat. We observed the lunch time meal where staff were observed not to communicate with two people they were assisting to eat their lunch.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what was their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly reviews records were all up to date in the six files looked at however there was limited information that reflected the changes of people’s health.

People were not having person centred activities provided by the provider to promote their wellbeing.

People told us they felt safe with staff and this was confirmed by people’s relatives we spoke with. The registered manager had a good understanding of safeguarding. The manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We found that medicines were managed safely and records confirmed that people received the medication prescribed by their doctor.

The staffing levels were seen to be adequate in all areas of the home at all times to support people and meet their needs and everyone we spoke with considered there were adequate staff on duty. However staff did not have time to provided activities or one to one stimulus to promote wellbeing.

The home used safe systems for recruiting new staff. These included using DBS checks and annual self-disclosure checks made with the manager. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy managers and the registered manager.

People were able to see their friends and families when they wanted. Visitors were seen to be welcomed by all staff throughout the inspection.

Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.

The six care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. People were all registered with a local GP and records showed that people saw a GP, dentist, optician, and chiropodist as needed.

There were residents’ meetings seeking the feedback of the people living at Stapley. There was evidence this has happened frequently over time and was an embedded part of the culture of the home.

At this inspection we found breaches relating to people not being provided with person centred activities for stimulation and to support their wellbeing. The conditions in the basement of the building and it’s inappropriate use which was a risk. You can see what action we told the provider to take at the back of the full version of the report.

We spent time talking to staff and five people living at Stapley Residential Home, looking at records and two care plans. We spent time walking around the home and observing staff interactions with the people living there.

We considered all of the evidence we have gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

On the day of our visit we found the environment clean and fresh.

We saw adequate staffing on duty to meet the needs of the people living at the home and were told that a senior staff member or the manager was always available either working in the home or on call in case of emergencies.

A safeguarding policy and procedure was in place to advise staff what they should do if they suspected abuse and staff received regular training in safeguarding. We spoke to three staff members who all demonstrated a good understanding of types of abuse and how to protect the welfare of vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. We discussed the Best Interests of people at the home and were told that the social services and staff would attend. The manager told us that no one currently residing at the home was subject to a DoLs authorisation.

Is the service effective?

People told us that they were happy with their care. We spoke with staff and found that they knew the people living in the home well. The people who lived at the home were given a choice as to how they lived their lives at the home. People's comments included, "Staff always treat us respectfully", "Staff are really good" and "Very nice staff".

Is the service caring?

We spent time in all areas of the home and saw and heard staff to be kind and patient to the people who lived there. We saw that the people who lived in the home were comfortable in the company of staff and happy to have a chat with them. One person told us, 'I'm happy here, I would rather be in my own home but I'm not safe there".

We saw that workers were patient and gave encouragement when supporting people. Our observations confirmed this. One person told us about the staff, "They are really lovely".

Is the service responsive?

People's needs had been assessed before they moved into the home and were frequently reassessed whilst they lived there.

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded, however we found little information was recorded in monthly reviews. Other professionals, such as speech and language therapists, continuing care and district nurses were involved in people's care when necessary. We saw that relevant referrals were made to other professionals as and when required.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. Stapley has direct links with the Jewish community and the majority of people living there are Jewish and attend services regularly. People of other faiths were supported to practice their religious observances. All of the people we saw appeared happy and content in the home and communicated well with staff.

Is the service well led?

The home had a registered manager in post which indicated that the person had undergone the relevant checks with the CQC.

Staff had a good understanding of the ethos of the organisation and quality assurance processes were in place. However no quality assurance surveys had been completed for the people living at the home or their relatives for over 18 months to inform and evaluate the service provision. The manager and senior staff undertook a range of quality audits that were in place to ensure that any risks to people's health, safety and welfare were identified and managed. However we found an identified risk assessment had not been acted on as required.

We were told that the members of the board of the service spend a lot of time in the home. People who lived in the home told us that they are always available for a chat.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Not sure if it really matters but for the sake of consistency across all reports I think we should have them in the order of safe, effective, caring, responsive well led as per the guidance

Is the service safe?

People were cared for in an environment that was safe. The nursing care situated on the ground floor required the domestic team to ensure lower level and above eye level cleaning was carried out. The rest of the home including the residential floors was clean and hygienic. Equipment at the home was well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was always available on call in case of emergencies.

Staff personnel records we looked at for training, supervision and appraisal CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been made by the home, proper policies and procedures were in place. Staff were trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. One person told us. "I have all of my needs met wonderfully by the staff here. I could not be happier'. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

We spent time in all areas of Stapley where we observed staff to be kind and patient to the people who lived there. Care staff and nursing staff were patient with people, asking them what they wanted and not telling them, but encouraging them in the right direction. One person told us 'It's a fantastic caring place and I wouldn't want to be anywhere else'. A relative told us 'The staff are very caring, I go home knowing my husband is so well cared for. It gives me a lot of comfort knowing this'.

Is the service responsive?

People's needs were assessed before they moved into the home. People told us that all staff were very attentive and understood what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs were recorded and care and support provided in accordance with people's wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they had completed a customer satisfaction survey, and if they were unhappy with anything staff would always listen. Staff told us they were clear about their roles and responsibilities. They said the management team and trustees always consulted with them before implementing changes to the management of the home and their views were taken into consideration. One member of staff said 'We work as a team so all of the people living here have a good quality of life; we provide good care and would not tolerate bad practice'.

Each of the people using the service had a care plan which provided a good description of the person's needs and how to meet these. We saw some good examples whereby staff had requested specialist advice and support to meet people's needs.

We found there were enough care staff on duty to meet people's needs in a timely manner. However the service was running with some staff vacancies which the manager was in the process of recruiting to fill.

The manager regularly checked on the standards of the home and the provider was in the process of making improvements to the systems for checking quality. People who used the service were asked their views on the home as part of the quality checks.