Stanford House

Stanford House is a residential care home providing personal care and accommodation to up to 10 older people. At the time of our inspection there were 6 people using the service.

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

People were not always protected from risks in the environment, such as secured windows or the storage of chemicals. Medicines were not always stored safely, but people received their medicines as prescribed. People’s individual risks were not always regularly reviewed and documented. However, people felt safe at Stanford House and were satisfied with the 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 supported this practice.

Quality assurance systems were not always effective. Audits monitoring the quality of the service did not highlight the issues identified by our inspection. However, people and relatives felt the service provided a homely, family atmosphere which achieved good outcomes for people.

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 23 December 2021) and there was a breach of regulation. The provider was asked to complete 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 not been made and the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced focused inspection of this service on 21 October 2021. A breach of legal requirements was found. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve the governance systems at the service.

We undertook this focused inspection to check what actions had been taken and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 Stanford House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to how people’s safety was managed and how the service was run at this inspection.

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.

Stanford House provides accommodation for up to 10 people who require personal care. On the day of our inspection there were six people living at the home. People who lived at the home had varied needs associated with old age and frailty and some people had mental health needs.

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

Since the last inspection, systems and processes to provide good governance of the service had not been consistently completed. Audits that were in place had failed to identify a number of areas of concern that were found on inspection, such as medication management and ensuring care records provided staff with the most up to date information regarding the people they supported.

Systems were not in place to ensure any concerns of a safeguarding nature were reported to the appropriate authorities in the absence of the registered manager. Medicines management arrangements were not robust and required improvement. Accidents and incidents were responded to appropriately.

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 his practice.

Staff reported they would benefit from more up to date training, as training had not been updated during the pandemic.

We were not fully assured on some areas of infection control management and reported our findings to the registered manager.

People were supported to access healthcare services and the service worked alongside healthcare professionals to meet their needs.

People and relatives were complimentary of the service. People felt safe, supported by a consistent group of staff who knew them well.

Staff enjoyed working at the service and healthcare professionals were complimentary of the care provided to people living at Stanford House.

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 30 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, infection control and management oversight of the service. 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, effective and well led sections of this full report.

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.

We have identified a breach in relation to Regulation 17 (good governance) at this inspection. The provider responded to the concerns on the day of the inspection. Please see the action we have told the provider to take at the end of this report.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe 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 Stanford House 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.

We found the following examples of good practice.

¿A visiting policy was in place. By prior arrangement, on a one at a time basis people could sit in the entrance porch to speak with and see their family in line with social distancing guidance. Visitors to the home were required to wear full Personal Protective Equipment (PPE). People were supported by staff to remain in contact with their family and friends via telephone and video calls.

¿ People were encouraged to social distance in line with current guidance. Chairs had been spaced out to ensure they were at least two metres apart. Staff sat with people at a distance that allowed conversation but reduced the risk of infection transmission.

¿ People were supported by staff who wore the required PPE. PPE was disposed of in appropriate waste bins in line with in Infection Prevention and Control (IPC) good practice.

¿ As a matter of course staff had a COVID-19 test twice weekly and people every 28 days. Where people or staff tested positive, they were required to self- isolate in line with current guidance.

¿ The premises were clean. Cleaning schedules were in place and were complied with.

¿Staff were not allowed at the present time to work in a second care service and no bank or agency staff were used to reduce the risk of transmission of infection.

¿ People were supported by staff who were trained in IPC and PPE usage.

¿The provider's IPC policy was up to date and had been implemented within the home. Guidance to prevent infection being brought into and spread within the home was visible within the home.

Accommodation was provided over two floors. Communal areas included several lounges and a dining space, an additional dining area and kitchen. People either had their own room or shared with another person. People had access to large gardens at the rear of the home.

People’s experience of using this service:

People we spoke to were positive about the service. People told us they thought the service was well run and they enjoyed living there.

People were happy with the care they received and we observed friendly interactions between people and staff. A person told us, “This is a lovely place, they look after us well.” Another person told us, “I’ve been here for ten years, it’s lovely.”

They said they felt safe and there were sufficient staff to care for them. A person told us, “Staff have been here for years, there’s no turnover of staff, they get to know you and you get to know them. They’re not staff, they’re my friends.”

We observed there were sufficient staff to meet people’s needs, to give the support they needed and to spend quality time with them. Staff spent time with people as and when they wanted. We spoke to a relative who told us, “She’s really happy and content here, it’s small and nice, like a whole other family.”

People were supported by staff whose suitability was checked through a robust recruitment process. People’s medicines were managed safely.

Before they came to live at the home, people’s needs were fully assessed to ensure that staff could meet their needs appropriately. Staff told us they felt supported, received regular supervisions and an annual appraisal.

People continued to have access to a range of healthcare professionals and services. We received positive feedback from external professionals about the service, for example a community mental health nurse told us “Having worked in the community for 17 years, I can honestly say it is the only home I know that I would have no concerns about placing one of my own relatives in.”

Staff respected people’s choices and enabled people to be independent. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans guided staff about people’s needs and how to meet them. Staff supported people to be involved in decisions about their care and to live as independently as possible. No-one living at the home required end of life care at the time of the inspection.

People were supported by staff who were trained to recognise the signs of any potential abuse. Staff had been trained in safeguarding and knew what action to take if they had any concerns about people’s safety or welfare. People’s risks were identified and assessed appropriately. Staff knew how to keep people safe in an emergency, such as a fire. Arrangements continued to be in place to assess and monitor the quality of the service, so that improvements could be made.

This service met the characteristics of Good. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: Good. The last inspection report was published on 2 September 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for 'Good' services.

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

Stanford House provides accommodation for up to 10 people who require personal care. On the day of our inspection there were seven people living at the home and one person was in hospital. People who lived at the home were elderly and had needs associated with old age and dementia.

There was a registered manager in post and she was present during our inspection. 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.

People told us they felt safe at the home, and staff had received training to ensure they knew how to recognise and report concerns. We found risks to people were managed in a way to keep them safe. There was sufficient staff to support people and meet their needs. People received their medicines safely and as they had been prescribed.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions.

People received care and support from staff that knew their individual needs, and recognised when these changed. Staff were supported through regular supervision, and told us that if they had any concerns for people’s well-being they were able to get advice from senior staff or the registered manager.

People were encouraged to be independent and their privacy and dignity was respected. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health. People knew how to make a complaint and were confident that their complaint would be fully investigated and action taken if necessary.

People described the registered manager as approachable and they said they felt the service was well managed. Arrangements were in place to assess and monitor the quality of the service, so that improvements could be made. The management of the home was open and transparent.

We saw people were treated with respect, and were encouraged to do things for themselves so protecting their independence and self esteem. People told us staff respected their privacy when supporting them with personal care.

People told us they enjoyed their own interests and hobbies, and entertainment brought into the home.

We saw people were supported to eat and drink enough, and arrangements were in place to identify risks of weight loss.

The management of risks associated with people's mobility and skin care, had improved. Staff were aware of the importance of ensuring people's needs were re assessed when their dependency increased. This meant there was enough equipment to promote the safety and comfort of people.

Staffing levels were sufficient to manage people's needs. Everyone we spoke with was confident if they had any complaints these would be managed without delay. We found improvements in people's care records; these were up to date and included accurate information about how risks to people's health should be managed.