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Archived: Reside at Stour Road Requires improvement

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Reports


Inspection carried out on 11 December 2017

During a routine inspection

The inspection took place on the 11 December 2017 and was unannounced. It continued on the 12 and 28 December 2017 and was announced. Reside at Stour is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The care home accommodates 20 people in one adapted building and provides care to older people some of whom are living with a dementia. At the time of our inspection 16 people were using the service. Accommodation is over two floors and access to the first floor is by stairs or a lift. There is a communal lounge and dining area which provides level access into a secure garden.

The home had been without a registered manager in post since October 2017 but a manager had been appointed and was starting employment in January 2018. 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.

People had their risks assessed and reviewed monthly. Actions put in place to minimise identified risk were not always being followed. Two people had a high risk of malnutrition and actions had been put in place to minimise the risk of continued weight loss which included staff completing a food and fluid diary and monthly weights being recorded. Risk reviews and monitoring processes had not identified that some actions were not happening or not being effective which meant people were not being protected from avoidable harm. Health and safety audits had been completed but priority actions had not been completed in a timely way.

Prior to admission people were involved in an assessment of their needs and choices and this information was used to create care and support plans. Information in care and support plans was not always accurate in describing the care and support provided. People and their families were not involved in reviews of care. Staff were able to tell us about how people liked to be supported and about the actions they took to reduce risks to people. Engagement with people and their families about the service was limited and they were not always clear about the leadership. A resident and relative meeting had last been held in November 2016.

We have made a recommendation about good practice guidance on the subject of designing, delivering and reviewing peoples care and support needs and choices.

People had risk assessments carried out for skin damage and falls. Actions to minimise harm included specialist pressure equipment and the use of technology to monitor people’s movements. People had been involved in decisions about how risks they lived with were managed ensuring they had freedom and choice in their lives. People were protected from risks associated with infection control as staff had completed infection control training and the home was clean.

People were supported by enough staff to keep them safe and meet their assessed care needs. Staff had been recruited safely ensuring they were suitable to work with vulnerable adults. They had been trained to recognise signs of abuse and understood actions needed if they suspected abuse. Staff completed an induction and on-going training and support that enabled them to carry out their roles effectively.

People had a well-balanced diet and were able to choose from a selection of options each mealtime. Specialist equipment was available to support people to eat and drink independently. Support with meals was provided at the persons pace and respected their dignity.

People had their medicines ordered, stored, administered and recorded safely and had access to healthcare when needed. The serv

Inspection carried out on 29 December 2016

During a routine inspection

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

Inspection carried out on 16, 20, 22 October 2015

During a routine inspection

This unannounced inspection took place on 16, 20 and 22 October 2015. The home is a residential care home and provides support and personal care for up to 20 older people, some of whom had dementia. At the time of our inspection there were 18 people using the service. The home has a ground floor communal area and a first floor which is served by stairs and a lift. There was a garden at the back of the home for people to use.

The home was last inspected on the 2 and 3 of June 2014 and found not to be meeting the standards in the care and welfare of people, requirements relating to workers, assessing and monitoring the quality of the service and records. People’s needs were not assessed properly and care plans did not provide sufficient guidance on how to safely meet people’s needs. Staff recruitment checks did not include a full employment history for some staff who worked at the home. Although the provider had systems in place to monitor the quality of the service, action was not taken promptly to make improvements. Records were not maintained accurately or effectively.

At this inspection improvements had been made to the care and welfare of people, how people’s needs were assessed and how their records were maintained. There was improvement in how information was gathered on applicants’ employment history and the range of activities offered. The home had also recruited an activity organiser to review activities and arrange more variety and choice. While there were improvements in monitoring and assessing the quality of the service, we found that from previous inspections some actions had not been completed including concerns raised about furniture and the lounge carpet and no action had been taken following an internal quality check of the kitchen area by the provider.

The manager who was not a registered manager had recently started work at the service from June 2015. 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 manager was aware of the requirement to have a registered manager at the service and at the time of the inspection they were in discussions with the provider about this. The manager and the senior staff had started to identify the improvement and development needs at the home, including changes to how people’s needs were assessed and their involvement in the process and greater emphasis on recording and monitoring checks.

There was sufficient staff to care for people, however the manager acknowledged that two staff available after 8pm meant that some people could be put at greater risk of falling if left alone in the lounge when staff attended to other people.

We saw there was enough staff to help people with their activities and the support they needed during the day. On one of the days we visited, there were six staff, the deputy and the manager working at the home. The manager had also been recruiting new staff to the service.

People were at reduced risk of abuse and kept safe because staff were aware of how to report abuse and protect people from harm. For example, staff used body maps to record marks and how they would be alert to changes in the person’s reactions. Staff also explained measures to keep people safe from harm. One said, “We always have two staff to move people when using the hoist and we prepare the environment first and protect their feet from injury”.

People were assisted and cared for by staff that were aware of the individual risks to the people they supported. Individual risk assessments were used to keep people safe and included making sure staff had up to date information and guidance about the moving and handling needs of each person.

Medicines were managed safely and people received them on time. Medicines including controlled medicines and topical medicines were administered appropriately and according to the home’s medicine and infection prevention policy. Staff made the necessary safety checks and explained to people how their medicines would help them.

Staff did not receive consistent annual appraisals. While some staff had been involved in an annual review of their work others had not. New staff received induction and initial training to support their role and were expected to begin working towards their Care Certificate. These certificates have replaced the social care induction programmes. New staff were supported by senior staff with reviews at four, eight and twelve weeks to help them settle within their roles. One staff member explained that apprentices were offered the Diploma level two and three following a twelve week successful induction and received support to achieve this. One person said, “Staff are well trained and have the knowledge and experience”.

Newly recruited staff explained their experience of the recruitment process. They confirmed they had been asked to complete an application and had attended an interview and were asked about their work experience.

People were offered nutritious and varied main meals, deserts, seasoning and drinks of people’s choice. Some people requested alternatives like sandwiches and one person wanted yoghurt instead of the main desert. One person said, “The food is hot, good and you can have what you like”.

Some people living at the home did not have the mental capacity to make some decisions about their care and where they lived. The manager told us that soon after starting work at the home she had checked where people had a Deprivation of Liberty Safeguard (DoLS) authorisation and found these to be out of date. The manager explained that they contacted the local authority to identify people where the arrangements for their care may deprive them of their liberty and to request new DoLS authorisations. The manager was informed by the local authority that there was a delay in assessing DoLS authorisations. One person told us that staff approached them first to ask consent before they started caring for them.

People were cared for by staff who demonstrated compassion and kindness as they delivered care. People's relatives were welcomed to visit when convenient to their needs and were encouraged to get involved in their relative’s care, for example, by assisting them with their meals.

People received personalised care and staff received hand overs when changes were made. For example, one staff member told us that someone preferred their personal care later in the day and this was shared between staff at shift changes.

The management team were in the process of developing improvements to care planning and assessments. They acknowledged that they were working through this process to bring everyone’s assessments in line with person centred practice.

There were no complaints at the time of our inspection but staff showed us letters of thanks from relatives of people that had lived at the home.

While quality and safety checks had been carried out at the home, actions we had asked the provider to take at the previous inspection had not been fully completed. This included addressing a stained carpet and stained soft furnishings. We saw an internal quality check which had found the kitchen to be in need of attention but repairs had not been followed up. Findings from a Public Health Officer’s visit in 2014 had not been addressed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to governance at the service. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 2, 3 June 2014

During a routine inspection

This inspection was carried out by an inspector and a specialist advisor. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people told us, what we observed and the records we looked at.

Although we spoke with some people who lived in the home during our inspection, they were not always able to tell us about their experience. This was because some people had dementia. Therefore we spoke with four people's relatives who were visiting the home and observed people receiving support from staff to make our judgements.

If you want to see the evidence that supports our summary please read the full report.

Is it safe?

Relatives told us they felt their family members were safe in the home. They told us that staff looked after them and were kind to them. However, we found that people did not always receive safe and appropriate care. This was because people's needs were not always assessed properly to ensure all risks to their welfare were identified and managed. Care plans did not always contain sufficient guidance about people's needs and how to meet them. People's care was not always delivered in a safe, or consistent, way. Improvements were needed to ensure that people's needs were assessed properly and that their care was provided in line with a robust care plan. We have set a compliance action for this and the provider must tell us how they plan to improve.

Improvements were also required in relation to records about people's care. Accurate and effective records were not maintained. For example, some records about people's needs were not up to date, some contained insufficient, or conflicting, information and some records were missing. This did not protect people from receiving inappropriate or unsafe care. We have set a compliance action for this and the provider must tell us how they plan to improve.

We found that the home had a process in place to ensure checks were carried out on new staff before they came to work in the home. This process helped ensure that staff were suitable for employment and safe to work with vulnerable people. Although most checks were carried out appropriately, there was not enough information available about people's employment history or gaps in employment. Improvements were needed to ensure that this information was obtained as part of the recruitment process. We have set a compliance action for this and the provider must tell us how they plan to improve.

Is the service effective?

People who lived in the home, and their relatives, had confidence that the home was able to meet their personal care needs. For example, one person described their care as "very good", while a relative told us, "I could not have found a better place. I have no complaints."

However, we found that the home did not always meet people's needs in relation to activities. There was not enough for people to do and people were not always given opportunities to do things they enjoyed. For example, one person told us, "There is nothing much to do. I sit here most of the day. I said I would like to do a jigsaw but they said that people have to eat at the table so there is nowhere for me to do it."

We observed people spending long periods of time sitting in the lounge with nothing to do. The television was on but people were not watching it. Although care staff made an effort to initiate activities when they had time, activities were not always tailored to people's needs and preferences and not everyone was able to join in. We have set a compliance action for this and the provider must tell us how they plan to improve.

Is the service caring?

People who lived in the home, and their relatives, described staff as "lovely" and "nice". One relative told us, "They are very kind indeed, without exception."

We observed people receiving support from staff who spoke with them in a kind and sensitive way. For example, we saw staff asking people if they wanted help before intervening. We also saw staff explaining to people what they were doing to help them understand.

Staff spoke positively about their work, telling us they enjoyed getting to know people who lived in the home and spending time with them.

People's relatives were welcomed in the home and they were able to be involved in their family member's care, for example, by spending time with them and supporting them with eating.

Is the service responsive?

The home responded to people's changing needs by seeking professional advice. For example, where staff had concerns about people's health, we saw that this had been reported to a doctor. We saw that there was involvement from a specialist team where a person was nearing the end of their life and community mental health professionals were involved in assessing a person's mental health needs.

Relatives gave us examples of how the home had responded to changes in the health of their family members, for example, by calling the emergency services when people had fallen or calling the doctor out when they were unwell. Most relatives told us that the home also communicated with them effectively to let them know about changes in their family member's health which enabled them to be involved.

Staff were able to tell us how they had made changes to people's care in order to meet their needs, for example, by applying creams where people had sore skin, or caring for people in bed when they were unwell.

Is the service well-led?

There was a clear management structure in the home. People knew who the registered manager was and were clear about who they would approach if they had concerns.

Checks were carried out by the director and registered manager to ensure procedures were followed. There were also systems in place to monitor accidents and incidents which meant the home was able to identify emerging risks and take appropriate action where required.

There was a process in place to obtain people's views about the home. We saw that a relatives' survey had been carried out in 2013 in which people had made comments about what the home did well and what could be improved. Although most of the feedback received was very positive, we noted that activities had been identified by some people as an area for improvement. There was no action plan arising from the survey to tell us how improvements were being made and we identified that activities continued to require improvement at this inspection.

We found that improvements were needed to the home environment to ensure it provided a clean and comfortable place for people to live. We observed that some carpets were stained, some furniture needed to be replaced and some areas of the home would benefit from redecoration. A relative told us, “The only criticism of this place is it could be made more comfortable. It is not the standard one would expect in one’s home.”

The director told us they had put together a list of improvements that were needed in January 2014 and were waiting for funds to be released so that refurbishment could take place. Following our inspection, the director informed us that funds had been released to enable work to progress. However, we remain concerned about the delay in this work being undertaken. We have set a compliance action for this and the provider must tell us how they plan to improve.

Inspection carried out on 16 October 2013

During a routine inspection

During this inspection we spoke with two people who lived at the home and five relatives.We also spoke with five care workers, one visiting healthcare professional, the operations manager and the manager of the home.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

One relative we spoke with told us, "We have 100% confidence in the staff and management". Another relative we spoke with told us, "I am made to feel very welcome, my (relative) can be difficult but the staff are wonderful with them".

People's privacy, dignity and independence were respected.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had an effective system to regularly asses and monitor the quality of service that people receive.

Inspection carried out on 12 September 2012

During an inspection to make sure that the improvements required had been made

We had previously inspected Reside Stour Road in March and May 2012. At these inspections we were concerned that people's care was not always being delivered in line with their individual care plan and staff had insufficient training to meet people's needs.

The majority of the people who live at Reside Stour Road were not able to give an account of what it was like to live at the home because of their mental frailty, however we spoke with two people who were able to tell us what it was like to live there.

We used a formal method to observe people during the visit to help us understand their experiences. This involved observing four people for an hour. We observed their mood state, how they engaged in tasks and activities, and interacted with staff members, other people and the environment.

During our visit we observed the home had a relaxed, calm and happy atmosphere. People were given personal care in a respectful and dignified way.

One visitor we spoke to said their friend was “very happy” at Reside and they had no complaints. They told us they were always made to feel welcome and the standard of care provided to their friend was “very good”.

We found that care plans accurately reflected people’s needs and had been written in a person centred way with their involvement.

We observed the staff were confident in their roles and were properly trained in order to carry out their role.

Inspection carried out on 9 May 2012

During an inspection in response to concerns

We were assisted throughout this inspection by an Operational Manager for the organisation and the new manager who had only just started working at the home.

At the time of our inspection there were 14 people living at Reside at Stour Road. The home caters mainly for the needs of people who have dementia. The majority of people were therefore not able to tell us about their experiences of living at Reside at Stour Road. In order to assess their experiences we used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We were also able to speak to one visiting relative, who told us that they visited the home regularly unannounced. They said that they had no complaints or concerns and had been very happy with the care and support provided at the home.

As part of the inspection we spoke with three members of the care staff team. They told us there was a core of longstanding staff members and that there was now consistent staffing at the home. We were told that there was a good morale and that staff knew how to look after the needs of all the people living at the home. Staff told us they have received appropriate training and support.

During an inspection to make sure that the improvements required had been made

We had previously inspected Reside Stour Road in September 2011. At that inspection we were concerned that people’s care plans and risk assessments had not been done or regularly reviewed, safe guarding policies were not always followed, staff had insufficient training to meet people’s needs and the quality monitoring process was not robust.

As a result of the inspection visit in 2011 we issued compliance actions to tell the provider to improve standards in relation to the care and welfare, safeguarding people, staff training and quality assurance. We carried out this inspection visit to review if compliance had been achieved.

A visitor told us that their relative had just moved in. They told us that they had been involved in their relatives initial assessments carried out by staff from the home. They felt it was a thorough process and were pleased that the home was able to offer their relative support and reassurance in a way they wished.

We spoke with three staff members during our visit to the home. They had a good understanding of how to meet some of the people’s needs. Staff were able to tell us how they had put training into practice.

A visitor told us that they were confident their relative was safe at the home. They told us that the staff were caring and compassionate.

We observed care practices and the interaction between those who lived at the home and staff. The interactions were positive and it appeared that people felt safe in the company of the staff.

At the time of this review a safeguarding concern was currently being investigated by the local authority. If necessary, we will take further action following this investigation.

During an inspection in response to concerns

The people who use the service informed us that they felt the staff were kind to them and supported them with their day to day needs. One person told us that they get up when they like and that there is always someone around to help.

A visiting relative told us that they were very satisfied with the care and attention their relative received. They further commented that they considered that people were well cared for and gave examples of how their relative received a good service such as always been shaved with clean clothes and help is always being available to encourage their relative to eat.

A relative told us that they considered that the home keeps them informed of any changes in the needs of their relative and informed us that they are regularly asked for their thoughts into the care offered.

The interactions between the staff and people who live at home were observed as very positive and compassionate. Staff take their meals with the people that live in the home and take time to sit and talk if only for short periods.

Reports under our old system of regulation (including those from before CQC was created)