Archived: Reside at Stour Road

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 service worked alongside other organisations such as the community mental health team enabling better outcomes for people.

The principles of the Mental Capacity Act were being followed which meant that people’s rights were being upheld. Staff had completed equality and diversity training and we observed staff respecting people’s individuality and life style choices. People had been involved in end of life planning which reflected cultural and religious beliefs.

People and their families described the home as happy and told us the staff always would try and help them. We observed positive, warm, friendly fun relationships between people and the staff. Staff gave time to provide emotional support to people and demonstrated an understanding of people’s individual communication skills. Interactions were respectful and included people in decisions about their day to day lives. People had their dignity and privacy respected. Signage around the home and the general layout enabled people with a cognitive impairment to orientate themselves both in the home and garden independently.

People had opportunities to engage in a range of activities in the home. Family and friends were able to visit at any time and new friendships were encouraged. Links had been made with a local school and people had gone to watch a nativity play. One person was being supported to access the community with a volunteer. When people preferred to stay in their room this was respected.

A complaints process was in place that people and their families were aware and when complaints had been received they had been investigated with the outcomes fed back to the complainant.

Staff described the culture as open and felt able to share ideas and views and contribute to the development of the service. Staff meetings were held regularly and included discussions on practice providing learning opportunities. Staff felt confident in their roles and felt that communication was effective in keeping them up to date with any changes. Throughout the inspection management and staff responded positively to areas that had been identified as requiring improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.

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.

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.

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.