Archived: Stanton Court

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Stanton Court, on our website at www.cqc.org.uk

Stanton Court 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. Stanton Court provides nursing and personal care for up to 36 older people. At the time of our inspection there were 24 people living at the service.

Stanton Court is set in a rural location in the village of Stanton Drew. The service is a grade two listed building set over three floors. A conservatory at the rear of the service overlooks the large mature garden.

A registered manager was in post at the time of the 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 2008 and associated Regulations about how the service is run.

At our last inspection in June 2017 we found the service required improvement as care plans were not always person centred, pressure care was not always managed effectively and management structures had been unstable. An action plan had ensured these areas had been addressed and improvements sustained. A thorough audit system ensured the quality of care and support people received was regularly monitored and reviewed.

People enjoyed the activity provision provided by the service and the links established with the local community. People had access to safe and pleasant outdoor areas. People gave positive feedback about the food provided by the service and individual needs were catered for.

Medicines were managed and administered safely. People were supported by a consistent and motivated staff team. Staff felt valued and supported. Staff received effective induction, supervision and training to ensure they were skilled and competent in their role.

People were supported by staff who kind and caring. People had developed positive relationships with staff members. People told us there was a happy, friendly and homely atmosphere at the service. People were supported and encouraged to remain independent. Visitors were welcomed and involved in the service.

Care plans were person centred. The service was responsive to people’s care and support needs. People’s individual preferences and routines were respected. People were supported with their nutrition and hydration and healthcare needs and additional support sought when required.

Consent to care and treatment was sought in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards requirements were being met. Risk assessments were in place to minimise known risks. Accidents and incidents were reported and recorded. A system ensured actions were taken and steps taken to prevent reoccurrence.

The environment and premises were regularly checked, cleaned and maintained. The service continued to refurbish and upgrade the environment and premises. New equipment had been purchased to support people’s safety and promote people’s dignity.

The service was well led and managed. People, relatives and staff were encouraged to give feedback and suggestions about the service to ensure continual improvement. The registered manager was visible and approachable. Complaints were managed effectively and people and relatives felt comfortable in raising any concerns. The provider had clear oversight of the service. Staff and management told us they were well supported by the provider.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Stanton Court, on our website at www.cqc.org.uk

Stanton Court provides nursing and personal care for up to 36 older people. At the time of our inspection there were 24 people living at the service.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The previous registered manager had left the service in February 2017. A new manager had started in post in February 2017 and left the service in April 2017. A registered manager of another service was acting as manager whilst a new manager was being recruited. They were well supported by senior staff from within the service and the regional manager.

At our last inspection we found the service was failing to meet the regulations in regards to people being safeguarded from abuse, effective action being taken to minimise the risk of accidents and incidents, a lack of individual emergency plans, staff training not being up to date, consent to care and treatment not being sought in line with legislation, complaints not being investigated or responded to, notifications not being submitted to the Commission as required, the provider failing to display their rating and a lack of robust system to monitor and improve the quality of the service. The provider had completed the action plan they had produced. This meant the warning notice was complied with and all the previous regulations that were breached had now been met.

The service had undergone a period of change and improvement since our last inspection in December 2016. People, relatives and staff spoke positively about the changes that had occurred. This included improvements in activity provision, communication and responding to accidents and complaints. The improvements that have already been made will need to be sustained and stable management established.

We found the service was not always responsive as care plans lacked personal history and details. We found that pressure care had not always been effectively managed as people’s air mattresses were not always set correctly.

Improvements had been made to the safety of the environment through new call bell and fire systems. A scheme of redecoration to people’s rooms was underway and further improvements were planned to enhance communal areas of the service. Systems were in place to regularly check equipment and areas of health and safety. People had individual emergency plans that reflected people’s current support needs.

The storage and administration of medicines were safe. Recruitment procedures were followed and staffing levels were safe. Staff were supported by effective induction and training. Supervision of staff had not been regularly occurring but was now in place. Staff said they felt supported by senior staff.

Staff were clear on their responsibilities around safeguarding vulnerable adults. Accidents and incidents were reported and actions taken to prevent reoccurrence. People had assessments in place to minimise risks and maintained people’s independence.

People’s mental capacity was clearly assessed in care documentation. Where needed best interest decisions had been held which involved people’s family members and advocates. The service was compliant with the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. Conditions attached to a DoLS’s authorisation were being met.

People’s nutritional and hydration needs were met. People spoke highly of the quality of the food. People had opportunities to give feedback and be involved with food choices.

People were supported by staff who were kind and caring. People had good relationships with staff. The atmosphere was relaxed and happy. Staff worked well as a team and knew the providers values of care.

The service sought feedback from people, staff and relatives through meetings, surveys and audits. We saw that actions were taken from feedback gathered. Systems were in place for the acting manager and provider to monitor, review and improve the quality of care and support.

Stanton Court provides nursing and personal care for up to 36 older people. At the time of our inspection there were 26 people living at the home.

A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The home was going through a transition period as the company had been acquired by a new provider in October 2016. New systems, policies and procedures were being introduced. The new provider recognised that changes needed to be made to ensure improvements to the home took place.

The home was not always safe as the systems and process in place were not effective when a safeguarding incident occurred. We found that incidents were not consistently reported to the local authority safeguarding team or the Commission. Effective action was not taken to minimise future risks. Risk assessments were in place for people but they did not always provide enough guidance for staff on how to minimise the risks identified.

Medicines were managed and administered safely. Staffing levels were at the planned level and people and relatives told us there were enough staff to meet people’s needs. Safe recruitment procedures were followed to ensure staff were suitable for the role.

The service was not always effective as consent to care and treatment was not always sought in line with the Mental Capacity Act (MCA) 2005. Mental capacity assessments and best interest decisions had not been completed where appropriate. The registered manager was aware of their responsibilities in regards to (DoLS). DoLS is a framework to assess if the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm is required.

Staff had not fully completed the home’s induction programme. Training for staff had not always been completed or regularly updated in key areas such as the MCA or fire safety. Staff had not been supported by regular supervision. This meant that staff may not have the skills, knowledge or competence to be effective in their roles.

The service was caring as people were supported by staff that were kind and respectful. We observed positive interactions and relationships between staff and people living at the home. Staff knew people well and understood their personal preferences. Staff were prompt to respond to people’s support needs. People, staff and relatives commented on the positive and friendly atmosphere of the home. Visitors told us they were always welcomed in the home.

People were supported with their nutrition and hydration and spoke positively about the food provided by the home. Staff were observed to be attentive to people’s daily needs. There had been several positive compliments about the home.

The service was not always responsive. Care plans were not person centred and did always give clear guidance to staff as to how people wished to be supported. Changes in people’s care needs were not always reflected in the care records.

People and relatives had highlighted there was not enough activities to keep people stimulated and engaged. Complaints were not recorded in a systematic way so they could be effectively dealt with. Complaints were not always responded to.

The service was not well-led. Effective systems were not in place to monitor and review the quality of care and support. Notifications had not been reported to the Commission as required. The home had not displayed the Commission’s rating given after the inspection in September 2015 conspicuously as required. An action plan to show how the home intended to address regulatory breaches from the last inspection in September 2015 had not been submitted to the Commission, nor had effective action been taken. Meetings were held with staff and relatives, but these were not held regularly and minutes were not available to view.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.

We had also found that the provider had a system to assess and monitor the quality of service that people received. However we had found that environmental hazards to people were not being identified or safely managed.

The provider wrote to us and informed us they were compliant in the outcome areas on 27 November 2013.

We carried out our inspection to check that the provider was now compliant. We also checked the provider's infection control arrangements in the home. This was because of concerning information that we received prior to our visit.

At this inspection we spoke with 11 people who used the service. Every person we spoke with had positive views of the way they were cared for at Stanton Court and what it was like to live there.

At this inspection we also found that that people were protected from environmental infection control risks in the home.

People were protected against items that could be environmental hazards. Specifically we saw that corridors and communal areas of the home were free from obvious clutter and trip hazards. A new reception area had been built that provided additional storage space in the home.

People had positive views of Stanton Court. Examples of comments included, 'all the girls have been marvellous this is the best home in the area' and 'I'm more than happy here this is my home'.

People were effectively assisted by the staff so that their range of nursing and personal care needs were met.

The people we spoke with felt satisfied with the choices and quality of the meals that were provided for them at the home.

People who used the service lived in an environment that was appreciated by them because of its homely design and atmosphere. The environment was mostly safe for peoples' needs. However on the day of the inspection we found there were a number of hazards left in communal areas. These included household items left on corridors, plastic aprons and bottles of hand sanitizer left on grab rails, and cups of water left on an electric heater.

The quality of care and overall service people received was checked and monitored to make sure it was safe and suitable. However regular checks of the home environment to ensure it was safe and free from hazards were not up to date. This could put people at risk, for example if someone fell over a piece of household equipment that we saw had been left on a corridor.

We saw the provider had a policy on safeguarding people from abuse. Staff had attended training to help ensure that people who lived in the home were protected from the risk of abuse.

Evidence from speaking with people who lived in the home and staff and the staff rota showed that there were sufficient numbers of suitably qualified, skilled and experienced staff at all times.

We observed people enjoying sing -along session in the afternoon of our visit. One person told us they liked the activities, 'there's a lot to enjoy here'.

People told us they were able to discuss issues openly at the residents' monthly meetings. They said they were aware of the complaints procedure and would let the manager know if they were unhappy. One person said 'I have no complaints'.

Three relatives visiting the home told us their family members were in the best place. They said their relatives were happy and settled. One relative said staff were 'absolutely amazing they let my relative do what they want to do. For example helping to collect cups and plates after meals'.

We saw the provider had effective systems in place to regularly monitor the quality of service that people received.