Stratford Court

Stratford Court is a residential care home providing personal care and support for up to 30 people, some of whom were living with dementia. At the time of our inspection there were 25 people using the service.

Stratford Court accommodates people across 2 floors and people have access to 2 communal areas and the dining room. There was a lift to access the first-floor bedrooms.

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

The provider’s quality assurance systems were not being used effectively, had not provided effective oversight of the service and had failed to identify a number of concerns that came to light during the inspection. Systems were not in place to ensure a number of environmental factors were monitored and addressed including recording of fire drills, personal evacuation plans, fridge temperatures and servicing of equipment.

People were supported by staff who were aware of the risks to them, but care plans and risk assessments had not been consistently reviewed and kept up to date. Accidents and incidents were responded to and acted on appropriately. However, the information gathered was not analysed for any lessons to be learnt. Visiting arrangements in place did not reflect current government guidance and relatives were requested to make appointments prior to visiting loved ones.

Arrangements in place to admit new people were inconsistent as the provider did not always fully assess people prior to them coming into the service. Staff felt fully supported in their role, but arrangements were not in place to ensure their knowledge and skills were routinely reviewed and assessed for any gaps in their learning.

People were supported to eat and drink to maintain a balanced diet but there was a lack of information available regarding some people’s likes and dislikes. People told us staff responded to their requests for support in a timely manner. Staff felt supported in their role and able to approach management with any concerns they may have.

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.

People told us they felt safe and were supported by staff who were aware of the risks to them and how to act on any safeguarding concerns that came to their attention. People received their medication as prescribed. Staff wore personal protective equipment [PPE] when supporting people and there were supplies of PPE around the home.

People were supported by a group of staff who worked well as a team and alongside a variety of healthcare professionals to ensure people’s healthcare needs were met. People and relatives knew how to raise concerns and felt comfortable doing so. People’s feedback was sought via surveys. People, relatives and staff spoke positively about the registered manager and told us they would recommend 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 (published 12 April 2019).

Why we inspected

This inspection was prompted in part by a review of the information we held about this service. We received concerns in relation to a safeguarding concern that took place at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well led sections of this full report. During and following the inspection, the provider took action to mitigate the risks identified. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stratford Court on our website at www.cqc.org.uk.

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 and will take further action if needed.

We have identified breaches two breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stratford Court is a residential care home that was providing personal and nursing care to 30 people, some of them living with dementia. At the time of the inspection, there were 22 people living there.

People’s experience of using this service:

People told us they felt safe. Staff had an understanding of how to spot signs of abuse and how to report concerns within the organisation and externally. Risks to people were assessed and staff were aware of these risks and how to minimise them. People received their medication as prescribed. Staff wore Personal Protective Equipment (PPE) appropriately.

People were supported by staff who had the relevant skills to meet their needs. People had access to healthcare professionals when required. Staff gained consent before supporting people. Staff had an understanding the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were met.

People told us that staff were kind and caring in their approach. People were given choices and control over their care. People were supported to be as independent as possible. Staff protected people’s privacy and dignity when supporting people.

People’s needs were assessed and reviewed on a regular basis. People were encouraged and supported to engage in activities that they enjoyed. People and relatives knew how to raise concerns and felt comfortable doing so.

The provider had quality assurance systems in place and these were used to drive improvement. People’s feedback was sought via meetings and questionnaires and this information was used to implement actions and changes. People, relatives and staff spoke positively about the registered manager.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (07 August 2017). The overall rating for the service has improved to Good.

Why we inspected:

This was a planned inspection which took place on 12 February 2019. At the last inspection the service was not meeting the regulations and they were required to send us an action plan.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

There was a registered manager in post who was present throughout 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.

People and their relatives told us that they felt safe with the staff who supported them. Staff were aware of the need to keep people safe and understood their responsibilities to report allegations or suspicions of poor practice. Assessments had been undertaken to identify any potential risks to people and guidance was available for staff to follow to minimise those risks. These records were not well maintained and this may pose a risk to people’s safety. Moving and handling transfers were carried out in a safe manner. Medicines were being given as prescribed and stored safely.

Staff were provided with training, but we could not be sure how this was kept up to date. Staff told us that they had received an induction when they commenced working at the home, and safe recruitment practices were in place. People were provided with a good choice of food and were supported to access relevant healthcare professionals when needed.

People were cared for by staff who knew them well and who they described as kind and compassionate. People expressed how they wanted their day to day care to be delivered, but staff did not have sufficient information to apply the principles of the Mental Capacity Act in all instances. People told us that they were treated with dignity and respect, and were supported to maintain their independence.

The provider had begun to consider how to improve and enhance the home to assist people living with dementia. We recommend that the registered manager considers using national guidance about how to improve in this area.

People and their relatives had been involved in the development of their initial care plans, but it was unclear how people continued to have input into their ongoing care planning. People were supported to participate in some social activities. People told us that they felt enabled to raise concerns and complaints and were confident that these would be investigated and acted upon.

People, their relatives and staff described the home as well-led and felt confident in the registered manager. People told us that they were asked their views about the care and support they received, but not about how the home was run or any improvements they might like to see. The registered manager did not have systems in place to monitor and improve the quality and safety of the service provided. The home uses CCTV and further consideration about its use is needed. We recommend that the registered manager considers national guidance in relation to this matter.

You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection in January 2014 we found that the provider was meeting the requirements of the law.

The service had a registered manager, and they were present throughout 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.

People living at the home told us they felt safe, and this was supported in our conversations with relatives. People were encouraged to raise any concerns they had. Staff knew how to recognise when people may be at risk of harm and how to report any concerns. Risks to people had been assessed and identified but the assessments and measures to reduce the risk for the person had not always been updated when people’s needs changed.

The home had a passenger lift and hoists that helped people get in and out of the bath. These had been serviced but not tested as is required by Health and Safety legislation to ensure they were safe to use.

People were supported by staff who knew how to meet their needs. We saw staff responding well to a wide range of people’s needs, although records did not support that all staff had been provided with the required courses or had updates to their training. There were enough staff on shift who were effectively deployed to meet people’s needs. Staff knew people well and could tell us people’s preferences for support, their likes and dislikes and about important people in their lives.

Medicines were given in a dignified and safe manner. Only staff who had received medication training were able to give medicines.

People spoke highly of the care they received and praised the compassion and kindness of the staff who supported them. Feedback from relatives and health professionals supported this. People had access to healthcare professionals and the service was proactive in seeking advice when people’s healthcare needs changed. When advice was given prompt action was taken.

People were offered a varied and nutritious diet. The menu had been planned taking into account people’s preferences and dietary needs. People told us they enjoyed the food.

Only some of the staff we spoke with had received training on the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Some of the staff we spoke with were able to describe how this legislation was applicable to the people they supported.

Some people we met were living with complex and advanced dementia and were approaching the end stages of their life. We have made a recommendation that the provider develops further in this area, to ensure people with these needs receive good care.

People had the opportunity to join in a range of activities both as a group and individually. The majority of people we spoke with told us they enjoyed these.

People and their relatives knew how to raise any concerns or complaints and felt assured that these would be dealt with promptly. We saw the complaints procedure was accessible to all people living at the home.

There were systems in place to monitor the quality and safety of the service, but these had not always been effective at identifying issues where attention was required. The registered manager and the home owner worked at the home each day and had an in-depth knowledge of the home, challenges and areas for future development.

People told us they were very happy with the service they received at the home. One person told us, 'I'm treated as a person' and another said, 'The staff help me, if I ring my buzzer they come straight away.' People told us and our observations confirmed that people were consulted about their care and were asked for their consent to the care they were given.

Staff were aware of people's needs and plans were in place to deliver care in a personalised way. People's health care needs were met through community health services. There were systems in place to identify and manage risks to keep people safe.

We saw that people could choose to join in group activities or spend time on their own interests.

Staff were supported through training, staff meetings and supervision with senior staff to ensure that they could meet people's individual needs.

There were systems in place to ensure people's views were listened to and acted on. Systems were in place to monitor the quality of the service.

Most people using the service were able to tell us about the care and support they received. They told us that that they were comfortable living there and happy about how their care and support needs were being met. Comments included: 'If we are not well the doctor comes' and 'The staff help me to have a bath, I love feeling nice and warm.'

We observed the care and support received by a few people using the service that were not able to communicate with us due to dementia. Staff supported people in a respectful manner and offered choices of how and where they wanted to spend their time.

People told us about the quality and choice of food and drink available. They told us that they were satisfied with this. A person told us 'There is always something available that I like to eat.'

People told us that they felt safe and that they would speak to the staff if they had any concerns. A person told us 'If something bothered me I would talk to the staff.'

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They did not have any information to share with us about the quality aspects of the home.