Stuart House

We found the following examples of practice that required improving

During our inspection we found the handling of laundry required improving. This was because clean laundry was being stored in the laundry area. We also identified the laundry area had a sluice although we were informed this was not in use. We recommend the provider reviews their approach in the handling of laundry to prevent the spread of infections. Prior to our inspection we had received concerns that not all staff had received a vaccination in line with the governments condition of deployment. We found one member of staff required their COVID-19 vaccine. The registered manager confirmed the member of staff had completed their exemption form and would receive their vaccination before their exemption form was due to expire.

During our inspection we found the building to be clean and odour free. However, cleaning schedules were not always completed to demonstrate enhanced cleaning had taken place to high touch points such as banisters and door handles or what cleaning staff had undertaken within the afternoon shift. We raised this with the registered manager so they could address this shortfall.

We found the following examples of good practice.

We spoke to people and asked them if they were happy with the care and support, they received. One person told us, “Very good. Nice staff. Helpful and kind”. One relative told us, “Staff are nice. Nothing has ever been a problem”.

The registered manager confirmed COVID-19 had impacted the service and during this time they had resorted in using agency staff. The service had also had a number of vacancies which the registered manager confirmed at the time of this inspection had now been filled. Staff and people confirmed improvements were being made to the staffing. People told us, “It’s been difficult because of COVID-19. Not always been enough staff”. Another person when asked if there were enough staff told us, “Yes, there is enough staff”. Staff told us, “We use agency staff” and “Staffing is better now. We’ve all had COVID-19 but the staff are all lovely to work with and there is a good staff morale. Things are starting to improve now”.

People were supported by staff who had received infection prevention control training and who wore personal protective equipment (PPE) as required. Staff and visitors had access to PPE. Staff told us, “We have plenty of PPE” and “We use surgical masks, gloves and aprons. There is plenty”. One relative told us, “I always wear a mask”. Systems were in place to ensure staff and visitors had COVID-19 checks undertaken in line with government guidance. This included a negative lateral flow test and a temperature check under-taken prior to the start of their shift or visit.

People had visits from their loved ones and were supported to keep in touch at other times. One person told us, “My [Family] visit and ring all the time”. Relatives told us, “I can ring if needed” and one person who was an essential care giver said, “I visit every day”.

Stuart House provides accommodation and personal care for up to 21 people. When we visited, 19 people lived there, however one person was in hospital.

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

People were supported by staff that were caring and treated them with dignity and respect. Staff understood the needs of the people they supported. Through conversation, staff told us how they aimed to achieve positive outcomes for people.

Risks of abuse to people were minimised. The service had appropriate safeguarding systems and processes. Assessments of people’s needs identified known risks and risk management guidance was produced for staff which they understood. The service did not use a dependency tool to aid them in ensuring enough staff were deployed. We received mixed feedback from staff, people, and relatives about the number of staff on duty at times. We have made a recommendation in relation to this.

There were effective systems that ensured the service was safe. Health and safety checks, together with effective checks of the environment were carried out by dedicated staff. Guidance to aid staff and the emergency services in the event of an evacuation was completed and current.

People received their medicines as prescribed and medicines were stored securely, however we identified some areas that required attention. We found that systems to monitor stock balances and protocols for ‘when required’ medicines needed improving. We have made a recommendation around the management of medicines.

People, their relatives and a healthcare professional gave us positive feedback about the quality of care people received. The feedback on the leadership of the service and the registered manager was positive. However, we found quality monitoring systems had not been fully effective in identifying the improvements required in relation to medicines management or the evolving risk in relation to staffing numbers. We have made a recommendation about this.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood their role and were confident when performing it through a continual training package. Staff at the service worked together with a range of healthcare professionals to achieve positive outcomes for people and followed professional advice to achieve this.

There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority. Staff understood and acted in accordance with the principles of the Mental Capacity Act 2005 and associated guidance. People within the service were supported to eat and drink sufficient amounts.

People’s care plans were personalised and aided staff in supporting people in a person-centred way. People’s communication needs were recorded, and care was planned to meet people’s needs. There were activities in place and service had recently employed new activity staff to increase provision. There were escalation plans in place for end of life care and we discussed the further development of end of life care planning with the registered manager. People's concerns and complaints were listened and responded to. Accidents, incidents and complaints were reviewed to learn and improve the service.

Rating at last inspection:

The last rating for this service was Good (published February 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

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

Stuart House is situated in Weston-super-mare, Somerset and one of the 11 services provided by N. Notaro Homes Limited. Stuart House is located within walking distance of the town and seafront in a quiet residential area. The home is registered to provide residential care for twenty one older people living with dementia, however the provider uses the double bedrooms as singles for a maximum of 19 people. The home also cared for older people living with mental health issues such as Korsakoff’s syndrome (alcohol related brain damage). At the time of the inspection 17 people were living at Stuart House with another person receiving temporary respite care. People were also able to book in for day care.

The last inspection was carried out in July 2014 and we found the service to be compliant with the standards we inspected and meeting all the legal requirements in relation to the regulations.

At this inspection we found the service was still meeting all regulatory requirements and did not identify any concerns with the care provided to people living at the home.

There was a registered manager. 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.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. People were encouraged and supported to maintain their independence.

There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or went out. The majority of people were living with dementia and were independently mobile. Staff engaged with them in ways which reflected people’s individual needs and understanding.

People said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. People said they would speak with staff if they had any concerns and seemed happy to go over to staff and indicate if they needed any assistance.

Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said “I don’t have any problems, the manager and all the staff are lovely. “

People were well cared for and were involved in planning and reviewing their care as much as they could, for example in deciding smaller choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on. Staff were present with family when the care planning was discussed, for example some people living with dementia were able to say if they would like a key to their room or not and have input into activities they liked to do. For example, one person liked to go for a swim and told us about how they enjoyed doing that to alleviate their aches and pains.

There were regular reviews of people’s health, and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

Medicines were well managed and stored in line with national guidance. The home used a new computer medication administration system. Therefore, electronic records were completed with no gaps, with on screen alerts highlighting medication due to be given. There were regular audits of medication records and administration and to ensure the correct medication stock levels were in place.

Staff had good knowledge of people, including their needs and preferences. Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. Comments about staff included, “They are so nice. I had bad rheumatism once and went to lie down. They came and checked on me. They really care” and “The staff are nice. They help me go for a walk when I want.”

People’s privacy was respected. Staff ensured people kept in touch with family and friends. One relative told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private. For example, if a person did not want to go to their room a privacy screen was used in the communal area to maintain privacy but also reduce distress from moving. We saw how staff positively supported relatives, especially where the behaviour of the person living at the home could be challenging due to their dementia, reassuring the relatives and discussing positive aspects of the person’s day.

People were provided with a variety of opportunities for activities and trips. These were individual as well as group organised activities, such as a trip to the shops, putting up Christmas decorations, arts and crafts or simple board games. People could choose to take part if they wished. Staff also used subtle ways to promote independence such as asking people to pick up their drink from the trolley to ensure some movement. Activities were not only organised events such as trips out and external entertainers but on-going day to day activities. For example, there was always something for people to do for stimulation such as chatting with staff, playing games, looking at books, household chores or just tidying or moving things. People looked comfortable and happy moving around the home, some people stopping for rests or a nap, other people walked around touching and moving things in a purposeful way. Staff were always visible to interact or sit with people. One care plan said, “[Person’s name] likes one to one with staff so take time to sit with them every day.” This person was playing dominoes with a care worker during the inspection.

The registered manager showed great enthusiasm in wanting to provide the best level of care possible. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. Some staff had returned from working elsewhere because they missed working at the home. Other staff had worked at the home for many years and all comments were positive. They included, “It’s lovely here, there is a lovely feel. We do a good job looking after people so I love my job” and “We get to know people well. It’s nice to see them doing well. We work well as a team and [registered manager’s name] is great. That’s why we stay.” Recent thank you cards from relatives stated, “Both my [parents] settled in quickly and it was a great joy to see [person’s name]’s face would light up and tears of happiness filled their eyes when they spent time with the genuinely warm, compassionate and happy carers and staff of Stuart House. [Person’s name]’s wit and playfulness could be engaged even at the end of their life. We are indebted and extremely grateful to you all.”

There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider audits. There were systems in place to share information and seek people’s views about the running of the home, including relatives and stakeholders. People’s views were acted upon where possible and practical, and included those living with dementia. Their views were valued and they were able to have meaningful input into the running of the home which mattered to them. For example, some people said some of the chairs in the lounge needed replacing and these were ordered.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). Staff clearly understood the importance of seeking people's consent and offering them choice about the care they received. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff spoke positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were up to date. Staff confirmed they receive

If you wish to look at our findings in detail please see the full report.

Is the service safe?

People told us that they felt safe. The environment was clean. There were sufficient numbers of staff on duty to meet the needs of the people in the service. Staff were confident to raise safeguarding concerns to the manager and were able to describe the steps to take if they were concerned that abuse had taken place. The premises were secure from anyone entering unannounced, and care records were retained in secure areas and only accessed by authorised staff.

Is the service effective?

People can be reassured that their needs will be met at this service. Each person had a detailed care plan that described their support needs. Staff had a good understanding of people's needs and they knew people in the service well. One relative told us, "They're all very lovely here.'

Is the service caring?

People were supported by kind and attentive staff. We saw that the staff demonstrated a great deal of patience when supporting people. One staff member told us, 'We always try to do our best.' We saw that people were not rushed to make their own decisions. A relative told us "We have no concerns at all, because it's a lovely home.' We saw a survey that had been sent to families was complimentary and positive.

Is the service responsive?

People's support needs were assessed before they were admitted. The service worked with other agencies to ensure people were supported in the best possible way. Care records reflected people's individual needs and described staff interventions. People and their relatives were invited to meet with their keyworkers each month to review their care plans where necessary. People had access to activities that were important to them.

Is the service well-led?

The provider had systems in place to monitor the quality of the service being provided. These included feedback by the use of monthly audits, complaints received and surveys issued. All findings were evaluated and actioned. Staff had a good understanding of the aims of the service. All care records we viewed were current. All risks had been assessed, and safeguards put in place where necessary.

Meals were well-presented and nutritionally balanced. People ate independently but staff were available to provide support when necessary.

Staff were suitably qualified, skilled and experienced. All the staff we spoke to were happy in their work. One staff member told us "I am happy here, it's nice and really friendly". Staff told us about the training they had received. They were able to demonstrate how they would recognise signs of abuse and assured us they were confident to report any abuse.

The provider had systems in place to assess and monitor the quality of the service provision. Regular audits and patient surveys were carried out to continually monitor the service provision. Any findings were evaluated and actioned upon, in order to improve and develop the provision of services.

Some people who lived at Stuart House were unable to comment on the care and support they received. However those people spoken with who were able to comment all told us they were very happy living at Stuart House. One person said, 'They are very efficient here, it is run just how I like it'. Another person told us, 'I really do like it here and I had a good Christmas'.

We observed staff organised meaningful activities and treated people who lived in the home with respect and dignity.

We found that care planning was person centred and agreed by the individual, a family member or an advocate. Regular reviews were carried out and involved the individual.

We found that the receipt, storage and administration of medication was managed safely within the Royal Pharmaceutical Society guidelines.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager. The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.