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Inspection carried out on 2 November 2017

During a routine inspection

Stewton House is registered to provide accommodation, nursing and personal care for 48 older people. There were 44 people living in the service at the time of our inspection visit.

The service was run by a company that was the registered provider. The company’s area manager was also managing the service and had applied to be registered by us in that role. 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. In this report when we speak about the company we refer to them as being, ‘the registered person’.

At our last comprehensive inspection on 6 September 2016 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating our domains ‘safe’, effective’, ‘responsive’ and ‘well led’ as, ‘Requires Improvement’. In relation to our domain ‘safe’, we found that there was a breach of regulations. This was because the registered person had not ensured that sufficient care staff were always deployed to enable people to promptly receive all of the care they needed. The other breach was in connection with our domain ‘effective’. This was because the registered person had not established suitable systems to plan and monitor the delivery of some parts of the care people needed to receive.

After this inspection the registered person wrote to us and explained what they intended to do to address the concerns we had raised. We completed a focused inspection on 11 April 2017 when we found that sufficient progress had been made to meet the two breaches of regulations. However, we did not change the ratings of the domains in question. This was because we needed to see that the improvements would be maintained. As a result the overall rating of the service remained as being, ‘Requires Improvement’.

At the present inspection the overall rating of the service was changed to, ‘Good’. We found that most of the improvements had been maintained and we rated each of our domains as being, ‘Good’.

In more detail, there were systems, processes and practices to safeguard people from situations in which they may experience abuse. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, most of the necessary provision had been made to ensure that medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before new nurses and care staff had been appointed. People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. People enjoyed their meals and were supported to eat and drink enough to maintain a balanced diet. In addition, people had been enabled to receive coordinated and person-centred care when they used or moved between different services. As part of this people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They were also supported to express their views and be actively involved in making decisions about their care as far as possible. This included having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that was responsive to their needs, although improvements were needed in the way care was planned for people who had developed sore skin. Nurses and care staff had promoted positive outcomes for people who lived with dementia including occasions on which they became distressed. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met. The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people consistently received safe care. Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered person and manager worked in partnership with other agencies to support the development of joined-up care.

Inspection carried out on 11 April 2017

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

We carried out an unannounced comprehensive inspection on 6 and 13 September 2016. Breaches of two legal requirements were found. This was in relation to care plan recording being poor and not up to date and insufficient staff to meet people’s needs. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We undertook this focused inspection on 11 and 13 April 2017 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection on the 11 and 13 April 2017 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Stewton House on our website at www.cqc.org.uk.

Stewton House provides care for people who require personal and nursing care. It provides accommodation for up to 48 people. At the time of the inspection there were 39 people living at the home.

There was a registered manager in post. 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 our inspection we found that the registered provider had begun to audit all care plans to ensure relevant information was available for each person. Staff had evaluated each care plan on at least a monthly basis so that they were aware of people’s immediate needs. The provider had calculated staffing levels to see whether sufficient staff were on duty to meet people’s needs. People told us their needs were being met, but not necessarily in a timely way.

Inspection carried out on 6 September 2016

During a routine inspection

We inspected Stewton House on 6 and 13 September 2016. This was an unannounced inspection. The service provides care and support for up to 48 people. When we undertook our inspection there were 42 people living at the home.

People living at the home were mainly older people. Some people required more assistance than others either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some having loss of memory.

There was not a registered manager in post. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was no one subject to such an authorisation.

We found that there were insufficient staff to meet the needs of people using the service. The provider had not taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were not involved in the planning of their care. The information and guidance provided to staff in the care plans was clear, but was not always followed by staff. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and how they chose to live their life.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home, but they had not received any feedback from concerns they had raised. Quality checks had not been completed to ensure services met people’s requirements.

Inspection carried out on 29 January 2016

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

We carried out an unannounced comprehensive inspection on 11 May 2015. Breaches of two legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

At the last inspection on 11 May 2015 we found that the provider was not meeting the standards of care we expect in relation to ensuring there were sufficient staff on duty to meet people’s needs. Care could not be delivered to people as they wished and they told us their needs were not always met. Also people’s medicines were out of stock and staff did not follow safe practices when administering medicines.

We undertook this focused inspection on 27 January 2016 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection we found the provider had made improvements in the area we had identified.

This report only covers our findings in relations to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Stewton House on our website at www.cqc.org.uk.

Stewton House provides care for up to 48 older people who require nursing and personal care. At the time of the inspection there were 45 people living at the home.

At the time of the inspection there was not a registered manager in post. 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 area manager was temporarily looking after the day to day running of the home, whilst inducting a new manager.

On the day of our inspection we found staff interacted well with people and people were cared for safely. People told us their needs were being met. Staff told us they had sufficient time to meet people’s needs and to help them take part in social activities. The provider had systems in place to ensure they knew the needs of people living at the home and could adjust the staffing levels when required.

We saw there were sufficient supplies of medicines available so people could receive their prescribed medicines as directed by medical practitioners. Systems were now in place to ensure the stocks of medicines remained constant. We observed staff administering medicines safely.

Inspection carried out on 11 May 2015

During a routine inspection

We inspected Stewton House on 11 May 2015 This was an unannounced inspection. Our last inspection took place on 06 January 2014 and the service was compliant. The service provides care and support for up to 48 people. When we undertook our inspection there were 45 people living at the service.

People were of varying ages who lived at the home. Some were able to move around the home with the assistance of staff, whilst others required a wheelchair which they propelled themselves or staff helped to move. Some people were ill and did not want to leave their bedrooms. Some people were in varying stages of dementia and required assistance from staff for most tasks each day.

There was a registered manager in post. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. There was one person living at the home that was subject to such a restriction. Staff were not fully aware of how to record people’s legal rights such as maintaining a Court of Protection order.

There were insufficient staff to meet people’s needs. The provider had not taken into consideration the complex needs of people who used the service and how to deploy staff to meet those needs. People could be put at risk of harm if suitable numbers of staff are not available to meet their needs.

The administration and stock control of medicines was poor. Staff did not ensure during the administration of medicines process that stocks were securely locked away. Staff had not ensured all the necessary medicines were in stock which resulted in people going without their prescribed medicines.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the number of staff available at times and in administration of medicines. You can see what action we told the provider to take at the back of the full report.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. However, people’s individual interests and hobbies were not taken into consideration when planning activities.

People had a choice of meals, snacks and drinks. And meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the internal processes to take if they were concerned about the welfare of an individual, but not what happened with the referral once it was received by statutory agencies.

People had been consulted about the development of the home and quality checks had been completed. Feedback was not given to staff when audits had been completed. Lessons learnt from incidents were not passed on.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were not involved in the planning of their care and had not agreed to their care plans. The information and guidance provided to staff in the care plans was unclear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe. You can see what action we told the provider to take at the back of the full report.

We have made a recommendation about involving people in the planning of their care.

Inspection carried out on 6 January 2014

During a routine inspection

People who used the service told us all their needs were being met and staff treated them with dignity and respect. Care plans were kept on each person, which they knew about and were generally up to date. Where they had not been as up to date as they could have been the manager was informed and took action the day of our visit. One person told us, "I am settled here and have all my homely bits and pieces around me."

The premises were clean and maintained. Staff needed to take more attention to detail and ensure the home was kept tidy and free from hazards. One person told us, "They change my bed linen a lot and clean my room well. I try and dust my ornaments, I don't have to but I do."

The provider had a training programme in place. Staff had completed all mandatory training. Staff told us the management team were approachable and they had received sufficient supervision in the last year. People who used the service told us, "Staff will always find out what I enquire about."

People told us they knew about the complaints procedure and felt confident staff would handle any concern in confidence and quickly. A log was kept of complaints which detailed satisfactory outcomes for each person. One person said, "Staff tell me to speak up if I have any concerns, which I don't."

Inspection carried out on 18, 20 February 2013

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

Everyone we spoke with talked positively about the staff and felt they fully supported their care needs. One person told us,"Staff know what they are doing." Another person said, "Staff are there for me day and night, they answer my call bell promptly."

Inspection carried out on 5 September 2012

During a routine inspection

As part of our inspection we spoke with a number of people who used the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed that they were supported to make choices and decisions about the care they received. Some people gave us negative comments about the one to one care they would like to receive.

Positive comments included, "I feel safe here", "All the staff are very, very good" and "If I had a problem I could speak to any of the staff."

Negative comments included, "I would like staff to sit with me more", "When I press my nurse call I sometimes have to wait a long time."

During the visit we spoke with visitors who expressed their satisfaction with the standards of care at the home. They told us the staff were good and they could ask anything of any staff. However they also told us they would like staff to take more attention to detail in doing small tasks such as cleaning spectacles of their family members and cleaning wheelchairs.

Health and social care professionals we spoke with told us staff were knowledgeable about the people they looked after and were professional at all times.

Inspection carried out on 8 March 2012

During a routine inspection

On the day we visited Stewton House had 38 people living there, 18 of which required nursing care.

People told us they were happy with the care received at Stewton. One relative we spoke with said, “The rooms are always nice and the care is consistently good.”

People told us they had a choice of food and that the food was good. One relative said everyone had recently received a questionnaire about the menu and what improvements they would like.

One person told us the activities lady was excellent, while another told us there was always something happening such as bingo, dominos and keep fit. Another said the cook bakes cakes and they had a coffee morning where friends and family were welcome.

Three relatives we spoke with were concerned about the level of fluids people received. They told us that while drinks were handed out, people were not encouraged to drink. We saw three people had cold cups of tea they had not drunk. Water was available in the communal rooms but people were not always mobile enough to help themselves.

People who have reduced mobility can be at risk of developing pressure ulcers. To prevent ulcers occurring special equipment such as mattresses and cushions are used. We saw two people had their pressure ulcer prevention reduced by removing special mattresses. We checked their care plans and could see there was no reduction in their risk level.

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