Stanholm Residential Care Home for the Elderly

Stanholm Residential Care Home for the Elderly is a care home providing personal care for older people, some of whom were living with dementia. The service can provide support to up to 26 people and at the time of the inspection there were 21 people living at the service.

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

People told us they felt safe and protected from harm. Staff had completed safeguarding training and explained the steps they would take if they had concerns. Care plans contained risk assessments that covered all aspects of people’s support needs. Staff had been recruited safely and there were enough staff every shift to support people. Medicines were stored, administered and disposed of safely and guidelines relating to infection prevention and control and visiting had been followed throughout the pandemic. Accidents and incidents had been recorded, investigated and any learning shared with all staff.

Before people moved to the service the registered manager or deputy manager carried out thorough pre-assessments to ensure that the service could provide the care and support people needed. Staff had been trained to support people with different needs and were supported by managers. People told us they enjoyed the food provided at the service. Everyone’s nutrition and hydration needs were met. The cook was knowledgeable about people’s needs, likes and dislikes. Staff supported people with health and social care appointments. 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.

Staff treated people with kindness and respect. People’s dignity was protected and privacy respected. We observed multiple interactions between people and staff during our inspection, all were positive. People were encouraged to make day to day choices and to be as independent as possible but were supported when needed with some tasks.

Care plans had recently moved to a computerised system. Care plans were person centred. People were offered a wide range of activities both in small groups and one to one, provided by a full-time activities co-ordinator. People’s communication needs had been considered as part of care planning and staff know people well and how best to communicate. A complaints policy was in place and this was accessible. People and relatives told us they were confident to raise issues. End of life care training had been provided and staff knew the important aspects of people’s care towards the end of their lives.

The atmosphere and culture at the service was positive. Everyone spoke well of the registered manager who provided a visible presence throughout the service. A robust auditing system was in place, made easier by the new computer system. Trends and patterns were quickly identified. People, relatives and staff had a variety of ways to provide feedback about the service and this was collated and acted on by the registered manager. The duty of candour had been complied with and the registered manager worked well with statutory partners and had a clear vision of continuous improvement.

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

Rating at last inspection and update

The last rating for this service was good (published 12 December 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were well supported by staff to have telephone and internet contact with their family and friends. The service facilitated in person visits in a manner which minimised the risk of infection spread, including outside visits, and visits using a dedicated room with actions to minimise contact between visitors and other people.

Plans were in place to isolate people with COVID-19 to minimise transmission. Staff were cohorted to care for residents testing positive in the event of an outbreak. The service had good supplies of personal protective equipment (PPE) that were readily available at stations throughout the service. Staff were seen to be using PPE appropriately.

Visitors were asked screening questions and to wash their hands with soap and water when they arrived. There were plans in place to implement lateral flow testing for visitors from 8 March 2021 in line with guidance.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and people were regularly tested for COVID-19. The building was clean and free from clutter.

Staff ensured people’s welfare had been maintained and they had sufficient stimulation, such as additional activities led by staff.

We found the following examples of good practice.

• There was an ongoing programme of replacing flooring and furnishings in communal areas to make these areas easier to keep clean.

• People living at the service had a Covid-19 risk assessment. This was to help identify any issues which might make them more vulnerable.

• The registered manger had arranged for all staff to undertake infection prevention and control training since the beginning of the Covid-19 pandemic.

Further information is in the detailed findings below.

Stanholm Residential Care Home for the Elderly provides personal care to older people and people living with dementia. The service accommodates up to 26 people in one adapted building. At the time of the inspection 22 people were living there.

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

People told us they felt safe. Individual and environmental risks to people were assessed and managed safely. There were enough safely recruited staff to meet people’s needs. Medicines were managed safely. The service was kept clean and systems were in place to ensure food safety. Accidents and incidents were monitored, action was taken to prevent a reoccurrence and any identified improvements were made.

The staff team worked closely with other health and social care professionals to ensure all people’s health care needs were met. People received the care they needed to stay well and achieve the best quality of life. People were supported by a consistent, knowledgeable and well-trained staff team. People told us the food was good and they were given choices. People enjoyed the mealtime experience.

The provider had made improvements to the environment which was homely, accessible and met people’s needs. 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 were happy living at the service. Staff were caring with people and knew them well. We saw positive and respectful interactions throughout the inspection. People were involved in their care and supported to make choices. Staff respected people’s privacy and dignity and people were encouraged to maintain their independence.

People received person centred care which met their individual needs and preferences. People’s communication needs were met, and people were supported to maintain relationships that were important to them. People were encouraged to take part in a wide range of activities and social events. People were happy with the care they received and knew how to raise and complaints they had.

The provider and registered manager had ensured the delivery of high quality and safe care. Quality assurance systems were used effectively to monitor and improve the service. Feedback was used to make improvements. There was a caring, open culture in the service. People, relatives and staff were all able to raise any concerns or ideas and were listened to.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Stanholm Residential Care Home for the Elderly 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.

Stanholm Residential Care Home for the Elderly is located in an old detached building with the accommodation spread over two floors. Stanholm Residential Care Home for the Elderly is a dementia residential home. The ground floor has a dining room, lounge, small kitchenette, some bedrooms and the top floor is used for people’s bedrooms. There is a lift that services the two floors.

At our last inspection on 19, 23 and 24 October 2017, the service was rated Inadequate and placed in special measures. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that six of the eight breaches of regulation we previously found in relation to, medicines, safeguarding, dignity and respect, staff training and supervision, and person centred care had all been met and the service is no longer in special measures. However, despite some action being taken to address shortfalls we also found that two breaches relating to risk and quality monitoring that were continuing breaches, and we found one new breach relating to planning for people’s health needs. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager employed at the service. 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.

Quality monitoring systems required some improvements as they had not identified the shortfalls found at this inspection relating to care planning, risk assessment and implementation of activity plans. There had been some improvements since our last inspection in quality monitoring and a new system was being implemented.

People had access to healthcare professionals; however, some people were at risk of not having their needs met as care plans had not always been updated or made available to staff. Some people’s assessed needs did not have care plans written for them as the programme of updating care plans was not complete.

People were being kept safe from abuse. Staff understood their responsibilities in keeping people safe from abuse and had been trained. Staff knew how to report any possible concerns. People were supported safely around risks and were encouraged to take positive risks after control measures were applied. However, some risk assessments had not been updated on to the new format and were therefore lacking in detail. There was a plan in place to update all risk assessments. We have made a recommendation about this in our report.

Other risks such as environmental risks were being managed safely and there were protections in place in relation to possible hazards such as fire. Staffing levels met people's needs and people told us that they could find staff to help them when they needed to and we observed staff were not rushed when helping people.

People received their medicines safely and when they needed them by staff trained to administer them. Medicines were being stored and managed safely. The risk from infection was reduced by effective assessments and cleaning rotas and the housekeeping team kept the home clean. When things went wrong the provider had learned from these and had shared that learning with staff.

People’s needs were met by the design of the building and suitable adaptations had been made. However, some people told us that one shower room did not have enough ventilation and was too hot. We have made a recommendation about this in our report.

People received a comprehensive assessment of their needs and support was given in line with nationally recognised tools to monitor things like people’s weight and skin condition. Staff had the necessary skills and had been trained to carry out their roles. Staff had been supervised and had their performance appraised by a manager.

People received enough food and drink to maintain good health and told us that they liked the food. Staff worked in partnership to provide consistent support when people moved to or from the service. People received effective care when they moved to or from the service.

People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Staff treated people with kindness and compassion and people told us they liked their staff. Staff knew people’s needs well and people told us they valued their staff. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as safely possible.

There was a complaints policy in place and available to people. Complaints were being recorded and acted upon. People received a pain free and dignified death at the end of their lives. Staff supported people with compassion and worked with local hospice teams. People were supported in a personalised way that reflected their individual needs. However, some people’s assessed needs were not being provided in terms of their activities. We have made a recommendation about this in our report.

There was an open and inclusive culture that was implemented by the management team. People, their families and staff were engaged in the running of the service. The service was working with other professionals and local health providers to ensure partnership working resulted in good outcomes for people.

The service had 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.

We previously inspected this service on 29 May and 01 June 2015 where we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and we rated the service as Requires Improvement with a rating of Inadequate in the safe domain. These breaches of regulation related to safeguarding people, safe care and treatment, maintenance of premises, good governance, safe staffing, consent, person centred care, and acting on complaints. The provider sent us an action plan stating that they would address all of these concerns by July 2015. We further inspected the service on 25 and 26 August 2016, and found that improvements had been made and nine breaches had been fully met. However, there were ongoing breaches of regulations relating to consent and person centred care. We also found a new breach of regulations in safe care and treatment. The registered provider sent us an action plan stating that they would address all of these concerns. At this inspection we found that although some improvements had been made, the registered provider continued to breach the regulations relating to safe care and treatment, consent and person centred care. We also found seven new breaches of regulations in relation to nutrition and hydration, dignity, display of ratings, requirements relating to the registered manager and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not being managed safely. Staff who were trained to give medicines did not have a check of their competence to administer medicines safely, stocks of one controlled drug were not accurate, the administration of creams was not being managed safely and not all people received their medicines on time.

Falls and other risks were not being managed safely. Risk assessments did not contain control measures to mitigate potential hazards and had not been updated following incidents. The auditing of falls had not been effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. For example, people had not been assessed to determine whether they had the capacity to make a decision. The requirements of the Mental Capacity Act 2005 had not been met.

Not all people’s healthcare needs were being met in a timely manner. One person had not been eating due to a medical condition. Staff had recorded this but had not taken any further action despite the person going 44 hours without food.

People’s dignity was not always upheld. Some practices around mealtimes were not empowering, and one person was left to watch a film in a chair where they could not see the television screen.

Activities were not person centred, varied or frequent enough and people who were at risk of isolation had not been evidenced as being engaged in activities. Care plans were not personalised and contained contradictory information. Daily care reports were focused on physical care tasks and not insightful enough to give a clear picture of the care people had received and their overall wellbeing.

Audits were not effective in highlighting the shortfalls in service delivery found in this inspection. Audits and systems to monitor the quality of service had not generated action plans or driven improvements.

People were kept safe from abuse at Stanholm. Staff knew how to report any concerns. We noted that the local authority safeguarding information was out of date. We have made a recommendation about this in our report.

Staffing levels were adequate to meet people’s needs and keep them safe. The rota used to record hours provided only included care workers and did not contain the hours worked by the management team, cleaner or cook. We have made a recommendation about this in our report.

Staff told us that they had the training they needed to carry out their roles and where needed they had received additional training, although we found some training was not effective such as around the Mental Capacity Act 2005. Supervisions and appraisals were provided to staff but were not planned. We have made a recommendation about this in our report.

People told us that they received adequate food and drink to maintain good health although we found one person had not received adequate nutrition. People’s special dietary requirements, such as diabetic friendly, were known to the cook and staff.

People were supported by staff that had got to know them well and people told us that they liked their staff. Some good interactions were observed throughout our inspection, such as staff sitting and talking with people as equals. People could have visits from family and friends whenever they wanted.

Complaints had been dealt with effectively in line with the complaints policy. The complaints procedure did not evidence who people should talk to if they were not happy with the complaint response, which should include the local authority and Local Government Ombudsman. We have made a recommendation about this in our report.

There was an open, transparent culture in the service. The management team had positive relationships with the care staff and knew people well. The registered manager took an active role within the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post who was registered with the CQC. 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 on 29 May and 1 June 2015, we found 13 breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. These breaches of regulation related to safeguarding people, safe care and treatment, maintenance of premises, good governance, safe staffing, consent, person centred care, and acting on complaints. The provider sent us an action plan stating that they would address all of these concerns by July 2015.

At this inspection we found that the provider had taken action on all these areas, and was fully meeting regulations in nine areas where breaches had been found, relating to maintenance, safe staffing and recruitment, notifications and acting on complaints. The provider had implemented an effective system to ensure that the home was maintained to an appropriate standard. There were effective processes in place to fully investigate any complaints, and the registered manager was informing the CQC of all notifiable events detailed in the regulations. People told us there was enough staff available to meet their care needs. The registered manager was using an approved agency list to ensure that there were no gaps in staff numbers during times of leave and absence. The provider was using appropriate methods and systems to recruit staff that was safe. The provider had produced a new budget for training that ensured that staff received all mandatory training and could take part in additional training if requested. Staff received regular supervision and a yearly appraisal.

We found that the provider had also taken action to improve safe care and treatment, and good governance. Individual risk assessments were being completed and included risk of falls, pressure areas, bathing, moving and handling. People had their own personal emergency evacuation plan in place to give guidance to staff. People’s confidential information was being stored in a locked room accessible to senior staff only. However, we found other areas in which regulations were not being fully met.

At our last inspection on 29 May and 1 June 2015, we asked the provider to action and make improvements on how medicines were administered to people. At this inspection we found that action had been taken, and staff were seen to be administering medicines to people in a safe and dignified way. However, the management of medicines was not always safe. There was no safe storage for medicines that required refrigeration and medicine room temperatures were not being recorded. The provider took immediate action to ensure the safe storage of medicines at the time of the inspection. Medicine records did not always contain clear directions for the application of patches, or were not always double-checked or clearly updated with changes in dosages.

At our last inspection on 29 May and 1 June 2015, we asked the provider to action and make improvements on protecting people from harm and abuse. At this inspection we found that action had been taken to ensure that staff knew how to respond to potential abuse. Staff had received appropriate training to identify the forms of abuse and were given guidance on how to report this. However, we found that one incident was not effectively communicated to the registered manager. We have made a recommendation about this in our report.

At our last inspection on 29 May and 1 June 2015, we asked the provider to action and make improvements relating to staff understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), and to ensure effective assessments were taking place. At this inspection we found the provider had made these improvements but was not fully meeting these regulations. Staff had received training on MCA and DoLS and could demonstrate a good understanding. However, there were no records to show the processes used to gain consent from those who were deemed not to have capacity to do so. Consent was not being reviewed on a regular basis.

At our last inspection on 29 May and 1 June 2015, we asked the provider to take action and make improvements on activities that are on offer to people living at the service. At this inspection we found the provider had made improvements and people were offered activities that were based around their needs. The provider had plans to increase art therapy and to employ an activities co-ordinator. However, there were still periods of time where there were no activities on offer and there was a lack of choice for people with restricted mobility.

At our last inspection on 29 May and 1 June 2015, we asked the provider to take action and make improvements on the monitoring systems that were in place. At this inspection we found the provider was meeting these regulations and the registered manager had carried out audits on a monthly basis. The provider also took part in service audits to identify shortfalls so that the service could be improved. However, the registered manager was not fully auditing people’s daily notes. People’s records documented that they were being reviewed but there was evidence to show that in some cases they were not being fully updated with new information received. We have made a recommendation about these issues in our report.

People were being appropriately referred to health professionals when needed. Care plans showed referrals to GP’s and nurses and these were done in a timely manner. People were also supported to attend routine appointments such as health checks with a GP, chiropodist and opticians.

People were supported to have a healthy and nutritious diet. People could choose what they wanted to eat from a set menu or ask for an alternative meal.

People and their relatives told us they were involved in the planning of their care. Care plans were being reviewed by staff. People told us they were very happy with the care staff and the support they provided. Relatives told us they were happy with the service their loved ones received. Staff communicated with people in ways they were able to understand when giving support. Staff respected people’s privacy and dignity at all the times. The registered manager communicated outcomes of the investigations to relevant people.

People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions.

The registered manager was creating new links with the local community that included new activities for people to participate in and to find ways to get the local community involved with the service.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with the registered manager at any time and had confidence appropriate action would be taken. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service.

On this inspection, we found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We found that people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We found that the majority of windows did have appropriate restrictors. We also found that the home could not demonstrate that the home had regular fire inspections since 2005 or that risks assessments had been carried out to ensure fire exits within the home were suitable and safe.

We found the provider did not have an effective system in place to assess and monitor the quality of service that people receive. The provider could not demonstrate that results of feedback questionnaires on the quality of the service the home were collated, analysed and any necessary changes implemented.

We looked at the home's complaints system and found that the provider did not have

an effective complaints system available. The provider could not demonstrate that a complaint log was monitored and maintained.

People we spoke to told us that they were happy living at the home. Comments included 'I am quite happy here' and 'I am very happy with the food'.

People we spoke to told us that they liked the staff who cared for them. Comments included 'The staff are lovely, they are so helpful' and 'The staff here helped me to walk again'.