Strode Park House

Strode Park House is a residential care home providing personal and nursing care for up to 55 people. The service provides support to people with a physical disability, people also required support with complex health conditions. At the time of our inspection there were 41 people using the service.

Strode Park House is a large, adapted building with extensive grounds. People all lived on the ground floor over 4 wings. Each person had their own bedroom and there were communal spaces such as bathrooms, dining rooms and lounges.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People, relatives, and staff told us the service had improved since the last inspection. Staffing levels had improved, people were now supported to go out regularly, and take part in activities they enjoyed. The culture within the service had improved, staff understood their responsibilities to support people in the way they preferred.

There were systems in place to monitor the quality of the service and when shortfalls were identified action was taken to reduce the risks of them happening again. Medicine management had improved, however, some improvements had not been consistently maintained across all the medicine records, improvements were required in the recording of medicines available. Risks to people’s health and welfare had been assessed, some guidelines required more detail, however, staff were supporting people following best practice guidance.

Environmental risks had been assessed, equipment had been checked and maintained to keep people safe. Improvements continued to be made to the decoration of the communal rooms and corridors.

Staff had been recruited safely and received an induction and the training they needed to meet people’s needs. People and relatives told us they knew how to complain and were confident their concerns would be addressed. Staff told us they felt supported by the registered manager and part of a team.

People told us staff were kind, caring and treated them with respect. People were supported to be as independent as possible and involved in monitoring their health. People were referred to health care professionals when their needs changed.

People, staff, and relatives were given the opportunity to attend regular meetings. The provider and registered manager had been open and transparent about the need for changes within the service and how these were going to be achieved.

Right Support:

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.

Right Care:

People received person centred care, their privacy and dignity were always promoted.

Right Culture:

Staff and the registered manager had taken part in culture workshops to develop a culture commitment, which was shared with people and relatives. The culture commitment had been integrated into the interview process, to ensure new staff shared the same ethos and commitment.

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 29 June 2023) and there were breaches of regulations. 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.

This service has been in Special Measures since 11 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this comprehensive inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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 requires improvement to good based on the findings of this inspection.

Follow up

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

Strode Park House is a large-listed building in extensive grounds. All people live on the ground floor across 4 wings. At the time of our inspection, 1 wing was closed for refurbishment. Each person had their own bedroom, and some had already been through a refurbishment. There were shared spaces such as dining rooms, bathrooms and lounges.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Medicines were still not being managed safely placing people at risk of potential harm. People were not being supported by enough staff to keep them safe and provide them with a quality of life. The registered manager were developing systems for learning lessons from accidents and incidents. Most risks to people had been assessed and ways to mitigate them found. However, the provider had not considered the risk of entrapment or falls from the bed rails in use.

Systems were not in place to ensure people received safe care and treatment that led to a good quality of life. Concerns found during this inspection had not been identified by the provider. Inconsistent management had not supported consistent implementation of new systems. Current best practice and guidance was not always being followed. Staff and management were not always following the provider’s policies. The culture in the home was inconsistent from staff because there were inconsistent approaches and interaction with people.

The registered manager, who had been in post for three and a half weeks, had a clear vision of how they were going to improve the home. They had the support of the chief executive officer and board of trustees. Actions had already started to be taken in the short time the registered manager had been in post. The registered manager and chief executive were open and transparent during the inspection.

People were supported by some staff who were kind and caring. Other staff were task-based in their interactions with people. Mealtimes were a mixed experience for people, and we heard varied opinions about the food.

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.

Right Support:

People with learning disabilities and autistic people were not always encouraged towards independence. Their quality of life was limited by staffing levels impacted by national social care recruitment difficulties. Improvements were required to keep people safe.

People were unable to participate as part of the wider community as regularly as they would like. Support people received was mixed and agency staff lacked a thorough induction.

Right Care:

People with learning disabilities and autistic people were sometimes being supported by staff who knew them well. However, agency staff were less knowledgeable and systems to improve this were not always in place.

Staff support for people was mixed from some very kind and caring interactions to a lack of acknowledgement of people. Dignity was protected by staff knocking on doors. Systems were not always in place to encourage all people to communicate choices.

Right Culture:

Systems were not in place to ensure people with learning disabilities and autistic people received a high quality and safe level of care. Management had not always been stable to make sure a consistent approach was in place. Right support, right care, right culture guidance was not yet embedded into daily practice.

The registered manager had identified improvements were required around person-centred care. They had suitable plans in place which were being supported by the provider.

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 inadequate (published 11 January 2023) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, some improvements had been identified. However, we found the provider remained in breach of regulations.

This service has been in Special Measures since 11 January 2023. During this inspection the provider demonstrated that some improvements have been made.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, safe care and treatment, staffing and governance at this inspection.

We served 2 warning notices about safe care and treatment and governance of the service that needed to improve. These have been upheld and we will follow up once the given time period has ended to check whether improvements have occurred.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Strode Park is a residential home providing personal and nursing care to up to 55 people. The service supports people with physical disabilities and provides long term residential or nursing care, respite care and neurorehabilitation and supports people with a learning disability. At the time of our inspection there were 52 people using the service. There were four separate wings within the service, New wing, Basil Jones wing, Rees wing and Patton wing and each had adapted facilities to support people.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

The service did not support the model of care setting. The service supported 52 people at the time of inspection, some people who had a learning disability and/or autistic people. The service is larger than the guidance recommends for a service that supports people who have a learning disability and /or autistic. The service is also located on a site with other care services, rather than people being supported to live in smaller homes in the community. This is to ensure people are receiving the person-centred support they need. Staff did not support people with their medicines in a way that promoted their independence and achieved the best possible health outcome. For example, when people were prescribed ‘when required’ restrictive medicines to help with anxious and distressed behaviours, there was no guidelines in place to inform staff when and why they needed to be used. These were being given regularly with no detail as to why they were given.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People told us they were not always supported as they preferred. Staff did not consistently support people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. Staff, people and their relatives told us there was not enough activities for them to do.

Right Care:

The service did not always have enough appropriately skilled staff to meet people’s needs and to keep them safe. Staff did not consistently protect and respect dignity. People told us of occasions where their dignity had not been respected and staff had not always supported them with person centred care. Some people told us that staff were caring but there just wasn’t enough staff to support with all their needs. We observed Staff respecting people’s privacy.

Right Culture:

People did not consistently receive good quality care, support and treatment. Staff had not always undertaken training for people’s specific health concerns such as PEG care and emergency medicines for epilepsy. The culture of the service did not always enable staff to continuously learn and improve. For example, lessons learned from incidents were not always shared with staff to prevent similar events from happening again. Some people told us they were not always supported to lead empowered and inclusive lives, one person told us they felt institutionalised.

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 13 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and medicines management in the service. A decision was made for us to inspect earlier than planned to examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

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 of regulation in relation to the safe management of medicines, the management of risks to people’s safety, sufficient and suitable staffing levels, person centred care and the governance of the service.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 employed at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was responsible for the day to day control of the service.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

People were protected from the risks of abuse, discrimination and avoidable harm. People and staff embraced each other’s differences. People told us they felt safe and would not hesitate to speak with staff if they were worried about anything. Staff knew how to report any concerns, who to report them to and felt confident that action would be taken.

People were involved in discussing any risks to make sure they had the freedom, choice and control of their care. Risks to people were assessed, identified, reduced and monitored. Action was taken by staff to keep people as safe as possible. When people needed specialist equipment this was regularly checked to make sure it was safe to use. The premises were maintained to keep people safe.

People were supported by sufficient numbers of trained staff who knew them and their preferences well. The registered manager continuously monitored staffing levels and had contingency plans to cover any unexpected absence. Recruitment checks were completed to make sure staff were honest, reliable and safe to work with people.

People told us they received their medicines on time. Medicines were stored, managed and disposed of safely. Medicines errors were recorded, investigated and action plans implemented. Staff were trained to support people with their medicines and their competency was regularly reviewed.

People received effective care from staff who were trained and supervised to carry out their roles. The provider’s HR department monitored staff training to ensure refresher courses were booked on time to help keep staff knowledge up to date. New staff shadowed experienced colleagues to get to know people and their preferred routines. Staff met with their line manager for regular one to one supervision to discuss their personal development.

Staff understood their responsibilities under the Mental Capacity Act. Meetings were held with the relevant parties to make decisions in people’s best interest. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance

People were supported to eat a healthy diet and to drink enough. People told us they enjoyed the food. Staff monitored people’s nutrition and hydration needs to help them stay healthy. Risks to people with complex eating and drinking needs were identified and monitored and a speech and language therapist provided additional guidance which staff followed.

People were supported to maintain good health. Staff worked closely with health professionals, such as GPs and occupational therapists, and followed advice given to them.

People told us they were happy living at Strode Park House. There was an inclusive and cheerful atmosphere. People were treated with kindness and respect. People were comfortable and relaxed in each other’s company and with staff. Staff knew people and their families well. People’s needs, preferences, likes and dislikes were recorded.

People’s privacy and dignity were both promoted and maintained by staff. Staff spoke with people and each other in a respectful way. People’s religious beliefs and cultural needs were discussed and recorded. People told us they had friends and family visit them whenever they chose and that there were no visiting restrictions.

People’s preferences and choices for their end of life care were discussed and clearly recorded. People had access to support from specialist palliative care professionals when needed. Staff made sure people and their families had the support and equipment they needed to ensure comfort and dignity remained the priority.

People and their relatives were involved in the planning and reviewing of their care. People’s care plans were an accurate reflection of people’s choices and centred on them as an individual. People were supported to be as independent as possible. People were supported to follow their interests and take part in social activities.

People said they felt listened to, their views were taken seriously and any issues were dealt with quickly. People were able to provide feedback at any time about the quality of service. People, relatives and stakeholders were encouraged to provide feedback on the quality of the service. People told us they did not have any complaints about the service or the staff. When concerns or complaints had been received they were investigated in line with the provider’s policy.

People and their relatives had built strong relationships with staff. People were actively involved in developing the service. There was a culture of openness, inclusivity and empowerment which was promoted by staff. The registered manager and provider had clear visions and values which were understood and promoted by staff to make sure people received care and support in a dignified, respectful and compassionate way.

The registered manager led by example, motivating, mentoring and coaching staff on a day to day basis to provide safe and effective levels of care and support. Staff told us they felt supported by the management team and by the organisation.

Effective quality assurance and clinical governance systems were in place which was used to continuously drive improvements. Reports following audits detailed any actions needed, prioritised timelines for any work to be completed and who was responsible for taking action.

The registered manager had submitted notifications about important events that happened to CQC in an appropriate and timely manner and in line with guidance. The latest CQC report and rating was displayed in the service and on the provider’s website in line with guidance.

We found that people who used the service were asked to give consent and were involved in the decisions about the care and support they received. People told us that they were asked for their consent before any care took place and their wishes respected. One person told us, 'I have been involved in what support I need from the start'.

People told us that they received the care and support they needed to remain well and healthy. We saw records to show how people's health needs were supported and that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We observed that the provider had provided an environment that was suitably designed and adequately maintained. The home was clean and free from offensive odours.

We found that there were enough qualified, skilled and experienced staff to meet people's needs.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe.