Stanbeck Residential Care Home

Stanbeck Residential Care Home is a residential care home providing personal care to 11 people at the time of the inspection. The service can support up to 13 people. The service provides support to older people, people with a learning disability, and autistic people. The home is in one adapted building over 3 floors with a lift, large lounge area, and dining room.

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

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 most people take for granted. ‘Right support, right care, right culture’ is the guidance the Care Quality Commission (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.

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. Each person had their own private room they had decorated to their own taste. We saw staff supporting choice and control during our inspection.

Right Care:

The care was person-centred and promoted individuals' human rights. People had different interests and activities. Many people said they liked the staff and how they were being supported. Staff were able to discuss people individually and knew how to support them well.

Right Culture:

The ethos, values, culture, and attitudes of the managers and the staff were focused on supporting people to have inclusive lives. Managers and staff were complimented by relatives regarding the support they provided. Family members have told us they are happy with the support their relative receives. Staff encouraged people to be involved in activities where appropriate and where they wanted to. Staff also understood and respected when people wanted to be alone.

Systems were in place to support the safe management and administration of medicines. Staff who administered medicines had the required training and their knowledge was checked. Medicine counts matched records. There was no information on why people were taking each medicine and we have made a recommendation about this.

Risk management was effective. There were systems in place to assess risk, monitor safety, and respond to risks. Lessons were learned when things went wrong. Recent investment into fire safety had been undertaken and fire safety practices developed to ensure people were safe.

Staffing and recruitment systems ensured staff of good character were employed. Appropriate pre-employment checks had been undertaken.

People were safe and protected from abuse. There were systems in place to ensure safeguarding training was undertaken by all staff. Staff could tell us what abuse was and what they would do if they saw signs of abuse. There was a safeguarding policy in place which had been newly refreshed. People and their relatives told us they felt the service was safe.

The provider was following current guidance to keep people safe in preventing and controlling infection. There were no restrictions on visiting in line with current guidance.

Managers and staff were clear regarding their roles. The registered manager was able to demonstrate she understood the legal requirements of the regulations. People, relatives, and staff told us the registered manager was available and easy to talk to.

There was a positive culture which was person-centred and involved the people using the service and their relatives. The registered manager and deputy manager had created multiple channels for staff to communicate updates, hazards, and requests to gain quick responses and repairs.

The managers and staff worked well with other professionals. We received positive feedback from the local authority and healthcare professionals.

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 22 September 2022). 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.

At our last inspection we recommended the provider review and update their visiting policy. At this inspection we found the provider had acted and had made improvements and the visiting practices matched current guidance.

Why we inspected

We previously carried out an unannounced focused inspection of this service on 15 July 2022 and 10 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm if they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this 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 the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the well-led section of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Recommendations

One recommendation was made to the provider. This can be found in the safe section of the report.

Follow up

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

Stanbeck Residential Care Home is a residential care home providing personal care for up to 13 people. The service provides support to older people. At the time of our inspection there were 10 people using the service. The service accommodates people in one adapted building.

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

People were at risk of harm as fire safety had not been managed effectively. We made a referral to the fire service following our inspection. Systems were not fully embedded to support the safe and proper use of medicines for people. Although staff were knowledgeable about risks to people, this information was not always reflected in people’s care records, in particular for people with diabetes. While visitors were able to see their family members and friends, the visiting arrangements did not reflect current guidance. We made a recommendation about the provider’s visiting policy.

The provider did not have oversight of the service to ensure people were receiving effective care. Systems were not established to support the monitoring of the service to monitor it and identify any improvements needed. Whilst there were shortfalls with the provider’s systems, people’s experiences of their care were positive. They complimented the staff on their approach. The registered manager was fully involved with the service and regularly spoke to people about their care.

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.

At the time of the inspection, the location did not care or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Rating at last inspection

The last rating for this service was good (published 01 January 2020).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to initial inquiries to determine whether to commence a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of bed rails, risk management and staffing.

We undertook a targeted inspection to follow up on these specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks.

We inspected and found concerns with fire safety, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and well-led.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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

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

Enforcement and Recommendations

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 in relation to safe care and treatment and good governance at this inspection.

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.

Stanbeck Residential Care Home is a care home providing accommodation and personal care to 12 older people at the time of the inspection. The service can support up to 13 people in one purpose-built building.

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

At the last inspection we made a recommendation about improving the way some medicines were handled. The provider had made these improvements. People were now supported to manage their medicines safely by trained staff.

People were safe and protected from abuse and avoidable harm. Risks to people’s safety had been identified and managed. There were enough staff to support people. The provider carried out checks on new staff to ensure they were suitable to work in the home Infection control was well managed and the home was clean and free from hazards.

The staff were trained and skilled to provide people’s care. People enjoyed the meals and drinks provided. Health care professionals were positive about how the home worked in partnership with them to promote people’s well-being. The staff asked for people’s consent and respected the decisions people made. 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 and relatives spoke of the homely feel created and liked that the home was a family run business. A number of people told us that they felt part of “one big family.” The staff treated people with kindness and respect. They gave people their time and understood this was important in supporting people’s well-being. Staff knew the importance of encouraging people to maintain their independence.

The staff knew people well. They planned and provided care to meet people’s needs and to take account of their preferences. People could see their visitors as they wished and maintain relationships that were important to them. The provider had a procedure for receiving and responding to complaints about the service.

People told us this was a good home and said they were well cared for and happy living there. The focus of the service was on providing people with a service that placed them at the centre of their care. The provider took action promptly when concerns were shared with them. They had systems to share learning from incidents with the staff team to improve the service further.

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 8 June 2017).

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.

Stanbeck Residential Care Home is situated in a residential area of Workington. It is approximately half a mile from the centre of town and is on a bus route serving the town centre. The home has a large garden and patio areas and provides accommodation for up to 13 older people. Bedrooms, accessible by a lift or stairs, are for single occupancy with ensuite toilet facilities. There is a dining room on the first floor that leads out to a patio and a lounge is on the ground floor with direct access to the garden.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the (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.

During the inspection we saw there were sufficient numbers of suitably qualified staff to meet people’s needs and promote people’s safety.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

When employing fit and proper persons the recruitment procedures of the provider had usually been followed. However we saw for one person recently employed that one of the checks the provider usually completed had not been done in line with the company’s procedures.

We saw medicines were being administered and recorded appropriately and were being kept safely. However we found that supporting information or ‘protocols’ were not made clear to guide staff to administer medicines which were prescribed to be given “when required” or as a “variable dose”. Clear guidance is needed to help ensure people are given these medicines safely.

We have made a recommendation that written protocols for staff to follow would help ensure people are given these medicines safely and in the way they were prescribed.

People’s rights were protected. The staff team were knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to and was required to maintain their safety and welfare.

Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them. People living in and visiting the home spoke highly of the staff and told us they were very happy with their care and support.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access activities and pass times of their choice.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the home.

Stanbeck care home is situated in a residential area on the outskirts of Workington.

Accommodation is provided over two floors with a variety of communal lounges, dining room, patio and garden. All bedrooms are for single occupancy and have en-suite toilet facilities.

The service is registered for 13 people. On the day of our inspection there were 12 people living at Stanbeck.

At our last inspection of this service on 28 June 2013 we asked the provider to make improvements to the care planning and risk assessment processes that were in place at the home. This action had not been completed.

We also asked the provider to make improvements to make sure medications were administered safely. The registered provider had sent us an action plan detailing how and by when these improvements would be made but adequate actions had not been taken.

There is a registered manager at the home. 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.

All of the people who used this service, who we spoke to during our inspection, told us that the staff were “very nice” and most said they were “treated kindly.” We did not receive any complaints about the service although one person did say that the staff could sometimes be “brusque.” However, they did not want to give us any further details about this.

A visitor to the home told us; “There seems to be plenty of things for people to do here. It is a small home and I think the people who live here get more attention.”

Care workers told us that they had; “Time to give care because it is a small home” and people who used the service all said that the staff “usually” attended to them “very quickly.” We saw that staff were respectful of people’s privacy and dignity and only intervened when necessary or when people requested their help.

On the day of our inspection the home was generally clean, tidy and there were no unpleasant odours. One of the people who used this service particularly commented on the good standard of cleanliness of their room.

The registered provider had safeguarding procedures in place but these were unclear, inaccurate and needed to be reviewed. More than half of the staff at the home had not received training to help them identify and effectively report abuse allegations.

In the sample of care records we looked at we found that people’s care plans and risk assessments were out of date and did not reflect their current support needs and preferences. There were inconsistencies in the way people were supported with eating and drinking.

The needs of people at risk of poor nutrition were not effectively managed. Assessments and reviews of people’s nutritional requirements had not been carried out as their needs changed.

Care workers told us that they found the electronic care records difficult to access and relied mostly on the handover book. This meant that people who used this service may not have received appropriate and safe care that met their wishes and expectations.

We found that there had been some improvements in the way medicines were managed and handled but there were inconsistencies in the safe administration and management of topical medicines such as ointments, creams and lotions. Information and staff understanding regarding the use of “when required” medicines was unclear. This meant that people who used this service may not always have received their medicines as their doctor intended.

Care workers told us that they were well supported by the registered manager. We noted that they received regular supervision and appraisals and that staff meetings took place. However, there were some shortfalls in the staff training records and training plan. Staff had not had their skills updated for some time and the training plan gave no indication as to when training would take place.

There were three people living at Stanbeck who were subject to Deprivation of Liberty safeguards. One of these people had been supported appropriately by an independent mental capacity advocate because they had no representative to help them.

We checked the information we held about Stanbeck. Care homes are required to notify us about any applications they make to deprive a person of their liberty under the Mental Capacity Act 2005 and about the outcome of those applications. They are also required to notify us of other incidents that affect the health, welfare and safety of people who use the service. The registered provider had failed to do this.

The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

We spoke to Cumbria Fire and Rescue about some of the practices at the home, for example wedging open fire doors. The Fire Officer visited the home and offered advice on these matters.

There was a complaints process in place at the service. We did not receive any complaints during our visit to the service. We checked the information we held about the service, we found that we had not received any complaints during the last 12 months.

The registered manager had carried out various audits to monitor the quality of the service. Where shortfalls had been identified action plans had been developed to help drive improvements to the service. People who used the service were able to comment on their experiences and quality of the service. We saw that this had been done via questionnaires.

We found breaches of the following Regulations:

Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used this service did not have a plan of care and support that had been specifically personalised for them. This meant that the care they received may not always have met their needs or reflected their preferences . You can see what action we told the provider to take at the back of the full version of this report.

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used this service were placed at risk because the registered provider had not assessed the risks to the health and safety of people receiving care and support. You can see what action we told the provider to take at the back of the full version of this report.

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were placed at risk of not receiving their medicines safely or as their doctor intended. You can see what action we told the provider to take at the back of the full version of this report.

Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used this service were not properly protected from the risks of abuse or improper treatment because the registered provider did not have robust systems and processes in place. Staff had not been provided with proper training about keeping people safe. You can see what action we told the provider to take at the back of the full version of this report.

Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People who used this service were placed at risk of receiving inadequate support with their nutritional and hydration needs. The registered provider had not ensured people had received assessments and reviews of their nutritional needs and could not demonstrate that appropriate food and drink had been provided to meet those needs. You can see what action we told the provider to take at the back of the full version of this report.

We have made a recommendation that the service seek advice and guidance about providing information to people who use this service, in a format that meets their needs.

We have made a recommendation that the service considers current guidance with regards to current health and safety legislation.

We have made a recommendation that the service finds out more about training for staff, based on current legislation and best practice, in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

We have made a recommendation that the service finds out more about training for staff, based on current best practice, in relation to equality and diversity.

Since our previous visit the provider had installed a new electronic recording system and we found that care plans were now reviewed each month. We found that the daily records written by staff were up to date and in good detail. This ensured people received the appropriate level of care to meet their needs.

The manager had reviewed the procedure for the administration of medicines. During this visit we found the records were correctly completed and up to date. There had been updates to staff training in the safe handling of medication to ensure staff were aware of their responsibilities.

We judged that that the service was now compliant.

We found there was sufficient and suitably skilled staff working at Stanbeck and that there was an effective complaints policy in place. One person told us, "I would just tell the manager if I had a complaint. But I don't. It's great here." Another person said, 'There's always plenty of staff if I need them. They're all great."

There was a medication policy in place and staff were trained in handling medicines. However, we found the policy was not always adhered to and did not cover the administration of the "when required" types of medication.