Archived: Stanton Hall Care Home

This unannounced inspection took place on 9 April 2018. At the last inspection we placed the home in special measures and the overall rating was ‘Inadequate’. There were also regulatory breaches in safe care and treatment, staffing and good governance. At this inspection these breaches had not been met and we identified further breaches in other Regulations. Following the last inspection in September 2017, the provider was asked to complete an action plan in November 2017, to show what they would do and by when to improve the key questions of safe and well led to at least good. The provider had not met all the actions on this plan at the time of this inspection and the overall rating for this service is Inadequate which means it remains in special measures. We do this when services have been rated ‘Inadequate’ and we cannot see sustained improvements.

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

Stanton Hall 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. The care is provided in one building across two floors. There are communal living areas and dining areas on the ground floor. The home provides accommodation and nursing care for up to 45 people who are living with dementia. There were 15 people living at the service when we visited.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had recruited a manager who had been working at the service since October 2017, they told us they were going to apply to register with us. At the time of this report they had commenced this process.

We found that risk was not managed sufficiently to ensure that people were kept safe. Due to the reduced staffing levels, plans were not always followed to ensure that people received safe care. Risk assessments were not followed and medicines were not always managed safely. The home completed cleaning schedules to prevent and control infections; however the fabric of the building required substantial maintenance and repairs and this had an impact on some areas of the home.

There were continued concerns about the leadership of the home and the support provided to reflect the care people required. These concerns had been identified and related to lack of maintenance of the building, audits and the staffing levels linked to the level of support people needed. The manager had not completed notifications to enable us to monitor and review the provider’s response to such incidents.

The records in place were not always clear or up to date, to guide staff on the support people required. People did not always receive stimulation which could reduce the risks associated with their individual safety.

At the last three inspections we identified there were not enough care staff, this continues to be a concern and this had an impact on people’s wellbeing. At times this had an impact on the care provided by staff. Safe recruitment procedures were not always followed to ensure that staff were safe to work with people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff provided a kind and caring approach to people and when possible spent time with them offering support and affection.

People’s health care and the support they received to prevent sore skin had improved. Referrals were made to a range of health care professionals and support was followed. People enjoyed the meals and their dietary needs were being met.

Staff training had improved and these skills were being used to develop the care provided. There had been no complaints to the manager or provider since our last inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Registration Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The service had did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had employed a new manager in March 2017; however they had not completed their registration. After the inspection the provider informed us this manager had left their employment. The provider told us they would be placing a temporary manager in place until they could recruit another manager to the home.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that staff had not received recent training in safeguarding adults and showed limited understanding. Some staff had not received training as part of their induction; this meant staff had not been given the skills to support their role.

People had not been protected from sore skin and when they required the use of equipment, we could not be sure the correct piece of equipment would be used. The majority of staff had received training in moving and handling, however evidence on the day of the inspection identified that staff were not using equipment correctly.

We found people's medicines had not been managed safety. Some people had not received their medicine and the stock of medicines was not monitored. The medicine recording sheets had not always been completed correctly and when medicine was disposed of we could not be sure this was in line with guidance. Some people required thickener in their drinks to reduce the risk of choking, we saw that generic thickener was used, which meant we could not be sure the consistency would be correct for each person.

There was not enough staff to support people’s needs. Staff were unable to be responsive and people had to wait to receive personal care support. Care plans did not demonstrate people's involvement and the plans were not up to date.

The service could not demonstrate how they sought people's opinions on the quality of care and service being provided. People were not always stimulated in meaningful daytime activities and we saw there was a lack of opportunities for people to participate in activities.

Care staff did not feel supported in their role. There were no quality assurance systems in place to identify areas that needed improvement.

The provider was not meeting the Care Quality Commission registration requirements. They had not send notifications to CQC for notifiable incidents, such as serious injuries.

People had mixed views about the staff and the level of kindness. Some people had their dignity compromised. We saw that some staff used language which was not dignified. This language is not personal or reflective of a caring and a compassionate approach to people’s needs.

We found the service had a policy on how people could raise complaints about care and treatment however there was no evidence to demonstrate how complains had been received and dealt with.

The rights of people who did not have capacity to consent to their care had been protected and the provider followed the associated guidance. People had access to healthcare professionals as required to meet their needs. We saw that the previous rating was displayed in the reception of the home as required. People enjoyed the food and their weight had been monitored.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection visit was unannounced and took place on 5 October 2015. At our last inspection visit on 7 September 2016 compliance actions were issued in relation the level of staffing. The provider sent us an action plan on 25 November 2015 explaining the actions they would take to make improvements. At this inspection, we found improvements had been made; the provider had taken some action to comply with this requirement and had increased the staffing levels. However we continued to have concerns relating to the continuity of the support offered in relation to the staffing levels.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had recruited a manager and our records show they were progressing their registration.

There were not always enough staff available for people and on occasions people had to wait to be supported. The evacuation plans, did not support the correct procedure to support people in case of an emergency. There had been several changes of manager which had impacted on the consistency of management support. Areas relating to audits had not been maintained to monitor the quality of care people received. Equipment requirements were not always met to support the staff in fulfilling their role.

People felt safe and we saw staff had received training to ensure they knew how to report any concerns. People received their medicines as required and different methods had been considered to meet individual’s requirements. Risks to people were identified and managed in a safe way, providing staff with guidance and equipment. The provider ensured staff were suitable to work within the home.

People’s capacity assessments had been completed and reflected specific decisions or activities. People were encouraged to make choices and their consent was sought before assistance was given. People enjoyed the food and they had a choice. When required support and advice around health and nutrition had been considered. Staff received training to enable them to support people. Support from health professionals was requested and available when needed. Staff felt supported and looked forward to the new manager taking on her role.

People were happy with the staff and had established relationships with them. Staff treated people in a kind and caring way. People were encouraged to be independent and make choices about how they spent their day. Relationships and friendships that were important to people were maintained

We saw that the care records reflected people’s preferences and choices about their care. Activities were provided which included a wide choice dependent on individual’s interests. There was a complaints procedure and people felt able to raise any concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We also used observation to understand people's experience, as some people had communication needs and were unable to tell us their views and experiences.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Stanton Hall and that they were treated well. One person explained: 'They are good people, they look after us well.'

We talked to staff to determine whether there were enough staff on duty to meet the needs of those in their care. We received various responses. One care worker told us: 'On a good day it's brilliant, on a bad day, it's horrendous.' Another care worker explained: 'There are usually four of us [care workers] that is enough, you can't help sickness.'

People who used the service also shared that sometimes they were concerned about the numbers of staff on duty. One person explained: I sometimes get a bit frightened when there's only one carer on. If they are new I have to tell them what to do and that's not my job.'

The manager completed a pre-assessment before people moved in to the service to make sure people's assessed needs could be met. Review systems were in place to ensure care plans and risk assessments were up to date and kept people safe.

We looked at the records kept to monitor how much food and drink people had consumed during each day. We found that not all of these were up to date. This meant that the provider could not demonstrate that people were protected from the risk of malnutrition or dehydration.

Staff spoken with knew what to do if they suspected that someone was being abused. One care worker explained: 'I would report it to the nurse in charge and go one step further if necessary.' Another care worker told us: 'If I was concerned about a care worker, I would take it to the senior. If I was concerned about the senior, I would take it to the manager. If I was concerned about the manager I would take it higher.'

On checking the medication records we found that on two occasions, a registered nurse had failed to properly record in the medication administration records the accurate amount of medication held for people who used the service. This meant that inaccurate records had been held.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the acting manager on duty at the time of our visit understood when an application should be made. Not all of the staff spoken with understood what it meant to deprive someone of their liberty and why this might happen.

Personal protective equipment was available for staff to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

Is the service effective?

We spoke with people who used the service and they told us that overall, they were satisfied with the care and support they received. One person told us: 'The staff are very good, they look after me well.'

Relatives spoken with told us that, on the whole, they were happy with the care and support their relative received. One relative explained: 'The staff are great, courteous and kind.'

Care plans provided staff with information about people's care and support needs. It was clear from our observations and from speaking with staff, that they understood the needs of the people they supported. This ensured that people's needs were met.

The provider had systems in place that demonstrated they co-operated with other health and social care professionals. This meant people received a person centred approach to their health, safety and welfare needs.

Although an assessment of need had been carried out for the people who used the service, there was no evidence to confirm that they, their relative or their advocate, had given their consent to the care or support received. The acting manager assured us that this would be addressed.

Is the service caring?

We observed staff going about their work. On the whole we observed them treating the people they supported in a helpful and caring way. We did observe one member of staff who did not attend to a person who used the service in a caring manner. This was brought to the attention of the acting manager and was addressed appropriately with the staff member involved. This meant that the people who used the service generally received the care and support they required in a caring and considerate manner.

The people who used the service told us they were treated with respect and we observed staff knocking on doors and calling people by their preferred name. One person told us: 'They treat me very well, I don't feel uncomfortable with the care.'

Is the service responsive?

The needs of the people who used the service had been assessed before they moved into the service and they and their relatives/advocates had been involved in this process. This ensured that their care and support needs would be met.

Relevant professionals had been involved in people's care. Records showed that visits had been arranged when necessary. These included visits from their doctor, their optician and the local speech and language team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information needed, should they wish to make a complaint about the service they received. A copy of this document had also been provided to each new person who used the service. A copy of the service's statement of purpose and service user guide was also provided. This ensured that the people who used the service were fully informed about the service they received.

Is the service well-led?

An appropriate quality assurance system was in place and the management team regularly assessed the service provided. This ensured that people received the care and support they needed.

Care plans and risk assessments had been reviewed on a monthly basis. This enabled the staff team to monitor people's needs. Where changes in people's health and welfare had been identified; these documents had been updated to reflect this.

Staff meetings had been held with a staff meeting arranged for the day following our visit. This provided the staff team with the opportunity to have a say on how the service was run. A meeting for the people who used the service and their relatives and advocates had been arranged for the beginning of July this year. This again ensured that they had the opportunity to have a say about the service provided.

Staff on the whole felt supported by the management team and told us that they felt able to talk to someone should they have a concern of any kind. One member of staff explained: 'I do feel supported, there is always someone to talk to if you need to, the nurse or the manager.'

Most people said that they liked their meals, which included a choice of foods. Appropriate records were kept to ensure that people were offered a choice of foods, and received sufficient diet and fluids.

We found that people received appropriate care and treatment to meet their needs. However several people we spoke with felt that more staff were needed at times, particularly during the morning. Since our visit the provider has increased the staffing levels to ensure that people's needs were being met.

The premises were clean, safe and adequately maintained. Essential safety checks were carried out to ensure the premises were safe.

Most people who were able to express their views told us they were happy with the care they received, and felt that their needs were being met. Comments included 'I've only been here a short while. I think the care is very good, I'm very well looked after; it's alright here, staff takes us out. We are going out for a meal and then to the fair; they look after me well although they are short of staff, they do what they can.'

Relatives said they were generally satisfied with the care their family member received, although one person said that their relative did not always receive consistent standards of care.

We found that the care and treatment was not always provided in a way to meet people's individual needs.

Most said that they liked the meals, which usually included a choice of food. They also said that they received enough to eat and drink, although appropriate records were not kept to show this.

People said that they felt that the premises were comfortable and decorated to a good standard. We found that the premises were clean and adequately maintained. However not all safety checks had been carried out at the required intervals, to ensure the premises were safe.

The service provided sufficient equipment to meet people's needs, which was properly maintained and safe to use.

We spoke with six relatives; five said they were generally satisfied with the care and support their family member received. One relative was unhappy with aspects of their family member's care. Three relatives felt that more staff were needed at times to meet people's needs.

We found that people received consistent care from regular staff who knew their needs. Whilst most people experienced care, treatment and support that met their needs, certain people's needs were not been fully met.

The provider needs to continue to regularly seek the views of people using the service, and people acting on their behalf, to ensure that their views and concerns are listened to, and acted on to improve the service.

We found that people's care records overall were accurate and up-to-date to ensure they received safe and appropriate care.