Archived: Stockdove House

Stockdove House is a residential care home providing accommodation for persons who require nursing or personal care for up to 10 people. The service provides support to older people who may or may not be living with dementia. At the time of our inspection there were eight people living at Stockdove House.

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

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.

Medicines were stored, managed and administered as prescribed. People were safe and protected from abuse and avoidable harm. The management team identified risks, and this was documented to guide staff and ensure people’s safety. Staff followed infection prevention and control procedures related to COVID-19 and other infections. Visitors were welcomed into the home and asked to follow infection prevention measures to keep people and staff safe. Staff were recruited safely, and staffing levels were enough to meet people’s needs. The management team had systems to learn from incidents to further improve the safety of the service.

The management team had governance systems to maintain ongoing oversight of the service and make improvements where necessary. Quality assurance processes ensured people were able to give their views of the service and improvements were made when they were required. The introduction of new systems had improved communication between staff and management. A member of management said, “Communication is really important, and we can work better together.”

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 12 November 2021) and there were 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.

At our last inspection we recommended that the provider look at how staff are deployed to meet people’s needs. At this inspection we found no concerns with response times. At our last inspection we recommended the provider review the storage of prescribed medicines. The provider had made changes and was in the process of changing to a new chemist that would collect, check, dispense and deliver medicines along with the appropriate documentation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 November 2021, and 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 Fit and proper persons employed and Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm 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 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.

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

Follow up

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

Stockdove House is a care home providing support to up to 10 older people who may be living with dementia. At the time of the inspection 7 people were receiving support.

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

The provider had not ensured all information was available in relation to recruitment records. Risk assessments were carried out to help minimise the risk of avoidable harm but were not consistently documented. People could not be assured governance systems were sufficiently implemented and embedded to drive improvements at the home. Actions identified on risk assessments were not always actioned in a timely way.

Medicines records were sometimes incomplete. Staff were trained in the safe management of medicines and people received their medicines when they needed them. We have made a recommendation about the safe management of medicines.

Staff wore personal protective equipment to help minimise the risk and spread of infection and people were enabled to access appropriate vaccinations to help maintain their well-being. Cleaning took place to help ensure the environment remain hygienic. Improvements were required to the infection control policy, wearing of PPE and some furnishings although clean, were worn. We have made a recommendation about the management and control of infection.

Staff knew the help and support people needed to help keep them safe and people told us they felt safe at the service. Relatives voiced no concerns with people’s safety and staff told us they would act to keep people safe. People told us and we saw, support and assistance were provided quickly if people needed this. We identified key times when staff support may be delayed due to a reduction in the numbers of staff available. We have made a recommendation regarding this.

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 the service was good and was published on 12/04/2018.

Why we inspected

We received concerns in relation to the management of documentation and assurance processes. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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 coronavirus and other infection outbreaks effectively.

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 Stockdove House on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to recruitment practices, record keeping and quality checks. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stockdove House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in place. 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 the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People we spoke with told us they felt well cared for and the staff were always friendly and attentive. One person who lived at the home said, “This is the best move I have made, I feel safe living here.” We found people were protected from risks associated with their care because the registered provider had completed risk assessments.

People told us there were enough staff on duty and staff came quickly to any requests for support. We reviewed medicines administration and documentation and found this to be safe. We looked around the home and found it was clean and homely; however some parts of the home require refurbishment.

We found the home offered a choice of menu and had policies and procedures in place to ensure people had support to enjoy a balanced healthy diet. One person told us, “The food is very nice, but I am really fussy and [cook/provider] often makes me something different”.

We received consistent positive feedback about care provided at Stockdove House Rest Home from people who lived at the home and their relatives. Staff were observed interacting in a patient and kind way. Nothing was rushed and they understood the needs of people they supported and it was apparent trusting relationships had been created.

The service demonstrated good management and leadership with clear lines of responsibility and accountability within the management team. Stockdove House has been owned and managed by the same family for over 20 years.

There was recorded evidence that showed the registered provider worked in partnership with other agencies to provide safe care and treatment. The registered manager said they received good support from the local doctor’s surgeries and the community nurses. During the inspection two district nurses visited the home; it was evident that there was a good relationship between them and the staff team.

Care plans we looked at were clear and informative. The registered manager had completed a comprehensive assessment of peoples support needs. People and family members spoken with during the inspection knew there was a care plan and had been asked about the care and support they needed.

People were free to live their chosen lifestyle and retain maximum choice and control of their lives. Staff were observed supporting people in the least restrictive way possible; the policies and systems in the service support this practice.

We found that the registered manager had an understanding of the Mental Capacity Act 2005 (MCA) and clear guidance was provided for staff.

Further information is in the detailed findings below.

The provider responded by sending the Care Quality Commission (CQC) an action plan of how they would address the findings from the previous inspection. We found evidence the manager had addressed the concerns from the previous inspection.

The provider sent copies of safety certificates confirming gas appliances, the lift, fire alarm and bath hoist used to assist people bathing had been serviced and were safe to use. The provider also sent us a test certificate confirming the homes electrical appliances were in a safe working condition.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We also spoke with Lancashire council's contracts monitoring team.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and their rights and dignity were respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard people they supported.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

The service was clean and hygienic. One person we spoke with said, 'I haven't been here very long but I have been very impressed with how clean the home is. My room is immaculate.'

Some equipment had been maintained and serviced. However we did find examples of equipment that had not been maintained and serviced regularly. This was putting people potentially at risk of harm. We asked the registered manager to tell us what they were going to do to meet the requirements of the law and ensure people's safety.

Is the service effective?

People's health and care needs had been assessed with them. Specialist dietary needs had been identified where required. Care plans had risk assessments completed to identify the potential risk of accidents and harm. One person being nursed in bed had up to date records confirming they were receiving regular pressure relief and their food and fluid intake was being monitored. These provided a clear picture of the care and support the person was receiving. A visiting healthcare professional told us the person's health was responding to the care and support being provided.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. The people we spoke with were very happy with the care being provided. One person said, 'I moved in to the home because I was unwell and not coping very well on my own. I have found it to be a good home with good staff. There isn't one I don't like. The meals are very good. I really look forward to meal times.' Another person said, 'I have just finished my breakfast which I really enjoyed. All the meals provided are good. The staff are lovely people who look after us so well. They will do anything for us you only have to ask.'

A visiting healthcare professional told us they had no concerns about the care people were receiving. They told us they found the staff polite and helpful when the y visited. The healthcare professional said, 'I find the atmosphere in the home very calm and relaxed. The staff who assist me when I visit are very patient and caring.'

Good care practices were observed and people told us they were happy with the support they were receiving.

Is the service responsive?

People spoken with said they were happy with their care and had no complaints. Records showed admissions to the home were well planned. Information about people's care and dietary needs had been recorded. We also saw potential risks to people's health and welfare had been identified. Guidance had been provided for staff to ensure they provided safe and appropriate care.

We saw people received regular health checks with their General Practitioner and other healthcare professionals. The outcome of these visits had been recorded on their care records. These confirmed what care and treatment people had received.

Is the service well-led?

The service worked well with other agencies and services to make sure the people they supported received their care in a joined up way. Two visiting healthcare professionals told us the home cooperated with the planning and provision for the people they were visiting. They told us this ensured people received appropriate care and treatment.

Systems for monitoring the quality of service provided were informal. However the registered manager had recently developed a survey/ questionnaire for residents and families to complete. This was to be completed annually to get their views on the way the home provided care and support.

People we spoke with confirmed they were satisfied with the service being provided. They told us communication with the registered manager and provider was good. They said they felt confident they could talk with the manager and they were available any time if they had any issues or concerns.

We spoke with a range of people about the home. They included the manager, staff, a relative/friend and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of the service provided by Stockdove House.

We had a walk around the premises and found radiators were made safe by having fixed guards where required to ensure peoples safety. The manager said, 'We have also produced risk assessments for health and safety of the premises.'

Staff we spoke with told us they received regular formal supervision and access to training courses were available and supported by the manager. One staff member said, "I have recently received my certificates for courses I attended since November.'

The manager was reviewing all systems in place to monitor the home. Some monitoring systems were acknowledging the views of residents and relatives.

Recruitment was not robust. Staff had been appointed without all the necessary checks. They had not all received the necessary induction and training to support people effectively. Risk assessments were not always completed and the provider did not monitor the home for risks to people.

People living in the home and their relatives were satisfied with the care they received. Staffing levels had improved since the last inspection. This meant that staff were able to provide leisure activities in the home and the local area. It also allowed senior staff enough time to complete care records.

Enforcement action was taken and compliance actions made at the last inspection but these was not fully met on this inspection. As there had been some improvements made, we have allowed more time to complete these.

Recruitment was not robust. Staff had been appointed without the necessary skills, qualifications and experience. Staff had not received the necessary induction and training to support people effectively. There were not enough skilled and experienced staff on duty to provided appropriate care and satisfactory record keeping. Risk assessments were not completed or were not up to date.

People living in the home and their relatives were satisfied with the care they received. People's immediate needs were usually met and staff responded quickly when people needed assistance. However staffing levels meant there were few leisure activities or outings.