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Stainsbridge House Requires improvement

We are carrying out a review of quality at Stainsbridge House. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 August 2018

Stainsbridge House 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 service can provide accommodation and personal care for up to 46 people at this location. At the time of our inspection there were 42 people living in the home. The inspection took place on 4 and 5 June 2018 and was unannounced.

At the last inspection on April 2017 we asked the provider to take action in response to the concerns found around staffing levels. The service was in breach of Regulation 18 Staffing. At this inspection we found that the service had met this previous breach, however a further three breaches of Regulations were identified. This is the second consecutive time that this service has been rated as requires improvement and we are considering what further action will be taken in response. Full details of CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home did not currently have a registered manager in place. The previous registered manager had recently left the service and the deputy manager was in the role of acting manager. The acting manager was being supported by a registered manager from another of the provider’s services and the director who were present throughout our inspection. 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.

Prior to this inspection we received concerns about the service which we asked the provider to investigate and report back to us. We further assessed these concerns during this inspection and full details of what we identified is in the main body of this report.

Medicines were not always managed safely. There were concerns identified regarding the safe use of prescribed fluid thickeners for people who had swallowing or choking difficulties.

Risk management and documentation to support identified risks was not always managed safely. For example, one person’s support plan contained a body map, dated 24th May 2018, which recorded that the person had a bruise on their forehead. The manager was unaware of this; there was no further information in the person’s daily record and it had not been reported as an incident or accident. This meant that the cause of the bruising had not been investigated.

During our inspection we observed staff were visible on the floors to support people. We heard call bell times answered in a timely manner and people and relatives felt the staffing levels were mostly good. Staff we spoke with however consistently told us they felt the staffing levels could be better. We observed on the first day of inspection that three people were walking around at 5:30pm in their night wear, which staff attributed to staff shortages.

There was a lack of understanding around the appropriate process to follow for people who lacked capacity and were unable to consent to the care and treatment provided.

We found that some care plans lacked detail and person-centred information. Information relevant to the needs identified were not held together for staff to gain an overall picture on how to meet the needs. Monitoring records were not appropriately completed to ensure action could be taken in a timely manner.

Quality monitoring of the service was in place; however, it did not provide a clear rationale of what this attributed to the overall picture of the service. The previous registered manager had been quite insular in managing the documentation and due to this there had been a lack of provider oversight in the day to d

Inspection areas

Safe

Requires improvement

Updated 15 August 2018

This service was not always safe.

Medicines were not always managed safely. There were concerns identified regarding the safe use of prescribed fluid thickeners for people who had swallowing or choking difficulties.

Risk management and documentation to support identified risks was not always managed safely.

Safe recruitment practices were followed before new staff were employed to work with people.

Effective

Requires improvement

Updated 15 August 2018

This service was not always effective.

There was a lack of understanding around the appropriate process to follow for people who lacked capacity and were unable to consent to the care and treatment provided.

Staff did not always speak positively of the induction they had received on commencing employment. Staff had not all received regular supervisions, until recently when the acting manager had taken up their role.

People said they liked the food because they had a good choice and alternatives were available if they wanted something different.

Caring

Good

Updated 15 August 2018

This service was caring.

Staff demonstrated that they knew people well and supported people accordingly.

People appeared comfortable around staff and were happy to approach them when needed.

People’s backgrounds and cultures were respected and encouraged. We saw that people were able to follow their spiritual needs at Stainsbridge House or within the community if they preferred.

Responsive

Requires improvement

Updated 15 August 2018

This service was not always responsive.

We found that at times care plans lacked detail and person-centred information. Information about people’s needs was kept in several places which made it hard to gain an overall picture of that individual’s needs.

Some people had monitoring records in place, if they needed support with eating, drinking or to change position. We saw that these records were not appropriately completed to ensure action could be taken in a timely manner.

People were encouraged to follow their interests and participate in daily life at Stainsbridge. People spoke positively about the opportunities they had.

Well-led

Requires improvement

Updated 15 August 2018

This service was not always well-led.

Quality monitoring of the service was in place; however, it did not provide a clear rationale of what this attributed to the overall picture of the service

The previous registered manager had been quite insular in managing the documentation and due to this there had been a lack of provider oversight in the day to day running and how quickly improvements had been implemented.

People were given the opportunity to provide feedback on the service they received. We saw that the service had received compliments about the caring nature of staff care and engagement offered.