Archived: Stamford Court

We found the following examples of good practice.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. Staff were adhering to personal protective equipment (PPE) guidance and practices, and there was a space for staff to change before and after their shift.

Communal areas were well spaced and people, with support from staff were encouraged to maintain social distancing. Clear plans were in place for those who were required to self-isolate. For those people who struggled with isolation additional support was provided.

The provider had created a safe and dedicated window visiting area to allow people to see and speak to their friends and relatives. The room was well-ventilated and cleaned between visitors. Following updated Government guidance the service also had systems in place for safe visiting within the home.

Staff continued to support people to access healthcare, and arrangements were in place should people need to attend hospital safely.

Stamford Court 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. Stamford Court is registered to provide nursing and personal care for up to 40 people. At the time of our inspection there were 27 people living at the home.

The service had 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. Although the registered manager was new to her post, we found she provided good leadership and was committed to maintaining and improving standards. There was managerial oversight of the home through the provider’s quality team.

This was an unannounced inspection which took place on 1 and 2 October 2018. We last inspected the home in July 2017, when we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely, assessments of risk were not always completed or updated accurately, recruitment checks of agency staff were not sufficiently robust, the provider was not acting in accordance with the Mental Capacity Act 2005 (MCA), records monitoring care and treatment provided were not accurate or complete and the provider had failed to assess, monitor and improve the quality of the service provided. The provider sent us an action plan following the inspection, which explained how they would make the necessary improvements. This inspection was to review the action plan and check if the improvements had been made. At this inspection, we found improvements had been made and the service was no longer in breach of the regulations.

The home was clean, well-maintained and attractively decorated and furnished. There were effective infection control and prevention measures in place. Checks and servicing of equipment, such as for the gas, electricity, passenger lift and hoists were up-to-date.

Systems were in place to help safeguard people from abuse. Staff had a good understanding of safeguarding matters, how to identify signs of abuse and what action to take to protect people in their care. Risk assessments had been completed to show how people should be supported with everyday risks.

Medicines were managed safely. Medicines records we viewed were accurate and up to date.

Checks had been carried out to ensure staff, including agency staff, were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond promptly to people’s needs.

Staff had completed training in a variety of topics. This provided them with the knowledge and skills to support people safely. All staff received regular supervision. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns.

The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent before helping and supporting them.

Staff worked closely with health care professionals to ensure people were supported to maintain good health. People were supported to eat a well-balanced diet and were offered a choice of home-cooked meals. The service provided a range of social events and activities for people living at the home.

We observed staff interacting with people who used the service in a kind and caring way. People's privacy and dignity were respected.

The service had a formal process for handling complaints and concerns. Records we checked showed complaints had been dealt with appropriately. People and relatives were encouraged to give feedback about the service.

People's care plans contained detailed information about how they wished staff to support them. However, we found a few of the care monitoring charts we reviewed were incomplete.

The registered manager worked collaboratively with the local authority, clinical commissioning group and other professionals involved in people's care. In March 2018 an embargo on newly commissioned placements was imposed on Stamford Court by the commissioners of the service. The provider developed an action plan and worked closely with the commissioners to provide them with assurances that the actions were being implemented. The embargo was lifted in June 2018 when both the commissioners and the provider felt the improvements were sustainable.

The new registered manager was committed to maintaining and improving the standard of care provision at the home. Staff told us they felt supported by the manager. Audits and quality checks were undertaken on a regular basis and any discrepancies addressed with appropriate actions.

At this inspection we found that improvements had been made and the requirement actions had been met. However, we found five further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because medicines were not managed safely, assessments of risk were not always completed or updated accurately, recruitment checks of agency staff were not sufficiently robust, the provider was not acting in accordance with the Mental Capacity Act 2005 (MCA), records monitoring care and treatment provided were not accurate or complete and the provider had failed to assess monitor and improve the quality of the service provided.

You can see what action we have told the provider to take at the back of the full version of the report.

Stamford Court is a large two storey building set in its own grounds on the outskirts of Stalybridge. It provides nursing and personal care to a maximum of 40 older people some of whom are living with dementia. At the time of our inspection there were 39 people living at the service.

Medicines were not managed safely. Staff were not provided with sufficient information about medicines that were to be given ‘when required’. Keys for the medicines storage room were not kept by the person responsible for the medicines, records indicated that medicines were not being stored at the correct temperature to ensure they remained effective and no action had been taken to rectify the problem and records indicated that one person had not received their medicines as prescribed.

We found that risks to people’s health and wellbeing had been identified but records were not always accurate or updated when people’s needs changed.

Peoples care needs were assessed before they started to live at the service. Care records showed that all activities of daily living had been planned for. However we found the monitoring records were not completed in sufficient detail to accurately reflect the care and support provided.

Where people were deemed not to have capacity, evidence of capacity assessment were not present in their records and required conditions of The Deprivation of Liberty Safeguards (DoLS) were not always actioned.

There were systems of weekly, monthly and annual quality assurance checks and audits carried out by the service and the provider. We found that checks and audits carried out by staff within the home were not sufficiently robust as they had not identified the issues raised during this inspection. Whilst the provider’s audits had identified the improvements needed they had not ensured the required actions had been completed in a timely manner.

People told us they felt safe at Stamford Court. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.

Recruitment procedures were in place which ensured staff employed by the service had been safely recruited. However the service needed to improve the systems for accessing checks for staff who were working at the home but employed by another agency.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control. Staff had access to and wore person protective equipment when undertaking person care tasks.

Accidents and incidents were appropriately recorded. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately. People had their health needs met and had access to a range of health care professionals.

The home was clean and accommodation was of a good standard. Recent improvements had been made to the decoration, furnishings and fittings of the home. People’s rooms were personalised with their own photographs and belongings.

There were sufficient staff to meet people’s needs. Staff received the training, support and supervision they needed to carry out their roles effectively.

People told us the staff were nice and caring. A visitor told us, “All the staff are very courteous.” We saw staff interactions were polite and friendly. We found staff to be responsive, polite and caring. Visitors told us they were made to feel welcome.

The service had recently employed an well-being coordinator. There was a range of social events and activities available and people were positive about the plans the new activity coordinator had to improve the range of activities.

The service had a registered manager who had worked at the service from September 2016 and had been registered with CQC in January 2017. 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.

People were complimentary about the changes the registered manager was making and told us the service had improved. All the staff we spoke with were positive about the registered manager and working at Stamford Court. We found the registered manager to be enthusiastic and committed to improving the quality of the service provided.

We saw there was a system for gathering people’s views about the service. There was a system in place to record complaints and the service’s responses to them. People told us they didn’t have any complaints but were confident that they would be listened to and action would be taken to resolve any problems they had.

The service had notified CQC of any DoLS authorisations, accidents, serious incidents and safeguarding allegations as they are required to do.

The CQC rating and report from the last inspection was on the provider web site and displayed in the entrance hall.

We last inspected Stamford Court in April 2014. At that inspection we found that one of the five regulations we assessed was not compliant. We carried out a follow up inspection in August 2014 and found that the regulation previously found non-compliant in April 2014 was compliant.

Stamford Court is registered with the Care Quality Commission to provide nursing and residential care to a maximum of 40 people, primarily to older people with various disabilities. At the time of our visit 34 people were using the service.

There was a registered manager in post. 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.

We identified two 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.

Staff we spoke with had a clear understanding of the role and responsibility in protecting people and making sure people remained safe and free from potential harm.

Those staff who we asked confirmed that before they were allowed to administer medicines at the home they received appropriate training and training records seen confirmed this. At the time of our inspection only nurses administered medicines.

We found staff recruitment to be thorough and all relevant pre-employment checks had been completed before a member of staff started to work in the home.

Staffing rotas showed that there were consistently enough nurses and care staff on duty with the right competencies, experience and skills to keep people safe.

Suitable arrangements were in place for the prevention and control of infection. All bathrooms and toilet areas seen were found to be clean and hygienic and all contained a wall mounted liquid soap and paper towel dispenser.

People who used the service and the visitors we spoke with were positive and complimentary about the attitude, skills and competency of the staff team. Individual care was assessed and planned and was subject to regular review.

Nursing staff we spoke with told us they were supported to maintain their clinical knowledge and skills. We looked at five staff training files to confirm training had taken place and certificates that had been issued. Staff told us that the training provided was good and met their job role expectations.

Staff gained people’s consent and cooperation before any care or support was offered or given. Where people were unable to give verbal consent, staff knew by the person’s body language or facial expression if they did not agree with the action being suggested .

We spoke with the chef who told us that they received training specific to their role and had good knowledge around specialised diets for people.

People’s healthcare needs were considered as part of the care planning process and we saw and were told that good relationships were had with visiting healthcare professionals such as doctors and other community health services.

We saw that the needs of people receiving end of life care had been recorded and kept under review.

People’s individual preferences and independence was promoted by the team of staff and we saw and heard care staff encouraging people to make choices about their daily life style.

The provision of ‘spot’ beds in the home to people requiring support before returning home meant that people using that service on a permanent basis had their daily lifestyle and privacy intruded upon by the visitors and visiting health care professionals to those people using the ‘spot’ beds.

We looked at the care records for one person admitted into one of the ‘spot’ beds. The dependency rating for this person was rated ‘high’ but no care plan had been formulated and no information was therefore available to guide staff when supporting this person.

The service had a written complaints policy and people using the service, who we spoke with, were confident that any complaints or concerns raised would be dealt with appropriately.

We saw evidence that systems were in place to demonstrate that regular checks had been undertaken on all main aspects of the management of the service.

The provider supported the home manager to provide a consistent service.

At the time of our visit the service was changing documentation records from the previous provider to the new.

We considered the evidence collected under this outcome and addressed the following question, is the service effective?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service effective?

The service had a manager, who was registered with the Care Quality Commission.

People's health and care needs were assessed with them, or with the support of their relatives or other designated representatives.

We saw that some improvements had been made since our last inspection. A system had been introduced to make sure all care files and related documentation were reviewed each month by nursing staff. The majority of nursing and care staff had completed training in record and record keeping. We saw that regular spot checks of care related documentation were being conducted by the registered manager and the operational manager for the service.

Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observation during the inspection; speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff team. One person told us, 'The care I get is very good, I have to rely on the girls [staff] for most things, but they never grumble'.

We asked one person if they felt safe living in Stamford Court and they told us, 'I feel more safe here than when I lived at home. I can at least sleep at night now'.

Systems were in place to make sure that the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and safeguarding investigations. This reduces the risks to people and helps the service to continually improve.

We saw that policies and procedures were in place to support staff in delivering safe and effective care. These policies and procedures included those in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

On the day of our visit the clinical lead was in charge. They told us that staffing levels were determined by the number of people living at the home and the level of support they required.

Comments from people using the service and staff varied about the levels of staffing available in the home. In light of those comments the provider may wish to consider if sufficient levels of staffing are being provided and maintained on a day to day basis to meet people's assessed needs.

Is the service effective?

People's health and care needs were assessed with them, or with the support of their relatives or other healthcare professionals when required.

We found that some of the documentation relating to assessments and care planning were not always being fully completed. Lack of such important information being available and up to date meant that staff did not always have proper guidance to inform them of the up to date health status of the person using the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping.

Is the service caring?

People were supported by kind and attentive staff. We observed care staff showing patience and giving general encouragement when supporting and assisting people. People commented, 'I'm very happy here, the staff are excellent. I'm being well looked after'.

The atmosphere in the home was calm, relaxed and friendly and staff we spoke with appeared to have a good knowledge and understanding of people's needs.

Is the service responsive?

Evidence was available in records to demonstrate that other healthcare professionals were involved in meeting people's care and support needs where appropriate. For example, visiting physiotherapists, mental health practitioners and speech and language therapists. This meant that people using the service received co-ordinated care and support.

Is the service well-led?

We found that there were a number of systems in place to audit and monitor the quality of service and care being provided in the home. There were also independent audits by local commissioners of services to check the quality and standard of service delivery on a regular basis. Such monitoring of the service helped to ensure that people received a high standard and quality of service at all times.

People told us what it was like to live in Stamford Court and how the staff cared for them and supported their needs. One person told us, 'I have never heard one bad word being said by any of the staff. They are very friendly, patient and, most of all, understanding.'

We looked at the care records for people who used the service and found that they were personalised and contained relevant information about people's choices and preferences.

At our last inspection visit to the service in November 2012 we had some concerns around lack of support for people with their nutrition and hydration. We carried out a SOFI (Short Observational Framework for Inpsection) observation to help us assess if improvements had been made. SOFI is designed to be used where people are unable to give their verbal opinion on the services they receive. We found that satisfactory improvements had been made to support people with their nutrition and hydration.

We found staff had received training on safeguarding vulnerable adults.

Staff were provided with appropriate training opportunities and received regular supervision.

Efficient systems were in place to monitor the service.

We spoke with one visiting relative of a person using the service. They were happy with the care their relative received. They had been provided with a copy of the latest care plan for their relative to read and approve.

Records demonstrated that the service worked well with other health care professionals involved in people's care, including dieticians, speech and language therapist and physiotherapist.

The main meal time in the upstairs dining room was particularly busy with staff being required to assist a high number of people being nursed in bed. This left people in the dining room with minimum staff support.