We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of three inspectors, and an Expert by Experience. On days one and three, one inspector visited the home. On day two, two inspectors visited the home. One inspector reviewed evidence remotely throughout the site visit days. An Expert by Experience carried out telephone calls to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Stilecroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with CQC, but this person had not worked for the provider for more than two years. A new manager was in post and was planning to register. This means that the provider and the registered manager are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the home had recently had an outbreak of COVID-19.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service, including social care professionals, community nurses and the infection prevention and control team.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with the nominated individual, two representatives from the provider, the manager, three senior care assistants, four care assistants, the cook, head housekeeper, two domestic staff and two maintenance workers during the site visit. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the local fire and rescue, fire protection officer who was visiting the home to review systems and processes at the same time as our inspection.

We reviewed a range of care records. This included eight people’s care records and medication records. We looked at two staff files in relation to recruitment, staff training and supervision. We examined the staff training matrix and staff rotas, and a variety of records relating to the management of the service, including policies and procedures, and environmental audits.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and care records. We spoke with 14 relatives and five more staff by telephone. We wrote to the provider to seek a response to immediate concerns about safety at the service. We liaised with the local authority, sharing concerns so that action could be taken, and the provider could be supported to make changes.