4 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 3 and 4 September 2018. This was unannounced on day one and we told the provider we would be visiting on day two. On day one the team was made up of three adult social care inspectors, one medicines team inspector and an expert-by-experience. Day two consisted of three adult social care inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. On this occasion the expert had knowledge and experience of caring for older people and those living with a dementia related condition.
We reviewed information we held about the service, such as notifications we had received from the provider and information from the local authorities that commissioned services with them. Notifications are when providers send us information about certain changes, events or incidents that occur within the service. The provider had submitted weekly action plans since the last inspection in April 2018 and was not asked to submit a Provider Information Return (PIR) before the inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with thirteen people who used the service, four relatives, two unit managers, a care practitioner, two nurses, three senior care workers, six care workers, one activities co-ordinator/administrator, one cook and a dementia specialist employed by Barchester Healthcare Homes Limited. We also spoke with the regional manager, the deputy manager and the registered manager.
We looked at records including care plans, risk assessments for eight people who used the service. We reviewed monitoring documents, such as food and fluid and repositioning charts. We also looked at five staff recruitment records, training records and training matrix and other documentation related to the running of the service. We observed lunchtime in each area of the home and reviewed eight records relating to the management and administration of medicines.
4 October 2018
The inspection took place on 3 and 4 September 2018. This inspection was unannounced on the first date and announced on the second date to ensure the provider was available to discuss feedback.
Stamford Bridge Beaumont 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 home accommodates up to 107 people across five separate areas, during this inspection 55 people were living at the service.
A new registered manager had applied to register with the Care Quality Commission (CQC) since our last inspection and their application had been accepted on 3 August 2018. They had worked for Barchester Healthcare Homes Limited for eleven years, some of which were spent managing and overseeing other Barchester run homes in the East Riding of Yorkshire. The registered manager had previously supported Stamford Bridge Beaumont and they were knowledgeable in terms of the current issues, work underway and plans to maintain sustained improvements across the service.
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 in April 2018 we found the provider to be in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) 2014 in Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good governance and Regulation 18 Staffing.
We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service as the law requires.
The service was rated Requires improvement. The provider continued to complete an action plan to show what they would do and by when to improve the key questions Safe to at least requires improvement.
We found during this inspection that the provider had made significant improvements, which achieved compliance to meet the requirements of Regulations 9, 10, 11, 12, 13, 17 and 18.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
At this inspection we rated the service Good. Although some areas of guidance and documentation needed embedding into day to day staff practice, overall there had been significant progress and improvement made throughout the service.
Management of medicines had improved since our last inspection. However, some areas of guidance and documentation required further attention. The impact to people was low as these were recording issues rather than errors in administration of medicines.
Quality assurance systems and audits identified where improvements needed to be made and noted good practice throughout the service so this could be communicated and celebrated with staff. However, some medicines audits required more detail to confirm which people’s medicines had been checked.
Staff deployment across the service had taken staff experience and skill mix into account to meet the dependency levels of people living at the service. Although we did observe a couple of minor concerns, overall this area had greatly improved. In addition, only regular agency staff were being used and the amount had further reduced since our last inspection. The management team had been working hard to recruit the right staff in line with Barchester's values.
Group activities were regularly organised and a new activities co-ordinator was in place until further staff had been recruited. The activities team told us they were speaking with people to find out their likes and interests to ensure one to one activities and outings were more meaningful for people. Staff confirmed they were interacting with people as and when they had the time. We observed positive interactions between staff and people living at the service throughout the inspection.
Recording of one to one activities was inconsistent. Although they were more descriptive since our last inspection, some had only start times with no durations noted and for some people we were unable to see activity records being maintained. People and relatives had observed regular activities and interactions being completed by staff. This was a recording issue and the provider explained how they had focused on improving higher risk areas since our last inspection. The regional manager told us that although staff were getting better at recording one to one activities, this would be an area of focus for the management team to make further improvements.
Care plans had been reviewed since our last inspection. These were detailed and included information about people’s health conditions and guidance for staff to deliver person centred care to people.
Risks to people had been identified and managed effectively. Guidance was clear for staff to follow and included signs to look out for in relation to risks associated to people’s health conditions. Environmental risk assessments were in place and appropriate measures taken to mitigate identified risks to people.
People had been supported to have maximum choice and control of their lives. The principles of the Mental Capacity Act (MCA) 2005 were fully understood by staff and in most cases the MCA process had been followed and documented. We identified some areas where best interest decisions had been completed when there was no need and in some instances records did not show that relatives had been invited to have input in decisions made in people’s best interests.
Safeguarding concerns had been documented and managed. The correct procedures had been followed by the registered manager, issues raised by staff had been reported to CQC and when necessary the local authority.
Accidents and incidents had been recorded fully with actions taken to mitigate risks. These had been analysed and appropriate measures put in place to avoid reoccurrences.
People’s nutritional needs had been assessed and measures put in place to support them. Food and fluid charts had been fully completed and totalled to ensure issues were highlighted and addressed immediately.
People and their relatives told us they were aware of the process to make a complaint and felt confident their concerns would be addressed appropriately. Staff morale had improved since our last inspection, the staff we spoke with told us they felt confident in the leadership at the home and would not hesitate to discuss their concerns with the management team or utilise the whistle blowing process.
A dementia specialist team had been working to support the service and ensure the environment was as dementia friendly as possible.
People told us they had ample choices of food and desserts, including regular homemade snacks and refreshments available throughout the day.
Servicing and maintenance of the environment including fire safety, servicing of utilities and equipment had been completed and certified by appropriately qualified professionals. Emergency evacuation procedures were available on each unit and at the reception area of the service. Contingency plans had been reviewed and updated to include current contact details for key stakeholders.