The inspection took place on 27 February, 12, 13, 18, 19, 26, March and 6 April 2018 and was unannounced apart from the final date when feedback was given to the provider.
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 59 people were living at the service.
There was a manager employed by the service, and they were in the process of registering with the Care Quality Commission. Following this inspection the managers application for registration had been accepted. 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 September 2017 we found the provider to be in breach of eight 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 14 Meeting hydration and nutritional needs, Regulation 17 Good governance and Regulation 18 Staffing.
The overall rating for this service is ‘Requires Improvement' and therefore the service will be remaining in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
We found during this inspection that the provider had met the breach for Regulation 14. Improvements had been made but not sufficiently to meet the requirements of Regulations 9, 10, 11, 12, 13, 17 and 18.
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 which the provider is legally required to inform us of. We will deal with the notification issue outside of this inspection process.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least requires improvement.
Care plans and risk assessments were not always aligned. There was a lack of guidance for staff around specific health conditions and how best to support people.
We saw many positive interactions between people and their relatives, but this practice was not consistent throughout the home. Some staff had little time to offer one to one interactions with people and those more isolated in their rooms had not received regular meaningful interactions.
People attended and enjoyed the group activities. The service had employed a mini bus driver to ensure regular outings in the community were arranged. However, there was a lack of stimulating activities and interactions for those people living with dementia or isolated in their bedrooms. Both staff and health professionals raised concerns around the lack of stimulation for some people living at the service.
People were not always supported to have maximum choice and control of their lives. The principles of the Mental Capacity Act (MCA) 2005 were not always fully understood by staff and the correct process for making decisions in people's best interests had not always been followed or documented appropriately.
Staff deployment across the service did not always take into account staff experience and skill mix to meet the dependency levels of people living at the service. During busy periods people did not always received the care and support they needed in a timely way. Staff were recruited safely and any gaps in support filled by agency staff, the numbers of agency staff had decreased since our last inspection during the day shifts but were still at high levels during some evening shifts. The manager told us they were focusing on this area to make improvements and had requested consistent agency staff to improve continuity for people.
Some medicines had not been managed well. We saw poor practice in the administration of one toxic medicine. As and when required medicines for pain relief were not always being monitored to ensure they were effective. Record keeping in some areas such as topical medicine charts was poor and in some cases creams had been used more than prescribed and others were unclear as to whether people had received their creams as prescribed.
Risks to people had not always been identified or managed appropriately to mitigate risks.
Staff had raised safeguarding concerns which had not been reported to the local authority or CQC.
Accidents and incidents and the actions taken were not always recorded at the time of the event happening.
Activity records were not detailed to include the time spent with people during any one to one periods and notes indicated some interactions may have been brief due to a lack of information.
People at risk of dehydration or malnutrition received an improved level of support from staff. Refreshments were seen to be given throughout the day and night to promote people's nutrition and hydration needs. Although we did see issues where fluid charts were inconsistent: they had not been totalled and no recommended amounts had been recorded. It was felt this was more of a records issue which the provider began to address during the inspection. The manager told us they had started contacting GP’s for each individual's recommended daily fluid intake to ensure improved monitoring of people's hydration.
People and their relatives knew how to make a complaint should they wish to do so. Although there were facilities for staff to raise whistle blowing concerns anonymously, despite these being in place some staff felt unable to utilise the whistle blowing procedure to raise their concerns.
The provider had numerous quality assurance systems and audits in place which identified areas that required improvements to be made. However, some of the issues found during this inspection had not been highlighted through the providers own auditing and monitoring systems. The audits lacked content and detail in some areas. For example: feedback had been gathered from relatives, people living at the service and staff, but no records reflected those that had been spoken with, the questions asked or answers obtained. During the inspection process the provider acknowledged that improvements would be made to capture this additional information.
Improvements had been made to the decoration of the premises, neutral colours had been used, spa baths introduced to create a sensory experience and near the reception a hairdressing salon and bistro type coffee area had been developed.
People enjoyed the food which looked nutritious and well presented, pureed sandwiches were available which were suitable for those with difficulty swallowing. Finger foods were also offered to people. The chef was knowledgeable about people’s dietary requirements and was aware of how to fortify diets and drinks to ensure optimum nutrition for people.
Positional changes had been completed in line with recommendations and hourly observations were being completed for all people living at the service.
Servicing and maintenance of the environment including fire safety and lifting equipment had been completed and certificates were current.
The overall rating for this service is 'Requires Improvement'.
Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.