Stocks Hall Nursing Home - Skelmersdale

Stocks Hall Nursing Home – Skelmersdale is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people, people that may be living with dementia and people who may have a physical disability. At the time of our inspection there were 48 people using the service.

The home is set over 2 floors, and both floors have good sized communal areas for people to use. Visitors have access to a car park and people and visitors can use the garden area.

People’s experience of using this service and what we found

Improvements were required to manage risk to some aspects of people’s health and wellbeing more effectively and to make sure medicines were managed safely. People were protected from the risk of harm and the risk of mistakes being repeated. People were supported by enough staff that had been recruited safely, and the home was clean and comfortable.

People enjoyed the food at the home, 1 relative said, “The meals are lovely.” The chef knew people’s likes and dislikes and there was a good amount of choice available. There were some gaps in the documentation of nutritional needs.

People were supported by staff that completed regular training and staff knew people well. One relative said, “It is very good care.” Staff supported people to live healthy lives and access wider healthcare agencies.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Improvements were required to the governance of the service to make sure elements of risk were identified and changes made where required. People were supported by staff that enjoyed their jobs. One member of staff said, “We get on together, we work well as a team.” Staff and relatives could provide feedback about the home and the registered manager worked well with external agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 September 2018).

Why we inspected

We received concerns in relation to the management of medicines, and the management of some health needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Stocks Hall Nursing Home - Skelmersdale on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to assessing risk, medicines and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection on the 3 February 2016 the location was rated 'good' overall, with all key questions being rated as ‘good’, except for ‘effective’, which was rated as, ‘requires improvement.’ At that time, we identified a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Con-sent had not always been obtained from the relevant person prior to care and treatment being provided. At this inspection we found this regulation to have been met.

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 question of effective to at least good. At this inspection we found consent to care and treatment had been obtained from the relevant people.

At this inspection we found the evidence continued to support the overall rating of ‘good’ and we found the service was meeting all requirements of the current

legislation. Therefore, all key questions were rated as ‘good’ on this occasion.

Stocks Hall Nursing Home 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.

Stocks Hall is located in a residential area of Skelmersdale. It provides accommodation for up to 60 people who require personal or nursing care, including those who are living with dementia. A range of amenities are within easy reach. The home is set in pleasant, well maintained grounds. Patio areas with garden furniture are available on both floors for those wishing to spend some time outdoors. Ample park-ing spaces are available. At the time of our inspection there were 56 people who lived at Stocks Hall Nursing Home (Stocks Hall).

The service had registered manager in post. A registered manager is a person who is 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.

The care files we saw were maintained electronically. The system contained de-tailed and person-centred plans of care, which were well organised. This provided staff with clear guidance about people’s needs and how these needs were to be best met. However, some terminology could have been simplified and although the plans of care had been reviewed every month, changes in people’s assessed needs had not been consistently reflected within the care planning process. We made a

recommendation about this.

There were some gaps in the recording of treatment room and drugs fridge temperatures on the Woodlands unit, but when they were done, the minimum and maxi-mum temperatures were within the manufacturers recommended range. We made a recommendation about this.

New staff were recruited safely and detailed induction programmes were implemented on commencement of employment. Staff were well trained and support mechanisms showed supervision and appraisals were conducted. An appropriate number of staff with relevant skills were appointed to meet people's

assessed needs and those we spoke with understood their responsibilities in relation to reporting allegations of abuse.

People who lived at the home and their relatives had no concerns about the safety of people who lived at Stocks Hall. They told us the staff team was kind and caring.

Risks were managed well and we saw evidence of actions taken to mitigate any identified hazards. We found some areas of the management of medicines could have been better. However, actions were taken immediately to address the issues raised which helped to mitigate the areas of risk.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was a comprehensive activities programme in place, which helped people to maintain leisure interests and prevented boredom.

We observed staff members treating people who used the service with dignity and respect throughout our inspection and their privacy was consistently promoted.

Choices of menus had been developed and where possible people were offered a choice of meal. The staff working with those who lived with dementia were fully aware of their likes and dislikes.

Where people required the involvement of health care professional’s referrals had been made and appropriate assessments had taken place.

There was evidence of regular audits and monitoring of the service taking place and records we saw confirmed feedback had been obtained from those who lived at Stocks Hall, their relatives and the staff team. In general, we received positive feedback about the leadership and management of the service from those who lived at the home, their relatives and staff members.

We last inspected this location on 3 February 2015, when we found some improvements were needed in the areas of ‘safe’ and ‘responsive’. The areas of ‘effective’, ‘caring’ and ‘well led’ were rated as ‘good’. The overall rating for this location at that time was, ‘requires improvement.’

This unannounced inspection was conducted on 3rd February 2016, when the registered manager was on duty. 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.

During our last inspection we found the home did not have effective arrangements in place to ensure that people’s medicines were safely managed. However, during this inspection we found the registered manager had made some good improvements, which had resulted in a safer system for managing medicines. However, we established that not all agency nurses, who worked at the home, were familiar with the new electronic system for managing medications. This was discussed with the registered manager at the time of our inspection and we were satisfied that this would be addressed appropriately.

New employees were guided through a detailed induction programme and were supported to gain confidence and the ability to deliver the care people needed. A wide range of mandatory training modules were provided for staff, with additional courses being available in relation to the needs of those who lived at the home. Supervisions and appraisals for staff were conducted. However, these did not appear to be available at structured intervals.

The staff team were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at Stocks Hall. Accidents and incidents were well recorded and a process was in place for monitoring their occurrence. The care plans we saw were person centred. However, not everyone had been involved in the planning of their care or that of their loved one and some information was not easily accessible by all relevant staff.

Recruitment procedures adopted by the home were robust. This helped to ensure that only suitable people were appointed to work with this vulnerable client group. However, consent had not always been formally obtained prior to care and treatment being delivered and legal authority had always been sought for those who lacked capacity and whose liberty was being deprived.

The premises were clean and well-maintained throughout. There were no unpleasant smells and clinical waste was being disposed of in the correct manner. This helped to reduce the possibility of cross infection.

Systems and equipment within the home had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. Good infection control practices had been adopted by the home. Risks were well managed and people were handled in a gentle and supportive manner. Emergency plans had been developed, should evacuation of the premises be needed. This helped to protect people from harm.

Staff were kind and caring towards those they supported and people were helped to maintain their independence with their dignity being respected at all times. The staffing levels on the day of our inspection were sufficient to meet the needs of those who lived at the home. We noted that there was involvement of a wide range of community professionals and that people’s health care needs were being appropriately met.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to need for consent.

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

Is the service safe?

People we spoke with told us they felt safe living at Stocks Hall and their dignity was respected. Safeguarding procedures were robust and staff understood how to safeguard people they supported. Systems were in place to help managers and the staff to learn from untoward incidents, such as safeguarding concerns. This helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Applications were made, as was needed. This helped to ensure people were not being unnecessarily deprived of their liberty. People (or their relatives) were involved in making decisions about the care and support provided.

At the time of our visit to this location, we toured the premises and found the environment to be fit for purpose. It was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore, people were not put at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support. The health and personal care needs of those using the service had been thoroughly assessed, with a range of people involved in their care and support. Specialist dietary needs had been identified, where required.

Systems were in place to ensure the service was effectively assessed, so the quality of service provided could be consistently monitored. A broad range of training modules were provided for staff, with regular mandatory updates. This helped to ensure the staff team delivered effective care and support for those living at the home.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of those with mental health disabilities. Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

We asked those living at the home about the staff team. Feedback from them was very positive. They said staff were kind and caring towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for those they supported and were observed speaking with people in a respectful and friendly manner. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

One person commented, " Oh gosh, I wouldn't want to be anywhere else." A relative remarked, "It is just great. I cannot fault it at all. The staff are lovely."

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own adapted minibus, which helped to keep people involved with their local community.

Staff were seen to be responding to people well by anticipating their needs appropriately.The service worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show the home responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service. People living at Stocks Hall and their relatives completed annual satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately.

Comments from those living at the home and some relatives included:

"I am happy here. Obviously it is not like home, but things are OK. We are looked after well and that is the main thing."

"They (the staff) are very nice you know. I cannot grumble."

"We can choose what we would like to do. There are some things going on and trips out are put on too. We don't have to join in if we don't want to, which is nice."

During our inspection we assessed standards relating to consent and how care and support was being assessed and delivered. We looked at the cleanliness of the environment and how the control of infection was being managed. Standards relating to recruitment and monitoring the quality of service provision were also inspected.

We did not identify any concerns in any of the outcome areas we assessed.