Spratslade House Care Home

Spratslade House Care Home is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

Spratslade House Care Home accommodates up to 30 people in one adapted building. There is a separate area within the home, called ‘The Court’. The Court has its own communal spaces and people with higher dependency care needs are supported in this area.

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

People told us they felt safe and were happy with the care they received. People’s risks were assessed and planned for and action was taken when required to escalate concerns to professionals. People received their medicines as prescribed and the manager acted, during the inspection to make improvements to the way topical medicines were managed.

There were enough staff to keep people safe and there was a consistent staff team who knew people well. Staff worked well together as a team to deliver good outcomes for people.

People knew the manager and said they were approachable and supportive. However, the manager was not registered with the Care Quality Commission, which is a condition of the providers registration. The manager was in the process of applying to register with us.

The manager had made improvements to quality assurance processes; however, some improvements were still required to ensure consistency.

People felt listened to and involved in the running of the service, as did staff.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 November 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out unannounced comprehensive inspection of this service on 30 September and 1 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Spratslade House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Spratslade House Care Home is a residential home for up to 30 people who have personal support needs. The building consisted of three floors. There were 29 people living there at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Peoples risk with weight loss was not always managed in a safe way. There were ineffective recording processes in place.

Peoples care files did not appropriately identify risk prevention to allow staff to ensure people’s risk of pressure ulceration was managed in a safe way. Risk assessments had not always been completed or had been filled out incorrectly.

The service could not demonstrate that it had a full employment history of some staff. They had a document for these checks in some staff files, but not all.

We have made a recommendation about the current legislation in relation to employment.

The registered manager did not always have an effective system to ensure that staff received appropriate training. The training matrix illustrated not all staff had completed the provider mandatory training in a timely manner.

We have made a recommendation about the management of staff training.

The service was not supporting anyone receiving end of life care, however, peoples end of life care and choices was not explored in detail

We recommend that the provider seeks to reflect the preferred preferences in the design of peoples end of life care to ensure their needs are met.

Medicines were managed safely. There were quality checks in place and staff received appropriate training before being able to administer medication. There were monthly medicine audits undertaken by the registered manager.

People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and Deprivation of Liberty Safeguards legislation and guidance

People were involved in decisions about the décor of their rooms, which met their personal and cultural needs and preferences. People brought furnishings of their choosing that allowed personalisation of their rooms.

We observed staff supporting people in a caring and compassionate manner. Peoples care plans clearly evidenced the support they required and their personal preferences.

Residents and relatives meetings were held regularly. Feedback was gained to help the development of the home and actions moving forward.

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 (report published 24 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified two breaches. Regulation 12 the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely. Regulation 17 The registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

You can see what action we have asked the provider to take at the end of this full report.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

The inspection took place on 27 October and was unannounced. Spratslade House Care Home is a residential home for up to 30 people who have support needs. There were 27 people living there at the time of the inspection.

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.

Medicines had not always been stored in line with guidance and some medicine was being given to a person that did not have the correct prescription label on. Some people that needed ‘as and when required’ (PRN) medicine had protocols in place for staff to follow, but they were not consistently available. Therefore, people were at risk of not always getting their medicine as prescribed.

Staff were aware of what constituted abuse and what to do if they suspected someone was being abused. Appropriate safeguarding referrals had been made to the local safeguarding authority.

People felt safe living in the home. The risks people may face had been assessed and plans put in place to reduce the likelihood of them occurring, such as falls and the use of equipment. We observed staff undertaking safe moving and handling practices when supporting people.

The likelihood of emergency events occurring in the home had been reduced with appropriate fire checks being in place and personal evacuation plans were in place for people. Other safety checks had been completed such as on the gas supply and whether call bells worked so people could summon assistance.

There was enough staff to meet people’s needs in a timely manner and people did not have to wait for support. Staff were deployed effectively and had the flexibility to move to different parts of the home to attend to people who had varying levels of support needs.

Staff were recruited safely with references sought, identity checks being carried out and checks had been made with the Disclosure and Barring Service (criminal records check) to make sure people were suitable to work with vulnerable adults.

Staff were suitably trained and were supported to refresh their training. Staff also felt supported by the registered manager and had regular supervisions to discuss progress and options for improvement in how they support people. Staff also told us they were checked to ensure they had understood their training and were delivering care correctly to people.

People were protected as staff acted in accordance with the Mental Capacity Act 2005, with appropriate assessments in place and referrals made to the local Deprivation of Liberty Safeguards team. Staff offered choice and checked consent prior to supporting people.

People enjoyed the food and were offered a choice in what they had to eat.

People had access to health professionals and regular visits were undertaken by GPs, District Nurses, dentists and opticians.

The service was very caring, as staff took their time with people, choices were regularly offered and staff explained things to people. People told us they liked the staff and were happy living at the home. People were encouraged to retain their independence and to do as much as they could for themselves.

People were supported to discuss their end of life preferences and this was respected and documented within their care plans.

The service was responsive and catered for the ranges of peoples differing needs, such as providing suitable implements to eat with and updating care plans and risk assessments following a change in a person’s needs.

There were activities and events that people could participate in, with plans to further extend the availability of hobbies and interest for people to partake in. People told us they could access the community and they liked the parties that took place.

Complaints had been taken seriously and action taken to resolve them. People told us they felt able to complain. Feedback from people and relatives was also sought through meetings and surveys.

Auditing systems were in place regarding the monitoring of the changing of people’s needs, accidents and incidents, care plans and the environmental aspect of the building which had documented when there had been a change or action had been taken.

There was a positive and open culture in the home. People had confidence in the management team and felt both the registered manager and deputy manager were approachable and acted upon feedback.

We considered our inspection findings in respect of the following issues:

Is the service safe?

From our observations and from the information we saw set out in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and safeguarding the people they supported. The staff demonstrated that they knew the people well and had read and understood the instructions set out in individual care plans.

We saw evidence that people were supported to make decisions and maintain their independence. The care plans detailed each person's capacity to consent. When people lacked the capacity to make important decisions, meetings were held to make decisions for them that were in their best interests. The service had the support of an advocacy service when required.

Staff showed people respect and maintained people's dignity at all times.

The deputy manager told us there were no current deprivations of liberty safeguards in place for the people who lived at Spratslade House. They said that in the light of new guidance they were reviewing the requirements.

The building and living environment in the home was maintained to a high standard. All the risk assessments and safety checks were in place and up to date. This meant that the building was safe and met the needs of the people who used the service.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required, the skills mix and experience staff would need. The night time staffing levels and on call system showed that the staffing provision was safe out of main hours.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's care needs had been assessed and detailed care plans were in place. There was evidence that the people and/or their representatives were involved in the assessments of their needs and care plan reviews.

We saw that people's health care needs were continually assessed and included in care plans. Specialist health and social care professionals regularly gave support to the service.

All care, activity and risk assessment plans were reviewed regularly. We saw that the people who lived at the home were supported to maintain their mobility and independence. We saw evidence in care plans and from talking with people who used the service that the care provided was being constantly adapted to meet people's needs.

Is the service caring?

The people we spoke to who lived at the home told us they were very comfortable there. They said the care and support they received was very good. One person said, "The staff are really nice, I like it here." Another person said, "Everyone looks after me and I have no complaints at all." A family representative we spoke with said, 'The care is excellent and the staff are brilliant, they cannot do enough to help'.

The staff we spoke with told us they were committed to provide high standards of care for the people who used the service. They demonstrated they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We found that care plans were person centred and contained detailed information about people's choice and preferences. We saw that people's health and support plans were regularly up dated to reflect people's changing needs.

There was regular support from external social care and health professionals when needed. This meant that people's health and welfare was regularly reviewed and monitored.

The families and people who lived at Spratslade House said that if they had any concerns, they could talk with the manager or the staff as they would always listen and addressed anything they raised.

The staff said they had regular training which equipped them with the knowledge to meet the support needs of the people who used the service.

Is the service well-led?

Spratslade House has had a stable staff team for many years and there was a clear management structure. The deputy manager and the staff we spoke with were knowledgeable about all the people who lived at the home.

The people we spoke with who lived at the home and the staff said that the manager, deputy and senior staff were always around to give advice and support. There were systems in place to provide feedback to staff about changes and developments.

All the staff we spoke with said they understood their responsibilities around safeguarding people's welfare. They said that if they witnessed poor practice they would report their concerns.

During this inspection we saw that improvements had been made. Effective systems were in place to ensure that medicines were administered and recorded accurately and safely. This meant that people were protected from the risks associated with medicines.

At our last inspection, we found that improvements needed to be made in how staff supported people to make decisions and how medicines were stored, administered and recorded.

During this inspection, we saw that improvements had been made to the way that the staff supported people to make decisions. People had an assessment of their ability to make decisions for themselves. Appropriate plans were in place for people who required support to make decisions, to ensure that the right support was given to meet people's needs.

People received care that met their individual needs, and they were supported by staff to maintain their skills and independence.

We saw that people were protected from the risk of infection, because staff were trained in the correct systems to reduce and manage the risk of infection. Communal areas within the home were found to be clean and tidy.

We saw that improvements had been made to the way that medicines were stored, but effective systems were not yet in place to ensure that people received their medicines as prescribed.

We saw that there was an effective system in place to investigate and respond to complaints.

We spoke with seven people that used this service and three people visiting this service. People using the service told us they were happy with the care provided. One person said, 'I wouldn't be anywhere else'. Visitors were also happy with the care provided and the care environment. One visitor reported that the home was, 'cosy and homely'.

During our inspection we observed staff treat people with care and respect. We saw that people were offered choices and that staff had a good understanding of people's individual needs.

We found that people's views were taken into consideration when planning their care; however the records were not always in place when people were unable to make decisions for themselves. This meant that we could not be sure that decisions were being made in peoples best interests.

We found that safe systems for the storage and administration of medication were not in place. This meant that we saw medicines stored and administered incorrectly which could place people at risk.

We found that there were systems in place to monitor the quality of the service and to make changes. This meant that the service was constantly improving.