We carried out a review of the data available to us about Stainton Lodge Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Stainton Lodge Care Centre, you can give feedback on this service.
Stainton Lodge is a residential care home providing personal and nursing care to up to 73 people. The service provides support to people across 2 floors. The ground floor specialises in providing support to people with a mental health condition. The first floor accommodates older people and people living with dementia. At the time of our inspection there were 55 people using the service.
People’s experience of using this service and what we found
We received mixed feedback on the quality of food and at mealtimes we observed areas where improvements could be made. We have made a recommendation about this.
People told us they felt safe. Medicines were managed safely. Significant improvements in all aspects of medicines handling had been made since our last inspection. Risks to people were appropriately assessed and managed. Detailed guidance was available for staff to help them reduce risk to people. There were enough staff to keep people safe and staff were recruited
safely. The home was clean and tidy and robust infection control procedures were in place.
People's needs and preferences, including their cultural, religious and ethical requirements were assessed and catered for. Staff received appropriate training and supervision to ensure they were competent in their roles. Staff worked well with other agencies and healthcare professionals and made timely referrals when needed. The service was designed and decorated in a way which met people's needs.
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.
Regular quality assurance audits were carried out and there had been a significant improvement in management oversight since our last inspection. The provider and manager were committed to
continuous improvement. Lessons learnt were shared with staff. The atmosphere was warm and inviting and there was a person-centred culture.
The new manager had introduced regular meetings for people who used the service, relatives and staff and feedback was also welcomed as part of the manager’s open-door policy. People who use the service, relatives and staff gave positive feedback about the new manager and the positive changes that had already been made.
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 (24 August 2022). 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 an unannounced inspection of this service on 29 June 2022. 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, good governance and staffing.
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, Effective and Well-led which contain those requirements.
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 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 Stainton Lodge Care Centre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Stainton Lodge is a residential care home providing personal and nursing care to up to 73 people. The service provides support to people across two floors. The ground floor specialises in providing support to people with a mental health condition. The first floor accommodates older people and people living with dementia. At the time of our inspection there were 65 people using the service.
People’s experience of using this service and what we found
People’s medicines were not always safely managed. People were exposed to risk of harm due to a lack of person-centred risk assessments. There were not always enough staff to ensure records were up to date and administration tasks were completed. Infection control was not always effectively managed in the home. Safeguarding investigations were not always done correctly and there was no evidence of lessons being learned following accidents and incidents.
People were not always supported to have maximum choice and control of their lives and the requirements of the Mental Capacity Act 2005 (MCA) were not always complied with. Staff supported people in the least restrictive way possible and in their best interests; however, the policies and records in the service did not always support this practice.
People were supported by staff who were not all up to date with necessary training. However, new staff did undertake a comprehensive induction. Staff knew the people they cared for and how to support them to make choices. The quality of care records was inconsistent. Some care plans were very detailed and person centred, but care plans for people staying in the home for a short period of time did not contain sufficient information. People received enough to eat and drink and there was a variety of dishes to choose from, however, people with dementia were not supported in the best way to make their choices. The home was pleasantly decorated and well maintained.
Quality checks of the service had not identified all of the issues we found. Staff told us morale was low and there was mixed feedback about how well they were supported by management. The manager understood the importance of sharing information when things went wrong. Staff had opportunity to raise concerns at staff meetings which were now being held regularly. People who used the service and their relatives were asked for their feedback via surveys and meetings. Most of the relatives we spoke with told us communication was good and they felt able to approach the manager or staff if they had any concerns.
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 5 March 2019)
Why we inspected
We received concerns in relation to the management of medicines, the handling of safeguarding concerns and the duty of candour. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We inspected and found the provider was not always working in line with the Mental Capacity Act 2005. There was a concern with the way mental capacity assessments were completed and the way Deprivation of Liberty Safeguards (DoLS) were managed. As a result we widened the scope of the inspection to include the key question of effective.
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.
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, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stainton Lodge Care Centre on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.
People’s experience of using this service: Risks were monitored and action taken to keep people safe. Medicines were managed safely. Sufficient numbers of safely recruited staff were in place.
Staff were supported with regular training, supervision and appraisal. 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. Staff supported people with eating and drinking.
People received kind and caring support and were treated with dignity and respect. Systems were in place to arrange advocacy support where needed.
People received personalised support based on their assessed needs and preferences. A range of activities were in place for people to enjoy. The provider had an effective complaints process.
A range of quality assurance checks was carried out to monitor and improve standards. We received positive feedback on the management and leadership of the service.
Rating at last inspection: At the last inspection the service was rated Good (Report published 20 August 2016).
Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
The service was last inspected in July and August 2015. At that inspection we found the service did not ensure the requirements and principles of the Mental Capacity Act 2005 were followed and did not have effective checks in place to monitor and improve standards at the service. These were breaches of our regulations. We did not take enforcement action but required the service to submit a plan telling us how they would be compliant with the regulations. When we returned for this inspection we found the issues identified had been addressed.
Stainton Lodge Care Centre is a nursing home. It provides care and treatment for up to 73 people who either have complex mental health needs or are older people living with a dementia. The service is located adjacent to Stainton Way, another service operated by the registered provider. The service is divided into two units across two floors. People with complex mental health needs live on the ground floor and older people living with a dementia live on the first floor. At the time of our inspection 34 people were using the service.
There was a manager in place, and they were in the process of applying to be the registered manager. 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.
People and their relatives told us the service kept them safe. Risks to people were assessed and plans put in place to minimise the chances of them occurring. These were reviewed on a monthly basis to ensure they accurately reflected people’s current support needs. Risks to people arising from the premises and equipment were also assessed and reviewed.
Systems were in place to record and monitor accidents and incidents. Where these occurred a report was completed setting out what happened and the remedial action taken. Plans were in place to support people in emergency situations. There was a business continuity plan in place to help ensure people received a continuity of care in emergency situations.
Medicines were managed safely. People were supported to take their medicines at their own pace, with staff explaining what the medicines were and what they were for. People were given a choice over whether they wanted their medicines. People we spoke with said they received the medicines when they needed them.
Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where issues had been raised records confirmed they had been investigated and dealt with appropriately.
The manager carried out checks to ensure there were enough staff employed to support people safely and recruitment procedures minimised the risk of unsuitable staff being employed.
The service was working within the principles of the Mental Capacity Act 2005. 32 people were subject to DoLS authorisations at the time of our inspection. Where this was the case this was recorded on the person’s care plan, along with details of the expiry date and whether the authorisation had any conditions attached.
Some of the care plans we looked at contained detailed information on people’s capacity, however, we also saw that some care plans lacked this detail.
Staff had not always received mandatory training but such training was planned. Staff also received additional training in specialist areas such as pressure sore care, stroke care and behaviours that challenge. Staff said training had improved since the manager joined the service. Newly recruited staff completed an induction process before they were allowed to support people without supervision.
Staff received support through supervisions and appraisals. Records of supervisions and appraisals confirmed that staff were free to raise any support issues they had, which were acted on.
People were supported to access food and nutrition and gave positive feedback on the food at the service.
People were supported to access external professionals to maintain and improve their health. Care records contained evidence of appropriate referrals to professionals such as tissue viability nurses, epilepsy nurses, district nurses, psychiatrists, chiropodists and the falls team.
The service was clean and neutrally decorated though was not always adapted to support people living with a dementia. The manager and deputy manager said they wanted to re-decorate the service to make it dementia friendly, including putting people’s photographs on their bedroom doors and installing sensory aids.
People were not always able to tell us what they thought of the service but from our observations we saw they were treated with dignity and respect.
Throughout the inspection we saw staff delivering support with care and kindness. This helped to create a relaxed and homely atmosphere.
There was an advocacy policy in place offering guidance to people and staff on accessing advocacy services and this was displayed publically in the reception area.
Nobody was receiving end of life care at the time of our inspection but the manager described how this would be arranged if needed.
Care and support was delivered based on people’s assessed needs and preferences. Most care plans reflected people’s personal preferences. However, we saw that some plans lacked this level of detail and asked the manager about this. The manager said all care plans were being reviewed so they had a consistent level of detail.
Care plans were regularly reviewed to ensure they reflected people’s current support needs, and we saw evidence that people and relatives were involved in these reviews.
People were supported to access activities they enjoyed. During the inspection we observed music and reminiscence sessions, which people clearly enjoyed. People and their relatives spoke positively about activities at the service, though staff thought more activities could be offered.
There was a complaints policy in place and this was publically advertised in the reception area of the service.
The manager had a clear vision of the culture and values of the service. Staff shared the manager’s positive vision for the service.
Staff spoke very positively about the manager, saying they had significantly improved standards and supported staff to feel included in how the service was run.
Feedback was sought from people, relatives, staff and visiting professionals through an annual questionnaire.
The manager carried out a number of quality assurance checks to monitor and improve standards at the service. Records confirmed that where an issue was identified, an action plan was developed to ensure remedial action was taken. The registered provider organised monthly quality assurance checks of the service, which were carried out by a management company.
The manager understood their role and responsibilities, and was able to describe the notifications they were required to make to the Commission.
We inspected Stainton Lodge Care Centre on 22 July, 5 and 11 August 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. We commenced the inspection at 6am, as a part of this routine inspection, to meet night staff and observe practices. This was the first inspection since the care home had opened.
Stainton Lodge Care Centre is a nursing home. It provides care and treatment for up to 73 people who either have complex mental health needs or are older people living with dementia. The service is divided into four units across two floors.
On the first day of the inspection the manager was on leave. The home has not had a registered manager in place since June 2014. When we commenced the inspection there was a manager in post who had submitted an application to become the registered manager. The manager intended to add this home to their existing registration as manager for Stainton Way Care Centre, which is located in an adjacent building. However, prior to completing the inspection we were informed that the manager had resigned. 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.
Not having a registered manager is a breach of the provider’s registration conditions. To date the provider has not formally notified us of this change and this is a breach of regulation 15 of the Care Quality Commission (Registration) Regulations 2009. Both of these matters we will be dealing with outside of the inspection process.
We found that the service provided in the unit for people with complex mental health needs was very well organised and in line with expected good practice. Since opening in May 2015 the unit had gradually filled and there were seven people using this service. People had variety of mental health needs but we found that the clinical lead had carefully considered people’s compatability when determining who to admit. Staff on this unit clearly understood how to meet people’s needs and what to do if people lacked the capacity to make decisions. It was a very well organised and run unit.
We noted that the home has been open for over a year but remained a very sterile environment. All of the units were decorated in beige colour schemes and were reminiscent of branded hotel schemes. We saw that no consideration had been given to making the residential unit dementia friendly or to make this unit easy for people to navigate.
On the residential unit for people living with dementia we found that staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training but remained unclear about the requirements of this Act. We found that there was no information to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finances. No records were in place to show that staff completed capacity assessments where appropriate and made ‘best interest’ decisions.
We found that on the residential unit some people had difficulty making decisions, were under constant supervision and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, what restrictions people were subject to or if there were conditions attached to any authorisations. One person persistently asked to leave and banged on the door trying to get out but staff could not confirm whether an authorisation was in place for this person.
We saw that assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were well-developed on the nursing unit. On the residential unit we found that staff needed to ensure these were updated and altered as people’s needs changed. At times staff were not recording the review of people’s needs that they had completed. Staff were able to discuss in-depth the support each person needed and how they worked with people.
Throughout the day we observed care practices and saw that they were treated with respect and dignity when care was provided. However, we noted that on the residential unit staff left the bedroom doors open whilst people were asleep in their rooms. Staff could provide no explanation for this practice and we saw it compromised people’s dignity.
The home had a good system in place for ordering, administering and obtaining medicines. However some improvements were needed in the way the staff managed medicines. We saw gaps in the recording of medicines on this unit; staff did not make sure discontinued medicines were removed from the medicine and administration records (MAR). Charts and protocols for as required medicines were not always in place. We saw that no action had been taken to ensure the labels on medicines were intact, which meant staff could not be sure that the medicine given was correct. Also there was some overstocking of medicines, which meant staff were re-ordering medicines when plenty were already in the home. We saw that a medicines audit was carried out but these were not always dated and staff on the residential unit were not using them to look at how to improve their practice.
Albeit the provider had systems for monitoring and assessing the service over the last few months a care consultancy had undertaken them. During the inspection the provider told us that this arrangement had ceased and they would recommence overseeing the service. We also found that when the manager was away the staff on the residential unit failed to complete audits and monitor the performance. Staff on this unit were also unclear as to who they reported to, with some staff referring to the deputy manager from Stainton Way overseeing them whilst others told us they reported to Stainton Lodge’s clinical lead. The clinical lead told us they were not involved in overseeing the operation of the residential unit. We discussed this with the manager on their return from holiday and they informed us this was an issue they had identified and were taking action to ensure the home operated as a whole and appoint a lead for the residential unit.
We visited from the early hours of the morning and spent time with people in each of the units. We found that people required varying levels of support. We saw that staff provided people with support to manage their day-to-day care needs and staff had taken appropriate steps to ensure people received care and support, which was tailored to their needs. We did note that on the residential unit there were no activities taking place throughout our visit. One of the staff showed us rummage boxes they had been making but none of these were out on display on the unit.
Checks of the building and maintenance systems were undertaken to ensure health and safety and the provider was taking action to resolve problems with the temperatures in the treatment rooms being excessive.
People we met were able to tell us their experiences of the service. They were complementary about the staff and found that home met their needs. People told us that they felt the staff had their best interests at heart and if they ever had a problem staff helped them to sort this out. They told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that individual’s preference were catered for and people were supported to manage their weight and nutritional needs. We saw that people living at Stainton Lodge Care Centre were supported to maintain good health. A external catering company provided the chefs and assistant cooks at the home. They reported that there was always plenty of ingredients to hand and they made home-cooked food.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. The new manager had ensured this had been improved and concerns were now thoroughly investigated. People we spoke with told us that they knew how to complain and felt the manager would respond and take action to support them.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. The clinical lead, a nurse, a senior carer, and seven care staff were on duty during the day and a nurse, a senior carer and five staff were on duty overnight. The manager split their time equally between Stainton Lodge Care Centre and Stainton Way Care Centre. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who had diabetes. We found that the staff had the skills and knowledge to provide support to the people who used the service. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs.
We found that all relevant infection control procedures were followed by the staff at the home.
We found the provider was breaching two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to adhering to the requirements of the Mental Capacity Act 2005, and governance arrangements. You can see what action we took at the back of the full version of this report.