Stanley Wilson Lodge Care Home

Stanley Wilson Lodge is a residential care home providing personal and nursing care for up to 75 people aged 65 and over. At the time of our inspection 72 people were using the service. The care home accommodates people across three floors in one purpose built premises. One unit specialises in providing care to people living with dementia and another for people with nursing needs.

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

The registered manager and provider shared a clear vision and very strong values. They led by example and were passionately committed to providing exceptionally good quality individualised care and support. They demonstrated a strong commitment to continuous improvement and took great pride from the service’s achievements. People’s views were listened to and were at the heart of how the service was provided.

Everyone was very positive about the registered manager, staff, and their exemplary approach to providing personalised care. Quality checks and audits enabled the registered manager to identify risks and actions to ensure quality standards were maintained. There was an open culture with evidence of lessons learnt when things went wrong.

Staff had a detailed knowledge of people's histories, their likes, dislikes and how they wished to be supported. This information was used to support people in a way that valued them as unique individuals and respected them for who they were. Staff went to exceptional lengths to ensure people had access to a wide range of activities that met their individual needs.

Staff were committed to ensuring people's wishes at the end of their lives were respected and that people were able to live well and die with dignity.

Risks to people’s safety and wellbeing were well managed. Medicines were managed safely with regular systems of audit to identify and rectify medicines errors promptly. Staff helped people to stay healthy and supported them to access a range of health care professionals.

People were supported to have maximum choice and control of their lives. People were involved in decisions about their care. Policies and systems in the service supported this practice.

Staff had been safely recruited, provided with relevant training relevant to the roles they performed which met people’s health and social care needs. There were enough staff to provide people with the personalised care and support they needed.

Staff were positive about the management of the home and felt valued and respected. This had a significant and positive impact on the quality of care and support of people living at the service.

The home was very clean, well decorated, maintained and furnished. People enjoyed the home cooked food.

The provider had exceptionally strong and effective governance systems in place. The management team continued to carry out a regular programme of audits to assess the safety and quality of the service and identify issues. The strong leadership put people first and set high expectations for staff.

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 30 March 2017).

Why we inspected

This was a scheduled inspection based on the rating at the last inspection.

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.

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

The service provides accommodation on three floors. Each floor accommodates people with a different level of need with the ground floor being predominantly residential, the first floor providing dementia care and the second floor nursing care. The service can accommodate up to 75 people and was full at the time of our inspection

There was a registered manager at the time of our inspection. 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 inspection we found a well-run service which operated in the interest of people using it. People received safe care by well trained staff who were familiar with people’s needs. Documentation told us what people’s needs were and how care should be delivered and identified any risks to people’s safety. Staff worked in conjunction with other professionals to minimise risk and promote safe care.

Staffing levels had increased since our last inspection and reflected the needs of the people using the service. This helped to ensure that people got timely, appropriate care. The environment was spacious and free from immediate hazards.

Staff knew how to recognise and manage concerns people might have. Safeguarding concerns were effectively managed to ensure the person’s safety was paramount and to prevent any additional harm.

Medication was administered by qualified staff. People received their medicines as required. Medicines were regularly audited to identify any shortfalls and ensure that if any had occurred they would be dealt with the urgency that was required.

Staff were well supported in their role and were helped to develop in confidence and the skills they required for their role. There were opportunities for staff support and we saw effective teams at work. Staff were happy and motivated with good communication across shifts.

People were supported to eat and drink in sufficient quantities for their needs and staff knew what their dietary needs were. Staff monitored this to ensure people’s health was promoted. The service had good links with other health care professionals and staff had the skills to know when they needed to contact the GP. They monitored people’s health care needs well.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards. (DoLS) The MCA ensures that where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interest according to a structured process. DoLs ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

We observed staff who were kind and caring and familiar with people’s needs. The environment and the staffing contributed to people having a good standard of care. We received many compliments and saw that the service involved and consulted with people and took into account people’s feedback in the way the service was managed.

People had an assessment of their needs before admission and this resulted in a plan of care being devised. These were kept under regular review to ensure they were still current and reflected people’s needs. The plans took into account people’s wishes and back ground.

Activities were provided to help keep people alert and to promote their well-being. They were based around their specific needs and were inclusive.

The service was calm and staff were focused on the needs of people using the service. Everyone felt the manager was supportive and visible in the service. The service was continuously developing and being shaped by people’s experiences and feedback. Audits helped ensure the staff knew what was working well and what needed to improve. The service worked in consultation with people, their families and the wider community to help ensure people had the support they needed. The improvements in the service were clearly notable and staff were motivated and committed.

There is 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.’

Our inspection concluded that people’s experiences in the service were mostly positive with people reporting good experiences on the ground and first floor but we did have some concerns about the care and clinical oversight of the care provided to people who required nursing care and resided on the second floor. These concerns were discussed the manager following our inspection and they took some immediate actions to rectify what we had found. In addition we met with the provider and they gave us a very detailed action plan which gave us confidence in the provider that they would address and had already addressed a number of shortfalls. The service in the main provided good care to people and staff were friendly, helpful and shown to provide care that was responsive to people’s needs.

Insufficient staffing to keep people safe was identified as a breach at the last inspection. During this inspection we felt there were enough staff most of the time. However the deployment of staff was not always used effectively to ensure people’s wellbeing and safety and there were times when people felt there were not enough staff. This was also highlighted by staff working at the service. The manager had systems in place to monitor the staffing levels in line with people’s needs. The standards of care was good but people’s safety could be compromised if current staffing levels were not maintained or increased according to changes in people’s needs.

Risks to people’s safety could be increased due to poor practices around infection control and poor monitoring and maintenance of equipment. We also identified issues with the management and storage of medicines, and creams. The care planning process required general improvements in terms of record keeping and monitoring of people’s health.

People were supported by staff who had all the required training and support they needed to work effectively. However we did identify some concerns around staff practices in relation to medication management and infection control practices.

People were supported to eat and drink enough for their needs and there was close monitoring of this. However we identified a number of risks around people specific dietary needs and risks from aspiration.

Although overall care delivery was kind and caring, staff did not always treat people with dignity and respect. People’s needs were assessed but we could not always see from the records that care had been delivered. Staff were familiar with people’s needs. Not all the people in the service had an opportunity to interact with others in a meaningful way and live full lives including participating in activities that interested them. The complaints procedure was not always effective in addressing people’s concerns.

The service had quality assurance systems in place and is constantly trying to improve the service it provides. However we identified concerns which had not already been identified or addressed by the provider. Areas of the service lacked leadership and engagement from senior staff to ensure staff practices were of a good standard and improvements were made as required. People did not feel their views were taken into account at all times and staff morale was low.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberties Safeguards (DoLS). The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People's independence was promoted as far as possible. People were consulted about and encouraged to stay mobile which could mean the risk of falls increased. However the service monitored risks and took appropriate action where identified.

We found breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 in multiple regulations. You can see what action we told the provider to take at the back of the full version of this report.

People told us there was a range of activities available which they could join in if they chose to. One person told us, 'There are plenty of opportunities to mix socially here.'

We found that people's needs were assessed and care delivered in line with their individual care plans. This ensured people's safety and welfare. We saw staff providing care and support to people living at the home. They spoke in a calm and respectful way, gave people time to communicate and did not rush them.

People were cared for in a clean, hygienic environment and staff were aware of procedures to prevent and control the spread of infection.

People were cared for by suitably qualified, skilled and experienced staff. People made positive comments about the staff who cared for them. One person told us, 'The staff are marvellous, all of them.'

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.