Stichell House

Stichell House provides accommodation and personal care for up to 35 people, some of whom are living with dementia. At the time of the inspection there were 34 people living in the home.

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

People felt very safe living in the home and with the support they received from staff. People and relatives spoke very highly of the staff and described them as “very kind,” “excellent” and “caring.” Comments included, “The carers are so patient with everybody, have a good sense of humour and keep the place happy all the time” and, “It is very well organised, very clean, welcoming and homely.”

Staff safeguarded people from abuse. Risks to individuals and the environment were well managed. There were enough staff to meet people’s needs. One person said, “There are loads of staff around and if you need anything, they are there on the dot. You don't have to wait long for anything at all.” The provider learned from accidents and incidents to mitigate future risks. Medicines were safely managed. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices. A relative said, “It is very, very clean both communal areas and rooms.”

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.

The home was well managed. The provider, manager and staff promoted a positive culture in the home. People and relatives were complimentary about the home and care people received. The provider had an effective quality assurance process in place which included regular audits. People, relatives and staff were regularly consulted about the quality of the service through regular communication, surveys, meetings and reviews.

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 14 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we decided to undertake a focused inspection to review the key questions of safe 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 remained good based on the findings of this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. 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 reports’ link for Stichell House 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.

We found the following examples of good practice:

• Staff had undertaken training in putting on and taking off personal protective equipment (PPE), hand hygiene and other relevant training. One of the duty managers was the Infection Prevention and Control lead. Staff practices were monitored to ensure high standards and correct procedures were followed.

• Additional cleaning of all areas and frequent touch surfaces was being carried out. A large team of domestic staff ensured high standards of cleanliness were maintained and deep cleaning could be done regularly. Suitable supplies of PPE were available and stored appropriately.

• Systems were in place to prevent people, staff and visitors from catching and spreading infections. The home supported people and staff to maintain social distancing.

• There was a clear process for visitors, which included screening for symptoms of acute respiratory infection, a temperature check and the wearing of PPE. Visitors were asked to provide contact details. At the time of the inspection only essential health and compliance visits could take place due to a recent outbreak of COVID-19. When visits recommence, plans were in place to safely manage visits via a booking system, in accordance with national guidance.

• Staff supported people's social and emotional wellbeing. People and their relatives were supported to keep in contact using a range of technology and regular newsletters.

• The home was following national guidance for anyone moving in. Staff worked with people and their relatives to ensure they were aware of self-isolation procedures. People were supported to understand the pandemic and the need for IPC measures.

• Infection control audits and checks were carried out. Recommendations from the local IPC team had been acted upon promptly.

• The manager spoke positively about the dedication of the staff team during this pandemic.

Further information is in the detailed findings below.

Stichell House provides care and accommodation for up to 35 older people. On the day of our inspection there were 34 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Stichell House was inspected by CQC on 14 July 2016 and rated Requires improvement overall and in the Responsive and Well-led domains. At the inspection in July 2016, we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 (Person-centred care) and Regulation 17 (Good governance). We carried out a focussed inspection on 9 January 2017 to look at the Responsive and Well-led domains. We found improvements had been made in these areas and re-rated the service as Good.

At this inspection we found accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Stichell House. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint but did not have any complaints about the service.

The provider had an effective quality assurance process in place. Staff said they felt supported by the manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

We carried out an unannounced comprehensive inspection of this service on 14 July 2016. Breaches of legal requirements were found. Specifically the provider had breached Regulation 9 – Person Centred Care and Regulation 17 - Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Clear care plans with detailed guidance were not always in place. Care plans did not always include ways in which people could maintain their independence. The lack of detail in care plans meant they were not always up to date with changes to people’s needs and preferences. A complete and accurate record of each person’s care and treatment was not maintained. Systems to assess, monitor and improve the quality of care records were not always effective in identifying where quality was being compromised.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Stichell House is a care home without nursing and can accommodate up to 35 people. At the time of the inspection there were 35 people using the service. All bedrooms are single and have ensuite toilet and wash basin facilities. Accommodation is provided over three floors, all of which have tea bar facilities. There is a communal dining area and lounge facilities as well as attractive, landscaped grounds. Stichell House is situated on the edge of Greatham, a quiet residential village, in the Hospital of God estate.

A registered manager was registered with the Care Quality Commission at the time of the 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.

We found improvements had been made. The quality and detail in care plans had improved. Information about people’s history and preferences were recorded in a person centred way.

Detailed strategies were in place for staff to follow to ensure people received appropriate care. Records were reviewed on a monthly basis or in response to a person’s changing need.

A new quality assurance system for the audit of care records had been introduced. Since the last inspection every person’s records had been audited at least once, actions had been identified to improve the quality and consistency of information and checks had been made to ensure actions had been completed.

Stichell House is a care home without nursing and can accommodate up to 35 people. All bedrooms are single and have ensuite toilet and wash basin facilities. Accommodation is provided over three floors, all of which have tea bar facilities. There is a communal dining area and lounge facilities as well as attractive, landscaped grounds. Stichell House is situated on the edge of Greatham, a quiet residential village, in the Hospital of God estate.

At the time of the inspection there were 34 people using the service and one person was due to move in.

A registered manager was registered with the Care Quality Commission at the time of the 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.

Care plans did not always contain detailed information about how staff should provide support with mobility and continence care, for example how to support people with the use of specialist mobility equipment.

Audits were completed but the care plan audits were not always effective in identifying the concerns we noted in relation to the lack of detail in care plans. When this was raised with the registered manager they immediately started work on a new audit tool which focused on the quality and content of care records.

Audits completed by the care service manager and proprietors were detailed and involved speaking with people, relatives and staff for feedback on the service provided. Actions were recorded and the registered manager was able to respond to the actions with either an explanation or confirmation that tasks would be completed.

There was a culture of openness and transparency within the service. A visiting healthcare professional said, “The home is open and transparent and the manager is receptive to comments / recommendations.”

Staff said they felt well supported and they received the training they needed to enable them to meet people’s needs. One person said, “I’m really lucky to be here, excellent staff I can’t praise them enough.”

People and their relatives told us they felt safe living at Stichell House. Risks were assessed and there were control measures in place to support staff to manage risks appropriately. Medicines were stored, administered and recorded in a safe way.

People told us there were enough staff to meet their needs and they did not have to wait for staff to respond if they needed any support. We observed staff spent time with people, and treated them with dignity, respect, compassion and care.

Staff understood the principles of safeguarding and mental capacity. People were actively encouraged to be involved in decision making about their care, and aspects of the home environment. Residents’ meetings showed people had been consulted about recent refurbishments and use of rooms.

The activities co-ordinator was active in people’s lives and spoke with people about their interests and hobbies, so activities could be meaningful for people. People were very complimentary about the activities and the efforts the activities co-ordinator went to with fundraising. One person said, “Special praise for the activity lady she keeps your mind going.”

Meals were freshly prepared and people had a choice, but if they did not like what was on the menu an alternative was offered to them. Specialist equipment was available to support people to maintain their independence during meal times.

Access to healthcare professionals was supported and a GP clinic was held at the home every fortnight. This enabled people to see a GP regularly but also gave staff the opportunity to ask questions and seek guidance and recommendations if needed.

People and their relatives knew how to complain but said they had no reason to do so. Where complaints had been received they were investigated, recorded and action taken. There were many compliments recorded such as, ‘excellent care provided – I only have praise for the work done, we are fortunate to have such a caring high quality facility.’

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

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People had assessments of risks associated with their care. They were cared for by staff who had suitable training. The manager ensured that safety checks were carried out regularly.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that assessments had been undertaken in relation to examining two people’s access to the community. These were comprehensive and included relevant assessments and meeting records. The applications were approved by the local authority.

Is the service effective?

The service was effective. There were systems in place to determine improvements and there was evidence that these were put into practice such as changing what was available at meal times and what activities were on offer.

One person told us “I have been ill and am much better now because of the care I have received”. Another told us “I have got my life back now”

Is the service caring?

The service was caring. People living there reported the staff “really care”, and that “they do the little things as well as the big things” We saw staff supporting people during meal times, and at other times. We were told by one person “the staff are brilliant they really care”.

Is the service responsive?

The home was responsive; we saw records of meetings with people who lived there where the manager had acted to take action about requests made. During observations we saw staff responding to people’s needs quickly to give help. One person told us “When I ring my buzzer at night someone comes along very quickly”

Is the service well-led?

The service was well lead. The provider and the manager had systems in place to monitor the service provided within the home. One person told us “there have been a lot of steady improvements since the new manager came”. The staff reported that the manager is “approachable and knows what she is doing”. On person living there told us, “ the manager is always around you see her a couple of times a day and she always has time to chat and see if you are ok”

At this inspection we went back to check the action staff had taken to ensure the records were being maintained appropriately. We looked at six of 35 (17%) care records.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate records were maintained.

Despite these improvements, we remained concerned about the standard of record keeping within the service. We found that risk assessments and action plans were not always reviewed in a timely manner. We also found that some actions plans did not accurately reflect the care and support needs of people.

We also found that the service did not have a system in place to effectively archive records

There was sufficient equipment within the service to ensure the safety and comfort of the people who lived there and this had been maintained.

People who used the service were happy with the level of staffing. Staffing levels were flexible to meet the changing needs of people. Staff had received training, support and supervision to make sure that they were able to meet the needs of the people they supported, although the system for monitoring supervisions and training needed to improve.

The service had a system in place to monitor and improve the quality of care and support people received. Where improvements were indicated, the service took action to make sure they happened.

Some of the records held within the service needed to improve to demonstrate that risk assessments and care plans were written and reviewed regularly, thus ensuring that staff had access to the most up to date information about people's health and care needs.