Archived: Stanmore Residential Home

Updated 26 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 22 and 23 March 2018. The inspection on 22 March 2018 was unannounced whilst the inspection on 23 March 2018 was announced. The inspection team consisted of one inspector. Before our inspection, we reviewed information we held about the home. This included notifications from the home, complaints received and reports provided by the local authority. The provider completed and returned to us a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

There were 23 people living in the home. We spoke with ten people who used the service and three relatives. We spoke with three healthcare professionals and received feedback from two social care professionals. We spoke with the registered manager, the part time activities co-ordinator, the chef and six care workers. The registered manager was on annual leave and we communicated with her on her return.

We looked at the kitchen, laundry, medicines room, communal areas, garden and people’s bedrooms. We reviewed a range of records about people’s care and how the home was managed. These included the care records for five people, five staff recruitment records, supervision and appraisal records. We checked the audits, policies and procedures and maintenance records of the home.

Updated 26 April 2018

This inspection took place on 22 and 23 March 2018. Stanmore Residential Home is a ‘care home’ which is registered for a maximum of 27 older people who may have dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 23 people living in the home.

Our previous inspection on 21 April 2016 found three breaches of regulations. We rated the home as “requires improvement”. At that inspection, we found there was no environmental risk assessment of the home in place. People using the service were not protected against the risks associated with unsafe or unsuitable premises because fire doors were not closed and held open by a wedge and items that may be hazardous to health were not stored safely. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.relating to Safe care and treatment. We served a warning notice in relation to this. We carried out this focused inspection on 30 August 2016 to check what action had been taken. We found the provider had taken steps to comply with the regulation and addressed our concerns in relation to people’s health and safety. There were arrangements in place to identify any potential health and safety risks to people using the service. Monthly environmental safety audits were being conducted to identify any health and safety issues. Fire safety concerns identified had been addressed.

We also found a breach of Regulation 15 HSCA RA Regulations 2014 relating to The Premises and equipment. We found people using the service were not protected against the risks associated with unsafe or unsuitable premises because the premises and equipment were poorly maintained. At this inspection we noted that issues mentioned in the previous inspection report had been rectified. However, we noted that there were other deficiencies such as glass panels of two windows in two bedrooms which were cracked and the window restrictors in two rooms were defective. This is a breach of Regulation 15 HSCA RA Regulations 2014 relating to Premises and equipment.

The third breach was in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. At our previous inspection on 21 April 2016 we found the systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people. At this inspection we found that the service had taken action to comply with the requirements made. There was a system of audits and checks to ensure people received the care they needed. We however, noted that further improvements were needed to ensure that checks and audits were more comprehensive and covered all important areas so that the service could promptly rectify deficiencies identified. We have therefore made a recommendation for the service to review its system of checks and audits to cover all important areas.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

Some arrangements were in place to keep people safe. Care workers understood how to safeguard the people they supported. There was a safeguarding adults policy and care workers had received training in safeguarding people. They knew what action to take if they were aware that people who used the service were being abused.

People's individual needs and risks were identified and managed as part of their plan of care and support. Risk assessments contained guidance to care workers on minimising potential risks to people.

There were arrangements for ensuring fire safety. Fire alarm tests and drills had been carried out. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records.

There were suitable arrangements for the recording, storage, administration and disposal of medicines and we noted from the records that people had been given their medicines as prescribed.

Care workers had been carefully vetted and the appropriate checks prior to them being employed had been carried out. The staffing levels were adequate. Care workers had received essential training, supervision and appraisals from the registered manager.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. We however, found that the service did not ensure that the premises were well maintained. The glass panels in two bedrooms were cracked. The window restrictors in two rooms were defective. Failure to ensure that the premises were properly maintained placed the safety of people at risk is a breach of breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Premises and equipment. The registered manager confirmed to us soon after the inspection that these defects had been repaired.

There were arrangements for the provision of meals to ensure that people’s dietary needs and preferences were met.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found evidence in the care records that that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

Care workers were aware of the human rights of people and the importance of treating people with respect and dignity and promoting their independence. There was a policy on promoting equality and valuing diversity (E & D) and respecting people’s individual choices, beliefs, culture, sexuality and background. Care workers were aware of the importance of treating people as individuals and ensuring that their diverse needs were attended to.

People received personalised care. Their care plans were informative and included details of people’s individual preferences and needs. This enabled care workers to provide people with the care and support they needed. There was documented evidence that people’s care had been reviewed with them and their representatives.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme and people were encouraged to be as independent as possible and participate in social and therapeutic activities.

There was a complaints procedure and relatives knew who to complain to. Complaints made had been promptly responded to.

Checks and audits had been carried out. We however, noted several deficiencies which the service had failed to identify and promptly rectify. These included glass panels of two windows in two bedrooms which were cracked and the window restrictors in two rooms were defective. The above demonstrated that there was a lack of effective quality assurance systems for assessing, monitoring and improving the quality of the service. This may affect the safety and quality of care provided for people and is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Soon after the inspection the registered manager informed us that a decision had been made to close the home. The home had submitted an application to cancel their registration. In addition, they had informed people who used the service, their relatives, care workers and the commissioning authorities involved.