Archived: Stoke House Care Home

Updated 10 September 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by three inspectors and one assistant inspector. Three inspectors carried out a site visit, whilst the assistant inspector made telephone calls to relatives and staff.

Service and service type

Stoke House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection, the registered manager had left the service and a new manager was present. They were in the process of submitting their registered manager application. We will continue to monitor this.

Notice of inspection

This inspection was announced. We gave the provider 10 minutes notice because we needed to check the current Covid-19 status for people and staff in the service.

What we did before the inspection

Before the inspection we asked the provider to send us their Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. This included any notifications we had received from the service (events which happened in the service that the provider is required to tell us about). We reviewed the last inspection report. We also sought feedback from the local authority and local clinical commissioning group. We used all of this information to plan our inspection.

During the inspection we spoke with one person who used the service and two relatives of people who used the service about their experience of the care provided. We also observed staff interaction with people. We spoke with the manager, deputy manager, regional manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with the clinical lead, a nurse, two senior care staff, two housekeeping staff, the cook and kitchen assistant, activity coordinator and two agency staff.

We reviewed a range of records. This included in part, seven people's care records. We looked at three staff files and agency nurse staff profiles. We reviewed a variety of records relating to the management of the service, including accidents and incidents, medicine records, audits, and checks on health and safety.

After the inspection we continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider’s current action plan, training data, policies and procedures and meeting records.

Updated 10 September 2020

About the service

Stoke House is a nursing home and accommodates up to 46 people in one building over two floors, accessed by a passenger lift. On the day of our inspection, 20 people were present at the service. People had either nursing or residential care needs and some people were living with dementia.

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

People did not receive consistent safe care. Risks associated with people’s individual needs lacked detailed and up to date guidance in places. Information was also contradictory and impacted on staff providing safe care.

Ongoing shortfalls were identified in the management of medicines. People’s hydration needs were not sufficiently monitored or met effectively. Clinical equipment was not monitored to ensure it was safe to use. Equipment which was not working was not replaced in a timely manner.

Infection prevention and control best practice guidance were not followed by all staff. The provider's infection control risk assessment did not include a clinical procedure, that posed a risk to staff and others. Neither did the provider have a policy for this clinical procedure or provided staff with required training.

There was a high use of agency staff and they had not received an induction when they commenced, to ensure they were familiar with health and safety procedures at the service. Concerns were identified with the deployment of staff. Staff were not always present in communal areas which was expected of them due to the level of people’s dependency needs.

Ongoing concerns were identified in the provider’s ability to develop the service and make the required improvements. Since the last inspection, there had been significant changes in the management and senior leadership of the service. A lack of consistent oversight had a negative impact. Improvements since the last inspection were limited and slow, with repeated breaches in regulations.

There continued to be a poor staff culture that impacted on people’s safety and wellbeing. Staff morale was low.

Staff recruitment checks were completed before staff commenced, to ensure they were suitable to care for people. Improvements had been made to the management of incidents, including analysis for themes and patterns and lessons learnt following an incident occurring.

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 Requires Improvement (Published 1 June 2019) and there were multiple breaches of regulation. 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 followed up on two of the breaches in regulation identified at the last inspection. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

The overall rating for the service has changed following this focused inspection to Inadequate.

Why we inspected

We received concerns in relation to the management of the service and the care and treatment of people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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

Enforcement

We have identified breaches in relation to safe care and treatment and good governance.

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

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.