Archived: Stoke House Care Home

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.

We conducted an unannounced inspection at Stoke House on 1 and 2 May 2019. 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, 31 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:

Action taken to assess and mitigate risks associated with people’s needs, were not consistently completed or responded to in a timely manner. People could not be assured they received their prescribed medicines as required. Guidance provided to staff to meet people’s individual needs was inconsistent or insufficiently detailed. The provider had not consistently submitted statutory notifications of reportable incidents.

Improvements were being taken in the process that reviewed, monitored and analysed accidents and incidents to protect people from harm. Staff had recently received training in understanding and managing behaviour and further training was planned. Staffing levels had increased and improvements around deployment of staff was ongoing.

Infection control practice was understood by staff and best practice guidance followed. Health and safety checks were completed of the premise and environment. Plans were in place to make some improvements to decoration, refurbishment and the use of communal spaces.

Staff needed to complete refresher training and the provider had plans to address this. Staff received opportunities to discuss their work, training and development needs.

The provider had up to date policies and procedures that reflected current legislation and used recognised assessment tools to support assessments of people’s needs. Improvements were required to ensure people were protected under the Mental Capacity Act. Inconsistencies were found in the use of assessments and best interest decision making. People were involved as fully as possible in day to day decisions, but communication and opportunities to be involved in review meetings about care and treatment were not happening.

Staff worked with external healthcare professionals in meeting people’s health care needs. People’s nutritional needs were known and understood, and people were happy with the choice of meals and drinks.

People received limited opportunities of activities, social inclusion and stimulation. The provider was in the process of recruiting dedicated activity staff.

People had access to the provider’s complaint procedure. People’s communication needs had been assessed and accessible information for people had been considered.

End of life care plans needed to be further discussed and planned with people, to ensure they received personalised care at the end of their life.

People received opportunities to share their experience about the service. The provider had an action plan that was detailed and confirmed the shortfalls in fundamental care standards we found during this inspection. The management team had started to make improvements at the service and further time was required for these to be fully developed, embedded and sustained.

The service met the characteristics of requires improvement in all areas we inspected. We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These included how risks were assessed and managed, how medicines were managed, how people received care based on their individual needs, how people were treated with dignity and respect and records maintained. Also, one breach of the Care Quality Commission (Registration) Regulations 2009 due to the provider not submitting statutory notifications as required. Details of action we have asked the provider to take can be found at the end of this report. More information is in the detailed findings below.

Rating at last inspection:

At the last inspection the service was rated Good (Published 12 April 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service has changed to a rating of Requires Improvement.

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.

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

The service had a registered manager in place 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.

People were supported by staff who understood the risks they could face and knew how to keep them safe. Risks to people’s health and safety were identified and assessed and action taken to reduce risks were known by staff and recorded in people’s care plans. People received their medicines as prescribed and these were managed safely.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were supported to make choices and decisions for themselves. When people were assessed as lacking mental capacity most people had capacity assessments and best interest decisions in place.

People required more support to protect them from the risks of inappropriate nutrition and hydration and to help them maintain their healthcare needs.

People were cared for and supported by staff who respected them as individuals, staff had friendly relationships with people and respected their privacy and dignity. People were involved in planning and reviewing their own care and some people were supported by relatives in doing so.

People received individualised care and were provided with meaningful interaction and activities. People felt confident to make a complaint and were confident these would be responded to.

We saw that staff worked well as a team and were supported by management to drive improvements in the service. Quality monitoring systems were in place which were effective in identifying issues.

We carried out an unannounced focused inspection of this service on 3 August 2016 as we had received concerns in relation to how people were supported with their mobility. A breach of regulation was found and we issued a warning notice as we were concerned about people’s safety.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. 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 Stoke House Care Home on our website at www.cqc.org.uk.

The service had a registered manager in place 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.

At our last inspection on 3 August 2016, we asked the provider to take action to ensure people were protected from the risk of harm. This was because there was a lack of adequate risk assessment and monitoring in relation to peoples moving and handling support needs. We also found that staff had not received sufficient training and guidance in order for them to support people safely with their mobility. For this reason we issued a warning notice which required the registered provider to ensure they meet the legal requirements of Regulation 12 (1) of the Health and Social Care 2008(Regulated Activities) Regulations 2014.

During this inspection, we found that the required action had been taken by the provider to ensure people were supported with their moving and handling requirements safely.

We had previously carried out an unannounced comprehensive inspection of this service on 11 and 12 May 2016. After that inspection we received concerns in relation to how people were supported with their mobility in the service. As a result we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stoke House Care Home on our website at www.cqc.org.uk.

The service did not have a registered manager at the time of our inspection. The service had been without a registered manager for approximately 21 months. A new manager had been at the service for approximately six months prior to our inspection and had made an application to become registered. 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 that people were at risk of harm due a lack of adequate risk assessment and monitoring in relation to people’s moving and handling support needs. We also found that staff had not received sufficient training and guidance in order for them to support people safely with their mobility.

Immediately after our inspection and feedback the manager confirmed the action they had, and would be taking to address our concerns.

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

The service did not have a registered manager at the time of our inspection. The service had been without a registered manager for approximately 18 months. A new manager had been at the service for approximately three months prior to our inspection and had made an application to become registered. 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.

At our last comprehensive inspection of the service on 27 July 2015 we identified five breaches of legal regulations and deemed the service to be inadequate. The service was placed in special measures to be kept under review. We returned to the service on 26 November 2015 to follow up requirements resulting from three of these breaches and found that improvements had been made although further improvements were required in relation to the safe care and treatment of people. During this inspection we found that the service demonstrated further improvement and is no longer rated as inadequate for any of the five key questions, therefore the service will no longer be in special measures.

Following our last comprehensive inspection on 27 July 2015 we asked the provider to take action to ensure there were sufficient staff on duty to meet people’s needs. During this inspection we found that people were cared for by sufficient numbers of staff. However, improvements were required to ensure that recruitment processes were robust and ensured staff were safe to work with people.

Following our last comprehensive inspection on 27 July 2015, we asked the provider to take action to ensure that concerns for people’s safety were responded to appropriately. During this inspection we found that people were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening.

Risks to people’s health and safety were identified and assessed and action taken to reduce risks were recorded in people’s care plans, however, we found that risk assessments had not always been completed correctly. People received their medicines as prescribed and these were managed safely.

People told us they were not always asked for their consent prior to support and treatment being provided. Decisions were being made appropriately in people’s best interests in the event they lacked capacity. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were protected from the risks of inadequate nutrition and specialist diets were provided if needed. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were at risk of receiving support which did not reflect their individual preferences as staff did not always ask people how they wished to be supported and people were not routinely involved in care planning. We observed that staff had friendly relationships with people and respected their privacy and dignity.

People’s care records did not always reflect that they were receiving care and support in line with care plans. At times we witnessed a lack of staff interaction with people; however, improvements had been made to the stimulation and activities available to people since our previous inspection.

People and their relatives felt able to raise concerns and complaints and records confirmed that these were dealt with appropriately.

People’s relatives told us they were involved in the development of the service and the manager told us of plans to further involve people who used the service.

We saw that staff worked well as a team and were supported by management to drive improvements in the service. The manager had a good understanding of effective quality monitoring systems and these were effective in identifying and acting upon issues within the service. However there were still some areas for improvement and the provider needs to demonstrate that the improvements can be sustained.

One person who lived at the home told us 'I am happy here. They are looking after me well. The food is good and there are plenty of things to do and music to listen to'.

A staff member told us 'It's like my second home here. I love it. There is always enough staff on the duty rotas. The management always listen to any complaints of concerns we may have. We also have regular staff meetings'.

During our inspection we reviewed the files of ten people who used the service. We found comprehensive records of care showing that care was planned, delivered and assessed appropriately.

The people we spoke with told us that their privacy and dignity were respected. One person said, "I am quite happy with them all [staff] here.'

We spoke to relatives of people who use the service and one person said, 'I think the staff are brilliant here.'

People using the service and relatives told us they felt safe with the support they were being provided. One person said, 'I feel safe and the staff are kind.' People told us that they liked the staff and staff were able to meet their needs. They also told us they felt they could speak to the manager or staff and they would be listened to.

We found that staff were supported to provide care that met people's needs. We also found that the provider took steps to assess the quality of the service being provided.