Stride Also known as Danes Lea

Stride is a residential care home supporting up to 29 people living with complex mental health needs. Single occupancy accommodation is provided over two floors. At the time of this inspection there were 13 people living at the service.

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

The service had made improvements since our last inspection which had been embedded into daily practice. Improvements had been made to the way people were involved with determining their care. Care plans were personalised, detailed and tailored to meet people's needs.

Staff knew where people were at risk and supported them to remain safe and make positive lifestyle choices.

The service had a stable staff team meaning people had continuity of care. Staff were recruited safely. Staff developed positive relationships with people and demonstrated a good understanding of the support people required.

People received their medication in a safe way. Medication reviews took place and all aspects of medication administration were reviewed and audited regularly.

Infection prevention and control procedures were in place and followed, and the latest government guidance was followed regarding COVID-19.

People were encouraged to become more independent, try new activities, and be involved in the local community.

There was an effective governance system to enable the manager and provider to monitor and improve the service. Lessons were learnt and shared amongst the team.

The manager understood their role and people and staff had confidence in their ability to run the service to a good standard. They worked to gain the views of the people living and working there in order to make improvements.

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

Rating at last inspection

The last rating for this service was requires improvement (published 14 August 2020).

At this inspection we did not inspect all key questions. We found improvements had been made regarding elements of a breach of regulation 9 which remained from an inspection report published on 27 March 2020 in the responsive key question. The provider was no longer in breach of this regulation.

Why we inspected

We carried out an unannounced focused inspection of this service on 29 July 2020. Elements of a previous breach of legal requirement remained from an inspection conducted between 15 January and 7 February 2020.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the

service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stride on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Stride is a residential care home supporting up to 29 people living with complex mental health needs. Single occupancy accommodation is provided over two floors; bathing and showering facilities are shared. At the time of this inspection there were seven people living at the service.

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

Since our last inspection the provider had introduced a number of checks to monitor the safety and quality of the service and improvements were evident. A new manager was in post and they spoke with us about their plans to improve people’s experience at Stride.

Although care plans and risk assessments were now in place for routine daily medicines, information about when and how to administer ‘as required’ medicines was not available to staff. Following our inspection, the manager put guidance in place to support the safe administration of these medicines.

There were enough staff to support people to be safe. However, staffing levels at weekends did not account for when managers and administration staff were not available to give additional support. We have made a recommendation about staffing.

Improvements had been made to the way staff managed risks to people. Detailed guidance was now available to staff about how to minimise harm. The provider had established a process for reviewing and investigating accidents and incidents and staff took steps to prevent reoccurrence.

People benefitted from a team of staff who knew them well and made appropriate referrals to outside services where appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 27 March 2020) and there were multiple breaches of regulations. 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 did not inspect all key questions. We found improvements had been made regarding the breaches of regulation noted in the safe and well-led key questions and the provider was no longer in breach of regulations in these areas.

This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service between 15 January and 7 February 2020. Breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. Breaches contained in the last report found in the responsive key question have not been reviewed at this inspection and remain as a breach of legal requirement.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stride on our website at www.cqc.org.uk.

Follow up

We will continue to communicate with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stride is a residential care home supporting up to 29 people living with complex mental health needs. Single occupancy accommodation is provided over two floors; bathing and showering facilities are shared. At the time of this inspection there were six people living at the service.

At our last inspection the service offered accommodation and personal care and support for up to 29 people aged 65 and older, some of whom were living with a dementia related condition. Since our last inspection of the service, the provider has made changes to their model of care and renamed the location. In addition, the provider had recently undertaken a complete refurbishment of the building.

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

People were at risk of avoidable harm; plans to manage known risks to people were unclear and did not provide staff with enough information to keep people safe. There was little evidence of learning from events or action taken to improve safety.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care and support plans failed to take into account a full assessment of people’s needs and the registered provider’s duty of care. Therefore, staff were unable to support people effectively

The provider failed to ensure effective governance systems to assess, monitor and drive improvement in the quality and safety of the service. This was the fourth consecutive inspection where the provider had failed to meet all regulatory requirements and improve their rating to Good. We identified three continued breaches of regulation and one new breach of regulation.

Despite widespread and significant shortfalls in the service, people praised the kind and caring nature of staff. We observed positive interactions between staff and people throughout the inspection.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 6 April 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 these breaches against the providers new model of care. Enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to risk management, consent to care, person-centred care and the management of the service at this inspection.

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 remains 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 could 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 next 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.

Stride is a residential care home supporting up to 29 people living with complex mental health needs. Single occupancy accommodation is provided over two floors; bathing and showering facilities are shared. At the time of this inspection there were eight people living at the service.

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

The provider had failed to address the widespread and significant shortfalls across the service. This was the fifth consecutive inspection where the provider had failed to meet all regulatory requirements and improve their rating to Good. The provider had failed to embed an effective governance system to assess, monitor and drive improvement in the quality and safety of the services provided; they had not identified the issues we found during the inspection.

People were not always protected from potential harm or abuse. Risks to people were not managed consistently and there was limited action to prevent reoccurrence when things went wrong. Staff did not always follow good infection control practises or manage medicines safely.

Recruitment was not robust; the provider had not always carried out required recruitment checks on staff to prevent unsuitable people from being employed at the service. Many staff had not completed the provider's mandatory training and not all staff had received an induction in preparation for their role.

Care and support was not based on a thorough assessment of people needs and/or preferences. Staff, including the manager, were not aware of the risks of or the need to monitor people's physical health for the emergence of side-effects relating to some prescribed medicines.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 6 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 and 10 October 2019. Breaches of legal requirements were found. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to risk management, safeguarding, person-centred care, consent to care, staffing and safe recruitment process and the management of the service at this inspection.

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 remains 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 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.

People’s experience of using this service: People did not always receive a service that provided them with safe, effective, compassionate and high-quality care. Care and support was not tailored to meet people's specific needs.

Risk management was ineffective and placed people at risk of harm. Medication practice continued to be unsafe. Concerns were raised regarding the environment which posed a risk of spread of infection. There was inadequate staff on a night time to meet people’s needs. Safe recruitment practices had not been followed.

People did always receive person centred care. People's human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to.

The service was not well led and there was an ineffective quality assurance system in place. During this inspection we found multiple failings at the service and risks to people had not been mitigated. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Four of these were repeated breaches which were found at the last inspection, and one of the breaches had been identified at the previous two inspections, which demonstrates learning and improvement had not taken place.

Staff did not always respond appropriately to people who were becoming distressed. People felt staff were caring but did not always have time to spend with them.

People did not receive personal care in a timely manner. Care plans were not reviewed consistently or updated when people's needs changed. Complaints had not always been responded to or investigated.

Rating at last inspection: This service was rated ‘Requires Improvement’ at the last inspection, with the well led domain being rated as ‘Inadequate’ (published 16 August 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We have identified breaches in relation to safety, person centred care, staffing, governance, and failure to submit statutory notifications at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

This inspection took place on the 19, 20 and 25 June 2018. The 19 June was unannounced and we told the provider that we would be returning on the 20 June. The 25 June was unannounced and during the evening. This attendance was prompted by anonymous concerns that were received by the local safeguarding team. Some of these concerns were substantiated.

The service had previously been rated Requires Improvement in June 2017. There was a breach in regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider did not ensure adequate standards of cleanliness. During this inspection we have found that there were four breaches in regulations, regulations, 9, 12, 17 and 18.

The service is required to have a registered manager in post. A registered manager is a person who has registered with 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. At the time of the inspection there was a manager in place and they were in the process of being registered with the CQC.

Processes in place for the administration of medicines at night were not sufficient and put people at risk. There was insufficient staff working at night on a regular basis and night staff were inappropriately trained to meet the needs of people.

Accidents and incidents were not always monitored and investigated effectively to ensure safe practices. Lessons learnt were not evidenced in all incidents. Not all incidents had been notified to CQC or the local safeguarding authority.

There was a lack of provider oversight which meant risks to people’s safety were not picked up by the provider.

Morning routines for some people were service led and not person centred.

Staff received training in safeguarding and had knowledge of whistleblowing procedures. Recruitment processes were in place and were found to be robust.

Infection control measures were in place to prevent the risk of infections spreading to people. Although the domestic staff and night staff felt that recent cuts in cleaning hours had impacted on the cleanliness of the service, we found that standards were maintained during the inspection.

Staff aimed to deliver a good standard of care that was caring. Staff demonstrated knowledge of people and this helped them to provide some person-centred care. Feedback from relatives and friends was very positive about the caring nature of the staff.

Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. Gaps in the reviews meant some care plans did not contain up to date information. Risk assessments were in place to reduce the risk to people. Peoples wider needs were met by the provision of activities and people’s care plans recorded their end of life preferences.

People’s nutrition and hydration needs were catered for however, the provider needed to make changes to the meal time experience to ensure that this followed best practice.

The manager had used a variety of methods to assess and monitor the quality of care. However, the governance systems had not picked up all the shortfalls identified during the inspection. Where shortfalls had been identified, action to address these were not clearly identified, recorded and monitored.

We made a recommendation about staff inductions, supervisions and appraisals.

We made a recommendation about provision of activities to meet people’s wider needs.

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

Danes Lodge (also known as Danes Lea) is in Bridlington and provides personal care and accommodation for up to 29 people. There were 25 people using the service on the day of our inspection. The service is a detached property set out over three floors. The top floor is used for storage and other purposes and all bedrooms are located on the ground and first floors. The registered provider of the service has links to three other care homes in the East Riding of Yorkshire and Hull area.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (the 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. The provider had employed a manager who was in the process of applying for registration with the Commission

People felt safe at the service. Staff had been trained in safeguarding of adults and knew what to do if they had any concerns and how to report any incidents.

Assessments identified areas where people’s health and safety may be at risk and these were acted upon. Medicines were administered safely by staff but where people administered their own medicines they were not always stored safely. Accidents and incidents were managed appropriately by the service and reviewed regularly by the care services manager.

The service was undergoing a programme of refurbishment but some areas had not been completed and did not have acceptable standards of cleanliness resulting in some odorous areas. Checks and servicing of services and equipment and been completed. The building had been adapted as far as possible to accommodate people’s needs. Where people were living with dementia adaptations to the environment had been made to assist people in finding their way.

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

Recruitment was robust with all relevant checks completed by the registered provider before people started work. There was sufficient numbers of staff on duty who had the skills and knowledge to meet people’s needs.

Staff had been trained in areas which supported their role. Where further training was due it had been planned with dates booked. Staff were supported through supervision and annual appraisals.

People’s communication needs were clearly identified in care records. Information was shared at regular staff, resident and managers' meetings.

The service was working within the principles of the Mental Capacity Act 2005.

People had a choice of what to eat and drink. Specific needs relating to nutrition were identified. Fluids were available to people throughout the day.

Staff were caring and compassionate. Their approach was kind and friendly. They involved people in their care and gave them information and support where appropriate. People were treated with dignity.

Advocacy services were available if people needed them. One person had an independent mental capacity advocate supporting them.

Care plans reflected individuals needs clearly. They were reviewed regularly.

People took part in a variety of activities of their choice.

Complaints had been dealt with in line with the registered providers policy and procedure.

Where necessary the manager had made notifications to CQC. They worked together with other agencies to promote people’s health and wellbeing.

Although there was a quality assurance system in place, quality audits had not identified some areas for concern.