Archived: Spurr House Short Stay Service

We found the following examples of good practice.

• The designated care scheme was housed in a fully self-contained segregated unit that had a separate entrance and exit from the rest of the care home. This allowed staff to care for people who had coronavirus separately from other people.

• The care home had a designated staff team working on the unit who did not work on any other unit. Staff had access to a range of facilities and supplies on the designated unit, for example, a changing room with shower, towels, uniforms, a laundry service, a lounge, a dining area and kitchen, a small outdoor space, and a desk and a computer. This helped minimise the need for staff movement away from the unit.

• The provider had given staff uniforms (scrubs) to wear during their shifts. Staff changed into their uniforms when they arrived at work. When staff left work, they placed their worn scrubs in designated laundry baskets, and the care home laundered them.

• All people self-isolated for 14 days on admission to the designated care unit. If a person moved to another unit in the care home once they were symptom-free, they had to self-isolate again for 14 days.

• The designated care unit had its own store of supplies such as personal protective equipment (PPE), cleaning materials and linen to prevent the need for staff to enter other areas of the care home.

• The home had an onsite catering service that delivered hot meals to the door of the designated care unit in disposable containers. The designated care unit had its own supply of utensils and crockery, which never left the unit. In addition, the unit had its own supply of hot and cold drinks, snacks and cereals to minimise the movement of staff, utensils and food between units.

• The designated care unit had full maintenance checks completed before it opened to mitigate the risk of issues that would require visitors such as contractors.

• The care home had access to the provider’s other care locations and sites in case of emergencies. However, given the risks associated with the current pandemic, the home had also arranged for refuge at a local hotel.

Further information is in the detailed findings below.

Spurr House Short Stay Service provides accommodation and personal care for up to 36 older people. Care is provided for people who require respite, short term or emergency support. The service is a large detached property in its own grounds. All accommodation is on the ground floor and the home is split into four self-contained units, each with their own lounge area. On the day of our inspection visit there were 22 people using the service.

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

People and their relatives spoke positively about the care provided. Staff were described as kind and respectful, ensuring people received support in line with their needs and wishes.

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.

People told us they felt safe during their stay with the service. Staff had a good underpinning knowledge about how to identify and report any safeguarding concerns. This was supported by a safeguarding policy and associated procedures.

The service was visibly clean and odour free with effective cleaning and infection control processes in place.

Medicines were being managed safely. People received their medicines as prescribed by staff who have been trained and assessed as competent to do so.

People were cared for by a staff team who were skilled and competent in their roles. Staff were up-to-date with any required training. Staff spoke positively about the training and support provided, including the completion of supervision and appraisals.

People were complimentary about the food and drink available, telling us enough was provided and they were offered choice. People requiring a modified diet received these in line with guidance.

Staff received equality and diversity training and demonstrated they were confident with difference and supportive in meeting the needs of people from different backgrounds.

Care plans contained personalised information about the people who used the service and how they wished to be supported and cared for.

People’s social and recreational needs were met through an activities programme, facilitated by an activity co-ordinator and staff members. A mix of activities were organised throughout the week which catered for all interests and abilities.

Systems for audit, quality assurance and questioning of practice that had been newly introduced or amended since our last inspection, were now well embedded into the service and operated effectively.

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 20 November 2018) and there were three 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 found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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

Spurr House Short Stay is a ‘care home’. 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.

Spurr House Short Stay Service provides accommodation and personal care for up to 36 older people, some of whom are living with dementia. Care is provided for people who require respite, short term or emergency support. The home is a large detached property in its own grounds. All accommodation is on the ground floor and the home is split into four self-contained units, each with their own lounge area. On the first day of our inspection there were 28 people staying at the home.

We last carried out a focused inspection of this service in November 2017. We found the service to be good in safe and well-led. It had an overall rating of Good.

During this inspection we found breaches of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed effectively, suitable arrangements were not in place to ensure people were protected from the risks of cross infection, systems for recruitment of staff were not always safe and systems in place to assess, monitor and improve the quality and safety of the service provided were not robust. You can see what action we have told the provider to take at the back of the full version of the report. We also made one recommendation about managing the risks from hot water

Medicines were not always managed safely. Records for the administration of medicines were incomplete. Protocols were not always in place to guide staff on administration of some ’as required medicines‘ including topical creams. Checks of storage temperatures of some medicines were not carried out properly and audits of medicines administration were not robust.

People were not protected from the risk of infection. Cleaning schedules were not clear and records of cleaning undertaken were incomplete.

Recruitment of staff were not always safe. All the required checks on staff’s suitability to work with vulnerable people were not made.

Systems in place to assess, monitor and improve the quality and safety of the service provided were not sufficiently robust to ensure best practice was followed and compliance with regulations.

Health and safety checks were completed on the building and equipment. However, some checks were incomplete. We found that all the required checks on the temperature of bathing water were not being completed. We have recommended the provider follows appropriate Health & Safety Executive guidance about managing the risks from hot water in health and social care.

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 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 positive about the registered manager and the way the home was organised and managed.

Staff were aware of their responsibilities in protecting people from abuse and could demonstrate their understanding of the procedures to follow so that people were kept safe.

Risks to people who lived at the service were well managed. Accidents and incidents were appropriately recorded.

There were sufficient numbers of staff to meet people’s needs. Staff received the training, support and supervision they needed to carry out their roles effectively.

The requirements of the Mental Capacity Act 2005 were being met. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment.

Care records were person centred, detailed and written using respectful terms. They gave staff information about what was important to and for the person. People told us they were involved in decisions about their care and support.

People had access to a range of health care professionals. People enjoyed the food on offer.

The registered manager and staff all knew people very well. We saw staff interactions that were caring, helpful and kind. People told us that staff respected their privacy and treated them with respect.

Staff we spoke with enjoyed their work, took a pride in the care they provided and demonstrated a commitment to person centred care.

There were a range of activities and social events in the home and in the community on offer to reduce people’s social isolation. People told us they enjoyed the activities and were positive about the enthusiasm of the activity coordinator.

There was a system in place to record complaints and the service’s responses to them.

Staff meetings were held regularly where staff had an opportunity to raise any issues and were used to look at developing good practice. Staff we spoke with liked working for the service and told us they felt supported in their work.

The service had notified CQC of any accidents, DoLS authorisations, serious incidents, and safeguarding allegations as they are required to do.

The provider had displayed the CQC rating from the last inspection in the home and on their website.

Spurr House Short Stay Service provides accommodation and personal care for up to 36 older people, some of whom are living with dementia. Care is provided for people who require respite, short term or emergency support. At the time of our inspection there were 26 people staying at the home. The home is a large detached property in its own grounds. All accommodation is on the ground floor and the home is split into four self-contained units, each with their own lounge area.

At our last inspection in June 2017 we rated the service Requires Improvement in the Safe and Well-led domains. This was because we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. We found medicines were not managed effectively and the service had failed to provide all the required notifications to the Care Quality Commission (CQC.) The service was rated Good in Effective, Caring and Responsive domains. Because of the breaches of regulations we found, the service was given an overall rating of Requires Improvement.

Following our inspection in June 2017 we received an action plan from the provider which informed us of what action they intended to take to make the necessary improvements to the service.

During this inspection we checked to see what action had been taken to address the breaches in the regulations and to see if the required improvements had been made. We found that the required improvements had been made.

Medicines were managed safely and people received their medicines as prescribed. Staff had received appropriate training in the safe handling of medicines and had regular assessments of their competency. We found that protocols were in place to guide staff on the administration of “as required medicines” e.g. paracetamol. Daily checks on the storage temperature of all stocks of medicines were carried out and recordings of these checks were complete. We found that since our last inspection the provider had introduced extra checks and auditing of medicines administration. This ensured that any errors were identified in a timely manner. There was a robust system of daily, weekly and monthly monitoring and auditing of medicines administration in place to help improve the quality of the service provided.

The service are required to notify CQC of events such as accidents, serious incidents and safeguarding’s. Records we reviewed showed that the service had notified CQC of all events they are required to.

This was an unannounced inspection which took place on the 5 and 6 June 2017. The inspection was undertaken by one adult social care inspector and an expert by experience. This was the first inspection of this service since the service transferred to a new provider.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. This was because medicines were not managed effectively and the service had failed to make all the required notifications to CQC.

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

Staff had received appropriate training in the safe handling of medicines and had regular assessments of their competency. We found that protocols were not always in place to guide staff on administration of “as required medicines” e.g. paracetamol. Routine checks on the storage temperature of stocks of some medicines were not carried out or recordings were incomplete.

The service had not notified CQC of all events they are required to. They had notified CQC of events such as serious incidents and when Deprivation of Liberty Safeguards applications were authorised, but had not notified CQC when safeguarding concerns were raised. We have written to the provider asking them to tell us how they will meet this regulation in future.

The service is required to have a registered manager in place. 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. The service had a registered manager in place who was present during this inspection. Everyone we spoke with was very positive about the registered manager and the way the service was managed.

Staff we spoke with were aware of safeguarding and how to protect vulnerable people. Staff were confident the registered manager would deal with any issues they raised.

Recruitment procedures were in place which ensured staff had been safely recruited. There were sufficient staff to meet people’s needs. Staff received the training, support and supervision they needed to carry out their roles effectively.

The home was clean. There was an on-going programme of improvements taking place. Areas of the home had been redecorated, with new furnishings and flooring fitted. The work was planned to be completed by October 2017.

Accidents and incidents were appropriately recorded. Risk assessments were in place for the general environment. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

People told us they liked the food and their preferences were respected. People at risk of poor nutrition and hydration had their needs assessed and monitored.

We saw records that showed people had given their consent to the support they received. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

All the people we spoke with were positive about the support they received and the caring attitude of the staff. People we spoke with said, “The staff are welcoming, caring and friendly” and “They couldn’t improve on the care provided.”

We found there was a relaxed and caring approach by staff and staff were polite and treated people with respect.

Peoples support needs were assessed before they moved into Spurr House Short Stay Service. Care records guided staff on the care people needed and reflected their support needs and personal preferences.

There were sufficient activities available for people if they wished to join in. People told us they were happy with the activities on offer.

Staff were positive about the service and the way it was managed and the improvements that had been made since the new provider took over the service.

We saw there was a system for gathering people’s views about the service, including regular meetings. There was a system in place to record complaints and the service’s responses to them.

There was a system of weekly, monthly and annual quality monitoring and auditing in place to help improve the quality of the service provided.