We inspected Stowford House Care Home over two days. The first visit was on 5 December 2016 and was unannounced. We returned to complete the inspection on 8 December 2016. Stowford House Nursing Home is registered to provide residential and nursing care for up to 51 older people some of whom are living with a dementia. At the time of this inspection, 48 people were living at the service. There were three vacancies at the service.
The service was previously inspected in November 2015 and we identified the service was not meeting two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not always administered as prescribed. We also identified that food was not served and maintained at the right temperature for the whole meal. People were not being supported to eat and drink where necessary. Following the inspection, the provider sent us an action plan, which detailed how improvements would be made. During this inspection, we did not see adequate improvements and also identified more concerns.
There was 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. They were supported by a deputy manager and regular visits from the provider's regional manager and a compliance manager.
Before the inspection, we had received a number of concerns about the staffing levels and the impact this was having on people receiving safe and effective care. We found there were not enough staff on duty on the day of our inspection. People and their relatives reported that people had to wait for an unacceptably long time before their needs were met. The provider was using a dependency level tool to calculate how many staff were needed to care for people. This was not evidenced as meeting the needs of people and the low staffing impacted upon most areas of the inspection.
People's medicines were not safely managed and not always administered as prescribed. We found gaps on the Medicine Administration Record (MAR). Records did not demonstrate clear guidance for staff in relation to medicines or topical creams.
Risks to people's safety had not been ensured. Clear plans to minimise and manage risks were not in place. Not all information was up to date and clear in the risk assessments meaning staff would not be able to take all necessary steps to promote people’s safety.
Staff generally felt well supported but we found minimum records of any meetings such as one to one meetings and annual appraisals. Some staff felt there was low morale due to the workloads associated with low staffing levels. A range of training was arranged to increase staff's knowledge and help them to do their job more effectively.
People were not always supported to ensure they had adequate nutrition and drinks. The quality and quantity of food and assistance required were not adequate. People did not always get the food they had chosen.
People were supported to access a range of services to meet their health care needs.
People found staff to be caring but people’s dignity was not always protected. People were not assisted as often as they needed to be and this meant they often had to wait in undignified conditions until assistance was available. Staff were rushed and did not have time to spend with people.
Care plans were not always up to date which meant staff could not respond appropriately to people's needs or provide care in a person centred manner. Information stated care needed to manage falls and wounds but these people no longer had these needs. Records recording food and fluids was not completed consistently and was done both electronically and on paper. This meant there was not a clear system for monitoring people’s food and fluid intake.
There was a complaints system in place. However, people and relatives had little confidence that complaints would be resolved to their satisfaction. Where areas for improvement had been discussed with people and their relatives the resulting actions had not always been effective in maintaining an improvement.
There were a range of systems to assess and monitor the quality of the service. However, not all were effective in identifying and addressing shortfalls. Accidents and incidents were being analysed yet action to minimise reoccurrence was not always sufficient.
Relatives and staff did not feel confident that the registered manager took on board all actions necessary to improve the service. We had many concerns raised before, during and after the inspection about staffing levels impacting on all areas of people’s safety.
We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.
The overall rating for this service is ‘Inadequate’ and therefore the service in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel their provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 re-inspect and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.