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Stowford House Care Home Requires improvement

Reports


Inspection carried out on 10 June 2019

During an inspection to make sure that the improvements required had been made

About the service

Stowford House is a care home that was providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The care home accommodates up to 51 people across two separate floors. One floor provides nursing care and the other floor provides care to people living with dementia.

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

There were not always enough staff deployed to ensure people’s needs were met. People were at risk of not receiving medicines as prescribed because medicines were not always administered safely. People and staff told us there were not always enough staff to support them in a timely way. The registered manager and provider did not ensure they were meeting all the requirements of their registration as they did not ensure there were enough staff deployed to meet people's needs.

The provider’s systems to ensure compliance with the regulations were not always robust. This included assessing, monitoring and mitigating all risks relating to the health, safety and welfare of people in the service. Staff told us they felt listened to, however they did not always feel action was taken to address issues. This included having enough staff to meet peoples’ assessed and changing needs.

The registered manager continually looked for ways to improve the service. There were links with the local community and there were plans in place to improve those links. There were systems in place to engage people, relatives and staff. The provider had effective recruitment processes in place which enabled them to make safer recruitment decisions. This included pre-employment checks to ensure potential staff were of good character.

People were supported by staff who understood how to report concerns relating to harm and abuse.

Rating at last inspection: The last rating for this service was Good (published 21 June 2018).

Why we inspected:

We received concerns in relation to the safe management of medicines and staffing levels. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. As well as the concerns raised, CQC was also aware of an incident where concerns had been raised in relation to the conduct of agency staff. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, we considered this information in assessing any ongoing regulatory risks to other people in the service.

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

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

Enforcement

We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were regulation 18 (Staffing) as systems were not robust in demonstrating staffing levels were adequate to meet people’s changing needs. Regulation 17 (Good governance) failing to effectively evaluate the safety and wellbeing of service users and use this information to improve practice.

Details of action we have asked the provider to take can be found at the end of this report. 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:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safe

Inspection carried out on 15 May 2018

During a routine inspection

We carried out this unannounced inspection on 15 May 2018. At our last comprehensive inspection in January 2017 we gave the service an overall rating of 'Requires Improvement'. We made a recommendation about the management of some medicines. We also found that accident and incident recording needed to be improved. We needed to be sure that the service demonstrated consistent good practice in all aspects of the care over a longer period of time. At this inspection we found improvements had been made.

Stowford House a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 registered to provide accommodation, nursing and personal care for up to 51 people. At the time of our inspection there were 37 people using the service. One of the units specialises in providing care to people living with dementia.

The service has a registered manager in post. 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 had a range of activities provided by the service to participate in. However, we heard from people and relatives that these could be improved. We have made a recommendation about improving activities.

People received their care and support safely. There were systems and processes in place to safeguard people from abuse and harm. People's risks were assessed and reduced by staff who understood how to protect people from improper treatment. People's medicines were stored securely and administered in line with the prescriber's instructions. Staff followed appropriate personal care and food safety practices to prevent infection.

People's needs were assessed and they receive the support they required to eat and drink. Staff were supported in their roles by the registered manager who delivered supervisions and appraisals and coordinated staff training. People had access to healthcare services whenever required. People were supported to have maximum choice and control of their lives and staff delivered care in line with the principles of the Mental Capacity Act 2005.

Caring staff maintained people's privacy and dignity. People were supported to maintain relationships with their relatives and friends. Visitors were made to feel welcome.

People had personalised care plans which detailed how they wanted staff to meet their individual needs. Information was available for people to access the provider's complaints procedure. The registered manager understood the provider's procedure for handling complaints and those that we saw were clearly documented. People received responsive and positive care at the end of their lives.

The registered manager had improved quality assurance processes since the last inspection which evidenced learning and sustainability. There was an open culture at the service and the views of people, relatives and staff were gathered. The service worked in partnership with other agencies to secure positive outcomes for people.

Inspection carried out on 11 May 2017

During a routine inspection

We inspected Stowford House Care Home over two days. The first visit was on 11 May 2017 and was unannounced. We returned to complete the inspection on 16 May 2017.

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, 38 people were living at the service.

At the last inspection on 5 and 8 December 2016 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Seven breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received regular action plans which set out what actions were been taken to bring the service up to standard.

We undertook this inspection on 11 May 2017 in line with our special measures guidance to see if improvements had been made. At this inspection we found considerable improvements in the service. We could see that action had been taken to improve people’s safety but further improvements were needed in some areas. We have made a recommendation about the management of some medicines. Improvements on recording were required so that accidents and incidents could be better monitored and managed.

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.

Staffing numbers had been increased to ensure there were sufficient numbers of suitable staff to meet people's needs. Staff had been recruited safely to ensure they were suitable to work with vulnerable people. Staff knew what action to take if they were concerned that someone was being abused or mistreated.

Risks to people's safety were appropriately assessed and managed. We found the premises were clean and tidy, with no unpleasant odours. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

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

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and supervision and appraisals had been scheduled in to ensure these meetings were undertaken regularly. Training and development plans were in place for staff.

People were supported to ensure they had adequate nutrition and drinks and were supported to access a range of services to meet their health care needs.

People and their relatives told us staff were caring. Staff treated people with compassion and dignity and respect during delivery of care.

Each person had a personalised care plan containing information about their life histories and support needs. The care plans had been updated in line with people’s changing needs. People said they were involved in making decisions regarding their care.

People were provided with the opportunity to participate in the activities they found interesting. People and their relatives were aware of how to make a complaint. Complaints had reduced considerably.

The management had acted on people's and relatives’ opinions on the service, including complaints. This had been used to implement changes to improve the service. The service had engaged an external consultant to support with improvements in the quality of care. People and staff had confidence in the management of the home and were complimentary about

Inspection carried out on 5 December 2016

During a routine inspection

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

Inspection carried out on 3 November 2015

During a routine inspection

We inspected Stowford House Care Home on 3 November 2015. The inspection was unannounced.

The service provides nursing and residential care for people over the age of 65. Some people at the service were living with dementia. The home offers a service for up to 51 people. At the time of this inspection there were 49 people using the service.

The home had a registered manager. 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 registered manager was supported by an area management team. The provider and management team were open to any suggestions to improve the service. They had a clear plan of further changes they were going to make to the service to improve the quality of service people received. However, systems to monitor the quality of the service had not identified some of the issues we found during this inspection.

Medicines were stored safely and administered in a safe way. However, two people had not received their medicines as prescribed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not always supported to have their nutritional needs met. Hot food was not always served and maintained at an appropriate temperature. Two people who required support to eat and drink were not supported in line with instructions in their care record. This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Mealtimes were relaxed and sociable. People were supported with specialist diets and nutritional supplements as prescribed.

Before, during and after the inspection we had received concerns there was not enough staff to meet people’s needs. The provider was aware of the concerns with staffing. There was an on going recruitment campaign and several new staff had been recruited. Minimum numbers of staffing had been achieved and the provider showed us a plan to increase minimum staffing levels on each shift when new staff were in place.

People felt safe and were supported by competent staff. Staff felt motivated and supported to improve the quality of care provided to people and benefitted from training in areas such as dementia awareness.

People were cared for in a caring and respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were provided with person-centred care which encouraged choice and independence. Staff knew people well and understood their individual preferences. Risks to people’s health were identified and plans were in place to minimise the risks.

People benefitted from a range of organised activities. People who were living with dementia benefitted from an interesting and stimulating environment.

The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions or who may be deprived of their liberty for their own safety.

The registered manager and management team sought feedback from people and their relatives and was continually striving to improve the quality of the service. People and staff were confident they could raise any concerns and these would be dealt with.

Inspection carried out on 5 August 2014

During an inspection to make sure that the improvements required had been made

At our inspection in May 2014 we found there were not appropriate arrangements in place for safely handling medicines. We served the provider with a warning notice. This required the service to be compliant by 30 June 2014.

This inspection was carried out by an inspector and a pharmacist inspector. We looked at the management of medicines. During this visit we found that the required actions had been taken and we saw significant improvements.

We found the provider had appropriate arrangements in place to manage people's medicines safely. Medicines were stored safely and within their recommended temperature range. Detailed records were kept when creams and ointments were applied as part of personal care. Allergy information was consistently recorded.

Medicines were administered by appropriately skilled staff.

Inspection carried out on 19 May 2014

During a routine inspection

At our last inspection we found that there were not enough qualified, skilled and experienced staff to meet people’s needs. We also found that people’s medicines were not stored securely and people were not protected from the risks of malnutrition. The provider sent us an action plan that set out their intention to improve in these areas. At this inspection we found that improvement’s had been made, however there were still concerns regarding to the safe administration of people’s medicines.

During our inspection we spoke with six people and seven people’s relatives. We also spoke with three care workers, a nursing assistant, two nurses and the manager. We reviewed six peoples care files and documents made available to us by the manager around staffing levels and quality assurance. We also carried out a short observational framework for inspection (SOFI). This is used to capture the experiences of people who use the service where they may not be able to express this for themselves.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service Safe?

The service wasn’t safe because appropriate arrangements were not always in place for obtaining and disposing of medicines safely. Medicines were stored safely in a locked cupboard and medicine trolleys which were secured to the wall when not in use. Suitable records were not always kept regarding medication administration. The home did not have appropriate systems in place to account for the amount of medicines given and for those left in stock. We saw that the amount of medication documented as being in stock for people’s medicines did not correspond with the actual amount of medication in stock. This meant that medicines were not always handled safely and securely.

Staff understood the needs of the people they supported. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

At our last inspection we found that there were not enough qualified, skilled and experienced staff to meet people’s needs. At this inspection we found that improvements in relation to staffing had been made. We concluded that there was an appropriate number of staff with the necessary skills and experience to meet people’s needs.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. While no applications have been submitted, proper policies and procedures are in place but none had been necessary. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people’s human rights were recognised, respected and promoted.

Is the service effective?

The service was effective because people told us they were happy with the care they received and felt their needs were understood and met. People’s relatives were also complimentary about the care their relatives received. Our SOFI observations identified a number of warm and meaningful interactions that visibly had a positive impact on people’s mood.

Is the service caring?

This service was caring because people we spoke with felt cared for. One person told us, “I like it here otherwise I wouldn’t stay.” Relatives we spoke with were also complimentary of the care their relatives received. One relative told us, “The staff are good. I have faith in them and I’m sure they do their best.” We observed a number of caring, warm and patient interactions between care workers and the people they supported.

Is the service Responsive?

The service was responsive because people’s needs were assessed when entering the home and were subject to on-going review of their needs. When people’s needs changed the service responded and took the appropriate action. For example, advice and guidance was sought from other professionals when required. People were offered a number of activities to participate in and also had access to music therapy.

Is the service well led?

The service was well led because staff we spoke with felt they had clear leadership from the registered manager who always had their door open and would listen to any concerns.

Robust systems were in place to monitor the quality and safety of the service. Systems in place ensured that care files were kept up to date and people’s care plans/needs were reviewed. We noted that audits were in place to protect people from the risk of malnutrition and ensure incidents and accidents were learnt from.

Where issues were identified appropriate action was taken. Relatives told us they attended relatives meetings and were able to speak to the manager if needed.

Inspection carried out on 23 October 2013

During an inspection in response to concerns

We conducted this inspection following three concerns we received regarding the care and welfare of people and staffing levels within the home.

We spoke with eight people and four people's relatives. We also spoke with six care workers, two nurses and two activity co-ordinators.

People told us they were happy with their care and had no complaints. One person told us that they were "well cared for". Another person told us that “staff worked really hard”.

People's nutritional care was not always delivered in line with their care plan. For example, one person's nutritional care plan indicated they should be referred to a dietician or GP if they lost weight. This person had lost 7kg in the last six months but a referral had not been made.

People were provided with a choice of suitable and nutritious food and drink. Two choices of main meals and puddings were available to people on a daily basis. Where people wanted an additional option this was provided. For example, we saw that one person requested salmon for lunch and this was provided.

Medicines were not always secured safely. For example we noted that the downstairs clinical room was accessible throughout the afternoon.

There were not always enough qualified, skilled and experienced staff to meet people’s needs. Everyone we spoke with felt there weren’t always enough staff on duty. One relative told us, "as far as carer's go they're fantastic. There is not always enough of them".

Inspection carried out on 11 July 2013

During a routine inspection

During our visit to Stowford House we met with the registered manager, the senior nurse and the area manager. We spoke with seven people who used the service and seven care staff.

People were asked for their consent before receiving care. One person we spoke with said "they ask permission before helping me”. We saw that staff consistently asked permission and sought involvement from people before administering their care.

We saw that people's needs were being met by a team of busy staff. A person told us “I like to get up at lunchtime. There are two people [staff] who help me with the hoist. They are quick to give me help. It’s very nice here”. Care plans were personalised and included peoples' likes and dislikes such as 'does not like cold drinks'.

All the people we spoke with told us they were safe, one said “Absolutely safe, no concerns”. We saw records confirming all staff received safeguarding training.

We reviewed staff files and found that the provider had undertaken appropriate checks before staff were allowed to begin work. We saw that induction training took place before staff started their first duty.

People were asked for their views on the service they received. We saw that people asked for activities and that activity organisers had been recruited. The provider held monthly quality audit meetings.

Inspection carried out on 15 May 2013

During an inspection to make sure that the improvements required had been made

We visited Stowford House in response to information of concern received in relation to numbers of staff on duty.

We were told there were not enough staff on duty during the day to meet people’s needs. We saw that staff were busy. However, we observed that people’s care needs were being met.

We spoke with five people who used the service, with three relatives of people and with four members of staff.

One person we spoke with who used the service told us "You can get up when you want. Always someone to help you".

We reviewed staff duty rosters covering a period of seventeen days, equating to 34 day time shifts. We saw that on seven occasions there had been eight staff on duty. However, on seven other occasions there had been ten staff on duty. The registered manager told us they aimed to have nine staff on duty for the forty three people who were using the service at the time.

Inspection carried out on 22 August 2012

During an inspection in response to concerns

The people we spoke with expressed a good level of satisfaction with the service. We heard positive comments about the accommodation, choice and quality of the food and how they were looked after by staff.

People also told us they felt safe and secure in the service. One person thought the staff could have more knowledge of some neurological conditions. They had discussed that with the manager and a training session with a specialist nurse had been arranged.

Relatives also gave a positive impression of the service. One told us the staff were “very patient, helpful and kind”. They said they had no concerns about the home, staff or about the care given to their relative.

One person who had been in another home described the service as “Terrific” and “Light years ahead of the previous home”. They said the staff were friendly and had time for people. They told us they could enjoy time in the garden whenever they wished. Two people, who, for medical reasons, were unable to communicate verbally communicated well by facial expression. Both expressed satisfaction with the service.

A relative visiting their partner who had dementia told us the staff understood their partner’s needs and provided the care required to meet them. They had made it clear they wanted to be consulted about their partner’s care and the service had facilitated this.

Inspection carried out on 20 April 2012

During a routine inspection

People told us they were happy at the home. They said the food was "very nice" and there was plenty of choice and variety. They told us that they were able to personalise their spacious bedrooms with small items of furniture, pictures and ornaments. They told us the home was "comfortable and warm". People told us the staff were friendly, courteous and helpful and were quick to respond when they required assistance. They said staff offered them appropriate levels of support and did so with kindness. People told us staff maintained their dignity, privacy and independence when providing care. They said they were involved in making decisions and had the opportunity to say how they wished to be supported.