We carried out a review of the data available to us about Stockingate Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Stockingate Residential Home, you can give feedback on this service.
People's experience of using this service and what we found
People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the care and support people needed. Staff received regular training and supervision which helped to ensure they had the knowledge and skills to look after people safely. The home was clean and tidy. Regular cleaning helped ensure people were protected against the risk of infection.
Staff knew people well and understood the risks associated with their support. Care plans and risk assessments provided guidance about individual and environmental risks. People received their medicines safely, when they needed them. Recruitment procedures ensured only suitable staff worked at the service.
There was evidence of continuous learning. Following an accident or incident there were discussions with staff to identify if there were any themes or trends and what could be done to prevent a reoccurrence. The culture of the home was positive and staff worked hard to ensure people lived happy lives. The quality of the service was regularly monitored through audits, meetings and feedback surveys. Improvements were made where needed and there was an ongoing improvement program for the home.
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 CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 30 December 2021) and there were breaches in 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
We carried out an unannounced focused inspection of this service on 19 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve infection prevention control and good governance.
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 and well led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last focused inspection, by selecting the 'all reports' link for Stockingate Residential Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Stockingate Residential Home is a care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 25 people.
People’s experience of using this service and what we found
Staff were not following current guidance around infection control management for COVID-19 as they were not changing clothing on arrival and departure at the home. Some instances were identified where staff were not wearing their face masks correctly, although all care workers were seen wearing this PPE correctly.
At the last inspection, we made a recommendation around improving the quality of recording relating to people's care and treatment. At this inspection, we found staff knew people’s care needs, but care plans were not sufficiently person-centred. Systems of governance had not identified these gaps. Three incidents which were notifiable to us had not been reported.
People were being asked for feedback about the care they received. Staff meetings had not restarted due to the ongoing pandemic, although other systems were used to share key information. Feedback regarding the support from the management team was found to be positive. Staff received ongoing support through training and supervision. People and relatives knew how to complain and were satisfied with action taken where they had raised concerns.
Risks to people had been assessed, although steps to reduce one person’s falls risk were not being followed on the day of inspection. Some areas of the home needed maintenance.
Some issues were identified around the recording of medicines management. Staff signed to say they administered all prescribed medicines. However, one person was given their medicines, but they were not observed taking this. Records were not sufficiently detailed for a controlled drug in stock.
People told us they felt safe living at this home and their relatives agreed with this. People, relatives and staff said there were sufficient numbers of staff available to support them. A gap in a staff member’s employment history had not been followed up at the recruitment stage, but this had been identified by the provider before our inspection. Other background checks had been completed.
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.
We observed natural interactions which were kind natured, between people and staff. Staff took a genuine interest in people’s welfare and responded well to people living with dementia. Feedback we received from people and relatives about the staff team was positive. It was evident privacy and dignity was maintained. A well-delivered programme of activities was taking place in the home.
We have made a recommendation regarding dementia friendly features in the home.
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 17 January 2020).
Why we inspected
We received concerns in relation to safeguarding people from abuse. As a result, we undertook a focused inspection to review the key questions of Safe, Caring and Well-led only. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
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 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 Stockingate Residential Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to infection control management and having sufficient oversight of the service.
Please see the action we have told the provider to take 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 meet 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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Stockingate is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 25 people.
The home is over two floors, with communal living spaces on the ground floor. People’s bedrooms are on both floors.
People’s experience of using this service and what we found
People felt safe, and risks were known by staff, although not always thoroughly recorded and there were some inconsistencies between care records and practice. Medicines management was safe overall, although recording of medicines and written procedures lacked detail. Safe recruitment processes were followed and there were enough staff to meet people’s needs. Accidents and incidents were monitored and staff understood safeguarding procedures.
People’s needs and choices were assessed. Systems were in place to support staff in providing effective care and supervision meetings were being improved Training information showed staff had completed a series of short reading modules with a knowledge check at the end, as well as some practical training. People’s consent to care and support was obtained, monitored and reviewed in line with legal requirements and national guidance.
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.
Positive relationships with staff ensured people felt cared for and at home. Some planned activities took place, although people were not meaningfully occupied for long periods of time. Information in care plans was not always consistent and there were some gaps in records.
Staff felt supported through the way the home was managed and said the management team were actively involved in people’s care. Systems were in place to assess and monitor the quality of the provision although these were not always effective and did not show clear actions taken when issues were identified. Electronic systems were being introduced to provide more rigorous and consistent audits. We made a recommendation to improve the quality of recording relating to people's care and treatment.
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 Requires Improvement (published 18 October 2018). The service remains requires improvement. This service has been rated requires improvement for the last three consecutive inspections. In the provider’s inspection history, the six previous inspections have been rated no better than requires improvement, with two of these being inadequate.
There was work being done to help the service to continuously improve, although progress was slow.
Why we inspected
This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.
The overall rating for the service has not changed from Requires improvement.
We have found evidence that the provider needs to continue to make improvement. Please see all sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stockingate on our website at www.cqc.org.uk.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will meet 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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Stockingate Residential Home provides care for up to 25 older people. At the time of the inspection 19 people were using the service. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.
A registered manager was 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.
The provider had improved their arrangements for managing people’s medicines but they needed to develop their systems further to make sure safe administration practice was always followed. Staff knew what to do to make sure people were protected from abuse. The home looked clean and checks were carried out to make sure the premises and equipment were safe. Risks to people had been identified, assessed and managed. There were enough staff and the same workers provided support so people received consistent care.
The provider had improved the support given to staff but they still needed to develop this further to make sure there was a consistent approach to training and supervision. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received support at meal times and enjoyed the meals. However, they did not have access to condiments, serviettes and tables were not laid prior to the meal being served. People accessed services which ensured their health needs were met. People were comfortable in their environment and freely walked around different communal areas of the service. Work to improve the environment was in progress.
Throughout the inspection we observed staff were friendly and caring in their approach. They knew people well and talked about things that were important and relevant to the person. Staff were confident people received a good standard of care.
Care records were being transferred to an electronic care recording system. Staff had received training to help ensure they could use the new system effectively and efficiently. Current care plans outlined people’s needs and covered key areas of care although some were basic. The management team were confident the new system would be more person centred. People enjoyed a varied activity programme which provided opportunities for them to engage in individual and group sessions. The provider had a system for investigating complaints and people told us they would raise concerns with staff and the management team.
We received positive feedback about the registered manager and saw they engaged with people who used the service, visitors and staff. Resident meeting minutes and surveys showed people were satisfied with the service they received. The provider had systems for monitoring quality and safety, however, some of these were basic and did not always drive improvement.
Stockingate Residential Home is registered to provide care for a maximum of 25 people. The manager told us 22 people were using the service when we inspected. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of the inspection the service did not have a registered manager although a manager had been appointed and told us they would be applying to register as the manager of Stockingate Residential Home. 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 received positive feedback about the manager. The provider carried out a range of checks and audits but these were not always effective. Their systems and processes did not enable them to appropriately assess, monitor and manage quality and safety.
People felt safe but the provider did not have systems in place to safeguard people’s finances. Financial records were not robust and people were not provided with lockable facilities. The provider did not always follow safe management of medicine practice. Systems were in place to assess and manage risk to individuals although documentation was not always clear and this could result in risk being inappropriately managed. People lived in a safe and clean environment although one shower was very hot so put people at risk of scalding. The provider took swift action to rectify this.
There were enough staff to meet people’s needs and the same workers provided support so consistent care was provided. Recruitment checks were carried out but this was not always done robustly. Staff felt well supported but not all staff had received the agreed number of formal supervision support sessions during 2017. New care workers did not complete the Care Certificate which is a set of standards for social care and health workers.
People told us they were happy living at Stockingate Residential Home and staff were kind and caring. We saw people were treated with kindness. Everyone told us they enjoyed the meals and had pleasant dining experiences. The choice of activities was varied. People had opportunity to engage in group and person centred one to one activities within the service and accessed the local community.
People’s care records were person centred and detailed preferences, dislikes, history and what was important to them. However, care plans around management of falls, mobility and management of finances did not always provide sufficient guidance. Staff knew people well. Systems were in place to make sure people’s health needs were met.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: The provider was not managing medicines safely: Staff did not receive appropriate training and supervision: The provider’s systems and processes around safeguarding people’s finances were not established and operated effectively to prevent abuse of people who used the service. The provider’s systems and processes did not enable them to assess, monitor and improve the service. You can see the action we have told the provider to take at the end of this report.
We previously inspected the service on 11 and 13 July 2016 and at that time we found the registered provider was not meeting the regulations relating to safe care, premises safety, consent, person centred care, safeguarding service users from abuse, meeting nutritional needs, complaints, staffing, good governance, safe recruitment and notifying CQC of specific incidents. The service was placed into special measures and we took urgent enforcement action to require the service to improve. The provider sent us an action plan outlining the improvements they would make. On this visit we checked to see if improvements had been made.
The service provides residential care for up to 25 people, some of whom are living with dementia. We placed a stop on admissions to the service following our last inspection due to concerns about the quality and safety of the service. At the time of this inspection there were 18 people using the service.
The service is required to have 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 had left the service on 4 April 2016 and a new manager had come into post on 11 April 2016. They left the service in July 2016 and the provider placed a temporary manager at the service. A new permanent manager was appointed in October 2016. They had applied to register with CQC but at the time of this inspection and the application had not been finalised.
People who lived at Stockingate residential home told us they felt safe.
Our inspection on 11 and 13 July 2016 found the registered provider was not meeting the regulations relating to safeguarding people from abuse because the manager of the service had not acted on safeguarding concerns raised by people who used the service, staff and relatives. On this inspection we found improvements had been made because the management team had acted on any safeguarding concerns raised. Staff had an understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.
Medicines were managed in a safe way for people. We found the registered provider was meeting the regulations relating to the management of medicines and medicines trained staff were deployed on the night duty rota so people were always able to access as ‘required’ (PRN) medicines at night.
Risk assessments were individual to people's needs and minimised risk whilst promoting people's independence. We found improvements had been made because risk assessments were comprehensive, up to date and reflective of people’s needs. Measures were also in place to reduce risks to people, for example where a person was at risk of choking.
People were protecting against the risks of unsafe or unsuitable premises because the necessary safety checks were regularly completed and emergency plans were in place.
We found sufficient suitably trained staff were deployed to meet people’s needs in a timely way and keep them safe.
Safe recruitment and selection procedures were in place to ensure staff employed by the service were suitable to work with vulnerable adults.
We found people were protected against the spread of infection. The service was free from odours and personal protective equipment (PPE) was available throughout the home.
Staff received training to enable them to provide effective support to people who used the service, for example staff were now up to date with training in managing behaviour that challenges and fire safety.
People’s capacity was not always considered when decisions needed to be made to ensure their rights were protected in line with legislation, for example when deciding to use a door sensor. This was a continuing breach of regulation 11(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, need for consent.
People who used the service told us they enjoyed the meals. We saw a choice of meals, snacks and drinks was available and appropriate action was taken to ensure the risk of weight loss was addressed.
A range of healthcare professionals were involved in people’s care as the need arose.
We observed staff interacting with people in a caring, friendly manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported. We found the choices of people who used the service were respected.
People were able to make choices about their care. We found people received care that was planned to meet their assessed needs and activities were provided to meet people’s social needs.
People told us they were confident the manager would act on their complaints and we saw evidence concerns had been addressed by the manager.
At our last inspection we found the registered provider had not notified CQC of a number of safeguarding incident in line with legislation. At this inspection we did not find any incidents that had not been reported to CQC in line with legislation.
Staff told us they were working together as a team to improve the service for the people who used it, they felt supported by the manager, and there was a positive atmosphere at the service.
The manager held meetings with staff and the relatives of people who used the service to gain feedback about the service provided.
We found the registered provider had taken action to address concerns about the quality and safety of the service and had in place a more robust system of oversight. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
You can see what action we told the provider to take at the back of the full version of the report.
We previously inspected the service on 29 July 2015 and at that time we found the registered provider was not meeting the regulations relating to management of medicines. We asked the registered provider to make improvements. On this visit we checked to see if improvements had been made.
The service provides residential care for up to 25 people, some of whom are living with dementia. At the time of our inspection there were 19 people using the service, one of whom was a temporary admission.
The service is required to have 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 had left the service on 4 April 2016 and a new manager had come into post on 11 April 2016. They had applied to register with CQC but at the time of this inspection the application had not been finalised. The new manager of the service is no longer in post.
Some people who lived at Stockingate residential home told us they felt safe and three people we spoke with had concerns about safety.
Our inspection on 29 July 2015 found the registered provider was not meeting the regulations relating to the management of medicines because medicine to be returned to the pharmacy was not secured; so on this inspection we checked to see if improvements had been made.
We found medicines were not always managed in safe way for people and people were not always able to access as ‘required’ (PRN) medicines at night as there were no medicines trained staff on night duty. This was a breach of regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe management of medicines.
Staff had an understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse, however the manager of the service had not acted on safeguarding concerns raised by people who used the service, staff and relatives. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Individual risk assessments were not always comprehensive and up to date to reflect risks to people and measures were not always in place to reduce the risks. Risk assessments were not always updated or followed to ensure people’s safety when eating. This was raised at our last two inspections as a concern. This was a breach of Regulation 12 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found people were not always protected against the risks of unsafe or unsuitable premises because the necessary safety checks were not being regularly completed and emergency plans were not in place. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Sufficient suitably trained staff were not deployed to meet the assessed needs of people who used the service. This was a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We looked at the recruitment records of four members of staff. We found all the necessary checks had not been carried out for three of these before commencing employment with the home. This was a breach of Regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found poor practice in the prevention and control of infections, which meant people were not protected against the spread of infection. This was a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff had not always received training to enable them to provide effective support to people who used the service, for example most staff were not up to date with or had not received training in managing behaviour that challenges or fire safety training. This was a breach of regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People’s capacity was not always considered when decisions needed to be made to ensure their rights were protected in line with legislation, for example when using a door sensor. This was a breach of regulation 11(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, need for consent.
People who used the service told us there was little choice of meals, and drinks were not always available. We found the risk of weight loss was not always managed well. This was a breach of regulation 14 of the Health and Social Care Act Regulated Activities Regulations 2014
A range of healthcare professionals were involved in people’s care as the need arose, however one person did not receive the health care they required in line with their care plan.
We observed staff interacting with people in a caring, friendly manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported, however we saw on one occasional a person’s dignity was not protected with prompt personal care.
The choices of people who used the service were not always respected.
People did not always receive care that was planned to meet their assessed needs and there was a lack of meaningful activities for a number of people who lived at the home. These issues were a breach of Regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Relatives told us they knew how to complain, however they told us the manager had not act on complaints. We saw no complaints had been recorded since the new manager had commenced employment with the service. This was a breach of regulation16 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Some relatives we spoke with felt consistent management had not been in place in recent months which impacted on support for their relatives.
We found the registered provider had not notified CQC of a number of safeguarding incident in line with legislation. This was a breach of Regulation 18 (2) (e) of the Care Quality commission (Registration) Regulations 2009 (Part 4).
Staff told us they did not feel supported and the manager was not visible in the service.
Appropriate records were not always kept and shared with CQC accurately during the inspection process.
People were not always consulted in how the service was run, however occasional meetings were held with relatives and staff.
The registered provider had some audits in place, but this system was not robust enough to identify and address the multiple risks and problems we found. The above issues were a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.
The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the 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 or 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 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.
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.
The inspection took place on 29 July 2015 and was unannounced. The service provides residential care for up to 25 people, some of whom are living with dementia. At the time of our inspection there were 14 people living at Stockingate Residential Home.
There were several breaches of the legal requirements that we checked at the last inspection in January 2015. Following this previous inspection we took enforcement action because people who used services were not protected against the risks of receiving care or treatment that was inappropriate. We also asked the provider to send us an action plan to show how they were meeting nutritional and hydration needs, maintaining safe premises and equipment and ensuring good governance. The provider sent us an action plan which detailed the improvements they had made and we checked these at this inspection. We found the provider had made significant improvements to the service and to the monitoring of the quality of the provision.
At the time of our inspection there was a registered manager in post, although not present during our visit. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
The service was friendly and welcoming with a calm and relaxed atmosphere. People were supported through caring relationships with staff who understood their individual needs.
People were treated with respect and their dignity and rights were promoted.
Staff had a sound understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).
Staff worked together with one another and with visiting professionals to support people’s health care needs. Handover information was appropriately shared between staff shifts to ensure people’s care was properly maintained.
Staff had sufficient opportunities for regular training and professional development to enhance their skills and knowledge of working with people in the service.
People’s care plans were not always robustly followed by staff to enable them to support people’s individual needs safely.
Risk assessments were not always updated or followed to ensure people’s safety when eating. This was raised at our last inspection as a concern.
People were given good explanations about their medications and staff took time to make sure people were supported to take their medication when they needed to. However, storage of medication to be returned to the pharmacy was not secure.
Systems to monitor and review the quality of the provision were in place.
You can see what action we told the provider to take at the back of the full version of the report.
This inspection was unannounced and took place on 26 January 2015. At the last inspection on 18 June 2014 we found the provider was breaching regulation 9, care and welfare of people who use services, regulation 15, safety and suitability of premises and regulation 10 assessing and monitoring the quality of service provision. At this inspection we found some improvements had been made however, the provider was still in breach of regulation 9, 10 and regulation 15. We also found there was a breach of regulation 14 meeting nutritional needs.
Stockingate Residential Home is registered to provide accommodation and personal care for up to 25 persons. At the time of our inspection the home did not have 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.
We found areas of concern relating to the premises. The new windows at Stockingate Residential Home had window restrictors which could easily be disengaged by hand. We identified this issue to the manager and area manager at the time of our inspection. Since our inspection the window restrictors have been changed to comply with HSE guidance. The area manager said they had consulted others when they installed the new windows and restrictors. There was a trip hazard on the ground floor and repairs to the roof were required. The medication room was too hot and the drugs fridge was overheating.
We found some people’s risk assessments did not contain up to date information.
We looked at medication and saw there was a good system in place for the administration of medication. However, we found night staff were not trained to administer medication.
We looked at the recruitment records of four members of staff. We found all the necessary checks had been carried out before commencing employment with the home.
Staff were able to confidently speak about safeguarding and knew what to do should they suspect abuse. People we spoke with told us they felt safe living at Stockingate Residential Home. We found there were enough staff to keep people safe.
We observed the lunch time meal and found some people were not given their food as stated in their care plan. One person was given burger, chips and bread. The burger should have been pureed and the chips and bread cut into small pieces. The burger was not pureed and staff did not cut up the person’s food until they had eaten half of it. We found people’s food was not fortified if they had lost weight. Staff told us people did not get a choice of food.
We found staff had not received recent supervision meetings although the new manager had instigated a matrix for staff appraisals. Staff told us there was plenty of training and their induction was very comprehensive.
People’s care was delivered with consideration given to the mental capacity act and Deprivation of Liberty Safeguards (DoLS). This is where a person can be lawfully deprived of their liberties where it is deemed to be in their best interests or their own safety. Staff told us they had completed DoLS training.
We looked at the care plans of five people living at Stockingate and found documentation regarding obtaining consent from people in the back of their care records which in three cases had not been completed.
Staff spoke to people calmly and sensitively and seemed to know people well. We saw some good interactions between staff and people who used the service; however, we did see an example of a person having their fingers prised from their cup and fork.
We looked at the care plans of people who used the service and found they were lacking in detail and in some cases there was important information missing.
Staff and people who lived at the service told us they thought the new manager was good and had made some positive changes to the service.
You can see what action we told the provider to take at the back of the full version of the report.
We carried out the inspection with our five questions in mind; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found:.
Is the service safe?
Staff had a clear understanding of how to ensure people were safeguarded from abuse and the procedures to follow to make sure people were protected if concerns arose.
However, due to the nature and number of safety concerns we found relating to the premises, we referred our findings immediately to Environmental Health and the Local Authority Commissioners. A senior Environmental Health Officer visited the home promptly following our visit and issued four Improvement Notices under the Health and Safety at Work Act 1974, which directly related to the concerns we had raised.
Is the service effective?
We saw interacted with people in a caring way. However, people's care needs were not fully documented and care provided was not in keeping with information contained within the care plans. Systems and records to inform staff of people's needs were not up to date
Is the service caring?
Staff were kind, patient and caring in their interactions with all people. When walking with people, staff supported them at people's own preferred pace and care was not rushed or hurried. Staff tried to make sure people had what they asked for and they responded promptly to what people were saying.
Is the service responsive?
We saw some people who spent their day entirely in the small lounge. When staff spoke with them, it was friendly and kind. However, these people's contact with staff was infrequent, offered limited stimulation and was therefore not responsive to their needs.
The manager had made some improvements in response to the previous inspection findings and safeguarding concerns, which had impacted positively on staff interactions with people.
Is the service well-led?
Staff were clear about the line management structure and who they would go to for support in their role. Staff said they thought the home was managed effectively and teamwork had improved.
However, systems for assessing and monitoring the quality of the provision were not robust and did not identify or address areas which required improvement.
We were unable to speak with the manager as she was absent. Therefore we were unable to determine whether the requirements for outcome 16 (assessing and monitoring the quuality of the service provision), which was non-compliant at the last inspection, were met. This will be reviewed at the next scheduled inspection.
We spoke with a company management representative and the senior carer in charge. We also spoke with another senior member of staff and two care assistants.
We observed the care of people in the home and spoke with four people who lived there. We spoke with four relatives who visited during our inspection. People and their relatives told us they were happy with the standard of care.
We found people were respected and involved in their care and staff interacted with them in a kind and caring manner. We saw people's care was managed in such a way that their individual needs and choices were promoted.
Staff we spoke with were clear about people's individual needs and how to support them. Information about people's care was displayed in the staff office as well as in their care records. We saw evidence of improvements to people's care documentation and people or their relatives had been consulted and involved. We looked at two people's care records and other documentation to support how people's care was managed.
We found people's care needs were appropriately met, staff behaved in a professional manner and were knowledgeable about their roles and responsibilities.
We spoke with three staff members and identified risks with the laundry process during the night shift. This was discussed with the operations manager following the inspection.
We looked at care plans but were unable to see evidence of any involvement from residents or relatives.
We saw how staff maintained people's privacy and dignity, and maintained confidentiality when speaking to people and other staff.
We spoke with three residents who told us they like living at Stockingate. One person said; 'we're like one big family.'
People told us that they were happy with the cleanliness of their room and one person said; 'yes, they do it for me without me even asking.'
People told us they were happy with the staff and comments included:
'Two of them make my day; I might as well be family.'
'Staff are kind, one of a kind.'
We spoke with three of the relatives of people who use the service who were happy with the care provided. One person said; 'if he doesn't want to go to bed until 10pm he doesn't have to.'
When asked for any other comments about the service these included:
'They do have good meals but it would be nice to see a weekly menu.'
'The tea trolley should go round more often.'
'I would like them to make more of the garden; it's a resource that's going to waste."
A visiting hairdresser said people always appear to be happy and well cared for. A visiting Social Worker writes in a Satisfaction survey 'Staff are always pleasant and helpful' and people are well cared for'. A visiting District Nurse satisfaction survey says ' As a team we have noticed great improvements to the home, The staff are very helpful and they carry out what we ask them to do'.
People say they like living in the home. One person said 'If they have any concerns they can tell someone and its sorted' Another says the staff listen to what they have to say and things get changed'
People say they like living in the home. One person said they like their bedroom and they have everything they need. People we could not communicate with were observed to be relaxing in comfortable surroundings that are clean and well maintained.
People say they like the people caring for them. One person said the carers are very good and very caring. Another says 'there is always someone there when you need them.
People say they like the people caring for them. Some people we could not communicate with appeared to be happy and positive relationships were observed being fostered between those living in the home and those caring for them. One person said the staff are very good and listen to what they say.
People living in the home say they like the people caring for them. People we could not communicate with appeared to be relaxed and comfortable with those supporting them.
The satisfaction surveys completed by people living in the home, their relatives and visiting healthcare professionals, and staff show people are happy with the services provided. People are also impressed with the changes and improvements making life better for people using the service.