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Stratton Court Requires improvement

We are carrying out a review of quality at Stratton Court. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 18 February 2021

During an inspection looking at part of the service

About the service

Stratton Court is a residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection 30 people, some who lived with dementia, were receiving support. The service can support up to 60 people.

The care home accommodates people in one adapted building and at the time of the inspection people lived on two of the three care floors. People’s accommodation comprised of single bedrooms with ensuite toilet and washing facilities. Each care floor provided a lounge, dining room and communal toilets. A courtyard garden provided safe outside space for people to use.

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

Improvements to the provider’s overall quality monitoring system had led to improved standards of care since the last inspection. However, further improvement was needed to ensure the provider’s quality monitoring system was effective in identifying shortfalls, in practice and process, so that people were fully protected, and ongoing improvements could be made.

We identified that arrangements were not fully in place to safely support people who could become anxious and exhibit behaviour of concern, originating from their dementia or mental health condition. A recognised pathway, underpinned by evidence based best practice, had been adopted by the service, but was not always followed. Action had not been taken to ensure staff had access to robust behaviour support plans which provided them with the guidance they needed to effectively and safely support people when incidents between them occurred. We made a recommendation to support the development of good practice in this area.

We identified that risk assessments needed to be developed for people who were prescribed anticoagulants and who would not be able to self-isolate successfully in a COVID-19 outbreak or if they tested COVID-19 positive. The service’s monitoring systems had not fully identified that prompt action had not been taken in relation to a medicine error and had not identified that national guidance related to COVID-19 staff testing had altered so had not taken action to address this. Managers took immediate action to address these shortfalls once we made them aware of them.

People had benefited from improved processes for monitoring their health needs. A new care records system had also supported improvement in care record content and how staff accessed information about people’s needs to guide them in how to meet these needs. This was except for people’s behaviour needs. People’s care records had improved overall, and improvements had also been made to how staff received information and guidance about people’s needs. This had included improvements in the recording of consent for care and treatment. These improvements had led to improved standards of care and outcomes for people. A new care records and care monitoring system had been introduced, enabling staff to access electronic guidance about people’s care quickly. People had already benefited from this as staff recorded the care they delivered, in real-time, which was then monitored by senior care staff. Work was in progress to transfer people’s more detailed care plans from paper format to the new system.

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.

Access to health reviews by healthcare professionals, had been maintained during the COVID-19 pandemic and the service was part of a pilot, which would see further improvement to people’s access to virtual health consultations.

Stratton Court had successfully worked with commissioners, healthcare professionals and other agencies to provide access to care and support for people who required this during the pandemic.

Leadership for staff had improved. Senior staff were empowered to support

Inspection carried out on 7 December 2020

During an inspection looking at part of the service

Stratton Court is a residential care home which provides nursing and personal care to people over the age of 65 years; some people receive support to live with dementia. The service can support up to 60 people. At the time of this inspection 23 people were receiving care.

We found the following examples of good practice.

People had been supported to maintain relationships with those who mattered to them throughout the COVID-19 pandemic. Staff also supported people to use technology to remain in contact with family members.

There were designated bedrooms for people to self-isolate in for at least 14 days following their admission to the home. All bedrooms, including these, had private toilet and washing facilities which reduced the risk of infection spreading.

Staff were using personal protective equipment (PPE) correctly and there were measures in place to refresh staff training on this and to monitor their ongoing use of PPE.

Regular COVID-19 testing was being completed in line with national guidance. People were tested, with their consent, every 28 days and so far, this had included everyone. All staff were tested weekly.

Managers and staff were aware of potential COVID-19 symptoms and monitored people for these.

Staff were supported to remain absent from work for the required period of time if they became symptomatic or received a positive COVID-19 test result.

The layout of the home allowed staff to support social distancing and to implement zoning and segregation in the event of a COVID-19 outbreak. An outbreak management plan was in place.

Measures were in place for the safe management of laundry and waste.

Staff movement was minimised to reduce the spread of or introduction of infection. Staff worked in the one location only and if required, agency staff would be booked to work solely at Stratton Court.

There was a designated infection prevention and control lead who ensured all policies, procedures and guidance remained up to date. Staff were kept informed of any changes to these. There was management support in place at all times to ensure full infection control measures could be instigated immediately if required.

Inspection carried out on 8 November 2019

During a routine inspection

About the service

Stratton Court is a residential care home providing personal and nursing care. At the time of the inspection 23 people received care. The service can support up to 60 older people. People are accommodated in one adapted building. Two of the three care floors were open, a third floor, specialising in dementia care, was due to open in early 2020.

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

People and their representatives had mixed experiences of the services and care provided. One person who used the service said, “They look after us well here” and a relative said “I’m blessed [name] is here.” Three other people’s representatives told us the service fell short in several areas; these being delivery of appropriate care, consistent and effective communication and what they perceived to be an overall lack of effective management.

At the last inspection in November 2018 we found the provider had failed to effectively monitor the service to ensure it met all necessary regulations. During this inspection we found the provider was still not meeting all the required regulations. The provider had not always effectively monitored and assessed risks to people and the quality of services provided to people. We found that when they had become aware of concerns, they delayed acting on these to mitigate potential risks to people.

During this inspection we evidenced that some improvements had been made to the quality of services people received, such as improved social activity opportunities and support at mealtimes. Further work was required however, to ensure, people received safe care and treatment, that requirements in line with the Mental Capacity Act 2005 were followed and accurate records were kept of people’s risks and care needs. These were areas for improvement in the last inspection which the provider had not subsequently monitored to ensure improvements in these areas were made and sustained.

Following this inspection arrangements were made by representatives of the provider to closely monitor the quality and risks in the service. An external auditor had completed a quality monitoring visit (on behalf of the provider) and planned to revisit on a regular basis. Members of the provider’s senior management team were due to remain present in the home until improvements were achieved.

The service was reliant on agency staff to ensure it could operate safely. Some agency staff worked at the home on a regular basis so had become familiar with people’s needs and preferences which helped. Some successful recruitment of permanent staff had taken place however, improvement was needed to establish a consistent, well-co-ordinated and informed care team.

Gaps in effective monitoring systems and clinical leadership had resulted in people’s care delivery not being sufficiently monitored and a breakdown in effective communication with those who mattered about people’s care and treatment. People’s representatives and relatives told us they had to seek out information about their relatives’ care and often they were not informed about relevant changes or decisions made about this. The provider had not ensured that relative meetings and care review meetings had taken place.

People and their representatives and relatives told us staff were kind and caring. People’s dignity and privacy was maintained during care delivery. People were treated equally and not discriminated against.

There were arrangements in place to administer people’s medicines safely. Plans already in place, to provide additional staff with medicines administration training, were aimed at ensuring people received their medicines in a timely manner.

People had access to healthcare professionals although managers recognised that these arrangements needed some improvement to ensure people received more regular and planned reviews of their health needs.

Improved links with the local community and groups within it were being made so that

Inspection carried out on 26 November 2018

During a routine inspection

This inspection took place on the 26 and 29 November 2018 and was unannounced.

Stratton Court is 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. At the time of our inspection Stratton Court was not providing nursing care.

Stratton Court accommodates sixty people in one adapted building. At the time of our inspection visit there were four people using the service.

Stratton Court did not have a registered manager in post. The current manager’s intention was to apply for registration. 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.

Safe recruitment procedures were not always followed before staff were appointed to work at Stratton Court.

Risks to people receiving care had not always been assessed and plans put in place for staff to follow.

Effective systems were not always operated to monitor and improve the quality of care people received.

Improvements were needed to ensure when decisions about people’s care were made on their behalf the principles of the Mental Capacity Act 2005 (MCA) would always be followed.

Peoples medicines were safely managed although some improvement was needed to managing medicines for occasional use.

There were sufficient staff to meet people’s needs. We found the environment of the care home was clean and had been well maintained.

Staff received training and had the knowledge and skills to carry out their roles. People were supported to eat a varied diet.

People received support from caring staff who respected their privacy and dignity. People received individualised care to meet their needs. Staff were positive about the support they received from the new manager.

Further information is in the detailed findings below. We found breaches of The Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.