Archived: Stratton Court

Stratton Court is a residential care home providing accommodation to persons who require nursing or personal care, for up to 84 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 48 people using the service. People are accommodated in 1 adapted building.

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

People were not always protected from the risk of harm as incidents had not always been appropriately investigated to ensure appropriate action had been taken. This meant the provider and registered manager had not always ensured lessons were learnt and changes were made to the service to protect people from the risk of avoidable harm.

People’s care plans and risk assessments had not always been updated following these incidents. However, care staff were taking action to protect people from the risks associated with their care. The provider had arranged for additional training for staff to assist them in managing the needs of people who can become anxious.

The provider and registered manager had not always informed CQC of notifiable events. The registered manager took immediate action to address this concern at the inspection.

People were at risk of not always receiving their medicines as prescribed. There were not always effective systems for staff to ensure people received their medicine as prescribed and to ensure people’s medicines were administered in accordance with manufacturers guidance.

The provider and registered manager did not always operate effective systems to monitor, assess and maintain the quality of service people received at Stratton Court. While some improvements had been made to good governance processes in relation to the environment, infection control and falls, there were not effective systems in relation to the concerns we identified at this inspection.

People and their relatives spoke positively about the level of engagement and support their loved ones received. People throughout the home enjoyed a range of activities and were being actively supported to be engaged in the community. Since the last inspection, action had been taken to provide a dementia friendly environment and tailored activities on Highgrove (dementia care unit). People enjoyed 1 to 1 and group activities which were tailored to their needs.

Improvements had been made to ensure people’s care plans were person centred, however additional improvements were required for people living on the Highgrove unit.

People and their relatives shared mixed feedback about the management of the service. Whilst the majority of relatives were positive, some relatives raised concerns in relation to communication and their loved one’s care. The registered manager was taking opportunities to engage with people, their relatives and seek their views.

Staff spoke positively about the support they received and discussed how the provider and registered manager were responsive to their ideas and requests. Staff told us they felt the service was improving, thanks to management support and a reduction in agency staff.

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 5 January 2023).

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 while some improvements had been made in relation to some of these actions, there were additional shortfalls and the provider was not meeting all of the relevant regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21,22 and 23 November 2022. 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 person centred care and good governance.

Prior to this inspection we received concerns in relation to people’s care and treatment and the service was involved in safeguarding processes with the local authority.

We undertook this focused inspection to check the safety of people’s care and to check the provider 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, Responsive 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 remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stratton Court on our website at www.cqc.org.uk

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance, safeguarding service users from abuse and improper treatment, safe care and treatment. We also identified breaches of Notification of other incidents and Notification of death of a service user of the Care Quality Commission (Registration) Regulations 2009.

Please see the action we have told the provider to take at the end of this 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

Stratton Court is a residential care home providing accommodation to persons who require nursing or personal care, for up to 84 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 56 people using the service. People are accommodated in one adapted building.

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

The manager and provider had implemented new monitoring systems to continue to improve the quality of the service people received. The management team were implementing new governance systems based on their own analysis and professional feedback. While the new governance arrangements had brought about improvements, more time was needed to allow these systems to bring about and sustain good outcomes for all people.

People’s care records were not always current and reflective of their needs. The management team was aware of this shortfall and was taking action to improve people’s care records.

Whilst improvements had been made to promote people’s person centred care throughout the home, people living with dementia might not have always received care which promoted their wellbeing and was personalised to their needs. People and their relatives had not always been involved in planning their or their loved one’s care. Plans were in place to continue to improve care that met people’s individual needs and preferences.

People’s risks had been assessed and clear guidance was available for care and nursing staff to follow. Where people had specific healthcare needs, these were clearly documented. There were systems in place to monitor people’s needs and ensure people’ received appropriate care following incidents and accidents.

The management team was working with an independent professional to focus on staff training and competency. They were focused on improving staff communication and knowledge with the aim of improving the quality of care people received.

Improvements had been made in relation to people’s prescribed medicines. Staff had received support and training to administer people’s medicines safely. The management team had implemented new systems and had taken action to ensure people received their medicines as prescribed.

Risks relating to the environment were now assessed. The management team and provider had clear systems in place to ensure people were protected from the risks associated with their environment.

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

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. We were assured the service were working in accordance with government guidance.

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 10 August 2022).

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, however the provider was still in breach of two regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 28 and 29 June 2022. 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 safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17, and a requirement notice in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also received information of concern in relation to people’s personal care since our last inspection.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stratton Court on our website at www.cqc.org.uk

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a breach in relation to person centred care and care records in the Responsive key question, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stratton Court is a residential care home providing accommodation to persons who require nursing or personal care, to up to 60 people. The service provides support to older people; some whom live with dementia. At the time of our inspection there were 58 people using the service. People are accommodated in one adapted building split over three floors.

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

People were not always protected from avoidable harm. People’s care plans and associated records were not always current, accurate and did not provide staff with the correct information they required to safely meet people’s needs.

Where people had specific care needs, staff did not always keep a clear record of the support they had provided, including fluids people had received as part of their assessed care.

Monitoring systems were not always effective as the records supporting the management of the service were not always reliable. These systems had not always identified or addressed concerns found during our inspection, including concerns in relation to people’s care records, medicine management and fire safety.

People were placed at risk of not receiving their medicines as prescribed. Staff had not always ensured people had access to their prescribed medicines.

People told us they felt safe. They told us the staff were tolerant, patient and friendly. Although there had been challenges in recruiting staff, there were enough staff to ensure people’s care needs were met.

There were a range of activities and events for people to enjoy. However, some people who were not mobile, or were living with dementia were not always supported to access or enjoy these activities. Additionally, while we observed there were enough staff to meet people’s needs, staff did not always take the opportunity to engage with people and promote their wellbeing.

The provider, registered manager and staff had learnt from incidents and used this to inform their actions. A number of concerns identified at this inspection were immediately rectified by the management team.

People and their relatives felt the new manager was approachable, however had raised issues regarding communication. The provider was aware of these concerns and were aiming to improve communication with relatives and healthcare professionals.

Staff told us they felt supported and enjoyed working at Stratton Court. Staff had received training to meet people’s needs and the homes management team were providing training to staff to improve communication and engagement with people.

We were assured the service were working in accordance with current government COVID-19 guidance

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 27 April 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included information of concern about people’s care, support and medicine administration. We also inspected based on the rating of Stratton Court.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 Stratton Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, good governance and person centred care at this inspection.

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.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 and lead their staff teams. A whole home approach was in place in relation to quality improvement and risk management.

A person-centred approach to care had been maintained. Relatives and representatives had been kept well informed and involved in decisions made about people’s care, at a time when there had been limited opportunities for visiting.

People had been safely supported to remain socially and cognitively active and engaged with their relatives during the pandemic to support their wellbeing.

Arrangements were in place to ensure safe staffing numbers. Recruitment and retention of staff had remained a challenge during the pandemic, although more recently, a more stable staff team had been established. Staff received induction training when they first started work. The improved stability in the staff team was enabling managers to plan further staff development and training.

Arrangements were in place to seek and receive feedback from people, relatives and other visitors. This was used to make improvement to people’s care and the service generally. Complaints were managed according to the provider’s policy and procedures.

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 (report published 14 January 2020). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three rated inspections.

Following our last inspection on 3 August 2020, we served a Warning Notice on the provider. We required them to be compliant with Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 31 March 2021. During this inspection we found the provider had met this Warning Notice.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Further improvement was needed to move the rating to Good. Please see the Safe and Well-led sections of this full report

Why we inspected

This was a planned inspection based on the previous rating.

We carried out this focused inspection to check the provider had met the Warning Notice and to follow up on a previous breach of Regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements and areas of Requires Improvement.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement based on the findings 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stratton Court on our website at www.cqc.org.uk.

Follow up

We will request an improvement plan from the provider to understand what changes they will make to achieve the necessary improvement. We will work alongside the provider and 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.

Stratton Court is a residential care home providing personal and nursing care. At the time of the inspection 19 people were receiving care. The service can support up to 60 people. People were accommodated across two of the three care floors.

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

People told us they felt well cared for and the staff were kind to them. We observed caring and meaningful interactions, by staff, with the people who used the service

People’s health needs were met. There had been positive improvements in appropriate referrals to healthcare professionals for assessment and advice.

Risks to people’s health and care had been identified and action taken to reduce or mitigate these.

Staff were receiving better support to understand best practice guidance and to deliver people’s care safely and in line with people’s assessed needs. Staff told us they felt well supported and empowered to ask questions where needed. They told us they enjoyed working at the service.

People received support to take their medicines and medicines were generally managed safely.

Risks to people from infections were reduced because the provider’s infection, control and prevention plan was adhered to. We made a recommendation in relation to the removal of personal protective equipment (PPE) worn by visitors.

The provider has an inspection history of inconsistent management of the service. At this inspection the leadership provided to staff had improved. Some newly introduced processes had resulted in care staff being better informed about people’s care needs and how to meet these. This had a positive impact on the care people received.

Some provider audits had ensured that good practice was implemented in relation to medicine management and infection control as these had effectively identified any shortfalls and had driven improvement. Although the management of people’s risks associated with their and care had improved since our last inspection; these risks had not always been pro-actively identified and promptly addressed to ensure people were protected from potential risks. Risks to people had not been identified by the use of effective monitoring systems and processes, instead, after concerns had been reported or by individual managers observing poor practice. The effectiveness of the provider’s monitoring systems, to identify risk and drive improvement, in relation to people’s more complex needs was required. There remained shortfalls in some care and management records, which monitoring processes and a lack of enough scrutiny had not identified.

Representatives of the provider were keen to improve the service and told us about their plans to improve clinical governance and overall management of the service. Time was now needed for these plans to be implemented and developed and to be sustained moving forward.

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 14 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12 Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although some improvements had been made in relation to regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; further improvement was needed and the provider was still in breach of this regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also follow up concerns we had received about people’s care. We checked whether a Requirement Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We found the Warning Notice had not been fully met. The provider needs to make further improvements in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, to their monitoring systems and to some records in order to fully meet the requirements of this regulation.

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 checking to see if this Warning Notice had been met and what action was necessary and proportionate to keep people safe as a result of this inspection. The Warning Notice remains in place and we will review the provider’s progress in meeting this during a future inspection.

Follow up

We will work alongside the provider and local authority to monitor the services overall progress. We will request a report from the provider on their progress in meeting the Warning Notice. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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 people could benefit from these.

There were arrangements in place for complaints and concerns to be listened to a responded to, although this had not always led to learning and sustained improvements in the quality of the services provided. Work on resolving these areas of dissatisfaction were continuing at the time of this inspection.

Arrangements had been made to improve communication with both people, their representatives and staff generally and to promote a more inclusive culture. An open-door policy had been adopted by the current home manager and planned meetings with both relatives and staff took place just after the inspection visit. Future meetings were to be held with all groups on a regular basis and the views of people’s representatives were soon to be sought by using questionnaires.

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 January 2019) and we identified three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made however, planned improvements had not been successfully implemented or sustained to meet all of the relevant regulations.

This service has been rated requires improvement for the second time.

Why we inspected

This was a planned inspection based on the previous rating which was brought forward due to concerns received about the management of people’s care, staffing numbers, staff skills and the management of the service. A decision was made for us to inspect and examine those risks. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report. We have identified breaches in relation to the need for consent, safe care and treatment, and governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report. We issued a warning notice telling the provider they needed to make the required improvements to meet the requirements in relation to Good governance by 31 March 2020.

Since the inspection the provider has kept us informed about the action they are taking to mitigate further risks to people and we have included this in the summary above.

Follow up

We will meet with the provider following this inspection and request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

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.