Stubblefields House

About the service

Stubblefields House is a residential care home providing personal care and accommodation for up to ten adults or older people with a learning disability and/or autistic spectrum disorder. There were ten people living at the service on the day of the inspection. The service was not supporting anybody in the community at the time of inspection.

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

Systems were not effective to assess, monitor and improve the quality and safety of the service. The lack of systems meant the provider had failed to identify and address the concerns we found at this inspection.

Measures were not in place to mitigate the risk of the spread of infection. The service was not always clean and tidy and some areas of the environment required improvement. The provider acted during the inspection to improve infection control measures.

People were at risk of avoidable harm because risks to people had not always been identified, assessed and mitigated.

There was insufficient staff deployed which impacted on the cleanliness of the service and people’s ability to access the community. The management team were consistently working on shift which impacted their abilities to carry out their roles. The provider was actively recruiting staff.

People did not always receive individualised care and were not always fully supported to continue their hobbies and interests during the pandemic.

People received their medicines as prescribed but best practice was not always followed. We have made a recommendation about this.

Recruitment procedures were in place, but these had not always been followed. We have made a recommendation about this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People and their relatives shared positive feedback about the service. We received positive feedback about the management team and staff felt supported. It was clear people had developed positive relationships with staff and the management team.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This included people’s environment been restricted due to been used as a staff sleep area and a office in a communal corridor. People had not been supported to maintain hobbies and interests during the pandemic. The provider told us they would be working with the local authority to review individuals needs and support.

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 of this service was good (published 10 January 2018)

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting procedures. A decision was made for us to inspect and examine those risks.

We inspected and found there were concerns with infection control, person centred care and governance, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive and well-led.

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 has changed from good to requires improvement. This is 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 COVID-19 and other infection outbreaks effectively.

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 monitor the service 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 risk management, infection control, person centred care and governance 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 for 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.

There was a registered manager for this service. 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 observed that people felt safe with staff and they confirmed this. Staff had been trained to safeguard adults and were aware of how to recognise and report any incidents of abuse.

People who used the service were kept safe because safety checks were carried out within the environment to ensure it was fit for purpose.

Staff were recruited safely and there were sufficient staff on duty to meet people’s needs. Rotas confirmed the numbers were sustained.

People’s health and safety needs were identified and where necessary risk assessments were in place to support people’s safety. Accidents and incidents were recorded.

Medicines were managed safely. We saw that staff checked medicines thoroughly before they were administered. Records were completed properly.

The service was effective because staff used the training they had received to best effect. They knew people well and followed guidance in care plans and from professionals to ensure people received care that met their needs. Staff were supported through supervision.

Staff followed the principles of the Mental Capacity Act 2005 by ensuring that where people could not make their own decisions the best interest decision making process was followed to ensure that people’s wishes were carried out.

People were given a healthy nutritious diet. People were encouraged to be as independent as possible when eating and drinking.

Staff were caring and kind showing people respect. People at this service clearly felt that they mattered and staff reinforced that. They knew how to make a complaint if necessary.

Care plans were person centred and reviewed regularly with any changes noted.

People took part in a variety of activities at the service and in the local community.

The quality monitoring system was effective with regular audits being carried out. Surveys were sent to people to gather their views about the way in which the service was run.

We carried out an announced comprehensive inspection of this service on 8 May 2015. At this inspection we identified two breaches of regulation. This was because medication had not been recorded safely and the quality assurance systems had not identified or resolved issues with poor record keeping. We asked the registered provider to take action to make improvements to Regulation 12: Safe care and treatment and Regulation 17: Good governance. After the comprehensive inspection on 8 May 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breaches of regulation.

Stubblefields House is registered to offer accommodation and care for up to 10 people. The service supports younger and older adults who have a learning disability or autistic spectrum disorder.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. Improvements had been made to the management of medicines in the service and people received these on time and as prescribed.

We raised concerns with the registered manager about visitors being able to access the premises without a member of staff being present, as on arrival we were able to walk into the service without staff being aware of our presence for at least 10 minutes.

Improvements were made to the number of staff employed in the service. Recruitment was on-going to ensure enough staff were employed to meet the needs of people who used the service and the registered provider anticipated that this would be completed by November 2016

New staff were given a one-day induction to the service. From the paperwork made available and comments received from the staff we found that this was not in-depth, but did cover the basics of health and safety and working in the home. Work was on-going to embed more robust induction processes in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included some staff supervision and monthly staff meetings. Work was on-going to embed more frequent supervision and appraisal sessions in the service.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. They told us they were satisfied with the meals provided by the service. People had been included in planning menus and their feedback about the meals in the service had been listened to and acted on.

People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the service. People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

We observed good interactions between people who lived in the service and staff on the day of the inspection. We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that the registered manager met with people on a regular basis to discuss their care and any concerns they might have. This meant people were consulted about their care and treatment and were able to make their own choices and decisions.

We observed that the culture of the service was open and friendly. Staff told us about the positive team approach and that they enjoyed coming to work. People said the registered manager was open, honest and easy to talk with and always available to them if needed.

We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. One person told us 'I am fairly independent, the staff let me get on with my life but they are around if I need any support.'

Staff had received appropriate training to ensure they could meet the needs of the people who used the service.

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose.

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary.

The provider had a domiciliary service operating from this location. We spoke to two people who used the service and looked at care records and documentation. People told us 'I am very happy with the service', I can highly recommend this service' and 'I find the staff professional and caring.' We have commented on the personal care service at the end of each outcome.