Stainsbridge House

People’s experience of using this service:

Risks identified had not always been assessed. This included incidents of behaviour that could be verbally or physically challenging.

Not all medicines administered as ‘when required’ had protocols in place to give staff clear guidance. All other areas of medicine management were observed to be safe.

One staff member had not received an enhanced Disclosure and Baring check before working within the service.

People told us they felt safe. Staff understood their responsibilities around reporting concerns. Safe levels of staffing were observed.

We saw that mental capacity assessments had been completed, but more detail was needed around evidencing how the decision had been discussed with each person.

People told us they liked the food and were able to make choices about what they had to eat.

We observed staff interacting meaningfully with people. They appeared to know people well and anticipated their needs. There were many positive comments about the kindness and caring nature of the staff.

Wellbeing staff were in place to provide opportunities for meaningful engagement for people.

We identified one notification had not been submitted to the Care Quality Commission. This was notification of when a person who was being deprived of their liberty had their legal application approved.

The system for monitoring the quality of the service had improved. However, some areas of the audits needed to include further details of what needed to be checked.

More information is in Detailed Findings below.

Rating at last inspection:

Requires Improvement (report published 15 August 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have told the provider they must take action to improve the service. We will continue to monitor the service and complete a further inspection to assess whether the improvements have been made.

At the last inspection on April 2017 we asked the provider to take action in response to the concerns found around staffing levels. The service was in breach of Regulation 18 Staffing. At this inspection we found that the service had met this previous breach, however a further three breaches of Regulations were identified. This is the second consecutive time that this service has been rated as requires improvement and we are considering what further action will be taken in response. Full details of CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home did not currently have a registered manager in place. The previous registered manager had recently left the service and the deputy manager was in the role of acting manager. The acting manager was being supported by a registered manager from another of the provider’s services and the director who were present throughout our inspection. 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.

Prior to this inspection we received concerns about the service which we asked the provider to investigate and report back to us. We further assessed these concerns during this inspection and full details of what we identified is in the main body of this report.

Medicines were not always managed safely. There were concerns identified regarding the safe use of prescribed fluid thickeners for people who had swallowing or choking difficulties.

Risk management and documentation to support identified risks was not always managed safely. For example, one person’s support plan contained a body map, dated 24th May 2018, which recorded that the person had a bruise on their forehead. The manager was unaware of this; there was no further information in the person’s daily record and it had not been reported as an incident or accident. This meant that the cause of the bruising had not been investigated.

During our inspection we observed staff were visible on the floors to support people. We heard call bell times answered in a timely manner and people and relatives felt the staffing levels were mostly good. Staff we spoke with however consistently told us they felt the staffing levels could be better. We observed on the first day of inspection that three people were walking around at 5:30pm in their night wear, which staff attributed to staff shortages.

There was a lack of understanding around the appropriate process to follow for people who lacked capacity and were unable to consent to the care and treatment provided.

We found that some care plans lacked detail and person-centred information. Information relevant to the needs identified were not held together for staff to gain an overall picture on how to meet the needs. Monitoring records were not appropriately completed to ensure action could be taken in a timely manner.

Quality monitoring of the service was in place; however, it did not provide a clear rationale of what this attributed to the overall picture of the service. The previous registered manager had been quite insular in managing the documentation and due to this there had been a lack of provider oversight in the day to day running and how quickly improvements had been implemented.

People said they liked the food because they had a good choice and alternatives were available if they wanted something different.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

Staff demonstrated that they knew people well and supported people accordingly. People appeared comfortable around staff and were happy to approach them when needed. Relatives were happy with the care their loved one’s received.

People were given the opportunity to provide feedback on the service they received. We saw that the service had received compliments about the caring nature of staff care and engagement offered.

You can see what action we told the provider to take at the back of the full version of the report. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The inspection took place on 25 and 26 April 2017 and was unannounced.

There was a registered manager in post at the 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.

Feedback we received from people's relatives, staff and health care professionals stated staffing levels were often poor and this led to people not always being supported in line with their needs. This was also confirmed by our observations during the inspection. Staff told us they had raised these concerns with the management team but that steps to deploy agency staff had not been sufficiently or promptly addressed. The registered manager and operations director told us they had a clear staffing policy and staffing was based upon dependency. The service was in the process of recruiting new staff and agency and bank staff were deployed on both days of the inspection.

There was a wide and varied activities program run by an activities coordinator, two activities support workers and two activities volunteers. People looked happy and comfortable during the group activities we observed and also from photographs on display around the home. However, people who remained in their rooms or were unable to participate in group activities did not have the same degree of attention. Staff told us this was due to there not being sufficient numbers of staff to support people. Whilst there were details in people’s care records about their likes, dislikes, preferences, interests and hobbies this information did not always provide specific details and staff had difficulty locating this information. Although staff said they knew people well, there was insufficient information documented for staff to refer to.

Medicines were mostly managed safely. However, advice had not been sought from a pharmacist regarding adding medicines to foods when giving them covertly. This requirement was not detailed in the service’s policy on medicines. This put people at risk from receiving medicines that may have had their therapeutic effects altered by being administered in this way.

Whilst systems were in place to monitor the quality and safety of the service provided issues around staffing, care planning and enrichment had either not been identified or not sufficiently or promptly acted upon.

Where people had risks which had been identified, there was guidance available in people’s care records to guide staff on how to mitigate these risks.

Staff were able to tell us what the different types of abuse were and how to report safeguarding concerns.

People were supported to have access to healthcare professionals in line with their changing needs. The service worked well with these professionals to ensure advice was recorded and followed up as appropriate.

Training records were up to date. Staff told us they were supported with training needs. The registered manager told us they had recently responded to feedback from staff on the type and quality of training offered in order to further enhance and improve their learning experience.

People said they liked the food and told us alternatives were offered when they did not like what was on the menu for that day.

People and their relatives spoke positively about the care they received from staff who treated them with compassion and kindness in their day to day care.

We found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. There were 44 people living at Stainsbridge House at the time of our inspection. They had varying degrees of dementia, which meant that many had limited ability to express their views about their care and treatment, or how they were involved in the service.

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

This is a summary of what we found:

Is the service safe?

We saw that people who lived at Stainsbridge House were not overly agitated and appeared relaxed in the company of staff and others who lived there. We found that the staff were aware of what to do if they witnessed abuse and had been trained with regard to safeguarding adults. One staff member told us ''Nothing like that goes on.'' The manager was aware of what actions to take in response to abuse allegations and had previously taken action to move a person to a more appropriate service, in order to safeguard those who lived in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications have needed to be submitted in relation to people currently living in the home, proper policies and procedures were in place and the manager and relevant staff had received training in relation to DoLS.

We found that systems were in place to regularly assess risks to people who lived in the home, visitors and staff. This meant that people benefited from safe care, treatment and support, due to effective management of risks to their health, welfare and safety.

Is the service effective?

We found that staff delivered the care that was detailed in people's care plans. Staff were trained and had received good support from the management team in order to carry out their role effectively. For those people who were physically unwell, we found that staff were providing appropriate care and that health care professionals had been contacted and were involved.

During our inspection, we found that some charts used for recording food and fluid intake and changes of position had not been filled in at the time the intervention had been carried out and that they were being completed retrospectively. We informed the manager and the registered provider that completing forms retrospectively was not seen as good practice as it may increase the possibility of inaccurate recording. They told us that they would consider an alternative to the current practice, in order to eliminate the need for retrospective recording.

We found that people were supported to access the local community. People were also supported to access the home's communal areas. This enabled them to experience a degree of social interaction.

Is the service caring?

We saw that the staff were kind and supportive towards people and a relative had stated on a survey 'Residents (are) treated with respect.' A person we spoke with said ''Yes, it's alright I like it'' when we asked if they liked the home and three others responded ''yes'' to the same question.

We found that the home had several systems to allow people to comment on the service it provided. This included annual surveys sent to people who lived there and to their relatives. We found that responses to the surveys were mainly very positive. Meetings were held with people and their relatives, which gave them the opportunity to raise any concerns. We saw that action was taken in response to concerns, which meant the home cared about the people who lived there.

Is the service responsive?

People's needs were assessed and care plans were in place in response to their needs. More work was planned to ensure that people's personal preferences were detailed. We saw that, where complaints had been received, the manager had responded promptly and appropriately.

Is the service well-led?

There were regular quality assurance processes in place, which included satisfaction survey's and meetings. This enabled people and their relatives an opportunity to comment on the home.

The staff received regular appraisals and staff meetings were also held. The majority of the staff felt that they were able to speak with the manager at any time; one described the support they received as ''excellent.'' The registered provider normally visited the home twice a week in order to support the manager and monitor service provision.

The provider had introduced paper files for recording incidents and accidents, daily notes and doctors notes to ensure that all staff had easier and quicker access to this information. We saw copies of care plans and risk assessments in people's bedrooms which were reprinted on a monthly basis or sooner if required. This ensured that staff had access to current information.

One care worker stated that the home had consulted with staff regarding the hours they worked. They told us that more staff now worked half days and said "For me the hours fit in really well with family life". The provider told us they now had more care workers on half day shifts which had resulted in it being easier to cover for absences.

We looked at the written care plans and risk assessments for three people. The documents were person centred as they included more detail about the person's care needs and preferences. Documents were now signed and dated and we found all records were more complete.

We spoke with four members of care staff. Staff told us they had received training in record keeping and care planning training and found this to be very helpful. Each member of care staff we spoke with was able to demonstrate a clear understanding of the information process for record keeping and their responsibility in ensuring accurate records.

We received information of concern which related to the number of staff on duty. The provider informed us that the home used an agency and had a core of bank staff to cover events such as staff sickness, holidays, training and any vacancies. Care workers told us that existing staff were asked to fill in for absences. They said they were not pressured into taking on additional shifts but did feel obliged to. Two care workers said they did not mind doing the extra shifts but other staff said the hours were too long.

We saw that Information was available to people and their families on how to make a complaint, we also saw that information was available about advocacy services. Staff told us that people would tell them in their own way if they did not like something.

We found that the home had upgraded their computerised data management system and the staff we spoke with reported that internet access had improved, however the required improvements to the care records had not been met and the system for the monitoring of the services was not robust.