Stamford Care Home

Stamford Care Home is a residential care home providing personal and nursing care for up to 90 older people some of whom were living with dementia. At the time of the inspection the service was supporting 82 people.

Stamford Care Home is a purpose-built care home spread across three floors with communal areas on each floor and access to a garden from the ground floor. All upper floors are accessed by lifts and stairs.

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

We observed people to be cared for by staff who were caring and compassionate. Relatives spoke positively of the caring and friendly staff team.

Medicines were not always safely managed. We found gaps and errors in recording and medicines administration.

People and relatives praised the service for keeping their loved ones safe during the COVID-19 pandemic, however, some relatives felt communication and updates could be improved.

Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow.

There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, additional cleaning and safe visiting precautions.

There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.

People had a care plan which detailed their needs and preferences. Staff knew people's care needs well. People were supported to engage in a varied programme of activities.

The provider and registered manager monitored the quality of the service. The service had quality assurance systems in place, which were used to good effect and to continuously improve on the quality of the care provided. The management team engaged well with health and care professionals.

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 good (published 3 May 2018).

Why we inspected

This was a planned inspection based on the previous 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 Stamford Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stamford Care Home is a care home providing nursing care. People in care homes receive accommodation and nursing or 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.

Stamford Care Home is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people living with dementia. At this inspection there were 82 people living in the 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.

At our previous inspection of this service on 1, 2 and 3 February 2017, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns found we issued a warning notice to the provider and registered manager on 14 February 2017, requiring compliance with the Regulation by 1 March 2017. On 4 April 2017, we carried out a focused inspection to check if the provider had made the necessary improvements to how the service ensured medicines were safely managed. We found that the provider had made significant improvements. However we identified some areas for further improvement. At this inspection, we found that medicines were safely managed and improvements made following the February 2017 inspection had been embedded and sustained.

This service is now rated as Good.

Accidents and incidents were appropriately recorded and investigated, and risk assessments were in place for people who used the service that described potential risks and the safeguards in place to mitigate these risks.

People's needs had been assessed and personalised care plans developed. Care plans were evaluated to check they reflected people's needs.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

People received a nutritious diet and enough to eat and drink to meet their individual needs. Timely action was taken by staff when they were concerned about people's health. Referrals had been made to other healthcare professionals to ensure people's health was maintained.

Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure oversight of when staff training, supervisions and appraisals were due.

People and relatives were positive about the service and the staff who supported them. People told us they liked the staff that supported them and that they were treated with dignity and kindness.

People told us they felt safe living at Stamford Care Home. Staff understood the importance of safeguarding and the service had systems to help protect people from abuse.

The service was clean throughout and there were hygiene controls in place to ensure that the kitchens were kept clean and food was safely stored. Utilities such as electricity and gas and health and safety checks were undertaken regularly and records kept.

A complaints procedure was in place which was displayed for people and relatives. Staff, residents and relatives meetings were held regularly and surveys were completed by people and relatives.

People, relatives and staff spoke positively of the management team. Quality assurance processes were in place to monitor the quality of care delivered.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service supported this practice. Care plans contained appropriate documentation confirming consent to care had been obtained.

Where people's liberty was deprived, the registered manager had applied for authorisation from the appropriate authority.

People were supported to attend activities and there was an activities timetable in place. We observed particularly caring interactions between the activities co-ordinator and people.

This inspection took place on 4 April 2017 and was unannounced. This inspection was carried out by a single pharmacist inspector. This report only covers our findings in relation to the safe management of medicines within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stamford Care Home on our website at www.cqc.org.uk

A registered manager was in place. 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.

At this inspection we found that significant improvements had been made to how the service ensured safe medicines management. We found that medicines stocks balanced with what medicines administration records (MAR’s) stated and medicines were stored safely and securely. We saw that the administration of medicines was documented appropriately.

However, the management of people’s medicines administered via Percutaneous Endoscopic Gastrostomy (PEG) was not always in line with best practice guidelines and advice. The maximum fridge temperature used for storage of medicines was not documented; therefore we could not be assured that medicines inside the fridge were stored safely. Some staff who administer medicines had not their medicines training competency assessed.

Although the provider was no longer in breach of the medicines regulation, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we found that that improvement was required in aspects of medicines management.

Stamford Nursing Centre is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people living with dementia. At this inspection there were 87 people living in the home.

There was a registered manager in place. 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.

Medicines were not being managed safely. We found that some medicines were not stored and disposed safely. People’s Medicine Administration Records (MAR’s) were not always completed in full or accurately. Medicines were not always administered as prescribed. Medicine audits had failed to identify the issues that we found. We also found that the home improvement plan did not include the findings from an audit carried out by the registered manager.

At this inspection, we found detailed current risk assessments were in place for people using the service. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

Significant improvements had been made to ensure that consent to care was obtained from the appropriate person. Care plan specifying best interests needs were in place. Staff had received training on Mental Capacity Act 2005 (MCA) and staff understood the importance of obtaining consent from people.

People received a nutritious diet and enough to eat and drink to meet their individual needs and timely action was taken by the staff when they were concerned about people's health.

Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure a better oversight of when staff training, supervisions and appraisals were due.

There were enough staff to meet people's care needs safely and also to provide individualised support in and out of the service. Staff were safely recruited with necessary pre-employment checks carried out.

We found that improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from staff regarding the management structure in place and the support they received.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Care plans were person centred and reflected what was important to the person. Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's preferences.

The registered manager and deputy manager were accessible to people and staff who spoke positively about them and felt confident about raising concerns. The provider had quality assurance processes and procedures in place to monitor the quality and safety of people's care.

At this inspection we identified a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management. You can see what action we told the provider to take at the back of the full version of the report.

Stamford Nursing Centre is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people with dementia. At this inspection there were 88 people living in the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection we found that appropriate checks had been made to ensure the premises was safe.

Some risk assessments were not updated to reflect people’s current needs and did not take into consideration people’s health needs. When a risk was identified it did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people from behaviours that challenged the service or people with high risk of skin breakdown.

During our observations, on occasions we noticed there was lack of interaction with people on the ground floor. People were either looking at the television or sleeping while staff were completing tasks. Some people required support when they were mobile with zimmer frames or during hoist transfers. Systems were not in place to calculate staffing levels contingent with people’s dependency levels.

People were given choices during meal times and their needs and preferences were taken into account. Nutritional assessments were in place for most people, which included the type of food people liked and disliked. We found food was not being monitored for some people with specific health concerns to ensure they had a healthy balanced diet. People’s weight were recorded regularly and there was an action plan in place should people were to lose or gain weight significantly.

Due to risks to their safety most people living at the home were not allowed to go outside without staff or relative accompanying them. Appropriate Deprivation of Liberty Safeguards had not been applied for people that required supervision when going outside.

Assessments had been made to check if people had capacity to make certain decisions. However, where people did not have capacity, we found instances when best interests meeting were not held with professionals or family members to make best interest decisions on people’s behalf.

Quality assurance systems had been implemented to allow the service to demonstrate effectively the safety and quality of the home. However, the provider’s quality assurance had not identified the shortfalls we found during our inspection.

Complaints were recorded and investigated with a response sent to the complainant. However, complaints were not analysed for common themes or learning identified and put into practice to improve the service. We made a recommendation that complaints are analysed to identify trends and use the information to improve the service.

Statutory notifications to CQC had not been made in respect to outcomes of Deprivation of Liberty Safeguards for people who used the service.

People told us they felt safe. Staff were trained in safeguarding adults and knew how to keep people safe. They knew how to recognise abuse and who to report to and understood how to whistle blow. Whistleblowing is when someone who works for an employer raises a concern which harms, or creates a risk of harm, to people who use the service.

Medicines were being managed safely.

Recruitment and selection procedures were in place. Checks had been undertaken to ensure staff were suitable for the role. Staff had received induction when starting employment and had received regular training to help provide effective care.

Referrals had been made to other healthcare professionals to ensure people’s health was maintained.

We observed caring and friendly interactions between management, staff and people who used the service and people spoke positively of staff and management. There was an activities programme in place and that was popular with people.

People were encouraged to be independent. People were able to go to their rooms and move freely around the house.

Staff and resident meetings were held regularly.

Surveys were completed by people about the service and there were systems in place to analyse the findings of the survey to make improvements to the service if required.

We identified five breaches of regulations relating to consent, risk management, staffing, nutrition and hydration and notifications. You can see what action we have asked the provider to take at the back of the full version of this report.

At the time of this inspection there were ninety people living in the home. Some people who used the service have dementia.

We observed the care provided and the interaction between staff and people who used the service. We spoke with eight people who used the service, five relatives and a healthcare professional. We also spoke with the area manager, the home manager, deputy manager, activities organiser, an administration staff, nurses and care staff individually.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People indicated to us that they felt safe with staff. This was also reiterated by relatives we spoke with. The premises were clean and regular health & safety checks had been carried out. The arrangements for the administration of medication was satisfactory. Staff had received training in safeguarding people and the home had a comprehensive safeguarding policy and procedure. We however, noted that an allegation of abuse had not been appropriately responded to or reported to the local safeguarding team and the Care Quality Commission. Failure to ensure that all allegations of abuse were reported to the appropriate authorities for investigation places people at risk since the allegations would not have been properly investigated and appropriate action taken in response.

Is the service effective?

Feedback from a healthcare professional, relatives and people who used the service indicated that the service was effective in ensuring that people were well cared for. One person stated, 'Staff are very nice and my room is lovely. When I need help, the staff come to me.' One relative wrote, 'Sincere thanks for the special care given to Y.'

People's care needs had been assessed before they arrived at the home and care plans were in place to ensure that their needs were met. People and their representatives had been consulted regarding their preferences and activities they liked to engage in. The service had a varied programme of social and therapeutic activities and we saw that people could participate in activities if they chose to. We were informed by the healthcare professional that the home had ensured that the healthcare needs of people were attended to.

Is the service caring?

The results of a recent satisfaction survey indicated that the majority of people who used the service and their representatives were satisfied with the care provided. People who used the service and their relatives made positive comments about staff. One person who used the service said, 'Staff are good to me. I am quite happy here. They treat me alright.' One relative wrote, 'You have all been so nice. Thank you for looking after X so well.'

Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs. We observed that staff were pleasant and spoke in a gentle and friendly manner towards people. We saw evidence that checks had been made to ensure that the people had been provided with personal care and the activities organiser informed us that those who were bedbound received one to one attention from activities organisers.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The manager and some staff had received training and had an understanding of the need to make an application for deprivation of people's liberty to be authorised by the local authority if this was needed for people's own safety. However, we noted that some people living in the home needed continuous supervision and control, and staff told us that due to risk to their safety people were not free to leave without staff or family members accompanying them. This may mean that deprivation of liberty authorisations were required. The manager agreed that to contact the local authority with regard to this issue.

Is the service responsive?

Most people who used the service indicated that staff were responsive to their needs. We noted that when a person who used the service approached staff for assistance, this was provided promptly and staff also arranged for a medical appointment for this person. However, three people who used the service and two relatives informed us that the call buzzer was not always promptly responded to. On our second visit to the home we were informed by a person who used the service that staff now responded promptly to the buzzer.

The service had a complaints procedure. Complaints made by people had been responded to, usually within a few days. People who used the service and their relatives stated that they knew who to complain to if they had any concerns.

Is the service well-led?

Staff meetings had been held and the minutes of these meetings indicated that staff had been updated regarding the management of the home and the care of people. Staff we spoke with said they had been provided with appropriate support to enable them to take good care of people. Essential training had been provided and staff were knowledgeable regarding the specific care needs of people.

There were arrangements for monitoring the quality of care. Regular audits and checks had been carried out in areas such as the medication arrangements and the cleanliness of the premises.

At this inspection we found that the staffing level had been increased in two of the three units and that more staff had been recruited so that it was easier to cover shifts. People using the service and relatives we spoke with told us that staff were "helpful" and "hard working". Staff told us that the staffing arrangements had "improved".

We saw that there were systems in place to check people's needs and we were told that staffing levels could be adjusted in line with needs. We also saw that the acting manager retained oversight of the staffing rota to make sure that staff cover could be provided when needed.

We saw that there were comprehensive care planning documents which staff had kept up to date. This meant that people had been cared for as planned. We saw that the managers carried out regular audits of health and care practice which enabled them to take action to address concerns if they arose.

Staff told us they felt supported and we saw evidence that relevant training had been provided. However, we saw that staff were rushed, particularly at lunch time. We saw that staff did not always have time to devote to people or to provide regular positive interactions. Some of the staff and relatives told us that more staff were needed, particularly at mealtimes and to provide cover when colleagues were unable to work a shift. We were told that a dependency analysis of people's needs had not been carried out in order to calculate how many staff were needed. This meant that people using the service could not at all times be confident there were enough qualified, skilled and experienced staff to meet their needs.

There was evidence that the manager and the operations manager regularly spoke with people using the service to gain their views about their care. People told us that they were offered choices in relation to how they wanted to be supported. They told us that they had regular meetings to talk about their care and could comment on how the service was run as well as make suggestions for improvements.

People were positive about the care and treatment they received from staff at the home. They confirmed that staff assisted them when they needed support with their care and that staff were helpful. One person commented, 'They are wonderful. They smile and make you feel comfortable.' A relative we spoke with told us the staff were 'very gentle.'

People told us that they felt safe with the staff who supported them. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the care worker if they needed to. One person told us, 'I'm not worried about anything.'

We saw that the provider carried out regular checks at the home including health and safety audits to make sure people were being supported in a safe environment. Please note that the registered manager has left the employment of this organisation.