Stratton Court

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked at 3 quality statements in this key question and found some improvements were needed. This key question has not been fully assessed to give a rating. We found 2 breaches of the legal regulations in relation to prevention and infection control and the safe recruitment of staff. During our onsite inspection, we found the provider had not ensured all areas of the home remained well maintained and cleaned in order to support good infection prevention and control measures and practices. The provider had not always ensured the previous employment of staff who had worked in the health and social care sector, had been effectively explored to ensure staff were of good character. We have asked the provider for an action plan in response to the concerns found at this assessment. However, Relative’s views about the safety of people’s care and the management of their risks were positive. They told us people’s risks were managed well and all incidents of concerns about changes in people’s health were communicated with them. However, the delivery of people’s care was not consistently recorded, therefore we were unable to determine if people’s risk were being managed in line with their risk management plan. The provider demonstrated how they assessed and planned for the required staffing levels in the home. However, we received mixed comments about the staffing levels in the home. Most relatives told us they saw regular staff members; however they had noticed staff were under a lot of pressure and staffing levels at the weekends were not always sufficient. Professionals shared they had encountered challenges in accessing staff to support their appointment if they had not informed the home of their pending visit. Staff told us they were trained to carry out their role but raised concerns about the frequency and effectiveness of their one-to-one supervision meetings.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives spoke positively about the care people received and the management of people’s individual risks. They told us staff knew people well which enabled them to monitor changes in people’s health. Staff took appropriate action when they observed changes in people’s health or mobility. One relative said, “I was on holiday when she had a fall. She fell out of bed. They did contact me. After she was moved to a different floor where she was nearer to the nurse’s station…… I was happy with the way they dealt with it.” Another relative explained, “I am very impressed with them. They have got to know her well. She had a fall some time ago in the corridor. She was taken to hospital in Swindon, and I visited her there.” Relatives told us communication from the home was generally good. A relative told us, “If anything happens, they contact me and they keep me up to date with his care.” People’s relatives spoke positively about the meals provided to people. We were told people’s weight was monitored and their dietary requirements were adjusted in accordance with their dietary requirements or weight loss and gain.

Staff were knowledgeable around people’s specific risks and used their professional judgement to assess the risk and needs of people who lived on the different units. One staff member told us they would inform the senior or the nurse on duty when they had concerns about changes in people’s well-being. However, visiting professionals felt some concerns about people’s care could have been escalated earlier by staff. Staff had regular handovers between shifts which enabled nurses to provide updates about people and any emerging risks to staff. We received mixed comments from staff about people’s pre-assessment process. Some staff members reported they were unable to effectively support new people in a person-centred manner as sufficient information about the needs of new people was not always available. One staff member explained, “We have grown so much, too many new admissions, so much paperwork to do. And I think that’s why we miss things sometimes.” This was being addressed by the provider.

We observed on both days of our inspection, staff did not effectively manage, or report concerns about people’s pressure relieving mattress when it alarmed, indicating there was a possible malfunction of the mattress. Not all staff had been adequately trained to the importance of ensuring the equipment used to reduce the risk of people developing pressure ulcers remained in good working order. This put people at risk of developing pressure ulcers or at risk of their existing skin condition worsening. One person had been assessed as being at risk to themselves or others and required one to one support from staff; however, we observed there was not always sufficient staff available to support them. This put the person or other people at risk of being harmed. We observed that staff knew people well and their approach with people was person centred so people’s individual needs were met. Staff provided support and responded to people promptly when they became agitated; they also used distraction techniques to alleviate people’s anxiety. Staff were observed supporting people to stand safely and provided them with assurance and encouraging words.

Staff had access to people’s care records which detailed their care requirements and the measures needed to support people to reduce their risks. However, staff did not always consistently record the care they provided to people. For example, staff did not routinely record people’s fluid intake or when they had supported people to reposition to alleviate pressure from their skin on monitoring charts in line with people’s care plans. People’s targeted fluid requirements for each day or frequency of repositioning were not always recorded. This meant managers would not be able to accurately determine if people had received the care they needed to achieve their daily personal targets. The provider had failed to ensure accurate, complete and contemporaneous records were maintained. Daily meetings were held to discuss and share any information, incidents, and events in the home with key members of staff from each department, who in turn cascaded this information to their respective teams. Regular clinical meetings were held to discuss people's health and risks. Key clinical staff within the service regularly met and monitored people’s health and escalated any concerns with health care professionals. People’s health needs were monitored regular by a designated GP who visited the home weekly. The provider had introduced a new system to enable health care professionals to feedback their recommendations with the aim of enhancing the working relationship between the staff and visiting professionals. The registered manager confirmed they were implementing an improved system for analysing accidents and incidents in order to be more proactive in taking preventive actions. However, further time was needed to ensure the systems were fully integrated to guarantee their effectiveness. The registered manager explained the provider’s electronic system notified them when to conduct care plan reviews with people and their families.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives were complimentary about the staff who supported their family member. One relative said, “All the staff are great.” The majority of relatives told us they saw regular staff who knew their loved one well; although some felt the staffing levels weren't always sufficient, especially during the weekends. One relative said, “They [staff] give her 80% [of care] and I top up the other 20%.” People who were able, were left with a call bell to alert staff for assistance, although two relatives said the call bells were not always left in accessible places for their family member. However, staff and relatives told us staff regularly checked on people especially those who were not able to call for support.

Staff had received training and had their competencies assessed to ensure they were working safely. One staff member however, commented that the skills of staff varied and that some staff needed more guidance. Staff reported they had received training to carry out their roles and were aware of their responsibilities to keep people safe. They also knew how to report incidents, accidents and any concerns about people’s well-being or poor care practices. We observed and staff shared with us their concerns about the staffing levels in the home. Some staff shared they felt under a lot of pressure due to staff absences and the changing needs of people. This view was supported by a visiting health professional who said, “There are not enough staff. I have to spend time trying to find a staff member to get medication and there is no-one around” and “Trying to find staff to get me the things I need can be hard.” Staff raised concerns about their long shift patterns and the hours they sometimes worked. This was brought to the attention of the registered manager, who stated this was usually a one-off situation to cover last minute sickness and staff were not forced to do extra shifts. They confirmed staff were not allowed to work more than 5 days in a row. Staff felt they had not always been given opportunities to attend regular staff meetings as pre-arranged meetings had been cancelled. This meant staff and managers did not always have opportunities to communicate with their colleagues, share practices and promote collaboration across the home. Staff spoke positively about their experience of being sponsored from abroad and how they were recruited.

We observed staff engaging well with people. There were positive interactions between staff and people on the dementia unit. Staff spoke to people kindly and we saw staff engaging in meaningful activities with people in the lounge. During our site visit we observed the service had installed a silent call bell system, so call bells came through to handsets. This resulted in a calming environment and reduced noise levels for people who may become distressed easily or were resting in their rooms.

We were not assured by the provider’s systems to assess fit and proper persons employed. The provider had failed to gain satisfactory evidence of staff’s conduct in their previous employment. We reviewed 4 staff recruitment files and found the provider had not always ensured they had thoroughly explored and checked the employment backgrounds of staff who had previous employment in health and social care to assess if the staff member was of good character to support people. However, systems were in place to monitor and manage staff support and development. The registered manager provided evidence of supervision and risk assessments being in place for staff. Staff completed online training which was supported by additional classroom-based training such as dementia training. Systems were used to calculate the staffing levels for each unit of the home. However, from our observations, feedback from staff and visiting professionals, we were not fully assured sufficient staff were always available or deployed to support and supervise people. The provider’s systems had not always ensured staff were available to support people who required one to one support. Through their own audits of each floor, the registered manager had identified that a review of staffing levels and training was needed.

Relatives generally felt the cleanliness of the home was good. We received comments such as “It is like a hotel. There is a library, and I can go and have a meal with her. Everything is kept clean. It has exceeded my expectations”; “Absolutely – it is a clean home” and “The rooms are kept clean.” However, some relatives reported some areas of the home needed redecoration and attention. For example, one relative said, “Her room is a bit tatty but otherwise the home is clean.”

Our concerns about the cleanliness and upkeep of the building were raised with the registered manager. They told us they were working on issues raised by staff and people’s relatives. They had reinforced the importance of holding regular meetings with the maintenance teams and ensuring the team checked the maintenance book daily for any new maintenance requests. Staff told us they had been trained in infection prevention and control and explained how they used PPE when supporting people with different activities.

During our site visit, we observed areas of the dementia and nursing unit had not been maintained or cleaned sufficiently, which placed people at harm and may give rise to infection control concerns. For example, we found parts of kitchen serveries and dining rooms had not been effectively cleaned. We observed chipped wall and woodwork paint, gaps between flooring, loose cupboard doors and a hole in one person’s bedroom wall. The equipment in place did not always support good infection prevention and control practice. We found the kitchen bin was not positioned in a way that allowed the staff to make use of the foot pedal and not all foot-pedal bins in the dementia unit and nursing unit were functional. This meant staff had to use their hands to access the bins. The bins in the dining room of another unit were observed to be overflowing.

We were not assured by the provider’s safe care and treatment systems. The provider’s infection control auditing systems had identified good infection control practices were not always being maintained. However, it was not explicitly clear that the actions required to improve the home’s infection control standards had been shared with relevant staff members or departments within the home or had been completed. From our own observations and feedback from relatives, we found the home’s environment and infection control equipment had not always been maintained. Our concerns about the infection control measures in place and the maintenance of the home were shared with the registered manager. They explained a review of the home’s housekeeping and maintenance processes and practices was in progress. This was to ensure staff from all departments had a clear understanding of their roles, responsibilities and that they worked in line with the provider’s relevant policies and expectations. They also explained that additional electronic systems were being implemented to enable staff and relatives to report any maintenance concerns. This system would also assist the managers to identify related issues and prioritise a schedule of work to address these.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.