Archived: Staverton House

Staverton House is a residential care home providing personal care to 17 people with dementia, aged 65 and over at the time of the inspection. The service can support up to 20 people.

People had access to shared living spaces, including lounges on both floors of the home and a large garden with seating areas. The home was on the same site as another home owned by the same provider. People had shower room en-suites and there were shared bathroom facilities.

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

We found different shortfalls when inspecting the key question, is the service safe? These related to learning from accidents and incidents, medicines management, staff recruitment, and record keeping for water temperatures.

The registered manager responded to our feedback around areas identified for improvement, with immediate action. They planned an investigation, weekly checks and an action plan for the improvements needed in medicine’s management.

We received consistently positive feedback from people’s relatives about the home. People’s relatives praised staff for their kind and caring approach and for always being patient.

There was good community engagement and the home were planning their second fete and dog show. Funds raised contributed to the activities budget, a juke box, and trips out of the home. This had included the local Armed Forces Day celebrations and the ‘festival of light’ at a local safari park. One person was supported to continue their swimming hobby. The home had also knitted ‘trauma teddies’ for Wiltshire Police to give to children following traumatic events.

People had a wide choice of activities to attend. These included a ‘gentleman’s club’, which had previously been for a pub lunch or to play games of pool and chat. Staff told us they liked being able to spend time with people where possible, to chat and get to know more about them.

People chose where they wanted to spend their time. Work had taken place to make the environment brighter through redecoration and re-carpeting. There were plans to update the chairs and furnishings in the home.

People’s bedrooms were decorated to colours of their preference. Their bedrooms were kept clean and tidy and the home was free from odours.

Staff spoke with enthusiasm about working in care and enjoyed their jobs. They told us they liked coming to work and being able to “put a smile on people’s faces.” Staff felt the morale in the home was high and the team worked well together. They described the home as being “like a family.” People enjoyed spending time with staff and the registered manager.

Assessments of people’s mental capacity to consent to decisions regarding their care were in place. 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.

The registered manager and staff team knew people, their backgrounds, interests and preferences well. We observed this knowledge being used to start conversations.

Staff spoke positively about the support they received from the management team of the home. They told us there was clear leadership and they valued how the service was being developed.

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 26 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection was unannounced and took place on the 29 November and 5 December 2016.

The service had a registered manager who was responsible for the day to day running of 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 the last comprehensive inspection in September 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA), when people lacked the capacity to give consent to receiving care at Staverton House. Sufficient numbers of staff were not consistently deployed to fully meet people’s needs and the service did not always provide care in a safe way by taking all reasonably practicable measures to mitigate risks.

At this inspection we found that the provider had taken action to address the issues highlighted in the action plan. We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly undertaken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staffing levels had improved. There were enough staff on duty to meet people’s care and support needs safely. Staff were visible at all times. Risk assessments were in place to support people to be as independent as possible. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

People appeared happy in their surroundings and the home was decorated to support people living with dementia in maintaining as much independence as possible. Individualised memory boxes were in place on people’s bedroom doors as well as appropriate signage to help them find their way around the home. Relatives spoke positively about the care and support their family member received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection.

People were supported to have sufficient food and fluids. People were offered a choice at meal times and where people did not want what was on the menu alternatives were available.

People’s medicines were managed safely. Systems in place ensured that people received the medicines as prescribed and at the correct time.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People also had an opportunity to share their views and make suggestions at the monthly residents’ meeting.

Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place.

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. The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support. Training was regularly refreshed, with staff attending a range of core training, as well as training specific to the needs of people using the service, for example dementia awareness.

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence. The management operated an on call system to enable staff to seek advice in an emergency. This showed leadership advice was present 24 hours a day to manage and address any concerns raised.

Relatives we spoke with were satisfied with the care provided for their family member. One relative said "I can't fault them (staff). It's excellent; it's not put on for us. The care they give is amazing!' Another relative told us 'my mother has been much better since she has been here. They know the people they are looking after.' One person we spoke with told us 'it's very nice. They're kind.'

We observed staff were patient and kind. They communicated effectively and provided support and activities to promote awareness for the person with dementia.

People were supported to eat safely and with dignity. The menu was varied and people's choices were accommodated.

We found people's medicines were administered and managed safely.

Staff records were easy to follow and included a checklist of information and documentation received in order to ensure the appropriate security checks.

Overall people's care records contained sufficient information for staff to provide safe, effective care. People's monitoring charts were not always accurately completed.

We saw overall the provider was following the Department of Health's Code of Practice on the prevention and control of infection (2008). They had addressed previous shortfalls in their processes to ensure people were cared for in a clean environment and cross infection risks were reduced. Care staff had received regular training about the principles of preventing cross infection. They were knowledgeable about their role in reducing cross infection risk.

People's plans of care were updated as their care needs changed. People's monitoring charts were maintained and updated as required. The provider had a system to monitor the completion of people's daily monitoring charts.