Archived: Stoke House

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have been needed to be submitted, proper policies and procedures were in place.

We looked at completed observational antecedents, behaviour, and consequence (ABC) charts. These were used to record what happened just before the behaviour (antecedent), what the person's behaviour looked like and what happened as a result of the behaviour (consequence). For example, one person became physically aggressive towards staff members on their return journey home after a health appointment. The ABC chart recorded the actions that triggered the behaviour, the person's behaviour as result of this and what staff did to de-escalate the situation. We saw a meeting was held to review the incident to ensure this did not happen again. This was signed and dated by the manager. This meant the service managed risk through effective procedures.

We spoke with the registered manager who advised us the policy was also available for staff to access on the computer. They explained staff members had to report all concerns to management who then contact the relevant agencies. This was confirmed by the staff members we spoke with. They demonstrated a good understanding of what safeguarding was and how they would protect people. The staff members told us they had attended the relevant training, training records reviewed confirmed this. This showed the service ensured people were safeguarded against the risk of abuse.

Staff members demonstrated a good understanding of infection control and told us what they would do to reduce the risk of the spread of infection. One staff commented, 'On a daily basis we do various checks such food and fridge temperature checks. We ensure the home is clean.' Another staff member told us, 'We wear gloves and aprons when carrying out personal care, which are always easy accessible for staff.' We looked at the laundry arrangements and found the service followed their infection control policy in regards to washing soiled linen. This showed people and employed staff were protected from identifiable risks of acquiring an infection.

Is the service effective?

We reviewed the care plan of one individual who presented challenging behaviours. The home devised a 'behaviour management plan to address this behaviour. We saw the person's relative signed to give consent to the behaviour management plan put in place. This showed consent was sought by the person who had sufficient knowledge of the person who used the service.

The home had a business continuity plan dated 6 March 2014. This provided detailed information about what emergency procedures were in place should an incident threatens to disrupt the home of carrying out their normal activities. The business plan outlined what should happen 24 hours following an incident and two to seven days following an incident. It contained staff details, key contact details and an 'emergency operations log'. The two staff members we spoke with explained what the evacuation procedure would be in the event of a fire and where the fire assembly point was. The manager showed us where information about people was stored in the event that everyone had to be evacuated. This showed there were arrangements in place to deal with emergencies.

Is it caring?

In one care plan we read how an individual with limited communication expressed themselves with the use of a few words. Staff members were instructed to use the 'picture exchange communication' cards (PEC). These were used as an aid to help the person understand what members of staff were saying, as well as the person being able to communicate with staff members. We observed this being done during our inspection. Staff members were also instructed to ensure they used the PEC folder when they were going to provide the person with personal care, taking them to health appointments or when visitors came to see them at the home. This ensured the care received was centred on the individual and all aspects of their individual circumstances.

Is it responsive?

The care plans captured people's preferences. One care plan recorded a person did not like lots of talking and liked to be left on their own. Whilst in another care plan the person liked to watching 'digital video discs' (DVD). Staff told us how they provided personalised care that met people's needs. One staff member commented, 'I ensure I read their care plans and work in line with that.' Another staff said, 'I read their care plans in order to know their preferences. This showed the delivery of care reflected people's preferences.

The manager told us they had low staff turn-over and staff who provided care, treatment and support to people were familiar with their needs. This was supported in our conversations with staff members and showed there was continuity of care.

Is it well-led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We reviewed the 'quality assurance questionnaire 2013' and saw this was completed by two relatives. This asked people's relatives or those who represented them various questions about the quality of the service. For example, if people felt they received full information about the service, if staff were attentive and if management responded appropriately to concerns raised. The responses were positive on both completed questionnaires. One relative commented, 'I am very happy with all the staff at Stoke House, I can see X is very happy here and would definitely recommend it to someone else. This showed the service regularly sought the views of people and those who acted on their behalf.

We found some changes had been made however, people and employed staff still remained unprotected from identifiable risks of acquiring an infection. The infection control policy did not indicate the date it was developed and the date it was to be reviewed. This meant there was a risk the home was not up to date with relevant infection control legislation.

We observed the home was clean with no malodour throughout. We saw bed linen in all rooms was clean.

We spoke to one member of staff about their understanding of infection control. They commented, 'Infection control is good practice to prevent the spread of infection. I wash my hands and wear gloves to prevent the risk of infection.' The staff member told us they had undertaken the relevant training such as infection control training and food safety and they were up to date. Training records reviewed confirmed this. This showed staff members received the relevant infection control training.

The deputy manager told us infection control audits were not carried out and thought this was covered by the weekly cleaning schedules. This showed there were no effective systems.

We found that care plans were personalised and relatives included in the planning of care.

People were given a choice of and involved in the purchase of food.

We found that the prevention and control of infection policy was in place but not dated and that processes were not followed.

Staff told us they were happy working at Stoke House. Relatives told us that they were happy with the care.

We found the storage of records was secure. There was duplication of policies and staff training records had not been consistently updated.

We looked at the Medication Policy and Procedure, which instructed staff on the correct procedures to follow when dispensing and recording medicine given. The medication administration record chart we looked at evidenced staff was following the policy.

Staff we spoke with told us that they had completed their mandatory training which they found beneficial. One member of staff told us, 'I received training on managing challenging behaviour, restraint techniques, management of medicine, safeguarding, first aid, moving and handling, food handling.'

We found that people using the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. One relative commented, 'I am very happy with the staff at Stoke House.'

We looked at the complaints policy today found it had been updated and clearly outlined the steps people should take if they were still not satisfied, with the way their complaint had been handled.