Stanwell Rest Home

Stanwell Rest Home is a care home for people living with dementia, a mental health need or other needs. The service supports up to 38 people across a main building and in eight purpose built apartments. People could access multiple communal lounge areas and there is a communal garden area. At the time of the inspection there were 33 people receiving care.

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

We found improvements were required to ensure people’s medicines were stored and managed safely, and in line with manufacturers advice. Some individual risks to people were not always identified or thoroughly assessed, and records relating to people’s care was not always complete or up to date. People were supported by staff who knew them and their needs well. Staff understood how to keep people safe and raise concerns. People were able to have visitors to the service and the provider ensured infection risks to people were considered and managed in line with national guidance.

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; however, the systems in the service did not consistently ensure people’s mental capacity to consent was assessed in line with relevant legislation. People’s nutritional needs were met, and people told us they enjoyed the food on offer at the home. People could access appropriate support from staff to meet their health care needs. The provider had made improvements to the building since our last inspection and planned works were on-going to fully embed national guidance on dementia friendly premises.

Systems to assess, monitor and improve the service continued to require improvement. Records in respect of people’s care did not always reflect the care that was being provided to keep people safe. The registered manager was open to our feedback and had taken some immediate actions to address the concerns identified in the report. Staff told us they felt supported and the registered manager encouraged a positive culture within the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 07 August 2019) and there were breaches of 2 regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of 2 regulations and an additional breach of regulations was identified.

At our last inspection we recommended the provider reviewed their medicines audit systems and ensured medicines were stored in line with national guidance. At this inspection we found the provider had failed to take enough action to make the required improvements and was in breach of regulation. At our last inspection we also recommended the provider reviewed and embedded national guidance on dementia friendly premises to promote people’s independence. At this inspection we found adequate improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Stanwell Rest Home is a care home for people living with dementia, a mental health need or other needs. The service supports up to 38 people across a main building and in eight purpose built apartments. At the time of the inspection there were 32 people receiving care.

People’s experience of using this service:

We identified a number of areas for improvement to ensure people living at Stanwell Rest Home were protected from the risk of harm.

Risk assessments and medicines procedures were not always robust enough to ensure people’s risks were minimised. We recommended the provider implement best practice guidance for the safe management of medicines.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice, specifically relating to their medicines.

The building was not fully adapted to suit people’s needs relating to their dementia. We recommended that the provider fully implement national guidance relating to dementia friendly premises to improve people’s independence.

Governance procedures were not robust enough to identify the issues we had identified on our inspection and records were not always detailed. The registered manager had an open approach to feedback and was motivated to improve following a challenging period of staffing changes.

There were sufficient numbers of staff, and staff had a caring and empathetic attitude towards the people they supported. There was a strong culture of promoting independence in the home and staff knew people well.

We received mixed feedback from visiting professionals, however feedback relating to staff support of people living with mental health conditions and dementia was very positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The service was previously rated Good (report published 11 November 2016).

Why we inspected:

The inspection was prompted in part due to concerns received about how responsive the service was to people’s changing needs, staffing levels and the suitability of the premises. A decision was made for us to inspect and examine those risks.

Enforcement:

We identified that the service was in breach of two regulations. For actions we told provider to take, please see the end of the full report.

Follow up:

We will continue to monitor information we receive about the service. We will re-inspect the service in line with our planned schedule for services rated ‘requires improvement’.

At our previous inspection, on the 07 and 10 July 2015, we found three breaches of regulations. The service was not meeting the regulations relating to keeping people safe from risk of harm, monitored the risk to people’s health and governance arrangements. We issued a warning notice and required the provider to make improvements. We returned to the service on the 14 December 2015 and found they had taken appropriate action. At this inspection we found improvements had been made and the identified concerns had been addressed.

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.

People felt safe living at Stanwell Rest Home and they were very much at the heart of the service. The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people. Staff received training in safeguarding adults and knew how to report concerns.

Staff were trained and assessed as competent to support people with medicines. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an appropriate induction programme.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day.

People felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices.

People had a choice and access to a wide range of activities and were able to access healthcare services.

‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service. People felt listened to and a complaints procedure was in place.

Staff were responsive to people’s needs which were detailed in people’s care plans. Regular audits of the service were carried out to asses and monitor the quality of the service. Staff felt supported by the registered manager.

During this inspection, we looked at the outcomes related to the care and welfare, safeguarding adult's process, medicines management, staffing, the process for assessing and monitoring the quality of service and records management.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with 11 people who use the service, three relatives and visitors to the service, the manager, two visiting healthcare professionals and seven staff. We reviewed seven care plans and records relating to the management of the service.

We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

The service was not safe because the arrangement for the effective management of people's medicines was not adequate. This may put people at risk of not receiving their medicines in a safely and consistently and according to their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to incidents of potential abuse.

The provider had arrangements in place to ensure staff received regular training to update their skills. There were not always enough staff to meet people's needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. The manager confirmed there was no one who was subject of a DoLS authorisation at the time of the inspection.

Is the service effective?

People were at risk of not receiving effective care. There were some assessments carried out but they did not cover all risks. The care plans contained detailed information about people's care and staff were knowledgeable about the people they cared for. This included appropriate support with food and fluids to meet people's nutritional needs. Equipment was in place to support people's mobility and to maintain their independence.

Is the service caring?

We saw people were supported in a caring way. Staff and people using the service had developed good relationships with people who were treated with respect. One person told us the staff were 'kind "and another person said 'the staff are all right and help you'. We saw people being supported in a caring manner with their meals. However, healthcare professionals raised concerns about certain staff's attitude, shown by the way they spoke to people and the tone of voice used. We also observed one incident which we shared with the manager at the time of the inspection.

Is the service responsive?

The service was mainly responsive because people told us they were satisfied with the care and support they were receiving. We saw people were supported to access external healthcare facilities as needed. Two visitors said their relative was able to access medical help as needed.

Is the service well-led?

The service was not always well led. The system to regularly assess and monitor the quality of service provided was not robust. This did not effectively identify shortfalls for action to be taken. The quality improvement system did not evidence how improvements would be embedded in practice. There was a lack of auditing to assess the quality of care provided including infection control, care plans and medicines.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing the quality of the service provision and monitoring the outcomes for people.

There was a complaints process to support people to raise their concerns and this information was available to people

We observed the care and support given to people in the communal areas of the home, and in particular the care of five people in the larger lounge. We saw that staff were caring, aware of people's needs and preferences, and responsive to them.

We spoke with three members of staff and the manager, and reviewed records related to people's care. We found people's care needs were assessed and their care plans reflected their needs. Care and support were delivered according to plans which were reviewed regularly. People were cared for in a clean and hygienic environment. We found there were sufficient numbers of staff to provide the care required. Processes were in place to monitor the quality of service provided.