Archived: Stewton House

Updated 7 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered person continued to meet the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

Before the inspection, the registered person completed a Provider Information Return (PIR). This is a form that asks them to give some key information about the service, what the service does well and improvements they plan to make. We also examined other information we held about the service. This included notifications of incidents that the registered person had sent us since our last inspection. These are events that happened in the service that the registered person is required to tell us about. We also invited feedback from the commissioning bodies who contributed to purchasing some of the care provided in the service. We did this so that they could tell us their views about how well the service was meeting people’s needs and wishes.

We visited the service on 2 November 2017 and the inspection was unannounced. The inspection team consisted of an inspector and a special professional advisor who was a registered nurse. There was also an expert by experience. An expert by experience is a person who has personal experience of using this type of service.

During the inspection we spoke with 13 people who lived in the service and with six relatives. We also spoke with a nurse, a senior member of care staff, four members of care staff, a housekeeper, the laundry manager, the chef and the kitchen porter. In addition, we met with the deputy manager and with the manager. We observed nursing and personal care that was provided in communal areas and looked at the care records for nine people who lived in the service. We also looked at records that related to how the service was managed including staffing, training and quality assurance.

In addition, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us.

After our inspection visit we spoke by telephone with three more relatives.

Updated 7 December 2017

Stewton House is registered to provide accommodation, nursing and personal care for 48 older people. There were 44 people living in the service at the time of our inspection visit.

The service was run by a company that was the registered provider. The company’s area manager was also managing the service and had applied to be registered by us in that role. 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. In this report when we speak about the company we refer to them as being, ‘the registered person’.

At our last comprehensive inspection on 6 September 2016 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating our domains ‘safe’, effective’, ‘responsive’ and ‘well led’ as, ‘Requires Improvement’. In relation to our domain ‘safe’, we found that there was a breach of regulations. This was because the registered person had not ensured that sufficient care staff were always deployed to enable people to promptly receive all of the care they needed. The other breach was in connection with our domain ‘effective’. This was because the registered person had not established suitable systems to plan and monitor the delivery of some parts of the care people needed to receive.

After this inspection the registered person wrote to us and explained what they intended to do to address the concerns we had raised. We completed a focused inspection on 11 April 2017 when we found that sufficient progress had been made to meet the two breaches of regulations. However, we did not change the ratings of the domains in question. This was because we needed to see that the improvements would be maintained. As a result the overall rating of the service remained as being, ‘Requires Improvement’.

At the present inspection the overall rating of the service was changed to, ‘Good’. We found that most of the improvements had been maintained and we rated each of our domains as being, ‘Good’.

In more detail, there were systems, processes and practices to safeguard people from situations in which they may experience abuse. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, most of the necessary provision had been made to ensure that medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before new nurses and care staff had been appointed. People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. People enjoyed their meals and were supported to eat and drink enough to maintain a balanced diet. In addition, people had been enabled to receive coordinated and person-centred care when they used or moved between different services. As part of this people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They were also supported to express their views and be actively involved in making decisions about their care as far as possible. This included having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that was responsive to their needs, although improvements were needed in the way care was planned for people who had developed sore skin. Nurses and care staff had promoted positive outcomes for people who lived with dementia including occasions on which they became distressed. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met. The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people consistently received safe care. Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered person and manager worked in partnership with other agencies to support the development of joined-up care.