Stoke View Residential Home

About the service

Stoke View is a residential care home that provides personal care and support for up to 9 people with a learning disability, autism or who have complex needs associated with their mental health. At the time of the inspection there were 9 people living at the service.

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

Right Support:

People were not always supported to have maximum choice and control of their lives and staff were not always supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

People were not always protected from the risk of harm as staff did not always have all the information needed to meet people's needs safely. People were able to choose how they spent their time and were supported by staff to take part in activities and pursue their interests.

Right Care:

People’s care and support plans were not always reflective of their range of needs. However, staff knew people well and understood how to communicate effectively with people. Staff respected the people they supported and provided care that was caring and compassionate. It was clear from what we were told that people and staff had developed good relationships.

Right Culture:

The management team had created an open culture where constructive feedback was encouraged. People and their relatives knew how to make a complaint and felt confident they would be listened to. However, we found more work was needed to ensure the service was operating in accordance with the regulations and best practice guidance.

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 21 March 2019).

Why we inspected

We received concerns in relation to safeguarding, staffing levels, the management of people’s monies, restrictive practice as well as the culture and governance of service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stoke View Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, the need for consent, notifications and governance at this inspection. We have also made recommendations in relation to person centred care, staffing levels, homely remedies and environmental safety.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stoke View provides care and accommodation for up to 9 people. On the day of our inspection there were 9 people living at the service. The home provides residential care for people with a learning disability.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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 inspection on the 6 September 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated good:

People were not all able to fully verbalise their views and staff used other methods of communication, for example sign language. One relative said of their relative; “Very happy and content.”

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults. There were adequate numbers of staff to meet people’s needs and help to keep them safe.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and competency checks to test their knowledge and to help ensure their skills in relation to medicines were up to date and in line with best practice.

People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staff practice, and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's health was monitored by the staff and they had access to a variety of healthcare professionals. The registered manager worked closely with external health and social care professionals to help ensure a coordinate approach to people’s care.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes. Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. Staff had built strong relationships with people who lived there. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People’s communication needs were known by staff. The provider had taken account of the Accessible Information Standard (AIS). The AIS is a requirement to help ensure people with a disability or sensory loss are given information they can understand, and the communication support they need.

Staff adapted their communication methods dependent upon people’s needs, for example using simple questions. Information for people with cognitive difficulties and information about the service was available in an easy read version for those people who needed it.

People could make choices about their day to day lives. The provider had a complaints policy in place and it was available in an easy read version. Staff knew people well and used this to gauge how people were feeling.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager and provider were very approachable and made themselves available. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

The provider worked hard to learn from mistakes and ensure people were safe. The provider and registered manager had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment. The previous rating was displayed in the main entrance.

Further information is in the detailed findings below.

We carried out this inspection on 6 September 2016. The service was last inspected in August 2014 and was found to be meeting the Regulations.

At the time of the inspection the registered manager had just moved to another role within the service. The owner was managing the day-to-day running of the service until it was decided who would apply to become the new registered manager. 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 and associated Regulations about how the service is run.

People told us they felt safe living at Stoke View and with the staff who supported them. People said, “It’s wonderful here” and “I have been here for 31 years, it’s my home.” Comments from relatives included, “I haven’t got any worries about the home”, “Staff understand people’s needs and look after them well” and “[Persons’ name] is happy living there.”

On the day of our inspection there was a relaxed and friendly atmosphere at the service. People were encouraged and felt confident to make decisions about their daily living. We observed people had a good relationship with staff and each other. There was plenty of friendly and respectful chatter between people and with staff. The staff team had developed kind and supportive relationships with people using the service. Relatives commented about staff, “Wonderful, caring staff” and “They [people] are treated well.”

Support was provided by a consistent staff team, who knew people well and understood their needs. People were supported to access the local community and take part in a range of activities of their choice. Each person had regular activities they took part in every week and for some people this included volunteering work. Staff arranged regular holidays and day trips for either the whole group or a smaller group depending on the type of holidays and outings people wanted to go on. People were supported by staff to manage their finances so they could purchase personal items and pay for outings and holidays.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support. People had access to an annual health screening to maintain their health. Specialist services such as community nurses, occupational therapists and dieticians were used when required. Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made. One relative said, “Staff take [person’s name] to hospital appointments. They ring me if there are any problems.”

People were supported to eat and drink enough and maintain a balanced diet and were involved in meal planning. Menu planning was done in a way which combined healthy eating with the choices people made about their food.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Risk assessment procedures were designed to enable people to take risks while providing appropriate protection.

Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. The management provided strong leadership and led by example. There was a positive culture within the staff team and with an emphasis on providing a good service for people. Staff told us they felt supported by the management commenting, “Lovely to work for”, “I love it, it’s so relaxed” and “Well managed, the owner is brilliant.”

The owner was visible in the service and regularly visited to check if people were happy and safe living at Stoke View. People were clearly comfortable with staff and management and relatives told us they had confidence it the way the service was run. Relatives said, “Very pleased with the home. I trust the owner and all of the staff” and “The owner really cares about the people living there.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. People and their families were involved in the running of the service and were regularly asked for their views through on-going conversations with staff and surveys.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe. Equipment at the home had been well maintained and serviced regularly. We saw that the kitchen was in the process of being re-tiled. There were enough staff on duty to meet the needs of the people living at the home and a member of staff was available on call in case of emergencies.

Staff personnel records showed that the home took all reasonable precautions to ensure that they only employed people who had been checked as not being a risk to vulnerable adults and who had the right sort of attitude for working in care homes.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We met with all eight of the people who were living at Stoke View when we inspected. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us "This is better than other places I've lived at, I've got my freedom, I can go out and buy my XXX and sometimes I get treated out for lunch." Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that the care workers were patient and gave encouragement when supporting people. When we first arrived staff excused themselves saying that they needed to assist people in washing and preparing for the day. People who lived at Stoke View looked after us and chatted with us telling us that there were always at least two staff on duty during waking hours and one awake worker during the night. They told us that they liked living at Stoke View saying "It's very nice here." and explaining that they could choose what they wanted to do. The home had a "homely" feel to it. Staff did not wear uniforms. People respected each other's privacy while at the same time clearly demonstrating that they were fond of each other.

Is the service responsive?

People's needs had been assessed on a regular basis. As the home was so small the manager told us that they responded to changing needs as and when necessary. We saw that one person had become unwell and therefore they had changed their bedroom to a ground floor room. Each person had a key worker who was responsible for ensuring their well-being was maintained. The key worker was also responsible for ensuring that the person's files were up to date and that all the care staff were informed of any changes to their care needs.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were updated and implemented. We saw that questionnaires were available in easy-read formats as was general information such as how to complain. We saw evidence that the manager sort professional advice when it was needed and responded appropriately when matters needed to be looked into. One visiting relative told us that they were very pleased with the quality of the staff who worked at the home.

We saw that people's newly updated personal support plans described their needs and how those needs were met. We saw that people's mental capacity was assessed and we saw records that showed that multi-agency meetings had been arranged to determine particular procedures were in people's best interest.

We saw that medicines were administered by suitably trained staff. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to administer and record medication.

All the staff we spoke to said that they felt well supported by their colleagues and management. We saw staff received the training they required to carry out their roles.

Some of the people we spoke with thought that the registered manager and the owner would handle complaints appropriately. We looked at the complaints procedure available to people which showed it was in an easy read format to assist people.

One staff member said, 'Home from home' and one person who used the service said, 'I have no worries' and 'All the staff look after me'.

People who we were able to speak to us said that they liked living at Stoke View. One person said 'The staff are kind, thoughtful and considerate'.

We saw that staff treated people respectfully, promoting choice and independence whenever possible.

People had been involved in discussions about their care and support and were able to look at their records and personal information. This involvement ensured that people's specific needs and wishes were understood and taken into account when planning their care.

We saw that the care planning system was being further improved to ensure that information was accurate and included people's personal wishes and future goals.

People were able to access a range of healthcare services and we saw examples of prompt action taken by staff to address any changes or deterioration in people's health.

Staff were aware of issues relating to abuse and were able to attend regular training opportunities to ensure that they could recognise and respond appropriately to abuse if it occurred within the service.

Systems were in place to regularly review the quality of the service, and changes were made when the need for improvements were identified.