Archived: Abbeyfield - Stangrove Lodge

The responsive follow up inspection was carried out by one Inspector, who visited unannounced on the 21 July 2014. We visited announced on the 28 July 2014 to discuss issues of concern that we had found on the 21 July 2014 with the manager. The visits were made to follow up on the two compliance actions that had been made on the 16 April 2014. Before the visit, we had received anonymous information that alleged that people's needs were not being met, there were not enough staff and there was insufficient equipment.

During the visit we met and talked with people that used the service, the manager, the care co-ordinator, senior care staff, care staff, and ancillary staff. They helped answer our five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We observed that care records were reviewed and regular auditing was undertaken to ensure that people were protected against the risks of inappropriate or unsafe care and treatment.

The provider had not taken proper steps to ensure that each person was protected against the risks associated with the use of equipment by ensuring that it was properly maintained and suitable for its purpose.

The provider had not taken proper steps to ensure that, at all times, there were sufficient numbers of staff working each shift to meet the needs of the people that used the service.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We found that the staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the specialist health care support they needed.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People we spoke with told us that they were happy with the care they received and that they got the help they needed.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Is the service well-led?

The manager told us that he was an experienced manager having worked at other homes owned by the company. He said that he started work at Stangrove Lodge in March 2014.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

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, clean and hygienic. Equipment at the service had been well maintained and serviced regularly.

At our inspection of 11 September 2013 we found that records relating to people's care were not always kept up to date. At this inspection we found that most people had a complete and up to date care plan that reflected the majority of their care needs, however some areas of need had not been included in the written plans. One person did not have written information and records to tell staff how to deliver the care they needed. Care records were stored securely, but were not always easily accessible to staff.

Accident and incident reports were being completed fully and all records were being signed and dated by the person completing them.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support the people using the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had 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?

People had an assessment before they moved to the service that identified their needs and took account of their preferences. We saw that most people had a care plan that ensured these needs were met. However, one person did not have a care plan in place and some people did not have plans in place to address all areas of their nutritional needs.

Our observations showed that people received the care outlined in their plan in the way it was agreed to be delivered. It was clear from what we saw and from speaking with staff that they understood people's care plans and that they knew people well. People told us that their needs were met in the way they wanted.

People had access to the equipment they needed to aid their independence and meet their needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient when supporting people and treated them with respect. People appeared relaxed around the staff that supported them and staff were quick to notice when people needed support.

Is the service responsive?

People's needs had been assessed before they moved into the service. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. However, one person did not yet have a care plan to ensure their assessed needs would be met. People had access to social activities and events that they told us they enjoyed.

Records showed the service responded to changes in people's health needs and made referrals to other professionals when needed.

Is the service well-led?

Quality assurance processes were in place to check on the quality of the service as well as the safety. This included daily quality checks by the senior person in charge and monthly audit reports completed by the manager. A senior manager visited monthly to carry out a quality check.

The manager of the service sought the views of people using the service and their relatives and took action in response to suggestions and requests they made. For example, a dementia information session had been arranged in response to a request from relatives.

Systems were in place to monitor and evaluate accidents and incidents in the service. Records showed that action was taken to reduce the risk of accidents occurring again.

The atmosphere in the house was relaxed and we observed staff being caring and supportive in their approach to people. They appeared to know them well and clearly understood their individual needs and preferences. One person we spoke with told us "They seem to have an awful lot of paperwork to do but they always put us first."

We spoke with seven members of staff about their understanding of safeguarding issues in relation to vulnerable adults. They all demonstrated a clear understanding of signs and behaviours associated with potential abuse that they should look for.

We observed that there had been sufficient staff throughout our visit to assist people when they needed support. We saw that people who used the service were supported with their personal care in private and in a way that promoted their dignity.

Staff told us that they were happy working for the service and said the new management team were approachable and supportive.

On the day of our inspection Abbeyfield – Stangrove Lodge was clean, tidy and in a good state of repair. The design and layout ensured that people who used the service could move around easily and there was adequate space for participating in activities, eating and socialising or finding a quiet space.

At our last inspection on11th of October 2013 we found that people were not protected from the risks of unsafe or inappropriate care and treatment as accurate records were not always kept. At this inspection we found an improvement in the quality of the records kept however some information was still not recorded accurately.

At our last inspection on 11th of October 2012 we found that the provider had not yet evaluated the quality of the service based on the views of people used the service. At this inspection we saw people who used the service, their representatives and staff were routinely asked for their views about their care and treatment and these had been acted on.

We spoke with six people who used the service who said 'the staff look after me well', "the staff are nice and helpful' ," I can choose what to do and what activities' and 'there are activities like word games but there could be more'.

We spoke with two relatives of people who used the service. One relative said, "the home has improved my relative's health and they are building a good picture of their needs and interests".' Another relative said, 'I am happy with the care and my relative always is offered choices, they are also clean and well dressed'.

Three people who used the service said that they thought there was enough staff available. A relative of a person who used the service said that staff were available when they visited and that they were always present supervising people in the sitting room.

We used the Short Observational Framework for Inspection (SOFI). This is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed that staff were attentive to people and they had a good understanding of their communication styles or body language. We observed staff offering support in a sensitive and caring manner. We saw a staff member support a person who had become upset in a supportive and caring manner.