Station House

Station House is a nursing home providing personal and nursing care for up to 71 older people including people living with dementia. The home is divided in to two separate units, one for people living with dementia the other for people who need general nursing or residential care. The home also provides Intermediate Managed Care and Transitional Care. Intermediate Managed Care promotes rehabilitation and/or recovery following accident or illness. Transitional Care offers short term care and support during a period of health or social care crisis. At the time of the inspection 51 people were living or were placed at the home.

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test, temperature checks and a health questionnaire before entry into the home was allowed.

There was an ample supply of PPE for staff and any visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE and we observed staff wearing it correctly during out inspection.

Zoning was in place and the home was split into two distinct areas to minimise risk of spreading infection. Staff members assessed as vulnerable were not required to work in areas where residents who had tested positive for COVID-19 were living. Separate zoned rooms were used for staff to put on and take off PPE and take breaks, there was no overlapping of staff.

Station House is a nursing home providing personal and nursing care for up to 71 older people including people living with dementia. The home is divided in to two separate units, one for people living with dementia the other for people who need general nursing or residential care. The home also provides Intermediate Managed Care and Transitional Care. Intermediate Managed Care promotes rehabilitation and/or recovery following accident or illness. Transitional Care offers short term care and support during a period of health or social care crisis. At the time of the inspection 70 people were living or were placed at the home.

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

People’s needs had been assessed, care plans developed, and risk assessments put in place to ensure people’s individual needs could be met and risks reduced or mitigated. Care plans were regularly reviewed and updated.

Regular staff had developed positive relationships with people and their relatives. They had a good understanding of how to meet each person’s individual needs and fully understood their routines and preferences. There was a high level of agency use that people told us affected some of the continuity of care. The registered manager used regular agency staff where possible. People’s privacy and dignity was consistently respected.

Safe recruitment procedures were in place and staff were supported in their role with appropriate training and supervision. The staff and management team worked closely with health and social care professionals.

Medication was managed safely by trained and competent staff. Medicines policies and procedures were available for staff along with best practice guidance. Emergency procedures and contingency plans were in place.

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; the policies and systems in the service supported this practice.

People’s dietary needs were assessed and met. People spoke positively about the food choices available at the home.

People had access to a variety of activities within the home and spoke positively about these. People were encouraged to maintain contact with relatives and friends.

Staff had access to and understood the importance of personal protective equipment (PPE). An infection control policy and procedure were in place and staff had completed training in this area.

The registered provider had effective audit systems in place that identified areas for development and improvement

Rating at last inspection and update: The last rating for this service was requires improvement (published 20 September 2018) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspect:

This was a planned inspection based on the rating of the last inspection.

Follow-up:

We will continue to monitor all intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

Station House is a ‘care home’. 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.

Station House is registered to provide nursing care for up to 71 older people. There are two separate units, one for people living with dementia, the other for people who need general nursing or residential care. The service provides long term care for people with nursing and / or dementia care needs. It also provides Intermediate Managed Care and Transitional Care. The aim of Intermediate Managed Care is to promote recovery and independence following an illness or accident. The aim of Transitional Care is to offer care and support for a short period of time, usually when there has been a health and /or social crisis. At the time of the inspection 62 people lived at or were placed at the home.

At our last inspection in June and July 2017, we had found that the service was not safe, responsive or well led and was not always effective and caring. We identified breaches of regulations including regulation 9 (person centred care), 10 (Dignity and respect) 11, (need for consent), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment, 16 (Receiving and acting on complaints), 17 (good governance) and 20 (Duty of candour) of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We took enforcement action and the service was put into special measures.

After our inspection in June and July 2017, the provider submitted an action plan to the Care Quality Commission (CQC) outlining the action they would take to improve the service.

At this inspection, we found that significant improvement had been made in all aspects of service delivery. We found that some further improvements were required and the improvements that had been made needed to be sustained. The overall rating for the service is upgraded to: requires improvement.

We found that the atmosphere in the home was relaxed and sociable. All the people spoken with including all relatives made positive comments about the staff and the standard of care provided.

We found that the home’s safeguarding systems, processes and practices had improved markedly. People were protected from abuse, neglect, harassment and breaches of their dignity and respect.

Managers and staff were knowledgeable about adult safeguarding procedures. They knew what action to take and enjoyed good working relationships with the local social services team.

There was a sufficient number of suitably trained and qualified staff on duty to meet the needs of the people who lived at the home. The staff presented in buoyant mood and told us that their morale had improved. They told us that they appreciated the support, direction and leadership of the new manager.

All people spoken with praised the standard of catering in the home and we could see that they enjoyed a varied and nutritious diet.

Care and nursing staff respected and promoted people’s privacy, dignity and independence. They were caring and compassionate in their approach and encouraged people to express their views and actively involved in making decisions about their care and support. Managers and staff acted in accordance with the Mental Capacity Act and ensured that people received the right kind of assistance to support them in making decisions.

Healthcare professionals were involved in people's care and visiting health and social care professionals made positive comments about the standard of care provided.

People’s concerns and complaints were listened and responded to and used to improve the quality of care provided.

Nursing and care staff were aware of the need to support people approaching the end of their life and care planning arrangements were person-centred to ensure their wishes and needs were respected. The relatives of a person admitted to the home for palliative care praised the staff and the standard of care provided.

The new manager presented as an enthusiastic and caring professional who was skilled at involving people and developing solutions to problems and concerns. Nursing and care staff presented with confidence and we could see that the home was generally well organised, well managed and staff were well supported.

The registered provider and manager had notified CQC of events and incidents that occurred in the home in accordance with our statutory notification requirements, with one exception.

The registered provider, the registered manager and all members of the management team were seen to be actively fostering a culture in the home which was open and transparent. The systems for auditing the quality of the service had been embedded and were consistently carried out. These had helped ensure improvements in the service. However, we saw that some of the issues that we identified on the inspection had not been picked up by the provider’s audit system and where not always effectively monitored. We found that staff were not always making records at the time the care was given and in one instances records were inaccurate and misleading.

The overall rating for this service is Requires Improvement. The registered provider’s representative and the registered manager told us that the home aims to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive.

Station House is registered to provide nursing care for up to 71 older people. There are two separate units, one for people living with dementia, the other for people who need general nursing or residential care. The service provides long term care for people with nursing and / or dementia care needs. It also provides Intermediate Managed Care and Transitional Care. The aim of Intermediate Managed Care is to promote recovery and independence following an illness or accident. The aim of Transitional Care is to offer care and support for a short period of time, usually when there has been a health and /or social crisis. At the time of the inspection 62 people lived at or were placed at the home.

At the last inspection in August 2016 the service was meeting the requirements of the regulations that were inspected at that time. However, we had found that the service was not always safe because medicines were not always administered safely and securely and made a recommendation about the safe administration and security of medicines.

This location requires a registered manager to be in post. A registered manager was in post at the time of our inspection. 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 this inspection, we found that the provider was in breach of regulations 6, 9, 11, 12, 13, 16, 17 and 20 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that the service was not safe, responsive or well led and not always effective and caring. During the course of the inspection, the response and actions of the registered manager, did not demonstrate that that they had the necessary competencies to manage the home safely and effectively. Quality assurance systems were in place but these had failed to identify uncontrolled risks presented to the people who lived at the home. There was evidence of a failure to analyse incidents and learn from experience when things had gone wrong.

Most of the people spoken with told us that they were safe and received safe and effective care but others expressed concern and one person did not want us to raise their concerns with the staff for fear of repercussions. We found that the management team were not taking effective action to safeguard vulnerable people when they were made aware of allegations of abuse and instances of actual abuse which had resulted in physical and or emotional harm. The registered manager was defensive and had failed to share evidence of actual abuse and allegations of abuse with the Commission and the local safeguarding authority. This had left vulnerable people without adequate protection. The Commission are looking into specific incidents prior to making regulatory decisions about the incidents known to us.

Investigation into evidence and allegations of abuse were not always carried out thoroughly or effectively so vulnerable people remained at risk. Complaints made by people who used the service and their representatives were not always recorded in the complaints system and a vulnerable person was served notice within 24 hours of their admission to the home because they had contacted an outside agency to raise concerns about the care they had received.

Care and nursing staff were found to be practicing restraint of a service user, in the interest of ensuring that they received effective personal care, but without required training in the use of safe restraint, effective risk assessment or lawful authority. This meant that staff and the service users’ health and well-being was put at uncontrolled and unmanaged risk.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments were in place to assist people with their decision making but the management team had not always acted in accordance with the mental capacity act code of practice.

On the first day of the inspection the home was short staffed because one member of staff had taken sick leave with short notice. We saw that the staff team pulled together, working as an effective team by ensuring that the priority needs of the people resident at the home were met in a safe and effective manner. We saw that there was enough staff to provide safe care. Most of the people we spoke with were satisfied with staffing levels.

During the inspection medicines were administered safely and effectively ensuring the health and well-being of the people resident at the home. Nurses were seen to work hands on alongside care staff providing effective care and sensitive support. This provided for a positive atmosphere in the home with the majority of people glad to inform us that they received safe and effective care and support.

Recruitment and selection of staff was carried out safely with appropriate checks made before new staff started working in the home. This reduced the risk of employing unsuitable people.

People told us they were offered a choice of healthy and nutritious meals. Drinks were available throughout the day and people’s dietary and fluid intake was monitored to ensure it was sufficient for good hydration and nutrition. People were complimentary about the meals with several people reporting that the food was excellent.

People in receipt of intermediate care expressed a high degree of satisfaction with the services they had received and one person who spoke with great insight described their experience as nothing short of excellent. Visiting Doctors and other health and social care professionals expressed the same sentiments.

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following our inspection we s we sent the provider a letter of serious concern and that they are working closely with us and updating weekly to improve the service.

Station House is registered to provide nursing care for up to 71 older people. There are two separate units, one for people living with dementia, the other for people who need general nursing or residential care. The service provides long term care for people with nursing and / or dementia care needs. It also provides Intermediate Managed Care and Transitional Care. The aim of Intermediate Managed Care is to promote recovery and independence following an illness or accident. The aim of Transitional Care is to offer care and support for a short period of time, usually when there has been a health and /or social crisis.

At the time of the inspection 70 people lived at or were placed at the home.

At the last inspection in July 2014 the service was meeting the requirements of the regulations that were inspected at that time.

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 told us they felt safe living at Station House and liked living there. People said they received their medicines when they needed them. However staff did not always administer medicines safely and securely.

We have made a recommendation about the safe administration and security of medicines.

The registered provider had procedures to protect people from abuse and unsafe care. Staff were proactive in reporting possible safeguarding concerns and took immediate action to reduce risks where they became aware of a safeguarding concern.

We looked at how the home was being staffed. We saw there were enough staff to provide safe care. People we spoke with were satisfied with staffing levels.

Recruitment and selection was carried out safely with appropriate checks made before new staff started working in the home. This reduced the risk of employing unsuitable people.

People told us they were offered a choice of healthy and nutritious meals. Drinks were available throughout the day and people’s dietary and fluid intake was sufficient for good nutrition. People were complimentary about the meals.

Staff had received training in care which gave them the skills and knowledge to provide support to people.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This enabled staff to work within the law to support people who may lack capacity to make their own decisions.

People we spoke with said staff were friendly, caring and respectful assisted them in a timely way. They said staff supported them to remain as independent as they could be. People and their relatives felt their needs and wishes were listened to and acted on. We saw staff were familiar with people’s care needs, likes, dislikes and wishes and supported them in the way people wanted.

There was a transparent and open culture that encouraged people to express any ideas or concerns. People said staff were easy to talk to and encouraged people to raise questions.

There were procedures to monitor the quality of the service. The registered manager sought people’s views in a variety of ways and dealt with any issues of quality quickly and appropriately. Staff told us she supported them and communicated well.

During the inspection we spoke with the deputy manager, the unit manager, the activities coordinator and three staff members. We also spoke with seven of the people who lived in the home and three of their relatives.

We considered all the evidence we had gathered under the outcomes we inspected. 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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We spoke to staff and they showed a clear understanding of consent issues. They demonstrated to us that people living in the home may be able to give consent in some circumstances but would need support in others. We saw that the staff had undertaken updated Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training in March 2014 and they told us that this had been useful in improving the support they offered to people.

We looked at the safeguarding policy. This was available in the office. All the staff we spoke to were aware of the policies and how to access them. The deputy manager was able to demonstrate a good understanding of the reporting systems for the local authority and the Care Quality Commission in relation to safeguarding people. They described to us the processes that were currently being carried out to ensure that Deprivation of Liberty Safeguards referrals were made to the local authority for people who lived in the home that they had assessed required it to protect them from harm.

Is the service effective?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We looked in some detail at the care and support provided to five people who lived in the home. These records included the person's care plans, risk assessments, and records about the support they had received from professional people outside of the home. We found the information in each person's care plan was detailed and reflected the person's needs.

We saw that the home maintained very good relationships with the local GPs who looked after the people living in the home. We saw that formal meetings were held every three months with the management team and the GPs. The deputy manager told us that they speak informally at the weekly visits. They also told us that the home had installed broadband so that the GPs could access their systems remotely and prescribe instantly in the home as required to meet the medical needs of people quicker.

Is the service caring?

During our inspection we spoke with seven people who lived in the home and three relatives. They all spoke highly of the staff who supported them and the care that they received. One person said "The staff here are lovely. I feel very lucky to be here." A relative told us "They are brilliant. They care for Dad and they are good with our family. They care for all of us really."

During our inspection we observed staff supporting people in a respectful way and asking them for consent prior to carrying out tasks.

Is the service responsive?

The unit manager from the dementia unit told us that Dementia Care Mapping was being used in the home. Dementia Care Mapping (DCM) is a tool developed by Bradford University to measure the care and interaction that a person with dementia receives in their care setting. The data is then used to look at the person's care and their care plan and make improvements to their daily life and their sense of well-being and opportunities for engagement in meaningful activities. The unit manager showed us how the environment had been improved to support the well being of the people who lived there and how this had impacted on people's care in a positive way.

We spoke to the activities coordinator and saw that many different activities took place in the home. On the day of our inspection a local television crew were filming the music therapy session in the home. We were told that a music therapist had been working with some of the people who lived in the home supported by musicians from the Manchester Camerata chamber orchestra. This had been very successful in improving communication and interaction for people. We spoke with some of the people who lived in the home and they were very excited about the prospect of being on the television.

Is the service well led?

Team meetings were regularly being held. We saw that there were head of department meetings, unit meetings, night staff meetings and clinical meetings as well as general staff meetings. We saw that the registered manager had held specific meetings to respond to requests made by staff. The staff we spoke to made very positive comments about the management team in the home, including the manager, deputy manager and unit managers. The staff described them as "very supportive". Comments included; "I can raise concerns whenever I like. If I tell them it's important they stop what they are doing and listen to me." Staff also said that they had been supported with personal issues and that this was appreciated.

We looked at the staff rotas for the six week period prior to our inspection. We saw that staffing levels were fairly consistent. We discussed staffing levels with the deputy manager. They told us that the home had enough staff to meet the needs of the people who lived there. They told us that every effort was made to cover shifts when staff were on holiday or were unwell. The home did not use agency staff, the sought cover from within their existing team. We were also told by staff that the registered manager and the deputy manager would cover shifts on days or nights if required.

Where they were able people were consulted with about their care and treatment. However assessments to show a person 'lacked capacity' to make specific decisions for themselves were not in place. Additional records where decisions had been made on behalf of a person were not always completed in sufficient detail. This did not demonstrate that people's rights were upheld in accordance with relevant legislation.

People's care records contained enough information to show how they were to be supported and cared for. People told us they were well looked after. Comments made included; 'They are looking after me very well, it is very free and easy here' and 'The staff are fantastic, it's really very good indeed'. Also 'It's first class' and 'The staff are all very good and look after him well'.

We saw that staff worked closely with other health and social care agencies so that people's needs were effectively met. We were also made aware of the systems that were in place to make sure information was passed on when a person's care was transferred to another service.

People were provided with a choice of suitable and nutritious food and hydration to ensure their nutritional needs were met. One person we spoke with told us, 'The food is good and there is always a choice. I could have a cooked breakfast, but I choose not to'.

The home gathered relevant information and carried out checks on people who had applied to work at the home. All records were in place prior to people commencing work. Interview records lacked detail about the applicant's knowledge and experience or how the decisions were made about their suitability.

The provider had systems in place for receiving, handling and responding appropriately to complaints. People were provided with clear information about the procedure in place for handling complaints.