Archived: Stinchcombe Manor

At the time of our inspection, 26 people were living at Stinchcombe Manor. Stinchcombe Manor is based in rural Gloucestershire. The service is split over two floors with communal spaces on each floor. The service has a small secure garden, as well as larger gardens overlooking local farm land which people could enjoy. This was an unannounced inspection.

We previously inspected the home on 9 March 2017 and rated the service as “Requires Improvement”. The service had not met all of the required regulations, for example the registered manager and provider did not have effective systems to monitor the quality of the service they provided. People’s care records were not always accurate, complete and contemporaneous. The provider sent us an action plan detailing the action they were planning to take. At our June 2018 inspection we found the service had taken appropriate action to meet the regulations and was rated ‘Good’ overall.

There was a registered manager in place at Stinchcombe Manor. 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 were safe living at Stinchcombe Manor. There were enough staff deployed to ensure people’s needs were being met. People received the support they required to meet their health and wellbeing needs.

People received their medicines as prescribed. The registered manager was working through an internal improvement plan detailing the actions they would take to improve the management and recording of people’s prescribed medicines.

Care staff treated people with dignity and ensured their nutritional needs were met. Catering and care staff were aware of and met people’s individual dietary needs. Staff spoke positively about the support and communication they received. Care staff felt they had all the training and support they required to meet people’s needs.

Care staff were caring and were aware of people’s health needs. People and their relatives felt their concerns and views were listened to and acted upon. Relatives told us the management team was responsive and approachable.

The registered manager and provider had implemented systems to monitor and improve the quality of service people received at Stinchcombe Manor. The registered manager had a clear vision of how they wanted the service to develop and improve, with a focus on providing people with varied and personalised activities.

Stinchcombe Manor is registered to provide residential and nursing care for up to 36 older people some of whom may be living with dementia. The home was a converted grade two listed manor house set within large landscaped gardens. The service has three shared rooms and all others were for single occupancy. At the time of our inspection there were 22 people in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. However, the day to day management of the service was led by the clinical lead nurse.

Improvements were still required to ensure people’s care planning documents and care records were accurate and complete. A new care planning system had been introduced but was not fully embedded. The staff required additional training to make this effective and ensure people did not receive the wrong care.

Improvements were also required with some of the providers quality assurance systems to ensure that any shortfalls were identified and acted upon.

The staff team understood their role and responsibilities to protect people from harm. Where safeguarding concerns had been raised, the service had worked with the local authority to address the issues raised. Any risks to people’s health and welfare were assessed and appropriate management plans were in place to reduce or eliminate the risk. Staffing numbers on each shift were sufficient to ensure people were kept safe.

The management of medicines was safe and improvements recently identified by a pharmacist were being acted upon. The premises were clean, tidy and fresh smelling and there were good infection control and prevention measures in place to safeguard people.

Staff received the training they required to carry out their roles effectively. New staff to the service had an induction training programme to complete and regular refresher training was arranged for the whole team.

The service worked in accordance with the Mental Capacity Act 2005 and where appropriate Deprivation of Liberty Safeguard applications had been made to the local authority. Staff asked people to consent to receiving care and support even of the person lacked capacity to make bigger decisions about their care and support.

People were provided with sufficient food and drink and staff monitored those people who were at risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

The staff team were kind and caring and had positive and caring relationships with the people who lived in the home. Relatives and other visitors to the service were welcomed, treated with respect and dignity and offered refreshments. People were involved in making decisions about how they wanted to be looked after and their privacy and dignity was maintained at all times. The service was working to achieve the National Gold Standard Framework accreditation for end of life care. The service had a suite of two beautifully decorated and furnished rooms, joined to but separated from the rest of the home. In this area there were facilities for visitors to rest and make tea and coffee.

People received care and support that met their individual specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.

The clinical lead nurse and the registered manager provided strong leadership and management for the staff team. They were both well respected by staff, relatives and the people who lived in Stinchcombe Manor. The service has made significant improvements since the last full inspection but there were still areas requiring action.

We found breaches of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At our comprehensive inspection of this service on 25 June and 1 July 2016 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with three warning notices and two requirement notices stating they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

This unannounced inspection was carried out to assess whether the provider had taken action to meet the warning notices we issued.

This report only covers our findings in relation to the warning notices we issued. We have amended the ratings for these areas since the inspection on 25 June and 1 July 2016. The overall rating is now ‘Requires Improvement’.

However, the service remains in ‘Special Measures’ until we carry out a comprehensive review. This will allow us to see if the improvements made have been sustained over time and check if action has been taken in relation to the requirements made at the last inspection. We will then be able to assess and rate each of our five key questions.

The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Stinchcombe Manor on our website at www.cqc.org.uk.

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 this inspection we found that the provider had taken action to address the issues highlighted in the warning notices.

The systems for the storage and administration of medicines had been altered since our last visit. As a result, people were safe from the risks associated with the management of medicines. Fire extinguishers were accessible and properly secured, fire exits were clear, fire doors were no longer propped open and fire drills were carried out. As a result, people were safe from the risks associated with fire.

The provider had ensured a qualified nurse was available throughout the day and night and had made changes to staffing levels. As a result, people were cared for by sufficient numbers of suitably qualified staff. Despite these improvements we made a recommendation that staffing levels were kept under review by the registered manager and provider to ensure people continue to be kept safe.

Systems to monitor and improve the quality of service people receive had been introduced. These included a system for seeking the views of people and their relatives. The registered manager and provider were monitoring accidents, incidents and complaints and appropriate records were kept. This meant they would be able to identify any themes and trends and make any changes required. Accurate and complete records of the care and treatment people received were now in place. A system was in place to ensure compliance with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The improvements reported above must now be sustained. Further actions the provider has told us they will take to address the requirements contained in the report of our visit on 25 June and 1 July must also be fully implemented.

This inspection was unannounced and took place on Saturday 25 June and Friday 1 July 2016. We last inspected the service on 1 and 2 December 2015. At that inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to ensuring people were cared for by suitably qualified staff and, the provider failing to submit notifications to the Care Quality Commission (CQC) as required by law. The provider sent us an action plan saying what they were going to do to make the necessary improvements. At this comprehensive inspection we checked if improvements had been made. CQC had also received information of concern from a number of sources. These concerns were followed up at 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.

People were not always kept safe. This was because there was not always enough staff and medicines were not always managed safely. Fire extinguishers were not always secured properly or accessible, fire exits were not always clear, fire doors were being propped open and there was no evidence of fire drills being carried out.

The service provided was not always effective. Where people were assessed as not having the capacity to make choices and decisions and, there were restrictions upon their freedom, the provider had not always sought authorisation from the appropriate authorities. People’s intake of food and drink and their weight was not closely monitored. The provider had carried out improvements to the home to make it easier for people living with dementia. Staff had received the training required to meet people’s needs.

People did not always receive a service that was caring. Staff treated people in a caring manner. People’s independence was promoted. Staff tried to ensure people’s privacy and dignity was maintained. However, some people shared rooms and their privacy was compromised.

The service was not always responsive to people’s needs. The provider had not maintained a clear record of complaints or monitored these over time to identify any themes or areas requiring action. People had access to a variety of activities that were planned taking into account their needs and interests.

The service was not well-led. The leadership and management of the service had not been consistent, resulting in people, relatives and staff lacking confidence in it. The provider did not operate effective systems to monitor and improve the quality of service people received. The provider had not operated audit and governance systems effectively to identify where improvements were required and take action. The provider had not ensured accurate records of people’s care were maintained. The provider had not published their ratings on their website.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.