Stradbroke Court

Stradbroke Court is a residential care home providing accommodation and personal care to up to 43 people in an adapted building across 5 units. The service provides support to older people, some living with dementia and mental health conditions. At the time of our inspection there were 34 people using the service.

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

Improvements were needed to ensure people always received good quality, compassionate, individualised and safe care as a minimum standard.

Risks to people were not always robustly assessed and mitigated. Staff did not always have the information they needed to provide safe care because risks associated with people's care had not always been fully assessed. This included risks relating to falls, diabetes, and choking.

There were not sufficient numbers of suitably skilled staff to make sure they could meet people's care and support needs; there had been a high number of unwitnessed falls in the service. Staffing levels were increased following the inspection.

Actions to detect, investigate and report allegations of abuse or neglect were not always sufficient. The local authority had received a high number of safeguarding referrals, which included concerns around people's sexual safety.

Infection control procedures required improvement. We found personal protective equipment (PPE) stored next to toilets, which posed a risk of cross contamination. The service was in significant need of redecoration. Paintwork was chipped in many areas and carpeting was worn. This meant that effective cleaning could not take place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Further work is needed to ensure mental capacity assessments and best interest decisions are in place for all aspects of people's day to day care.

People were referred to relevant professionals such as dieticians if people needed to gain weight. However, the current system in place for recording people’s nutritional intake did not support the staff to clearly monitor what people had eaten daily, including any snacks to encourage weight gain.

Referrals were made to health professionals when there were concerns about a person’s wellbeing. However, people’s records did not always show the date of the visit or the guidance received. Care plans had not been updated to incorporate the guidance to ensure people received consistent care which met their needs.

The staff training matrix showed gaps in staff training in areas such as first aid, falls awareness, and the Mental Capacity Act. Following the inspection, the care operations manager confirmed further face to face training had been booked in various subjects to ensure staff were up to date in their knowledge and practice.

Improvements were required to ensure that good practice in dementia care was being followed, such as designing and decorating premises in a way that supports people. There were no dementia care plans so staff had no information to understand when people were diagnosed, which subtype of dementia they had, and how this would affect their lives as it progressed.

Medicines were managed safely, and staff were recruited with suitable checks in place.

The provider's oversight and monitoring systems and processes had not been effective and failed to appropriately manage risks to people and ensure adequate numbers of skilled staff were deployed. Auditing systems had not always led to immediate improvements when issues were found. There were limited systems to gain people’s feedback about their care, and feedback which had been received had not been used to drive improvements.

The registered manager was on leave at the time of the inspection, and there was a new manager in post. The provider was responsive to the inspection findings, they told us they were willing to learn, improve and share the actions they would take to address the issues found at this inspection.

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

Rating

The last rating for this service was good (published 25 December 2019).

Why we inspected

We received concerns in relation to the safety of people using the service and the high number of safeguarding referrals that had been made. 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 inadequate 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 full 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 and focused inspections, by selecting the ‘all reports’ link for Stradbroke Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, governance, staffing, consent procedures and safeguarding.

Please see the action we have told the provider to take at the end of this report.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Stradbroke Court provides accommodation and personal care for up to 43 older people, some of whom were living with dementia. At the time of our visit 38 people were using the service.

What life is like for people using this service:

We carried out this inspection in response to concerns about people’s health, safety and welfare. At this visit we did not identify any concerns or shortfalls that would place people at risk of harm.

People who live at Stradbroke Court have their needs met by sufficient numbers of suitably trained staff.

Medicines were managed and administered safely.

Risks to people were identified, monitored and managed. The service was clean and appropriate infection control procedures were in place.

The provider had employed a new manager who was proactive in identifying areas for improvement. A new regional manager had also been appointed, who was overseeing the management of the service. Both were transparent in accepting that there were areas for improvement and development in the service. A thorough and robust action plan had been put in place stating how each area for improvement would be addressed and this was ongoing.

The quality assurance system in place to monitor the service provided to people was robust and capable of identifying areas for improvement.

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

Rating at last inspection (and update):

At the last inspection the service was rated Good. (Report published 6 December 2017)

Why we inspected:

We received concerns in relation to the care people received to keep them safe. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report.

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

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

During our inspection on 20 and 28 April 2017 we found there were six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed regarding safe management of medicines, infection prevention and control systems, staffing arrangements, safe care and treatment, person centred care and good governance.

We undertook enforcement action placing two positive conditions on the provider’s registration. One condition was to restrict admissions to the service and the other condition was for the provider to submit to CQC a monthly report of the actions taken to improve the quality of the service regarding safe management of medicines and infection prevention and control.

Following our inspection on 20 and 28 April 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection. This included unsafe management of medicines, inconsistent staffing arrangements, shortfalls in records, poor infection prevention and control systems, ineffective oversight and governance arrangements, not responding appropriately to people’s feedback including concerns, ineffective systems to reduce the risks of dehydration and poor quality of care provided. We received the provider’s monthly progress reports in relation to medicines and infection prevention and control measures. We also received regular updates on the provider’s action plan which told us the provider was making the improvements needed.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall. Therefore, this service is now out of Special Measures.

At this inspection on 11 and 19 October 2017 we found no breaches in regulations, and the necessary improvements had been made. The key questions, safe, effective, responsive and caring were rated as good. Well-led has been rated as requires improvement as the measures in place to address the previous shortfalls and to provide people with a safe quality service need to be fully embedded and sustained within the service to be rated as good. In the six months since our last inspection we were encouraged by the progress made by the management team to turn the service around and have rated this service overall good and removed the positive conditions placed on the registration of Stradbroke Court.

Stradbroke Court 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. Stradbroke Court accommodates up to 43 people who require support with their personal care needs, some of whom are living with dementia. At the time of this inspection there were 15 people using the service.

A registered manager was 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.

There was visible leadership in the service. Systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. The registered manager worked closely with the provider’s nominated individual and was supported by an external consultancy company and the registered manager of one of the provider’s other services; this had led to the overall quality and safety of the service improving.

People and relatives were complimentary about the care and support provided. Staff consistently respected people’s privacy and dignity and interacted with them in a kind and compassionate manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said.

People and their relatives were positive about the approach of the registered manager; saying they were accessible to them and that communication in the service had improved. They described how the registered manager had addressed previous concerns around quality of care and staffing arrangements and they were confident in their ability to address any issues and to move the service forward.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. Effective infection prevention and control systems had been implemented with staff following best practice and the advice from relevant professionals.

There were sufficient numbers of staff effectively deployed to meet people’s needs who had been recruited safely. Staff were trained and supported to meet people’s needs. They knew how to minimise risks and provide people with safe care and what actions to take to protect them from abuse.

Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Improvements had been made to ensure people’s care records reflected personalised care which were regularly reviewed and amended to meet changing needs.

People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. Appropriate referrals were made and acted on where concerns had been identified and people were encouraged to attend appointments with health care professionals to maintain their health and well-being. Where required people were safely supported with their dietary needs.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff understood the need to obtain consent when providing 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 were provided with the opportunity to participate in activities and to pursue individual interests.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. People knew how to make a complaint if they were unhappy with the service.

There was a positive culture in the service which meant that staff were aware of the values of the service and understood their roles and responsibilities. The atmosphere in the service was friendly and welcoming.

At our last inspection 8 December 2016 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were concerns with safe care and treatment, person centred care, staffing and good governance. We rated Stradbroke Court ‘requires improvement’ overall. We told the provider to submit an action plan to us to let us know how they intended to address the concerns we raised. At this inspection we found that the provider had not made satisfactory improvements to ensure that they were consistently delivering a high standard of care and that the standards of care had actually declined.

Due to a number of concerns raised about the service we brought forward this scheduled inspection so we could check that people were receiving safe care. At this inspection, we found people's safety and well-being was being compromised in a number of areas.

There have been several changes of manager since our last inspection. Currently there is a manager in place but they are not registered with CQC. 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.

This inspection identified serious concerns regarding the management and leadership of the service, safe management of medicines and infection prevention and control. People were being put at risk of harm and there was insufficient governance and oversight to monitor the service. Due to management changes there had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service.

We found the home was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Four of these regulations were continued breaches from the last inspection 8 December 2016. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people's health, safety and welfare were not managed effectively which placed people at risk of harm.

The systems in place to monitor the service provided were not robust enough for the service to independently identify shortfalls and address them. The service had received support from health and social care professionals and was working to address the concerns they had identified. To assist in making improvements in the service the provider’s nominated individual had recently employed the services of an external company.

Improvements were needed in the management of medicines. The service were working on addressing shortfalls identified by a health professional. In addition we identified that guidance provided to staff relating to medicines that were prescribed ‘as required’ PRN did not hold sufficient information to ensure that the risks to inappropriate use of these medicines were minimised. Medicines that were prescribed in variable doses, for example one or two tablets were not always recorded.

Improvements were needed in infection prevention and control systems. The service were working on addressing shortfalls identified by health professionals. Despite this there had been two recent outbreaks of sickness and diarrhoea in the service. In addition we identified areas within the service that were not hygienic and presented a risk to people.

There was a task led culture in the service. Improvements were needed in the deployment and organisation of staff to meet people’s needs safely and effectively. Recruitment processes were not robust.

The quality of information in people’s care records to guide staff in how people’s needs were met varied and these were in the process of being reviewed by the service following guidance from the local authority. Further consideration of how to provide more and consistent guidance to staff would ensure that people were provided with safe and good quality care at all times.

People’s nutritional needs were assessed. However, improvements were needed in how staff recorded the amounts that each person had to drink and eat each day, where required and how this is monitored to ensure people receive enough to eat and drink.

Staff supported people in the least restrictive way possible; the policies and systems in the service support this practice. However, improvements were needed in how people’s capacity and support to make decisions is included in care records to provide guidance for staff.

An effective complaints procedure was not in place. There were limited systems in place to gain the views of the service provided from people using the service and their representatives. Improvements were needed to ensure people’s concerns and complaints were investigated, responded to and used to improve the quality of the service.

Recruitment processes were not always adhered to; appropriate risk assessments were not carried out where there may have been concerns about a person’s suitability for the job role.

Despite some people living with dementia there was little in the way of signage and familiar items to help people navigate themselves. We recommend that the provider refers to current guidance from a reputable source about adapting the environment for people living with dementia.

The systems in place for staff to receive training, achieve qualifications in their role and be supported through supervisions needed further improvement.

People were provided with some opportunities to participate in activities but this was limited due to the staffing situation. People were treated with respect and compassion by the staff working in the service although improvements could still be made in this area.

Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse. There were safeguarding investigations being undertaken by the local authority, we will continue to monitor the progress and outcomes of these.

People were supported to see, when needed, health and social care professionals when required.

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.”

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

The registered manager was no longer in post but an application to cancel their manager’s registration to CQC had not been received. Following our inspection we received confirmation the provider had submitted an application to CQC to cancel the registered manager’s registration. 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. A new manager had been appointed by the provider to run the service and was in the process of registering with the CQC.

The provider has been registered for Stradbroke Court since 4 September 2015. During this time there have been significant management changes and prior to this inspection we received a high level of concerns relating to the safety and quality of the service from different stakeholders.

Where appropriate we made safeguarding referrals or asked the provider to investigate and report back their findings In addition we chaired a multi-agency meeting with the provider’s nominated individual and the manager to discuss information of concern received about the service from a number of stakeholders. These included insufficient staffing levels, ineffective leadership and governance arrangements, unsafe medicines management and poor moving and handling practices. In addition we were made aware of serious shortfalls regarding Legionella arrangements and health and safety procedures within the service, following a visit from the food/environment safety team. At the meeting the manager shared with us their development plan for addressing the shortfalls and improving the service. We decided to inspect the service to ensure risk was being mitigated and people were safe living in the service.

During the inspection we found there were shortfalls and inconsistencies across the service which impacted on the quality of care provided. Where breaches were identified you can see what actions we have told the provider to take at the end of this report.

Infection control measures were not robust. We observed maintenance contractors carrying disconnected sluice fittings past and over people eating their lunch time meal. The care staff were not alert to the risk of infection and did not challenge or re-direct the workmen. In addition the cistern of a toilet in one of the communal bathrooms was not secure presenting a risk of infection.

There was a task led culture in the service resulting in a lack of cohesion and team work amongst staff. Improvements were required in the deployment and organisation of staff to meet people’s needs safely and effectively.

Improvements were needed to people’s care records. We were not assured that information was accurate, reflected people’s needs and their preferences.

Although staff routinely gained consent before providing care, people’s care plans did not demonstrate a clear understanding of the Mental Capacity Act (MCA) and assessment process.

The atmosphere within the service was not calm. Internal door alarms, call bells and staff communicating to each other via internal radio’s created an unsettling and disruptive environment, making it difficult for staff to hear people calling out. However we observed that call bells and requests for assistance were responded to in a timely manner.

The environment of the service required attention. Internal paintwork within the four units was peeling and chipping and the communal carpets were sticky and stained. There was a discarded toilet in the courtyard which was undignified and disrespectful.

Overall people were provided with their medicines when they needed them and in a safe manner. However additional work was needed to embed best practice, for example we had to prompt staff to reduce the room temperature to ensure people’s medicines were stored at an appropriate temperature

Staff were not consistently supported to develop their skills within their role. An effective system was not in place to assess staff competency and performance. Supervision of staff was not carried out consistently.

Whilst we observed positive communication throughout the day between staff and people the majority of conversation was task focused. There was little incidental or social conversation from staff to engage and interact with people. Further work was required to ensure all staff were consistently caring in their approach, promoted people’s independence and used language that valued people.

People were not supported to live full, active lives and to engage in meaningful activity within the service. The activities coordinator was enthusiastic but working in isolation. We observed that at times people were socially isolated and disengaged from their surroundings. Improvements were needed to ensure people were provided with stimulating activities appropriate to their needs.

People told us that they felt safe. Staff knew how to minimise risks and provide people with safe care. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse.

People were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support. People’s privacy and dignity was promoted and respected.

The service was in a transitional period with a new manager in post. Although we found several inconsistencies within the service, progress had been made by the manager to address the immediate risks to people from unsafe medicines management and poor Legionella arrangements. In addition previous staff vacancies had been recruited to and changes to the management structure were being implemented.

The manager was working hard to address the shortfalls within the service. They were in the early stages of implementing a development plan to address concerns and to drive continuous improvement. The manager was open and responsive to issues we raised and acted immediately to make positive changes as a result.