Stocks Hall Mawdesley

Stocks Hall, Mawdesley is a residential care home providing personal and nursing care for up to 42 adults. The home is also registered to accommodate people who are living with dementia. At the time of our inspection there were 39 people living at the home.

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

Medicines were generally managed safely across the service. However, we have made some recommendations in this area.

The provider had established robust recruitment practices and records showed a good number of staff were employed. However, some people and some relatives felt staffing levels could be increased, particularly at night-time. We discussed this with the management team, who assured us the deployment of staff at night would be re-assessed.

People were mainly kept safe and protected from the risk of infections, including the transmission of Covid-19. We discussed good infection control practices around staff wearing face masks correctly with the acting manager at the time of our site visit, who assured us these would be addressed without delay.

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 needs were being assessed and they were supported by staff who were trained and knowledgeable. The home worked closely with a range of community professionals so that people’s health and social care needs were being met.

People received safe care and support. Their preferences and wishes were respected by the staff team and independence was safely promoted. We observed some lovely interactions by staff members, who were clearly committed to the people who lived at Stocks Hall. One relative told us, “If I mention something to one of the carers or nurses, I know it will be done. The staff are really good and very proactive.”

People were provided with a good quality service, which was regularly assessed and closely monitored. Any shortfalls identified were addressed without delay. People provided us with positive feedback about the staff team and the management of the home. People looked relaxed in the company of staff and the senior staff were visible around the home.

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 19 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the presence of pet dogs within the home. A decision was made for us to inspect and examine those risks. 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.

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.

The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stocks Hall Mawdesley 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.

At our last inspection on the 9 and 10 May 2017 the location was rated 'requires improvement' overall, with all key questions being rated as ‘requires improvement’, except for ‘caring’, which was rated as, ‘good.’ At that time, we identified breaches of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to medicines management and regulation 13, in relation to safeguarding people from abuse. Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective responsive and well led to at least good.

At this inspection we found improvements had been made. We found evidence to show the service was meeting all requirements of the current legislation. Therefore, all key questions were rated as ‘good’ on this occasion.

Stocks Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Stocks Hall Nursing Home (Stocks Hall) is located in a quiet residential area of Mawdsley, but is within easy reach of Preston, Chorley and the towns of West Lancashire. A range of amenities are available in the area and public transport links are nearby. There are four separate spacious and well-designed units within the home, which provide a variety of tastefully decorated and well-furnished communal areas and dining rooms. All accommodation is provided on a single room basis with ensuite facilities. Communal bathrooms are located throughout the home. There are 13 luxury apartments situated on the top floor of the home. These can be purchased for independent living with an option to have support provided by the care home staff, if needed. This support can include personal care, cleaning, food provision, activities and trips out. There are ample parking spaces adjacent to the premises. At the time of our inspection there were 41 people who lived at Stocks Hall.

The service had a registered manager in post. A registered manager is a person who is 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. The registered manager was on duty at the time of our inspection and she was co-operative and helpful throughout.

New staff were recruited safely and detailed induction programmes were implemented on commencement of employment. However, some records could have been completed more fully and application forms were not always available on the staff files we looked at, although where these were not available detailed Curriculum Vitae submissions had been received. We made a recommendation about this.

Staff had received a range of training, but records were not always kept up to date and some learning modules for some staff members were overdue. Supervisions and appraisals had been conducted, although these could have been more regular. An appropriate number of staff with relevant skills were appointed to meet people's assessed needs and those we spoke with understood their responsibilities in relation to reporting allegations of abuse.

Risks were managed well and we saw evidence of actions taken to mitigate any identified hazards. We found some areas of the management of medicines could have been better. However, actions were taken immediately to address the issues raised which helped to mitigate the areas of risk.

The care files we saw were maintained electronically. The system contained detailed and person-centred plans of care, which were well organised. This provided staff with clear guidance about people’s needs and how these needs were to be best met. People were involved in the planning of their own care, or that of their loved one. The plans of care had been reviewed every month, with changes in people’s assessed needs being reflected well.

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.

There was a comprehensive activities programme in place, which helped people to maintain leisure interests and prevented boredom.

We observed staff members treating people who used the service with dignity and respect throughout our inspection and their privacy was consistently promoted. Staff members we saw displayed a lovely, gentle approach towards those who lived at Stocks Hall.

Choices of menus had been developed and where possible people were offered a choice of meal. The staff working with those who lived with dementia were fully aware of their likes and dislikes.

Where people required the involvement of health care professional’s referrals had been made and appropriate assessments had taken place to ensure people’s health care needs were being met.

There was evidence of regular audits and monitoring of the service taking place and records we saw confirmed feedback had been obtained from those who lived at Stocks Hall, their relatives and the staff team. In general, we received positive feedback about the leadership and management of the service from those who lived at the home, their relatives and staff members.

Everyone we spoke with commented highly on the standard of care provided and the quality of the staff team. Most people felt safe and everyone said the home was a friendly, caring environment. Not all those who lived at the home knew about their care plans, but others were very much involved in the process of developing their plan of care. Those who said they could not recall their care plan had no concerns or worries, as they were happy with the care provided and found it appropriate for their needs.

Stocks Hall is registered to provide nursing and personal care and accommodation for up to 42 adults. The home is situated on a main road position in Mawdsley, a quiet residential area, but is within easy reach of Preston, Chorley and the towns of West Lancashire. There are four separate spacious and well-designed units within the home, which provide a variety of tastefully decorated and well-furnished communal areas and dining rooms. All accommodation is provided on a single room basis. Bathrooms are located throughout the home. There are 13 luxury apartments situated on the top floor of the home. These can be purchased for independent living, with an option to have support and personal care provided by the care home staff, if needed. This can include personal care, cleaning, food provision, activities and trips out. A range of amenities are available in the area and public transport links are nearby. There are ample car parking spaces adjacent to the premises.

This location is a new acquisition for Stocks Hall Care Homes Limited. This is the first inspection of the home, following registration in December 2015. The registered manager was on annual leave 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 of the Health and Social Care Act and associated regulations about how the service is run. The deputy manager was on duty and was cooperative and available throughout our inspection.

We toured the premises and found the environment to be warm, clean and hygienic throughout. Suitable equipment had been provided and accessible gardens were well-designed for those who lived at the home. A business continuity plan had been developed, which outlined action to be taken in the event of any environmental emergency, which could affect the operation of the home.

People’s needs had been assessed prior to a placement at the home being arranged and individual preferences had, in most cases been considered. However, the planning of people’s care and treatment was not always person centred and did not consistently reflect their needs. We found that people were treated in a kind and caring manner, with their privacy, dignity and independence being promoted.

We found that mental capacity assessments had not always been completed and formal consent had not always been obtained before the taking of photographs, the use of equipment and before care and treatment was provided. We made a recommendation about this.

At this inspection we found that people were receiving a nutritious and well balanced diet and meal times were being well managed, with good support being offered.

Records relating to those who lived at the home were stored securely. A system was in place for assessing, monitoring and improving the quality of service provided which helped to mitigate any potential risks and therefore promoted people’s safety. However, this could be extended to incorporate more areas and to identify how and when actions have been taken in order to address any shortfalls. A wide range of risk assessments had been introduced in relation to people’s health care needs and the safety of the environment.

The completion of Personal Emergency Evacuation Plans [PEEP] was discussed with the deputy manager on the first day of our inspection. Although these were in place in most cases, some information was missing. However, this had been addressed before we returned to the home the following day.

Records showed that people's views about the quality of service provided were sought in the form of surveys and meetings and complaints were managed well. Safeguarding incidents had not always been well managed, as significant injuries and repeated falls had not been appropriately reported.

People who lived at Stocks Hall told us they felt safe being there. We found that the recruitment practices were satisfactory, which helped to protect people from harm. Several people told us that there were not enough staff on night duty. We looked at the duty rotas and recommended that staffing levels be reassessed for the night time period, taking into consideration the layout of the building and people’s individual needs.

We noted that people were supported to mobilise, when help was needed and freedom of movement was evident within the home.

The staff team were well supported by the management of the home, through the provision of information, induction programmes and a wide range of training modules. The staff members we spoke with had a good understanding of people in their care and were able to discuss their needs well. However, regular, formal supervision and annual appraisals for staff were not always evident.

Interaction by staff with those who lived at the home was positive. Staff members provided good, sensitive and caring approaches. People were treated with kindness and compassion. Their privacy and dignity was consistently promoted.

A wide range of community professionals were involved in the care and treatment of those who lived at the home. This helped to ensure that people’s health and social care needs were being appropriately met. However, medicines were not being well managed at the time of this inspection.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and safeguarding service users from abuse and improper treatment.

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