Stinchcombe Manor

Stinchcombe Manor is a care home providing accommodation to persons who require nursing or personal care, for up to 19 people. The service provides support to people living with mental health and associated needs. At the time of our inspection there were 12 people using the service. Some people living at Stinchcombe Manor requires support when they become anxious or distressed.

Stinchcombe Manor is a large adapted home with a number of communal areas people can access, including two lounges, a dining room and garden.

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

The registered manager did not always operate effective systems to identify, assess the safety of the home to enable them to take action. The provider’s governance systems had not always identified or taken action in relation to concerns we found at this inspection.

People's care needs had not always been recorded in full. The registered manager was aware of this; however, action had not been taken from audits carried out in February 2023. Checks of people's environments were routinely carried out, however these hadn't always comprehensively identified potential shortfalls.

People spoke positively about Stinchcombe Manor and enjoyed the time they spend with support workers. On both days of the inspection people were enjoying games and activities with staff. Staff spoke positively about working at Stinchcombe Manor and the support they received to provide person centred care.

People's medicines were managed effectively, and people were protected from the risk of infection.

People's individual risks were known by support workers. Staff had clear guidance to support people when they became anxious. Where incidents and accidents occurred, the registered manager had systems in place to ensure appropriate action was taken to reduce the risk of avoidable harm.

The registered manager ensured the views of support workers and people were listened to and acted upon. Staff spoke positively about the communication they received and discussed the improvements happening at Stinchcombe Manor.

Deprivation of liberty safeguards had been applied for when people could not consent to live in the care home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

The last rating for this service was Good (published 23 July 2022). At this inspection the rating has remained the same.

Why we inspected

This inspection was prompted by a review of the information we held about this service, including information of concern in relation to people’s care and the management of the service. We also had received concerns about an incident which occurred at Stinchcombe Manor. This incident was subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the environment. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

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.

Enforcement

We have identified a breach in relation to good governance at this inspection. 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.

Stinchcombe Manor is a residential care home providing care for up to 19 older people living with dementia and/or mental health needs. At the time of our inspection six people were living at the service. Some people living at Stinchcombe Manor require support when they become anxious and distressed.

Stinchcombe Manor is a large adapted home with a number of communal areas people can access, including two lounges, a dining room and garden.

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

The provider had made improvements to the service following our previous inspection. Audits and checks were in place to ensure the quality and risks in the service were monitored. The provider addressed gaps and shortfalls identified through their own monitoring processes. The provider was working at embedding some of the newly introduced monitoring systems.

We observed people to be relaxed and comfortable around staff and staff were caring and kind in their interactions. Staff followed and understood safeguarding procedures.

Risks were assessed to ensure people were kept safe, and staff understood individual risks present within people's lives.

There were enough staff within the service to safely support people. Processes were in place to ensure staff were recruited safely.

Medicines administration and management was safe and people received their medicines as prescribed.

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.

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

The last rating for this service was requires improvement (published on 4 February 2022).

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 in relation to Safe care and treatment and Good governance.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 has changed from Requires Improvement to Good based on the findings of this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stinchcombe Manor is a residential care home providing care for up to 19 older people living with dementia and/or mental health needs. The provider reduced their number of beds from 36 to 19, from 27 October 2021. At the time of our inspection 9 people were living at the service. Some people living at Stinchcombe Manor require support when they become anxious and distressed.

Stinchcombe Manor is a large adapted home with a number of communal areas people can access, including two lounges, a dining room and garden.

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

The provider had made improvements to the service. However, further improvement was needed as not all requirements of the warning notices had been met.

There had been a reduction in incidents and accidents involving people at the service, however, further improvement was needed to ensure people received a safe service. The provider had invested in new systems to assist them in monitoring and improving the service for people. These were in the early stages of implementation and were not always operated effectively, as they were not yet fully established. Hence, we found shortfalls in management of some environmental and equipment related risks which had not been identified by the provider. The provider acted immediately by arranging contractors to carry out assessments of the environmental risk management shortfalls we identified during the inspection.

Where areas for improvement had been identified by the provider, effective and timely action to manage risks and improve the service was not always taken. Accidents and incidents people experienced were reviewed to ensure any new or escalating risks to them were identified and acted upon in a timely way to protect them from further harm. However, managers had not ensured all staff responsible for reviewing people’s risks continued to update relevant records to ensure risk management plans remained effective. This meant people were at risk of harm, as staff referring to these documents, including agency staff, may not always have complete and accurate information about the support people needed to keep them safe.

The service had made improvements to their processes and guidance to protect people from the risks of COVID-19. However, the service had yet to implement ‘Essential Caregiver’ status for people’s close friends or relatives, in line with national guidance. The registered manager and provider had notified CQC and other agencies of incidents as required.

We saw staff interacting kindly and patiently with people. Staff demonstrated understanding of people’s emotional and physical support needs. Staff told us they felt more supported and said the service had improved since our last inspection. A staff member said they had not previously understood some risks to people as important information had not always been communicated. Further to this, they told us there had been, “Real improvement in support and direction” from the registered manager and their deputy.

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 Inadequate (published 15 October 2021).

Why we inspected

We carried out an unannounced focused inspection of this service on 26 July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their notification of incidents and safeguarding of people from abuse.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also checked whether the two Warning Notices we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved from Inadequate to Requires Improvement and the service is therefore out of Special Measures. This is based on the findings 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.

We have found evidence that the provider needs to make improvement. 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 Stinchcombe Manor on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified continued breaches in relation to safe care and treatment and governance. We will continue to monitor the service through the enforcement action (Warning Notices for regulation 12 and regulation 17) already in place.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stinchcombe Manor is a residential care home providing care for up to 36 older people living with dementia and/or mental health needs. At the time of our inspection 22 people were living at the service. Stinchcombe Manor provides support to people who can often become anxious and distressed, which may result in behaviours others find challenging.

Stinchcombe Manor is a large adapted home with a number of communal areas people can access, including a lounge, dining room and garden.

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

People did not receive a safe service as risks to them had not always been safely managed and monitored. The accidents and incidents people experienced were not routinely reviewed to ensure any new or escalating risks to them were identified and acted upon in a timely way to protect them from further harm. As a result, people had not always benefitted from the advice and support provided by external health and social care professionals to ensure their needs were met safely and effectively. People’s risk assessments and support plans did not always contain important guidance for staff in how to support them safely. This meant people were at risk of harm as they did not always receive the support needed to keep them safe.

While the provider had been working to improve the systems in place to monitor and improve the service for people, the shortfalls we found at the service had not been identified by their systems. The provider had not identified that their safety incident monitoring system was not effective.

The registered manager had not always followed processes and guidance in place to protect people from the risks of COVID-19. The registered manager and provider had not notified CQC and other agencies of incidents as required. Where areas for improvement had been identified by the provider, effective and timely action to manage risks and improve the service had not always been taken.

We saw staff interacting kindly with people and relatives were positive about the care staff’s approach to their relatives. The provider told us how they were working to build a staff team with the right values.

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 3 October 2019).

Why we inspected

We received concerns in relation to risk management and the potential impact on people and staff. As a result, we undertook a focused inspection to review the key questions of safe 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.

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 changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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. The provider took immediate action to mitigate fire and choking risks to people. The provider sent us an action plan detailing actions they had taken, and further actions planned, in response to our feedback. It was too soon to say if these actions will be effective in mitigating risks to people.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified breaches in relation to safe care and treatment, governance, safeguarding and failure to notify CQC of specific incidents.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

At the time of our inspection 19 people were living at Stinchcombe Manor. Stinchcombe Manor is a large adapted home with a number of communal areas people can access, including lounges and dining rooms. The home is set in grounds which people were supported to access and enjoy.

We found the following examples of good practice at Stinchcombe Manor.

¿ The registered manager and provider ensured staff had access to appropriate personal protective equipment (PPE). There was appropriate PPE to care for people who were at risk or may have symptoms of COVID-19 and required support to self-isolate.

¿ All of the staff solely worked at Stinchcombe Manor which helped reduce the risk of infection into the home. Staff had received infection control and prevention training and support during the pandemic. The registered manager ensured staff used PPE in accordance with current guidance.

¿ People were supported with an activities programme tailored to their needs, which included support to interact with their loved ones remotely. The registered manager was reviewing guidance in relation to safe relative visiting which can take place indoors.

¿ The registered manager had implemented robust systems to ensure there was clear oversight in relation to infection prevention and control. The registered manager and head of housekeeping were carrying out infection control audits and cleaning schedules were in place to ensure the home remained clean and the risk of infection was reduced.

¿ The service followed recognised guidance in relation to the admission of people. The service understood the importance of supporting people to self-isolate if they exhibited symptoms of COVID-19. The registered manager had risk assessed people and staff members risks in relation to COVID-19. There were clear contingency plans in place in relation to seasonal flu and COVID-19.

¿ The registered manager had not implemented a regular testing programme for COVID-19 due to the departure of one member of staff. They had arranged for staff to have Covid-19 testing on an ‘as required’ basis when required. As part of the inspection process we signposted the service to local authority commissioners. Following this review, a routine testing programme was implemented.

Stinchcombe Manor is a care home providing personal care to 25 people aged 65 and over at the time of the inspection. Stinchcombe Manor Care Home can accommodate up to 36 people in one adapted building.

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

The service provided to people was safe. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. The risk posed to people had been assessed and suitable action had been taken to minimise the risk posed to people using the service.

Staff had received appropriate training. People were supported to access support from health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities.

Staff were kind and caring and were motivated to offer person centred care. People and relatives, we spoke with told us staff were caring. The principles of respect, dignity, compassion and, equality and diversity were embedded in the service. People were treated as equals regardless of age, gender or personal beliefs.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records contained good levels of details and provided evidence of person-centred care. Where required, people were supported to make decisions about end of life care which met their individual needs and preferences.

The service was well led. People, staff and relatives spoke positively about the registered manager. Quality assurance checks were in place and identified actions to improve the service. The registered manager sought feedback from people and their relatives to improve the service. There was a positive culture throughout the service which focused on providing person centred care.

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.

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

Rating at the last inspection

The last rating for this service was Good (published 2 August 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.