Archived: Stanbrook Care Home

We found the following examples of good practice.

¿ Visitors to the home were required to have their temperatures checked and complete a Covid-19 screening questionnaire prior to entering the home. A visiting policy was in place and visitors were provided with Personal Protective Equipment (PPE) including a fluid resistant mask, aprons and gloves.

¿ People were assessed for high temperatures twice daily and where symptomatic, were isolated and tested for Covid-19 as soon as possible.

¿ People who had tested positive for Covid-19 self-isolated in line with current guidance.

¿ People were encouraged to comply with social distancing guidance where possible. Tables and chairs in the communal lounge and dining area had been rearranged and spaced out and communal areas were free of clutter. Staff break times were staggered to ensure only one staff member was in the staff room at any one time.

¿ People’s social and emotional wellbeing needs were supported through visits from volunteers to engage in 1:1 activities to decrease the risk of social isolation.

¿ The provider had a dedicated Covid-19 lead who staff could contact for advice or support if needed.

Further information is in the detailed findings below.

Stanbrook Care Home is a residential care home providing personal care to 25 older people; including people who may live with dementia. At the time of the inspection 22 people were being supported by the service. The accommodation is provided in one adapted building with bedrooms on the ground and first floor and a small garden area.

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

Enough improvements had been made to meet the previous breaches of regulations but there remained some areas for further improvement. Some staff were not wearing PPE in line with current guidance. Care plans to support people with distressed behaviours required more detail however, staff were aware of people’s needs and risks were monitored. People told us they felt safe and were happy with their medicine support. Staff had received safeguarding training and knew how to recognise and report any concerns. People and staff told us they were enough staff in the day, but one person and some staff felt more were needed at night.

Audits were carried out by the registered manager and the provider, but they had not identified the infection control concerns we found on inspection. There were improved systems to ensure risks to people were monitored. The provider had followed our recommendation to improve the environment and positive changes had been made. People, relatives and staff gave positive feedback about the registered manager and their views were sought and acted on.

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 requires improvement (published 19 May 2020) and there were two breaches of regulation. We took account of the exceptional circumstances at the time arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe. We continued to monitor the service by contacting them on a fortnightly basis.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 18 May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check for improvements and to confirm they now met legal requirements. 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 remained the same 'requires improvement'. 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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor the service. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may inspect sooner.

Stanbrook Care Home is a residential care home providing personal care to 25 people aged 65 and over. At the time of the inspection 14 people were being supported by the service. The accommodation is provided in one adapted building with bedrooms on the ground and first floor.

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

Risks were not always assessed to protect people from harm. There was insufficient guidance and monitoring in place for staff to support people who were at risk of constipation, dehydration, displaying distressed behaviours and manual handling. Where needs had been identified the service had not always responded in a timely way to address them. Accident and incidents were recorded but there was no robust oversight to learn from them and improve care in the future.

At our last inspection we found the provider's governance and auditing systems was inadequate and further improvement was needed to ensure people consistently received safe care. This remained a concern at this inspection. Audits were carried out by the management team and provider, but they had failed to ensure that people were always safe and their needs were being met. As a result, people were exposed to the risk of harm and inappropriate care. The provider’s systems to ensure staff were competent and training was adequate were also not effective.

Most people told us they felt safe and staff were aware of how to protect people from potential abuse. People received their medicines as prescribed. We found some improvements in how the service supported people who had sore skin and with their oral hygiene.

Most people were positive about the food and told us they were given choices about what they wanted to eat. This was an improvement since the last inspection. There had been some recent changes to improve the environment, but further work was required to make it more homely and suitable for people living with dementia.

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. However, the policies and systems in the service did not always support this practice as some guidance in care plans did not evidence the least restrictive way to support people.

Whilst we saw many kind and caring interactions from staff, some people told us the support they received had not always respected their dignity. People and relatives were involved in their reviews and the service was taking action to involve people more in the decisions about the service.

Whilst the person-centred information in care plans had improved since the last inspection, further work was required to ensure identified needs were addressed in a timely way. We observed an improvement in leisure opportunities on offer, although we still received mixed feedback in relation to this. People knew who to speak to if they had any concerns. People had an end of life care plan in place and further work was being developed in this area.

Rating at last inspection

The last rating for this service was requires improvement (published 06 November 2019) and there were multiple breaches of regulation. Following the inspection, a condition was placed on the provider’s registration requiring them to complete monthly reports to show how they were improving.

At this inspection, enough improvement had not been made and the provider was still in breach of some regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We are mindful of the impact of 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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

Special Measures:

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

The care home accommodates people over two floors which were accessed by a lift in one adapted building. It provides care to older people, some of whom are living with dementia and mental health needs.

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

Safeguarding concerns had not always been raised and investigated appropriately and the information not always shared with the local authority or CQC. Similarly, accidents and incidents were not always followed through with the appropriate action to minimise the risk of re-occurrence. The service was working with the local authority to improve practice in this area. People told us they did not feel safe living in their home. Risks had not always been assessed to keep people safe and protected. There was insufficient guidance available for staff to ensure that people’s health conditions were managed appropriately to protect people from potential risks. People told us they received their prescribed medicines.

We received mixed feedback from people in respect of meals. People did not have a pleasant meal time experience. People were given limited meal choices for breakfast. People’s health care records did not contain sufficient information and guidance for staff to follow. People felt staff had the skills and experience to care for and support them. 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.

People told us they were not always treated with kindness and compassion by staff who supported them. People were not consistently supported to make choices about their lives. We saw instances when people’s privacy, dignity and confidentiality were compromised.

People did not receive personalised care that was responsive to their needs. People told us they did not contribute to the planning and reviewing of their care. There were limited opportunities for engagement and stimulation for people daily and within their local community. People could not be confident that their wishes during their final days and following death would be understood and followed by staff.

The management of the service was inadequate as the provider did not carry out robust checks to ensure that care was being delivered safely and effectively. The registered manager carried out audits of the service, but these had failed to ensure that people were always safe and that their needs were being met. People and their relatives told us the service had improved but had a long way to go.

Rating at last inspection

The last rating for this service was Inadequate (published January 2019). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating of inadequate 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 Angel Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care, safeguarding service users from abuse and improper treatment and the governance of the service.

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

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.