This was an unannounced inspection, which took place on 12 and 13 July 2017. The inspection was undertaken by two adult social care inspectors and a pharmacist inspector. We had previously inspected this service in May 2016. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to failures in ensuring people’s privacy and dignity were respected and care records were not sufficiently detailed or person centred. This resulted in us making two requirement actions. Following the inspection in May 2016 the provider wrote to us to tell us the action they intended to take to ensure the regulations were met. At this inspection we found that improvements had been made and the requirement actions had been met. However, we found five further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This was because medicines were not managed safely, assessments of risk were not always completed or updated accurately, recruitment checks of agency staff were not sufficiently robust, the provider was not acting in accordance with the Mental Capacity Act 2005 (MCA), records monitoring care and treatment provided were not accurate or complete and the provider had failed to assess monitor and improve the quality of the service provided.
You can see what action we have told the provider to take at the back of the full version of the report.
Stamford Court is a large two storey building set in its own grounds on the outskirts of Stalybridge. It provides nursing and personal care to a maximum of 40 older people some of whom are living with dementia. At the time of our inspection there were 39 people living at the service.
Medicines were not managed safely. Staff were not provided with sufficient information about medicines that were to be given ‘when required’. Keys for the medicines storage room were not kept by the person responsible for the medicines, records indicated that medicines were not being stored at the correct temperature to ensure they remained effective and no action had been taken to rectify the problem and records indicated that one person had not received their medicines as prescribed.
We found that risks to people’s health and wellbeing had been identified but records were not always accurate or updated when people’s needs changed.
Peoples care needs were assessed before they started to live at the service. Care records showed that all activities of daily living had been planned for. However we found the monitoring records were not completed in sufficient detail to accurately reflect the care and support provided.
Where people were deemed not to have capacity, evidence of capacity assessment were not present in their records and required conditions of The Deprivation of Liberty Safeguards (DoLS) were not always actioned.
There were systems of weekly, monthly and annual quality assurance checks and audits carried out by the service and the provider. We found that checks and audits carried out by staff within the home were not sufficiently robust as they had not identified the issues raised during this inspection. Whilst the provider’s audits had identified the improvements needed they had not ensured the required actions had been completed in a timely manner.
People told us they felt safe at Stamford Court. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.
Recruitment procedures were in place which ensured staff employed by the service had been safely recruited. However the service needed to improve the systems for accessing checks for staff who were working at the home but employed by another agency.
The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control. Staff had access to and wore person protective equipment when undertaking person care tasks.
Accidents and incidents were appropriately recorded. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately. People had their health needs met and had access to a range of health care professionals.
The home was clean and accommodation was of a good standard. Recent improvements had been made to the decoration, furnishings and fittings of the home. People’s rooms were personalised with their own photographs and belongings.
There were sufficient staff to meet people’s needs. Staff received the training, support and supervision they needed to carry out their roles effectively.
People told us the staff were nice and caring. A visitor told us, “All the staff are very courteous.” We saw staff interactions were polite and friendly. We found staff to be responsive, polite and caring. Visitors told us they were made to feel welcome.
The service had recently employed an well-being coordinator. There was a range of social events and activities available and people were positive about the plans the new activity coordinator had to improve the range of activities.
The service had a registered manager who had worked at the service from September 2016 and had been registered with CQC in January 2017. 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 complimentary about the changes the registered manager was making and told us the service had improved. All the staff we spoke with were positive about the registered manager and working at Stamford Court. We found the registered manager to be enthusiastic and committed to improving the quality of the service provided.
We saw there was a system for gathering people’s views about the service. There was a system in place to record complaints and the service’s responses to them. People told us they didn’t have any complaints but were confident that they would be listened to and action would be taken to resolve any problems they had.
The service had notified CQC of any DoLS authorisations, accidents, serious incidents and safeguarding allegations as they are required to do.
The CQC rating and report from the last inspection was on the provider web site and displayed in the entrance hall.