Stamford Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Systems were in place to protect people from the risk of abuse and harm. People's support needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Processes were in place to ensure staff were safely recruited. Recruitment checks included DBS checks, employment references and identity checks. Staff completed a thorough induction when they started their employment with the provider. Although staff received training, we found the completion dates for some training courses for a number of staff were not up to date. Medicines were managed consistently and safely in line with national guidance. However, we found discrepancies with the record keeping system.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were supported by staff who knew and understood their needs. People told us they had built good relationships with staff and staff were aware of their likes and dislikes. People had good links with family or advocate services and staff supported people to maintain this. Staff respected people's individuality and diversity and were aware of people's personal preferences. People and relatives were involved in the development of care plans and reviews. One relative told us, “I was involved in her initial care plan and we do regular reviews or discuss things as they come up and discuss any risks.”

Staff told us they knew how to report accidents and incidents. Staff also said they had regular meetings where any concerns about people were discussed. There were weekly clinical risk meetings where issues such as pressure wounds and falls were discussed, and prevention measures identified.

Processes were in place to monitor and analyse information and trends from accidents, incidents (including falls) and safeguarding concerns. Lessons learned reports were generated quarterly and findings were cascaded to the staff team. Actions from lessons were assigned to staff as needed. Reports showed lessons were learned around use of bedrails, UTI and weight loss – these were discussed within the staff team and actions for staff were identified.

People and their relatives told us the service worked closely with other agencies and health professionals in order to meet people's specific needs. One person told us, “I feel safe, good and looked after well, my wife visits every day. GP came to visit when I was unwell and the optician to check my eyes.”

The registered manager told us they worked closely with the CHAT team. They said, “When people are discharged from the care home, we make a district nurse referral to ensure continuity of care. If someone is on insulin, they are handed over to the community team so that they are not left on their own.” A nurse confirmed they worked in partnership with TVNs and made referrals to external healthcare services when needed.

A health care professional commented, “The Managers, the unit lead nurses, all the nurses and carers are very engaging when I visit. They request my support with residents who are new to the home, recently discharged from hospital, acutely unwell and palliative residents. They also contact me in between my visits if they need my support.”

Systems were in place to ensure people received a full assessment of their needs upon admission. The service involved people and their families in assessments. There were protocols in place which guided staff when to make referrals or escalate concerns.

People and relatives told us they received safe care. Everyone we spoke with said staff were very good and did their job well. A person told us, “I feel happy and safe. No problem with care here and I can always get support if need to.” A relative said, “It’s a good place they look after her well.”

The registered manager and staff had a good understanding of safeguarding. Staff could explain different types of abuse and what signs and symptoms to look out for. Staff told us if they suspected or saw any form of abuse they would report it to the manager. The registered manager told us that safeguarding was a regular topic at team meetings.

Processes were in place which protected people from abuse. Staff treated people with care and respect. Information on abuse and speaking up were displayed on notice boards in communal areas.

The provider had a clear process in place to safeguard people against abuse. Staff received training in safeguarding, this meant they were able to notice any concerns and report them to their managers. There were safeguarding and whistleblowing procedures in place. This meant staff had guidance to use if needed.

People told us they felt supported by staff who knew them well and were aware of their medical, health and social needs. People were encouraged and supported to be independent with daily tasks and activities but without compromising their safety.

Staff told us they had access to care plans and risk assessments. Staff knew people’s needs well and demonstrated knowledge in how to support people safely. For example, a staff member spoke about how they supported people who were at risk of malnutrition and dehydration. The staff member spoke confidently about how they ensured people consumed the right amount of fluids and how they were trained on thickening drinks. Staff also told us how they monitored people’s weight and reported any concerns to senior staff, who then made the appropriate referrals to the dietician. The registered manager said risk assessments were reviewed monthly or sooner. For example, if someone has a fall. They asked for input from relatives when reviewing care plans.

We observed staff members supporting people to mobilise safely with a Sara Steady hoist, they did so while interacting with people in a caring manner. We also observed staff supporting people with their meals, in particular those who were at risk of choking or had swallowing difficulties. At lunchtime, staff closely watched people and helped them, for example, moving their food when they moved to make sure they kept eating. One staff member told us, "If someone isn't drinking, we fill out an observation chart and put a fluid chart in place. Then every carer will know about the risk and the need to watch them closely." We saw these records were updated regularly. We checked the airflow mattress for a person was set at the correct setting as per their care plan. And we checked some equipment, such as slings, hoists, weighing scales and pressure mattresses and found they were in good working order.

Risk assessments were person-centred and contained clear instructions on how to support people safely. Risk assessments were incorporated in the care plans. Risk assessments covered a range of areas including mobility/falls, choking/swallowing, use of bedrails, diabetes, malnutrition, PEEP and skin integrity. People who were at risk of weight loss were weighed regularly and concerns were escalated to the dietician. People were also on fortified meals and offered meal replacement shakes as required. From records seen, we could see the provider had processes in place which enabled staff to work closely with other agencies such as the tissue viability nurses, speech and language therapists, GP, dieticians and podiatry services.

People told us they felt safe living at the home. A relative said, “It is very clean at the home, a nice environment and his room is clean. There is a nice garden they take him into.”

We received information of concern from the local authority about fire doors being propped open and a mice infestation at the service. We looked at this during our inspection and found actions had been taken by the management to address these concerns. The registered manager said they had intensified the cleaning regime in the home. We reviewed a recent Environmental Health report which confirmed no mice droppings were found and we also reviewed pest control reports which showed that they had been working with the service to address the mice infestation.

Checks and risk assessments in relation to the physical environment were in place. We observed doors were not propped open. Fire extinguishers were in date. Radiators in people’s rooms were secured to the wall. Window restrictors were in place. We noted there was uneven flooring at the dining room entrances and there was exposed piping in some people’s bathrooms. We raised this with the managers and these were immediately addressed.

Staff understood how to report any maintenance issues. There was a maintenance team who promptly addressed identified concerns. There were certificates in place which showed the provider kept the building and equipment regularly assessed and maintained. There was an up-to-date buildings fire risk assessment and all fire equipment were tested on a regular basis.

People and their relatives told us there was enough staff to meet people's needs. Relatives told us they were confident staff had the skills and knowledge to meet people’s needs. People were supported by staff who were motivated to carry out their role.

Staff told us they received the training needed to be able to perform their roles. One staff member said they were currently doing their Diploma Level 5, funded by the provider. Staff received regular supervisions where they had the opportunity to discuss their role and performance. Staff were aware how to raise a concern and told us what they would do if the need arose.

There were sufficient staff on the days we inspected. People received appropriate support from the staff team. We observed good teamwork among the staff team. Call bells were answered reasonably quickly and we noted pleasant interactions between people and staff.

There was a thorough induction process for new starters. Staff received training in dementia, autism and learning disability. However, we noted completion dates for some training courses for a number of staff did not seem to be up to date. The regional director told us that for some training, for example, moving and handling and infection prevention and control, staff had to do the training once and thereafter have their competency assessed annually. Staff would only complete this training again if they failed the competency assessment. This approach did not provide sufficient assurance that staff knowledge remained up to date and that they learned about changes to best practice (or updated guidance) that refresher training would provide.

People told us they felt the home was clean. They also said staff helped them clean and tidy their rooms to ensure their personal space supported their wellbeing.

Staff told us they had access to personal protective equipment (PPE) and had good knowledge of infection prevention and control (IPC) and handwashing practices. A nurse told us they did IPC audits every week.

We observed the premises, including communal areas and people’s rooms, were clean. Cleaners were seen on each floor. People’s toilets and ensuites were also clean. We did not see any evidence of mice droppings. The kitchen areas were clean including food storages, fridge, freezers and preparation areas. We observed staff wearing PPE appropriately.

The service had effective infection prevention and control measures in place. There were cleaning schedules in place which had been intensified after the local authority found concerns. IPC practices were discussed regularly in staff meetings and management forums. Staff ensured that touch surfaces were cleaned every two hours, they implemented deep cleaning, and used appropriate cleaning products to prevent the spread of infections.

People received their medicines as prescribed with dedicated trained staff to manage stock control, ordering and safe storage of medicines. We found medicines were managed consistently and safely in line with national guidance. We observed staff being patient and kind during medicine administration. People received their medicines safely and generally as prescribed, for example, medicines that should be given before food.

Medicines were managed by staff who had received the relevant training and who underwent annual assessments of their competency. Overall, appropriate management systems were in place to ensure medicines were managed safely. Medicines were kept securely in locked trolleys and administered by trained staff. Medicine Administration Records (MAR) contained sufficient information such as allergies of each person to ensure safe administration of their medicines. There were no gaps in charts and the stocks we checked tallied with the balances recorded. There were checks of medicines and audits to identify any concerns and address any shortfalls. Staff followed the guidance in place on managing 'when required' medicines for each person and documented the reasons why they had administered the medicines.

We found concerns with the electronic medication administration system (Emar). There seemed to be contradictions in the time the medicines were prescribed by the GP and the leeway given on the Emar chart for administration. For example, when the GP prescribed a medicine to be administered at 8am, the system gives the staff a 4-hour time gap to sign the chart. Staff we spoke with told us they found this confusing, as the system recorded the time signed, not the time administered. The risk was that sometimes medicines were signed close together, although staff we spoke with reassured us these were not administered close together. Managers took our feedback onboard and took immediate actions. They created tasks on the care planning system which alerted staff on their handheld devices.