Stobars Hall

We found the following examples of good practice.

There was a comprehensive COVID-19 testing programme for people and staff. Staff were tested daily as soon as they arrived at the home.

The service had a good supply of infection control resources to support the home throughout the COVID-19 pandemic.

The home was clean and the cleaning schedule had increased as a result of the pandemic.

Visitors to the home were screened on arrival. Relatives expressed positive comments about the visiting arrangements that were facilitated by the home, including for essential care givers.

Additional resources were in place to support the recruitment and retention of staff.

We found the following examples of good practice.

¿ Staff had completed infection and prevention control training and were able to explain the correct procedures for putting and taking off PPE. Posters were situated around the building advising on appropriate hand washing techniques and how to put on and take off PPE.

¿ Systems were in place to support visitors to access the service safely and reduce the risk of them spreading infection.

¿ People were supported to maintain contact with their loved ones in the absence of face to face visits.

¿ Quality assurance audits were completed to ensure safe infection control practices were being followed and to identify any improvements.

¿ Staff spoke positively about the support they received from the registered manager and deputy manager. Additional resources had been sourced to support staff’s mental health and wellbeing.

Stobars Hall is a residential care home which can accommodate up to 38 older people in one adapted building. At the time of our inspection 26 people were living there. One area, on the ground floor, specialises in providing care to people living with dementia.

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

The newly appointed registered manager and staff had worked hard since our last inspection to deliver the improvements required. People, relatives and staff had been included in improvement work and were proud of what had been achieved. They were very positive about Stobars Hall. They spoke highly of the registered manager and staff team and how well they were cared for.

The provider had strengthened the checks they carried out to monitor the quality of the service. They had put in place innovative new ways of working and developed very good links with healthcare professionals and the local community.

Processes were in place to keep people safe. There were enough staff to support people. Medicines were well managed. Staff regularly checked the building and equipment to make sure everything was working properly.

Staff now received regular training and supervision to make sure they had the skills and understanding to care for people. People spoke very highly about the food on offer. They told us it was always good quality and there was lots of choice on offer.

Staff had a better understanding about legal processes around people’s right to consent. 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 now supported this practice.

Care was provided in a person-centred way. Staff supported people with their choices. People could go to bed, and get up when they wanted. Staff knew people well. People and relatives told us staff were kind and treated them well.

Staff knew people’s needs and their preferences for how they would like to receive their care. Care records now clearly provided staff with the information they needed to care for people. There were a range of activities and events on offer for people to take part in.

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 13 September 2018). At that inspection we found four breaches of regulation. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

Stobars hall accommodates up to 38 people in one adapted building. At the time of our inspection 20 people were living there. One area on the ground floor specialises in providing care to people living with dementia.

The service had a registered manager in post. 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.

We found four breaches of regulation. These related to people’s care planning, people’s right to consent, staff training, recruitment checks and governance.

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

We also made recommendations that the service continue to develop its dementia strategy and improve person centred care.

This is the first time the service has been rated Requires Improvement.

People were not always supported to have maximum choice and control of their lives. The practices in the service required further development. People were not always provided with structured and meaningful activities. The provider told us they were changing the way activities were provided.

Risk assessments and care plans that should have provided guidance for staff in the home were not always present or reviewed correctly. We found evidence that people in the service were involved to varying degrees creating support plans and were able to influence the content.

The staff team told us they understood how to protect vulnerable adults from harm and abuse. Staff talked to us about how they would identify any issues and how they would report. However, guidance for staff on how to report a colleague was unclear.

Appropriate arrangements were not in place to ensure that new members of staff had been suitably checked before commencing employment. The registered manager ensured that there were sufficient staff to meet people's. Staff were not suitably trained and developed to give the best care possible. Staff had not received the appropriate training to help them support people living with dementia or at the end of their lives.

Any accidents or incidents had been reported to the Care Quality Commission as necessary and suitable action taken to lessen the risk of further issues.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. They accessed hospital appointments as a matter of routine.

People were happy with the food provided and we saw well prepared healthy lunch and evening meals that staff supported and encouraged people to eat.

Suitable equipment was in place to support people with their mobility and appropriate checks and maintenance had been carried out.

Staff knew people well and we observed them treating people kindly.

Stobars Hall is set in extensive grounds on the outskirts of the town of Kirkby Stephen and is registered to accommodate up to 38 people. Rooms in the home have views over the gardens, surrounding countryside and hills. It is a period property and as a result the communal rooms and bedrooms have many original features. There are three lounges and two dining areas on the ground floor. There is car parking available and the gardens are accessible for wheelchair users. At the time of the inspection there were 21 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The registered manager had notified the CQC of any incidents and events as required by regulation. However a safeguarding notification had not been managed well and appropriate forms used to notify CQC were not used. We recommended that the registered provider sought training for the management team on the handling of notifications to CQC.

People living in Stobars Hall told us that they felt safe living there and friends and relatives we spoke with told us they were “satisfied” with the care being provided. We saw that the people who lived there were well cared for, relaxed and comfortable in the home and the atmosphere was open and inclusive. Everyone we spoke with praised the staff who supported them.

The environment of the home was welcoming and the communal areas were decorated and arranged to make them homely and relaxing and we found that all areas were clean and free from lingering unpleasant odours.

People were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit the home. People were able to follow their own interests, practice their religious beliefs and see their friends and families as they wanted.

The staff on duty we spoke to knew the people they were supporting very well and their lives and preferences. Staff were aware of the choices people had made about their care and daily lives. People had a choice of meals and drinks, which they told us the food was “good” and “lovely” and that they enjoyed their meals.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

The service worked with local GPs and health care professionals and external agencies such as social services and mental health services to provide appropriate care to meet people’s different physical, psychological and emotional needs.

The staff we spoke with were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. We looked at the risk assessments in place for people and these included risk assessments for skin and pressure area care, falls, moving and handling, mobility and nutrition and for the management of a condition such as diabetes.

We looked at the risk assessments in place in regard to fire and how people would be moved in the event of fire. There was an overall fire risk assessment in place but this was overdue for a thorough review. The registered manager confirmed they would be contacting the Fire officer to take advice. We also passed this matter to the Fire Officer for Cumbria so they could follow this matter up with the registered provider and visit the service.

Systems were in place for the recruitment of staff and for their induction and on going training and development. Staff training was provided and staff said they were well supported.

The organisation had written policy on making adjustments to staffing numbers when needed. This showed the process that was used to assess staffing levels. This was to be done on an individual basis and at a frequency decided by the registered manager or senior care staff in line with needs. We recommended that the registered manager found out about systems that could be used to formalise and record this assessment process. There was a 24 hour on call system for staff to access management support if needed.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw that risk assessments had been carried out to help make sure that people who lived there received safe and appropriate care. We saw that the premises and grounds were being well maintained and were accessible to the people living there.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had appropriate policies and procedures regarding The Mental Capacity Act 2005.

Staff had received training on safeguarding vulnerable adults. Staff we spoke with were clear about the procedures to use in reporting any concerns. The service had systems in place to manage and monitor the prevention and control of infection and keep a clean environment.

Is the service effective?

People told us they received a good quality of care at Stobars Hall. They said the staff in the home knew the support they needed and how they wanted this to be provided.

We found that people's health and care needs had been assessed with them and they were involved in deciding the care and life styles they wanted. One person told us, 'If I tell them I want something put into my plan, they put it in'.

We saw records that showed staff had undertaken appropriate training to give them the skills and knowledge to look after people properly. Staff told us about the induction training they had received before they started work supporting people who lived there. This was to make sure they were prepared for their support roles.

Care plans in place showed the aids and equipment needed to support people and how they wanted this support to be provided.

Is the service caring?

We saw that the staff were kind and considerate in how they treated people. People were given choices about their lives, including recreational activities, and the support they received. We observed friendly and respectful interactions between the staff and people in the home.

One person who lived at Stobars Hall told us, "I am waited upon by the girls, I am well fed and everything I want is brought to me. I am perfectly happy". Everyone we spoke with made positive comments about the staff and life in the home. One person told us, 'The staff are so very caring' and another said, 'It's a wonderful place".

In the care plans we looked at we saw information about individuals that provided personalised information about their preferences, likes and dislikes. This gave staff a background on the person themselves and their lives before they came to live there.

The staff we spoke with showed that they knew people's preferences about their lives and how they wanted to be supported.

Is the service responsive?

People were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time.

We saw that where necessary people had been referred to other services. This was to make sure they received appropriate treatment and support for their needs and conditions.

We looked in detail at a sample of care plans. We saw that the plans of care and support were subject to evaluation, review and alteration in response to changes in people's needs and preferences.

Is the service well led?

The agency had quality assurance and monitoring system in place. This helped to identify and areas that had problems or needed to change.

There were policies and procedures in place to guide staff and these were subject to regular review. The manager of the home held meetings with people who lived there, their families and the staff employed to gather their views about the service.

The records we saw for planning people's care and assessing risks were being consistently audited and reviewed. This meant that the information about the welfare and safety of the people living there was accurate and where changes in their needs had been reported the plans of care reflected them.

The provider also visited the service to assess and monitor the quality of the care and facilities provided to people.

We did not receive any negative comments about the standard of personal care received, the food served, the cleanliness of the home or the staff approaches and support. People were very complimentary about the food and told us the meals were "Very good" and "Always plenty of choice."

From our observations and conversations with people living there we found they had received the support they needed and were given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence and control over their lives. All the people we spoke with gave positive feedback about how their privacy and dignity were promoted and how staff asked them what they wanted. We saw that people were comfortable and confident with the staff on duty. We were told that staff were "Very kind and patient."

We found that staff knew the people who lived there well and were familiar with their conditions and needs. The provider had systems for getting people's views and monitoring the quality of the services provided but some of these were on an informal basis.