Stamford House 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

There was a breach of regulation as people did not always receive safe care and treatment, and there was not always sufficient oversight of aspects of the safety and quality of the service. People’s care plans were not always accurate, detailed and clear in relation to people’s risks and changes in their needs meaning that staff did not always have the relevant information on how to safely support people. Accident and incident forms were being completed however they required further analysis of trends. The level of analysis was inconsistent and it was not always clear that risk had been appropriately mitigated. Improvements were needed to ensure good oversight of recruitment processes and that staffing levels and deployment were reflective of the need of people. Further oversight was needed to ensure timely action was taken to improve the environment to ensure it was meeting the needs of the people living at the service. At this assessment, the medication cycle had just begun. The information relating to the medicines people required had not all been correctly transferred in line with the new cycle. Where people required medication ‘as required’, directions for staff around the administration were not always available. The recording of thickeners was not being consistently recorded at the time it was given to people.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff were generally responsive and if there was anything they wanted or liked to eat they would get this.

The management team explained how lessons were learnt and described actions they were taking in response to incidents. It was not always clear if the rationale behind these changes had been fully explored, for example a person who was a high fall risk had been supported to move to a bedroom which was actually further away from communal spaces and staff oversight potentially placing them at increased but it was not clear this aspect of the change had been considered and explored looking at the persons support needs.

It was not evident the processes had been effective to ensure lessons were learnt and appropriate action was taken to ensure people were protected from avoidable harm. For example, we noted several instances where people had unwitnessed falls. However, it was not clear what action had been taken to mitigate these risks as much as possible, for example by reviewing staffing levels and deployment. Where action to mitigate risk has been identified, for example with supervising a person as they mobilised around the home, this was not taking place in practice. The provider told us they had reviewed staffing levels following our visit.

People felt safe and told us they had choice in what they did and how they spent time. People felt confident medical attention would be sought if needed and told us they had access to specialist input such as chiropodists as needed.

Staff told us they received regular updates when things changed within the service. For example, they were updated when new people moved in. However, this information was not always accurate about people’s needs. Kitchen staff were aware of people’s dietary needs and had a good oversight of how to meet the needs of the people living at the service.

Professionals spoke positively about the service supporting people with emergency placements but noted there were areas where improvements could be made.

Processes were in place, including handover records, to make sure staff were aware of people’s needs. However, these were not always of sufficient detail or easy to read to enable staff to identify and respond to any changes or deterioration on people’s health. Accurate records were not always being maintained to demonstrate how people were being supported. For example, records did not demonstrate that people were having regular support with their oral health care needs or personal care including regular baths and showers or that modified diets and thickened fluids were given to those who needed them consistently. The service supported people with emergency placements. At the time of the assessment, the care plan for one person had not been implemented to support this placement. There were specific concerns around supporting this person that had not been shared with staff and could have potentially exposed this person to risk.

People and families generally spoke positive about the service. They told us that staff were nice, and they felt safe living at the service.

Staff had a good understanding of how to look out for signs of abuse and how to raise concerns.

We observed that staff did not always follow the guidance and care plans developed for people. For example, there were people at risk of falling in the lounge who needed ongoing supervision from staff. However, there were times when no staff were present and there was no way for people to call for help.

The provider had suitable policies in place to safeguard people using the service. Staff completed training on safeguarding and information about safeguarding and how to raise concerns was displayed around the home.

People told us staff were generally good at supporting them. One person noted, “One of the residents sometimes wrecks the place, but they quieten him down quickly, and we resume to normality. The staff react quickly.” However, people and families were not able to confirm how they had been involved in making any decision around their care.

Staff told us they knew people well and understood their needs. However, staff did not always demonstrate they were up to date with people’s change in needs and guidance in care plans was not always followed.

Observations were not clear about how people were involved to manage risk. There were periods throughout the day when people who were at risk of falling were left alone and there was no clear way how they would call for help for support.

Care plans lacked detail and clarity. We found that not all relevant risks were highlighted and there was no consistency in the assessments and care plans completed. Contemporaneous notes were not being kept, making it difficult to be sure that people’s needs were being met in line with the assessments. Evidence based risk assessments, such as nutritional and skin integrity risk were not being used to ensure an accurate and robust reflection of needs and specific risks were not always clearly highlighted. For example, one person needed thickened fluids but this was not easy to identify from reviewing the care plans. Care plans lacked detail or contained conflicting information and one person who attended for day care had no information about their needs available within records. Daily records did not demonstrate how staff were responding to people’s specific needs and escalating areas of concern, for example if people’s appetite had reduced.

People felt improvements were needed to the environment. Some aspect of the environment meant that people’s needs were not able to be met, for example in relation to showering. However, people did not the home was working with other services to ensure access to resources needed. Some areas of the home were not as warm as other areas and one person commented, “It is cold in my bedroom. If they could give me a hot water bottle, I’d be happy, but I don’t want to be cheeky.”

The registered manager told us the process of redecorating across the home had begun.

We observed the environment was not always clean and areas of the home need redecorating and furnishings needed replacing. Some equipment including the lift and shower upstairs was not in working at the time of our assessment. We noted some areas of the home were cold. The home supported people living with dementia. However, there was a lack of signage in adaptation to support people living in with dementia to remain independent. For example, there was little signage to assist orientation for people and some of the bedrooms did not have numbers on them.

The home had numerous risk assessments in place to manage the risk across the home including generic and individual risk assessment. A fire risk assessment had been carried out at the service and identified multiple areas of improvement. At the time of the assessment, limited progress had been made to address the concerns. The registered manager provided assurances that these would be addressed within the recommended timeframe for completion. It was not always clear if the fire doors were set to sound if people used them to leave the building. Routine safety checks which were due to take place at the service, were not scheduled to ensure they were completed within the given timeframe. Some safety issues were identified on the first day of the assessment, on the second day of the assessment some of these had been addressed.

People generally spoke positively about the staff team. One person told us, “The best bit is having staff around. You sometimes have to shout to get someone, but there’s always someone about. They are very good with me.” However, some people and families felt there were not always enough staff available. One family member commented, “They can’t be there watching all the time, and I do see some residents who are not supposed to get up trying to do, so I tell them to sit down and wait for staff. Some residents wander. Staff can’t be there all the time.” Generally, people felt staff worked together as a team. However, one person shared concerns about night staff and said, “The night staff don’t do anything, and always say it’s a day staff job.”

Staff told us they worked well as a team and were happy in their roles. Staff did raise some questions about staffing levels and described being ‘rushed off their feet most days’. Staff had access to a variety of online training, had recently done some face to face training and generally felt well supported.

We observed that staff were not always available and people were not always supported quickly. There were numerous occasions where communal areas were left without staff present where people would have required assistance to stand and were at high risk of falling, despite this having been identified as an area of need from previous incidents.

Tools to assess people’s dependency and care needs were not always being accurately maintained meaning that tools to calculate the number of staff needed for the home were not effective. The layout of the home provided challenges for staff to support people. The staffing rotas showed that staffing levels fell in the afternoon. An additional member of staff was brought in to provide additional support however their main role was to support with the mealtimes. In practice, this meant there were less staff available to support people in the afternoons and this is when we observed people waiting for support. Recruitment records did not demonstrate that a robust recruitment process was followed which included full employment checks and robust interviews which explored where people had gaps in their employment history or left previous posts. The was a lack of oversight to ensure suitable processes were followed. The systems in place did not demonstrate staff received an appropriate and robust induction when they started working at the service, that checks of competencies relevant to the role were undertaken or that regular supervisions were completed to ensure staff were well supported.

People told us they were supported by staff appropriately and that staff used personal protective equipment (PPE) when supporting them with personal care.

Staff told us there was not always an allocated member of staff to complete laundry tasks. Care staff therefore had to split their time between other auxiliary roles. Staff told us there were sufficient supplies of personal protective equipment (PPE) available throughout the home.

The environment was not always clean and tidy to support good infection prevention and control. Cleaning staff were in place and worked shifts which ended early in the afternoon. Staff were seen to use personal protective equipment appropriately when attending to people’s needs.

Domestic staff were scheduled to work until 3pm daily. Rota and task allocation processes were not clear on who held the responsibility for cleaning when domestic staff were not there in the later afternoon and evening. The provider completed checks and audits of infection prevention and control (IPC). However, these had not identified the concerns observed on the first day of the assessment. These concerns were subsequently addressed by the service.

People received their medication on time. People were supported to obtain medication for pain relief when this was needed. People did not raise any concerns with the support they received in this area.

Staff understood their responsibilities around the safe management of medicines. However, the systems in place did not always support this safe delivery.

Staff had been assessed for their competency to support people to take their medicines. However, medicine administration records were not always accurately maintained. At the time of the assessment, a new medicines cycle had just started. When the new paperwork was put in place, all necessary documentation had not been maintained. This meant that staff administering medicines did not have access to all the information they needed to do this safely, for example guidance around protocols for medicines to be administered ‘when required’.