Stradbroke Court

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• 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

We inspected 5 quality statements for this key question; Safeguarding, Involving people to manage risks, Safe environments, Safe and effective staffing and Infection prevention and control. Our assessment of this key question found improvements had been made in assessing people’s risks, staffing levels and the safety of the care home environment. Relatives told us they felt their family member was safe living in the service. However, further improvements were still required to ensure staff were able to put their training into practice and care plans fully reflected risks.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us they felt their family member was safe living at Stradbroke Court and did not have concerns about their safety. A relative told us, “We are more than pleased with the care that our relative is receiving and we do feel that he is safe. They check on him all the time and whatever we want they do.”

Staff understood how to keep people safe from abuse and the procedures to follow if they suspected abuse. A member of care staff told us, “If I suspected abuse or harm, I would follow the safeguarding procedures and report it to the manager or senior staff immediately.” We discussed the incident regarding the fire alarm described below with the manager and the nominated individual. They told us that staff had recently received fire training from an external organisation. The training had been that staff should make sure people were safe and then leave them and attend the fire muster point. We pointed out that staff had not made people safe before leaving them. The manager has told us that since the inspection visit, they were sourcing fire marshall training and implementing weekly fire drills with written reports and action plans.

During our inspection visit there was an emergency activation of the fire alarm. We observed that staff left 6 people unsupported in the dining area to attend the muster point. This put people at risk of falls, choking, anxiety and distress. We observed a person at risk of falls trying to stand, a person at risk of choking with food left in front of them and others became distressed. A person who was distressed said to us, “I don’t like when they leave me, you won’t leave will you?”

There was a process in place for reporting safeguarding. This included sharing information with the local authority and via notifications to the CQC. We found the system of recording did not facilitate effective monitoring to check for any themes and trends. The manager put in a new recording system on the day of our inspection visit.

Relatives were satisfied risks to people from receiving care and support were managed effectively. A relative told us, “They seem to know what to do.” Another relative described there always being 2 staff present when their family member was being hoisted.

Staff told us care plans provided detailed information on individual needs and preferences which enabled them to provide care safely. The manager gave us examples of how they had made changes to people’s care and support to ensure they received care in a safe way. For example, a member of staff talking with a person when they were walking to distract them and staff ensuring they did not walk too fast, which could increase their risk of falling.

There was inconsistency in staff practice to support and care for people safely. Some staff took the time to explain what they were doing and encouraged people to make choices. We observed a person being supported to sit in a chair. They were guided to sit and given clear step by step instructions. However, the fire alarm incident where people with identified risks were left unsupervised put them at risk of harm.

Care plans contained risk assessments relevant to the care and support people received. However, risks were not always reflected throughout the care plan which could mean staff were not aware of them. For example, a part of the care plan for 1 person stated they had no allergies, but their medicines record indicated they had an allergy to 4 medicines. For another person their care records highlighted mental health needs, but the risk assessment is recorded as ‘challenging behaviour’. The risk assessment highlighted that telephone calls to their daughter helped and they required support with these, but this was not reflected in the care plan.

Relatives were positive about the ongoing refurbishment to the building. One person told us their relative now had an en-suite shower room rather than the toilet and basin as previously. They also felt that the environment was now cleaner and fresher in appearance. A relative said, “It's all open, bright and light colours and they have introduced other colours with cushions and pictures.”

Staff were positive about the improvements being made to the building. One staff member told us, “There is pride in the place.” Staff knew what to do to if they found something wrong. A member of care staff said, “I know how to report any breakages, anything that needs repair and where to raise those concerns.”

There was enough suitable furniture and equipment to meet people's needs and to ensure they were comfortable. The environment was clean, free from clutter and hazards. People had their own bedrooms which were bright, personalised and welcoming.

Improvements to the building were part of the service action plan. This included a new medicines room and a new hair salon. There was a system for staff to report any defects to the maintenance person. Processes were in place to ensure risks within the environment were assessed and monitored. This included regular checks on appliances and equipment such as wheelchairs to ensure they were fit for purpose and a maintenance system to ensure the home remained a safe place to live.

People told us they felt the service had adequate staff although they did report that, particularly in the evenings and at weekends, it could take a long time for anybody to answer the door or the telephone. A relative told us, “I do feel that they have enough staff as they seem to be able to take the time with people.”

Staff gave mixed feedback as to whether there were sufficient staff to meet people’s needs. Some staff were positive that there were enough staff, but others said staffing levels could be mixed. A member of staff told us, “Not always [enough staff] can be very understaffed or the other way too many, depends on who’s coming.” Other staff referred to their deployment during the shift. 1 member of staff said, “When I am on shift, I receive clear directions regarding my tasks and responsibilities for the day.” However, other staff said clear deployment and direction depended on who was leading the shift. Staff told us that they received the training they needed to provide care safely and effectively. However, they also told us they would like more training relevant to supporting people with mental health conditions and living with dementia.

On the day of our inspection visit leadership, coordination and delegation of duties was at times unclear leading to inconsistent practice. We saw the medicines round was delayed when a member of care staff was called away to another unit. This left the member of staff administering medicines alone with no other member of staff on the unit and no way to call them. This meant that people’s medicines administration was delayed. The lunch time meal arrangements were not well organised, and this led to a disruptive service. We saw 1 member of staff encourage people to make choices and not rush them whilst another talked over people and hurried them. During the morning activity of painting, we observed the 2 staff involved to be attentive and responsive to people. They praised and encouraged people for their pictures.

The service used a dependency tool to assess the number of staff required. The nominated individual told us that the tool took into account people’s support needs as well as the layout of the building. Since our site visit the manager made changes in the allocation of staff and number of units open in the service to address the issues we identified and improve staff deployment and allocation. Policies and procedures were in place to help ensure staff recruited were assessed as safe to work with people. Checks on the suitability of potential staff were completed. This included obtaining references and checks with the Disclosure and Barring Service (DBS). The DBS helps employers make safer recruitment decisions and help prevent unsuitable people from working in care services. Records showed that staff had received training in areas relevant to their roles. Staff received supervision sessions which provided an opportunity for them to discuss their performance and professional development. However, the service needed to ensure that staff understood and implemented their training.

Relatives told us that the staff used PPE and appeared to have adequate supplies.

The manager told us that the service had an infection control lead person in the service who carried out regular checks and audits and that they attended monthly the monthly infection control meetings. The infection control lead told us they also attended quarterly meetings with external stakeholders including healthcare professionals, where they received training and information which they cascaded to staff where applicable.

During our inspection visit we observed the service to be clean and well-maintained. Infection control measures such as lids on bins were in place. We also observed housekeeping staff cleaning communal areas in the service.

There were procedures for managing and preventing infections. Staff received appropriate training, and the manager and infection control lead carried out regular audits of cleanliness.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.