Archived: Stambridge Meadows

We found the following examples of good practice.

Suitable measures were in place to screen all visitors. This included temperature checks, the wearing of Personal Protective Equipment [PPE] and rapid flow testing to keep infection risks to a minimum.

People were admitted into the service safely. People’s COVID-19 status was sought prior to admittance and people self-isolated in line with current government guidance.

Arrangements to assess current and emerging risks presented by the pandemic had been identified for staff and people using the service.

Staff had received training on infection prevention and the correct use of PPE and specific training relating to COVID-19.

Appropriate infection prevention control practices were observed for staff, such as the wearing of masks, gloves, aprons and included good hygiene practices.

Cleaning schedules were in place and being followed. The environment was visibly clean and odour free.

Stambridge Meadows is a residential care home providing accommodation and personal care to 21 people aged 65 and over at the time of the inspection. Some people using the service were living with dementia. The care home accommodates up to 49 people in one adapted building.

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

Risks for people were identified and recorded. Risk assessments showed how risks to people's safety and wellbeing were to be reduced and the actions required to keep people safe.

Measures were in place to control and prevent the spread of infection. Staff employed at the service had received training on infection prevention and the correct use of Personal Protective Equipment [PPE]. Appropriate infection prevention control practices were observed, including the wearing of PPE to keep infection risks and the risk of transmission to a minimum. The environment was visibly clean and cleaning schedules evidenced the frequency of cleaning undertaken at the service. Suitable arrangements were in place to comply with government guidance on care home visiting.

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 7 December 2020] and there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the management of risk. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Stambridge Meadows is a residential care home and was providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 49 people in one adapted building.

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

People told us they were safe and liked living at Stambridge Meadows.

Effective arrangements were not in place to mitigate all risks for people using the service or staff employed. Not all appropriate measures were in place or being followed by staff to prevent and control the spread of infection.

This was a breach of Regulation 12 [Safe care and treatment] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

The leadership, management and governance arrangements provided some assurances to suggest the service was being managed well. Quality assurance and governance arrangements at the service were much better but still required improvement to ensure risks to people were mitigated, records relating to their care and support were accurate and infection, prevention and control measures were safe.

Since our last inspection in January 2020, people were protected by the service’s safeguarding arrangements. The deployment of staff was suitable to meet people’s care and support needs. Proper arrangements were now in place to ensure people received their medication as they should.

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 supported this practice.

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 Inadequate [published 19 May 2020]. 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 9 [Person-centred care], 13 [Safeguarding service users from abuse and improper treatment], 17 [Good governance] and 18 [Staffing].

This service has been in Special Measures since 19 May 2020. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions ‘Safe’ and ‘Well-Led’ which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stambridge Meadows on our website at www.cqc.org.uk.

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.

Stambridge Meadows is a residential care home providing personal and nursing care to 32 people aged 65 and over at the time of the inspection. Some people living at the service were also living with dementia. The service can support up to 49 people.

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

Safeguarding policies and procedures were not embedded and understood to keep people safe. Staff did not recognise or respond appropriately to abuse. Not all risks to people’s safety were assessed and recorded. Checks relating to the service’s fire arrangements were not regularly completed. Improvements were required in relation to medicines management. Comments about staffing levels were variable. Staff did not have the time to sit and talk with people and care provided was predominately task and routine focused. The deployment of staff was not always suitable to ensure people’s needs were met. Recruitment checks for staff supported people to stay safe. In general, infection control arrangements were managed well.

Not all newly employed staff had received a robust induction. Though staff had received regular supervision, the registered manager had not nor had they received an annual appraisal of their overall performance. People’s comments about the meals provided were positive, however the dining experience across the service was variable and not always well planned. The physical environment for people living with dementia is not suitable and improvements are required. The service monitors people’s health, care and support needs but does not consistently act on issues identified. Staff worked collaboratively with other services to meet people’s needs. Staff felt supported and valued by the registered manager.

Peoples comments about the care provided was positive but people told us staff did not have the time to sit and talk with them. Staff did not always understand the importance of making sure they had the time to give people support in line with their care needs, particularly for people living with dementia.

Not all care plans were up-to-date or reflective of people’s current care needs. People were not supported to follow their interests or encouraged to take part in social activities relevant to their interests and preferences. The service has not fully implemented the Accessible Information Standard. People feel confident to raise concerns or make a complaint. The service’s arrangements to manage concerns and complaints was appropriate, open and transparent.

Suitable arrangements were not in place to ensure the management and governance arrangements at the service were effective and outcomes for people assured good quality person-centred care. There was a lack of oversight by the provider and senior members of staff to identify and pick up poor practice, particularly on the first floor for people living with dementia.

Rating at last inspection

The rating at last inspection was good (published July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up

We will meet with the provider and request an action plan to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, Local Authority and CCG to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. The provider shared with us their action plan and this provided detail on their progress to meet the required improvements. At this inspection we found that these improvements had been made.

Stambridge Meadows provides accommodation and personal care for up to 49 older people. Some people also have dementia related needs.

This inspection was completed on 5 and 6 July 2017 and there were 33 people living at the service when we inspected.

A registered manager was 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.

People told us the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills and competencies to meet people’s needs. Staff felt supported and received appropriate formal supervision at regular intervals. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were very complimentary about the quality of meals provided. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the local authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Care plans accurately reflected people’s care and support needs and people received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The registered manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

Stambridge Meadows provides accommodation and personal care for up to 49 older people. Some people also have dementia related needs.

At the time of the inspection a manager was in post. The manager was previously the deputy manager and had been in their new role as manager of the service since the beginning of November 2016. The manager was not registered with the Care Quality Commission and an application to be registered with us had yet to be submitted. An assurance was provided by the manager that this would be submitted as a matter of priority. 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.

Quality assurance checks and audits carried out by the provider were not as robust as they should be. They had not recognised the issues we identified during our inspection and had not identified where people were placed at risk of harm or where their health and wellbeing was compromised.

While the majority of people told us they felt safe, suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk. Bedrail assessments had not always been completed to determine that these were suitable for the individual person so that any risks identified were balanced against the anticipated benefits.

Although staff had received training relating to safeguarding, not all staff understood the importance or procedures to follow to ensure people’s safety and wellbeing. Despite staff having attended training, not all staff understood the relevant requirements of the Mental Capacity Act [MCA] 2005 or the key requirements of the Deprivation of Liberty Safeguards.

People and staff told us the service did not always have enough staff available to meet their needs. This meant that people had to wait on occasions for care to be provided. There was a high number of vacancies at the service and this was impacting on the above.

Improvements were required to ensure people received their medicines as prescribed and medication records completed appropriately. This referred specifically to codes on the Medication Administration Records [MAR] and PRN ‘as needed’ protocols being in place.

Staff had received formal supervision, however improvements were required to ensure that where subjects and topics were raised by staff, this was followed up and there was a clear audit trail to demonstrate actions taken. Improvements were also required to ensure that aims and objectives were set as part of annual appraisal procedures.

People and their relatives were not fully involved in the assessment and planning of people’s care.

Not all of a person’s care and support needs had been identified, documented or reviewed to ensure these were accurate and up-to-date. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

The dining experience was generally positive although some minor improvements were required on the first floor. People were supported to have enough to eat and drink. People were supported to maintain good health and have access to healthcare services as and when required.

Arrangements were in place for staff to receive appropriate training opportunities for their role and area of responsibility. The majority of mandatory training for staff was up-to-date and staff received an induction.

Where appropriate people were enabled and supported to be independent. People were also treated with dignity and respect. Staff knew the care needs of the people they supported and people told us that staff were kind and caring.

The summary is based on our observations during the inspection, from speaking with seven people who were using the service, four staff who supported them and with two visiting relatives. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included six support plans, daily support records, staffing records and service quality monitoring processes.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Appropriate safeguarding procedures were in place and staff knew how to safeguard the people they supported.

The home had detailed policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

Staff we spoke with said they had been properly trained for their roles. Staff told us that they received good support from the management team.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People's health and care needs were assessed and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Most of the people we spoke with who were using the service said they were satisfied with their rooms and the facilities. However some people told us they would like the gardens and grounds to be kept in better condition and we found that not all areas of the premises and grounds were kept adequately maintained and suitable for people to use.

Is the service caring?

People were supported by kind and cheerful staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service we spoke with told us, 'The staff are really lovely, I'm very happy to be here.' Another person told us, 'I like it here, the staff have helped me so much since I moved in'. 'I can't fault the staff they are wonderful to me'.

A relative said, 'We are so pleased that our relative is living in this home, the staff are kind and good at keeping us informed about our relative.' Other comments we received from relatives were, 'The staff are very approachable, they listen to and take action on our requests, they are also caring and always busy trying to make sure our relative's needs are being met.'

The responses and views of people who used the service and their relatives were asked for as part of regular quality monitoring reviews of the service. Any shortfalls or concerns raised were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people's wishes.

Is the service responsive?

People had the opportunity to enjoy a range of activities and, mostly with family and friends support, were able to get out and about in the local community.

Since our previous inspection, in December 2013, afternoon staffing levels had been increased to try to ensure people's needs were being fully met.

A person who used the service we spoke with told us, 'The staff are around if I need them and they ask me if I want anything, if I tell them I'm worried about something they try to sort it out for me.'

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the aims of the home and of the standards of care and support that was expected of them.

Regular service monitoring processes were in place. This helped to ensure that people received a good quality service at all times.

A relative we spoke with told us, 'I am very happy that my relative is in this home, the staff are very good to my relative and the managers and staff are good at keeping me updated about my relative's wellbeing.'

We found that the provider had a falls prevention and management policy in place. Our evidence showed that the management team of the service was proactive in falls prevention and ensuring people's health and wellbeing. We found that medicines management was appropriate and protected people against the risks associated with the unsafe use and management of medicines. Improvements were required to ensure that there were sufficient numbers of staff on duty to meet the needs of people who used the service at all time.

The atmosphere within the service was calm and relaxed and staff interactions with people who live there were noted to be positive. Staff were able to demonstrate a good understanding of people's care and support needs. We spoke with two relatives and they confirmed that the quality of care and support provided for their member of family was very good. Comments included "I feel our relative's needs are met very well and nothing is too much trouble for staff", "I feel very relaxed knowing that our relative is so well looked after", "I feel the staff understand the needs of our relative" and "Our relative likes all the staff."

Records showed that the management of medicines at the service were good and there were appropriate arrangements in place for staff to receive a robust induction, training and supervision.