Archived: Stafford Court

Updated 12 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part following concerns raised by the Local Authority with the Care Quality Commission. The information shared with the Care Quality Commission indicated concerns about falls management, risks to people who have bedrails fitted, staffing levels and management oversight and this inspection examined those risks. Because of the Local Authority’s concerns, an embargo on placements at Stafford Court was imposed by them in September 2018.

This inspection took place on 1 and 2 November 2018 and was unannounced. On 5 November 2018 the service's administrator was requested to provide additional documents to the Commission as part of the inspection process.The inspection team consisted of two inspectors on both days. On 1 November 2018 the inspectors were accompanied by an expert by experience. An expert by experience is a person who has personal experience of caring for older people and people living with dementia.

We reviewed the information we held about the service including safeguarding alerts and other statutory notifications. This refers specifically to incidents, events and changes the registered provider and registered manager are required to notify us about by law.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 10 people who used the service, three people’s relatives, six members of care staff, three senior care staff, the staff member responsible for facilitating social activities, the administrator, the deputy manager and the acting manager.

We reviewed six people’s care plans and care records. We looked at the staff recruitment records for three members of staff, staff training information for the service, supervision and appraisal records for an additional three members of staff. We also looked at the service’s arrangements for the management of medicines, safeguarding, complaints and compliments information and quality monitoring and audit information.

Updated 12 December 2018

Stafford Court provides accommodation and personal care for up to 29 older people and people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Our previous comprehensive inspection to the service was on 12 and 13 October 2017. The overall rating of the service at that time was judged to be ‘Good’.

This inspection was completed on 1 and 2 November 2018 and was unannounced. On 5 November 2018 the service's administrator was requested to provide additional documents to the Commission as part of the inspection process. There were 25 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms 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.

A registered manager was in post, however in September 2018 because of sick leave, the registered manager delegated the day-to-day management of the service to two senior members of staff who were promoted to the role of acting manager and deputy manager. 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 were not robust, as they did not identify the issues we identified during our inspection and had not identified where people were placed at risk of harm and where their health and wellbeing was compromised. The management team of the service had not taken appropriate steps to ensure they had sufficient oversight of the service which ensured people received safe care and treatment. The lack of managerial oversight at both provider and service level had impacted on people, staff and the quality of care provided. Therefore, the management team were unable to demonstrate where improvements to the service were needed, how these were to be and had been addressed; and lessons learned to ensure compliance with regulatory requirements and the fundamental standards.

Suitable arrangements were not in place to act when abuse had been alleged or suspected. Although people told us they were safe, people were not protected from abuse and avoidable harm.

The management team had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people using the service, we observed some interactions which were not respectful or caring and failed to ensure people were treated with respect and dignity. People were not always actively encouraged to make day-to-day choices and we were not assured that staff always understood the importance of giving people choices and how to support people that could not make decisions and choices for themselves.

The standard of record keeping was poor and care records were not accurately maintained to ensure staff were provided with clear up to date information which reflected people’s current care and support needs. Suitable control measures were not always 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, and risk assessments had not been developed for all areas of identified risk.

Although appropriate recruitment procedures were in place to check staffs’ suitability to work with vulnerable people before they started work, improvements were required to make sure these were robustly completed for all staff employed to ensure safer recruitment practices. Not all staff had received a robust induction and the role of senior members of staff was not effective in monitoring staff’s practice and providing sufficient guidance and support. Training and development was not sufficient in some areas to demonstrate that people's care and support needs were fully understood by staff and embedded in their everyday practice. Staff had not received regular supervision.

People’s capacity to make day-to-day decisions had been considered and assessed. Nonetheless, improvements were required to ensure more significant decisions which had been made by staff were in people’s best interests and clearly recorded the rationale for these decisions.

People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required. The registered provider’s arrangements for the prevention and control of infection at the service was satisfactory.