Archived: Stanmore Residential Home

Our previous inspection on 21 April 2016 found three breaches of regulations. We rated the home as “requires improvement”. At that inspection, we found there was no environmental risk assessment of the home in place. People using the service were not protected against the risks associated with unsafe or unsuitable premises because fire doors were not closed and held open by a wedge and items that may be hazardous to health were not stored safely. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.relating to Safe care and treatment. We served a warning notice in relation to this. We carried out this focused inspection on 30 August 2016 to check what action had been taken. We found the provider had taken steps to comply with the regulation and addressed our concerns in relation to people’s health and safety. There were arrangements in place to identify any potential health and safety risks to people using the service. Monthly environmental safety audits were being conducted to identify any health and safety issues. Fire safety concerns identified had been addressed.

We also found a breach of Regulation 15 HSCA RA Regulations 2014 relating to The Premises and equipment. We found people using the service were not protected against the risks associated with unsafe or unsuitable premises because the premises and equipment were poorly maintained. At this inspection we noted that issues mentioned in the previous inspection report had been rectified. However, we noted that there were other deficiencies such as glass panels of two windows in two bedrooms which were cracked and the window restrictors in two rooms were defective. This is a breach of Regulation 15 HSCA RA Regulations 2014 relating to Premises and equipment.

The third breach was in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. At our previous inspection on 21 April 2016 we found the systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people. At this inspection we found that the service had taken action to comply with the requirements made. There was a system of audits and checks to ensure people received the care they needed. We however, noted that further improvements were needed to ensure that checks and audits were more comprehensive and covered all important areas so that the service could promptly rectify deficiencies identified. We have therefore made a recommendation for the service to review its system of checks and audits to cover all important areas.

There was a registered manager in place. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

Some arrangements were in place to keep people safe. Care workers understood how to safeguard the people they supported. There was a safeguarding adults policy and care workers had received training in safeguarding people. They knew what action to take if they were aware that people who used the service were being abused.

People's individual needs and risks were identified and managed as part of their plan of care and support. Risk assessments contained guidance to care workers on minimising potential risks to people.

There were arrangements for ensuring fire safety. Fire alarm tests and drills had been carried out. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records.

There were suitable arrangements for the recording, storage, administration and disposal of medicines and we noted from the records that people had been given their medicines as prescribed.

Care workers had been carefully vetted and the appropriate checks prior to them being employed had been carried out. The staffing levels were adequate. Care workers had received essential training, supervision and appraisals from the registered manager.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. We however, found that the service did not ensure that the premises were well maintained. The glass panels in two bedrooms were cracked. The window restrictors in two rooms were defective. Failure to ensure that the premises were properly maintained placed the safety of people at risk is a breach of breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Premises and equipment. The registered manager confirmed to us soon after the inspection that these defects had been repaired.

There were arrangements for the provision of meals to ensure that people’s dietary needs and preferences were met.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found evidence in the care records that that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

Care workers were aware of the human rights of people and the importance of treating people with respect and dignity and promoting their independence. There was a policy on promoting equality and valuing diversity (E & D) and respecting people’s individual choices, beliefs, culture, sexuality and background. Care workers were aware of the importance of treating people as individuals and ensuring that their diverse needs were attended to.

People received personalised care. Their care plans were informative and included details of people’s individual preferences and needs. This enabled care workers to provide people with the care and support they needed. There was documented evidence that people’s care had been reviewed with them and their representatives.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme and people were encouraged to be as independent as possible and participate in social and therapeutic activities.

There was a complaints procedure and relatives knew who to complain to. Complaints made had been promptly responded to.

Checks and audits had been carried out. We however, noted several deficiencies which the service had failed to identify and promptly rectify. These included glass panels of two windows in two bedrooms which were cracked and the window restrictors in two rooms were defective. The above demonstrated that there was a lack of effective quality assurance systems for assessing, monitoring and improving the quality of the service. This may affect the safety and quality of care provided for people and is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Soon after the inspection the registered manager informed us that a decision had been made to close the home. The home had submitted an application to cancel their registration. In addition, they had informed people who used the service, their relatives, care workers and the commissioning authorities involved.

After the comprehensive inspection, the provider sent us an plan to show what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 30 August 2016 to check that they had followed their plan, met the warning notice and to confirm that they now met legal requirements. We inspected the safe domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Stanmore Residential Home’ on our website at www.cqc.org.uk’.

Stanmore Residential Home is a care home and provides care and support to 27 older people who may be living with dementia. It does not provide nursing care. There were 25 people using the service at the time of our inspection.

There was a registered manager in post at the time of our inspection. 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 2008 and associated Regulations about how the service is run

At this inspection of 30 August 2016, we found that the provider had followed their action plan, the warning notice had been complied with and legal requirements had been met.

We found that the provider had ensured there was an environmental risk assessment in place which was being used to identify and address potential health and safety risks to people using the service. Suitable dorguard devices were fitted to the fire doors to prevent the spread of fire in the home and fire evacuation sledges were easily accessible. Fire exits were signed and clear of any obstruction. The garden was cleared of materials which could have caused harm to people if they accessed the garden.

There was a registered manager in post at the time of our inspection. 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 2008 and associated Regulations about how the service is run.

At the last inspection on the 10 December 2014 we found the registered manager was not meeting one regulation in relation to people not being protected against the risks associated with unsafe or unsuitable premises because fire doors were not closed and items that may be hazardous to health were not stored safely.

Following the inspection the registered manager sent us an action plan telling us how they were going to address the concerns identified. During this inspection we found that the registered manager had taken some action. However, we found some concerns about the maintenance of the premises and risks to people’s safety that had not been identified and actioned effectively.

People and their relatives informed us that they were satisfied with the care and services provided. On the day of our inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff.

Relatives of people who used the service and care professionals we spoke with told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Comprehensive risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm.

People's care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people's individual care needs. Staff did not appear to be rushed and were able to complete their tasks.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out at the home. The service had an infection control policy and measures were in place for infection control.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes.

People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people's needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that some authorisations had been granted and some were awaiting approval from the local authority.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met. People were mostly satisfied with the meals provided. Food looked appetising and was freshly prepared and well presented. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented.

People and relatives spoke positively about the atmosphere in the home. Bedrooms had been personalised with people's belongings to assist people to feel at home.

People and relatives told us that there were sufficient activities available. There was an activities co-ordinator that came to the home five days a week. On the day of the inspection we saw people taking part in playing with a ball and doing gentle exercises. People were also participating in singing songs of their choice. Later during the day, a hairdresser came to the home and styled people’s hair as they wished.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

An annual relative’s satisfaction survey had been carried out in 2015 and the results from the survey were positive.

There was a management structure in place with a team of, care workers, deputy manager, registered manager and the provider. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

Relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen. Complaints had been appropriately responded to in accordance to their policy.

We found the provider did undertake a range of checks to ensure the service was running efficiently covering areas such water temperatures, maintenance checks, electrical and boiler checks. However, there were no quality audits to effectively assess, monitor and improve the quality and safety of the services provided in the home.

We made one recommendation about seeking advice and guidance from a reputable source about adjustments required to meet the needs of people living with dementia.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of this report.

We are considering what action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.