Strawberry Fields Care Home

Strawberry Fields Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service supports older people living with dementia, memory loss and similar disorders. At the time of the inspection there were 37 people using the service

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

Staff had not always followed good infection control practices and the home was not clean and well maintained. Medicines were managed safely but medicines records were not always accurately maintained. Staffing levels were maintained, however the service experienced recruitment issues and relied on agency staff.

The provider's systems for monitoring the service were not always effective. Audits had not always identified shortfalls, or actions had not been taken to make improvements.

People and relatives were positive about the kind and caring nature of staff and had good relationships with them. Relatives and visitors were welcomed into the service. People and their relatives took part in their care planning. Staff worked well with other professionals to help identify and meet people's needs.

Staff said they were happy in their roles and told us they felt the management of the service was supportive.

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 good (published 9 May 2019).

Why we inspected

We received concerns in relation to infection control, staffing and quality of care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection prevention and control and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Systems were in place to prevent staff and visitors from catching or spreading infection. There were no visitors allowed in the home apart from relatives of people receiving end of life care.

• Every staff member and visitor had their temperature taken at the door and were provided with Personal Protective Equipment (PPE).

• The service had used technology such as video calls and phone calls to support people to maintain social contact with friends and relatives.

• Risk assessments related to COVID-19 were in place and regularly monitored; this included risks related to the health and wellbeing of both people and staff.

• Staff we spoke with were able to explain the procedures in place to reduce the risk of spreading the COVID-19 virus and cross contamination. Well stocked personal protective equipment (PPE) stations were located around the service. We observed staff wearing appropriate PPE for the task they were carrying out.

• We observed the home looked clean and hygienic. There were enhanced cleaning schedules which included regular cleaning and disinfection of high touch points such as handrails and light switches.

Further information is in the detailed findings below.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2018. More information about this is in the full report.

• The risks to people’s health and safety were now appropriately assessed resulting in safe care being provided. Improvements had been made to the way people’s medicines were managed. People were protected by staff who understood how to protect them from avoidable harm. The provider had acted on a recommendation made by the CQC at the last inspection to review the deployment of staff. Improvements in this area meant staff were now available for people when they needed them

• The risk of the spread of inspection was safely managed, although we did identify one piece of equipment and one room that required cleaning. Systems were in place to help the provide to learn from mistakes. This included the detailed analysis of accidents and incidents.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

• Staff training was largely up to date and they received on-going assessment of their practice. People were provided with care and support which protected them from discrimination. People received the support they needed to maintain a healthy diet. People at risk of weight loss or gain and dehydration were referred to health specialists. People had access to other health and social care agencies where needed. The environment had been adapted to support people living with dementia and/or a physical disability.

• People found the staff to be kind, caring and respectful. People were treated with dignity and their independence was encouraged. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

• Improvements had been made to the way people’s personal preferences and choices were used when care was planned for them. Improvements had been made to the activities provided with people now having a wider range of meaningful activities available to them.

• People’s needs were assessed prior to them coming to live at the home. This helped to ensure their needs could be met by staff. People’s personal preferences were considered when care was planned. People had access to information in a format they could understand. Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were basic and required more detailed reference to people’s personal preferences.

• Improvements had been made to the overall assessment of risk at the home. Audits were now effectively used to assist the registered manager and the provider in identifying and acting on risks in an effective and timely manner. People, relatives and staff praised the approach of the registered manager. Staff found her to be welcoming and they felt respected and valued. Relatives had been given the opportunity to give their views about how the service could develop and improve. Plans were in place to provide people living at the home the same opportunity.

• There was now continued focus on learning, development and improvement. The registered manager had a good understanding of the regulatory requirements of their role.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (25 January 2018).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

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 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.

During this inspection, we found the service was not consistently safe. People were at risk of not receiving their medicines when needed, as there were not always trained staff available to administer medicines. We also found other issues with the management of medicines, which placed people at risk of not receiving their medicines as required.

People were not always protected from risks associated their care and support. Risks were not always identified and addressed in a timely manner and this placed people at risk of harm. Risk assessments were not always sufficient and guidance in place to reduce risks was confusing and resulted in inconsistent practice in some areas. There were enough staff employed, however staff were not always deployed effectively to meet people’s needs and ensure their safety. Adequate steps had not always been taken to ensure people were protected from staff that may not be fit and safe to support them. There were systems and processes in place to minimise the risk of abuse and incidents were investigated thoroughly. The home was clean and hygienic.

Where people had capacity to make decisions they were asked for their consent by staff. However, where people lacked capacity their rights under the Mental Capacity Act (2005) were not respected at all times. Overall, people were supported by staff that had the skills and knowledge to provide good quality care and support.

People were not always protected from the risk of poor food and fluid intake as monitoring systems were not effective. People provided mixed feedback about the quality and quantity of food served at the home. People were supported to attend health appointments. However, there was a risk people may not receive appropriate support with specific health conditions as care plans did not consistently contain sufficient information for staff to follow. There were systems in place to ensure information was shared across services when people moved between them, however these were not always effective. People’s diverse needs had been taken into account in the design and decoration of the building.

People told us staff were kind and caring but commented staff did not have time to spend with them. We observed interactions were limited and task focused. People’s right to privacy was not always respected. People were not consistently provided with information in a way that was accessible to them and staff did not always demonstrate an understanding of how people communicated. People told us they were involved in decisions about their care and support, however we found this was not always the case. People had access to advocacy services if they required this.

People were at risk of receiving inconsistent support, as care plans did not all contain accurate, up to date information and staff did not always follow the guidance in care plans. People’s social and recreational needs were not met as there were very limited opportunities for meaningful activity. This meant many people who used the service spent their time unoccupied. People’s friends and family were welcomed into the home and were involved in the care and support of their loved ones. There were effective systems in place to investigate and respond to concerns and complaints.

Governance and audit systems at Strawberry Fields Care Home were not consistently effective. This meant some risks to the safety and wellbeing of people living at the home had not been identified prior to our inspection. Where areas for improvement had been identified effective action had not always been taken to address the issues raised. Accurate and up to date records were not kept of people’s care and support. People, their relatives and staff were positive about the registered manager and they had opportunities to express their views in relation to how the service was run.

During this inspection, we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.