About the serviceAngels (Stratton House) Ltd is a nursing home and was providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 24 people. Accommodation is laid out over two floors that can be accessed by stairs and a lift. Each floor provides bedroom accommodation, most with en-suite facilities and people have shared access to one bathroom and one shower room. To the ground-floor there are two communal lounges, dining room, and level access to front and rear gardens. The registered manager's office can be found on the first floor.
People's experience of using this service and what we found
There was a lack of provider oversight of the service and the quality of care provision. Governance systems
either did not exist or were not used effectively to identify the concerns, errors and omissions we identified during our inspection. The staffing structure did not always promote effective communication and staff did
not always speak about people in a person-centred way. We found one statutory notification had not been submitted in line with requirements. There was no oversight of safeguarding in the service. The systems in
place failed to support staff to recognise and identify that unexplained bruising may indicate potential abuse or neglect.
People were at risk from the spread of infection because staff had not received suitable training in relation to the application and management of personal protective equipment (PPE). When risks were identified,
they were not always managed in line with assessments. Staff were not recruited safely, and we received mixed comments about staffing levels in the home. Staff were not always undertaking training relevant to the needs of people they were supporting, and some
training was overdue.
The manager was working with a recognised training provider to implement a new training programme.
People were supported to eat and drink enough, however alternative meal choices were not always available.
The recently appointed manager was in the process of implementing changes, including introducing new ways to engage with stakeholders. Staff said they felt part of a team, and relatives spoke positively about
staff.
People were supported to access healthcare and external services.
The manager had identified that the premises were not always suited to people living with dementia and was working to improve this.
Routine health and safety checks were being completed. Improvements had been made in relation to the management of medicines.
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
The last rating for this service was requires improvement (published 25 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show
what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to food provision and staffing levels in the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Angels
(Stratton House) Ltd 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safeguarding people, infection prevention and control and risk assessment and management. Additional breaches relating to recruitment and staff training and the service's quality assurance systems were also identified.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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
return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
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 6 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 the 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.