Archived: Reside at Stour Road

Updated 28 February 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 checked 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 took place on the 11 December 2017 and was unannounced. It continued on the 12 and 28 December 2017 and was announced. The inspection was carried out by one inspector.

Before the inspection we looked at notifications we had received about the service. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive. We also spoke with local commissioners to gather their experiences of the service.

The provider was not asked to complete a Provider Information Return prior to our inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

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.

During our inspection we spoke with four people who used the service and three relatives. We spoke with the managing director, deputy manager, health and safety manager, administrator, five care workers, the chef and housekeeper. We also spoke with a visiting health care assistant from a local district nursing team to gather feedback on their experience of the service. We reviewed six peoples care files and discussed with them and care workers their accuracy. We checked three staff files, care records and medication records, management audits, staff and resident meeting records and the complaints log. We walked around the building observing the safety and suitability of the environment and observing staff practice.

Following the inspection the provider sent us additional information on management audits which we considered alongside evidence gathered during the inspection.

Updated 28 February 2018

The inspection took place on the 11 December 2017 and was unannounced. It continued on the 12 and 28 December 2017 and was announced. Reside at Stour is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 20 people in one adapted building and provides care to older people some of whom are living with a dementia. At the time of our inspection 16 people were using the service. Accommodation is over two floors and access to the first floor is by stairs or a lift. There is a communal lounge and dining area which provides level access into a secure garden.

The home had been without a registered manager in post since October 2017 but a manager had been appointed and was starting employment in January 2018. 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 had their risks assessed and reviewed monthly. Actions put in place to minimise identified risk were not always being followed. Two people had a high risk of malnutrition and actions had been put in place to minimise the risk of continued weight loss which included staff completing a food and fluid diary and monthly weights being recorded. Risk reviews and monitoring processes had not identified that some actions were not happening or not being effective which meant people were not being protected from avoidable harm. Health and safety audits had been completed but priority actions had not been completed in a timely way.

Prior to admission people were involved in an assessment of their needs and choices and this information was used to create care and support plans. Information in care and support plans was not always accurate in describing the care and support provided. People and their families were not involved in reviews of care. Staff were able to tell us about how people liked to be supported and about the actions they took to reduce risks to people. Engagement with people and their families about the service was limited and they were not always clear about the leadership. A resident and relative meeting had last been held in November 2016.

We have made a recommendation about good practice guidance on the subject of designing, delivering and reviewing peoples care and support needs and choices.

People had risk assessments carried out for skin damage and falls. Actions to minimise harm included specialist pressure equipment and the use of technology to monitor people’s movements. People had been involved in decisions about how risks they lived with were managed ensuring they had freedom and choice in their lives. People were protected from risks associated with infection control as staff had completed infection control training and the home was clean.

People were supported by enough staff to keep them safe and meet their assessed care needs. Staff had been recruited safely ensuring they were suitable to work with vulnerable adults. They had been trained to recognise signs of abuse and understood actions needed if they suspected abuse. Staff completed an induction and on-going training and support that enabled them to carry out their roles effectively.

People had a well-balanced diet and were able to choose from a selection of options each mealtime. Specialist equipment was available to support people to eat and drink independently. Support with meals was provided at the persons pace and respected their dignity.

People had their medicines ordered, stored, administered and recorded safely and had access to healthcare when needed. The service worked alongside other organisations such as the community mental health team enabling better outcomes for people.

The principles of the Mental Capacity Act were being followed which meant that people’s rights were being upheld. Staff had completed equality and diversity training and we observed staff respecting people’s individuality and life style choices. People had been involved in end of life planning which reflected cultural and religious beliefs.

People and their families described the home as happy and told us the staff always would try and help them. We observed positive, warm, friendly fun relationships between people and the staff. Staff gave time to provide emotional support to people and demonstrated an understanding of people’s individual communication skills. Interactions were respectful and included people in decisions about their day to day lives. People had their dignity and privacy respected. Signage around the home and the general layout enabled people with a cognitive impairment to orientate themselves both in the home and garden independently.

People had opportunities to engage in a range of activities in the home. Family and friends were able to visit at any time and new friendships were encouraged. Links had been made with a local school and people had gone to watch a nativity play. One person was being supported to access the community with a volunteer. When people preferred to stay in their room this was respected.

A complaints process was in place that people and their families were aware and when complaints had been received they had been investigated with the outcomes fed back to the complainant.

Staff described the culture as open and felt able to share ideas and views and contribute to the development of the service. Staff meetings were held regularly and included discussions on practice providing learning opportunities. Staff felt confident in their roles and felt that communication was effective in keeping them up to date with any changes. Throughout the inspection management and staff responded positively to areas that had been identified as requiring improvement.

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