About the service:

Five Stacks Residential Care Centre is an adapted building which provides accommodation and personal care for up to 30 older people including those living with dementia. This service includes a self-contained wing specifically for providing short break care for up to seven adults with learning disabilities (LD). There were 19 people living in the service at the time of our inspection; no one was using the LD respite facilities.

People’s experience of using this service:

People and their relatives were complementary about the service and would recommend it to others. One person told us, “I would recommend the home to everyone.”

People told us they felt safe living in the service and there were sufficient numbers of staff to support their needs.

Staff supported people to keep safe, and ensure they received their medicines as prescribed.

Care plans showed people, and where applicable their relative, were being consulted over their care, and had were encouraged to retain their independence.

Staff involved healthcare professionals to ensure people’s healthcare needs were met and supported.

People were supported by management and staff who were skilled, highly motivated, kind and compassionate.

Staff knew people well and understood people’s preferred routines, likes and dislikes and what mattered to them.

People had access to a range of activities to take part in if they wished. Their visitors felt comfortable visiting and praised the welcoming atmosphere of the service.

The provider had systems in place to check on the safety and quality of the service people received and act on the information to drive continuous improvement.

Rating at last inspection:

Requires Improvement. The date the last report was published was 11 April 2018.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor this service and plan to re-inspect this service within the published timeframe for services rated as Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Five Stacks Residential Care Centre is a residential care service that provides accommodation and personal care for up to 30 adults including those living with dementia. The service includes a self-contained wing specifically for up to seven people with learning disabilities. There were 26 people in the service when we inspected on 8 and 13 February 2017 plus one person staying on a respite basis on the 13 February 2018. This was an unannounced inspection.

There was a registered manager in post. 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.

At our last inspection in September 2016, we found breaches in regulations 9,11,12,13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed conditions on the provider’s registration requiring them to make improvements in relation to their risk management and quality assurance systems.

At this inspection, we found that improvements had been made and the provider was no longer in breach of the regulations. However, there were some areas where further improvements were still needed.

There were improvements in some areas of risk management but some areas still needed further work, particularly in relation to risks associated with specific health conditions and environmental risks. There were improvements in the management of people’s medicines.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Systems in place to reduce people being at risk of potential abuse were now more robust. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

Improvements had been made to the care records. They were written in a person centred manner and gave details about what was important to people, their likes and dislikes. Work was ongoing to ensure care records accurately reflected people’s current care and support needs. People told us that they received personalised care which was responsive to their needs.

Staff understood the importance of gaining people’s consent and were compassionate, attentive and caring in their interactions with people. They understood people’s preferred routines, likes and dislikes and what mattered to them. Staff were trained and supported to meet people’s needs effectively.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). 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 supported this practice.

People’s nutritional needs were assessed and met. People were offered meals that were suitable for their individual dietary needs, however further work was needed to give people more choice and improve the mealtime experience.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

The service had improved their quality assurance systems and additional audits and checks had been put in place to monitor safety and quality of care. However, the provider had not yet demonstrated that their quality assurance systems were robust enough to independently identify shortfalls and recognise where action is needed. They now need to demonstrate that improvements will be sustained and embedded in practice, so that people can be confident they are receiving safe, effective and responsive care.

The management team were open and transparent throughout the inspection and sought feedback to further improve the service provided.

Five Stacks Residential Care Centre is a residential care service that provides accommodation and personal care for up to 30 adults including those living with dementia. The service includes a self-contained wing specifically for up to 7 people with learning disabilities. There were 27 people in the service when we inspected on 4 May 2017. This was an unannounced inspection.

There was a registered manager in post. 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.

Systems in place to reduce people being at risk of potential abuse were not robust. We were not assured that all incidents which could constitute abuse had been appropriately referred to the relevant safeguarding authority.

The inappropriate management of people’s medicines placed them at risk of harm. People were not protected from the risks associated with moving and handling, pressure care or catheter care. The provider had failed to take the necessary actions to ensure that the risks to the health and safety of service users were assessed, mitigated and reviewed appropriately.

Despite our concerns, people presented as relaxed and at ease in their surroundings and with the staff. People told us they felt safe and there were enough staff to meet their needs. Concerns and complaints had been investigated, responded to, and appropriate action taken.

Care plans did not always accurately reflect people’s current care and support needs. Records were disorganised and it was not clear what was current information and what should be archived. However, care plans were written in a person centred manner and gave details about what was important to people, their likes and dislikes. People told us that they received personalised care which was responsive to their needs.

Staff were encouraged by the management team to spend time socialising with people throughout the day and engaging in activities with them. We discussed with the management team how people would benefit from a more structured approach to activities to ensure resources available to them were put to good use.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent before providing support or care and acted in accordance with their wishes. However we were concerned that people were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible.

Staff were compassionate, attentive and caring in their interactions with people. They understood people’s preferred routines, likes and dislikes and what mattered to them. They were trained and received regular supervision, however there were some areas such as moving and handling and challenging behaviours where additional training was needed.

People’s nutritional needs were assessed and met. People were offered meals that were suitable for their individual dietary needs. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. The service proactively engaged with these professionals and acted on their recommendations and guidance in people’s best interests.

The provider had quality assurance systems in place but these systems had failed to identify shortfalls and areas where improvements were needed. Quality assurance systems needed to be more robust to ensure all potential shortfalls were identified and responded to appropriately to ensure the delivery of safe, effective and responsive care and to drive continuous improvement.

During this inspection we identified