Stafford Court provides accommodation and personal care for up to 29 older people and people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Our previous comprehensive inspection to the service was on 12 and 13 October 2017. The overall rating of the service at that time was judged to be ‘Good’.

This inspection was completed on 1 and 2 November 2018 and was unannounced. On 5 November 2018 the service's administrator was requested to provide additional documents to the Commission as part of the inspection process. There were 25 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

A registered manager was in post, however in September 2018 because of sick leave, the registered manager delegated the day-to-day management of the service to two senior members of staff who were promoted to the role of acting manager and deputy manager. 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.

Quality assurance checks and audits were not robust, as they did not identify the issues we identified during our inspection and had not identified where people were placed at risk of harm and where their health and wellbeing was compromised. The management team of the service had not taken appropriate steps to ensure they had sufficient oversight of the service which ensured people received safe care and treatment. The lack of managerial oversight at both provider and service level had impacted on people, staff and the quality of care provided. Therefore, the management team were unable to demonstrate where improvements to the service were needed, how these were to be and had been addressed; and lessons learned to ensure compliance with regulatory requirements and the fundamental standards.

Suitable arrangements were not in place to act when abuse had been alleged or suspected. Although people told us they were safe, people were not protected from abuse and avoidable

The service was last inspected in October 2016 where the Commission highlighted a number of concerns. This service was rated as ‘Requires Improvement’ following this inspection.

The provider wrote to us with actions they had taken to improve the service. Improvements had been made since our last inspection, and the service has been rated overall as Good.

A registered manager was 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.

The service had a number of quality monitoring processes in place to ensure the service maintained its standards. The service had made improvements to ensure staff delivered support that was effective and caring and this was in a way which promoted people's independence and wellbeing, whilst people's safety was ensured.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people's individual needs to be met adequately. Trained staff dispensed medicines and monitored people's health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People's rights were also protected because management and staff understood the legal framework of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks.

Systems were in place to make sure that people's views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals.

An effective complaints procedure was in place and had been implemented appropriately by the registered manager.

The inspection was completed on the 11 and 13 October 2016 and was unannounced.

Stafford Court provides accommodation and personal care for up to 29 older people who may have care needs associated with living with dementia. There were 28 people living at the service at the time of our inspection. The service does not provide nursing care.

A registered manager was 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.

During our inspection we found a lack of governance. The service did not have robust systems in place to effectively monitor and improve the quality of the service people received. Although there were processes in place to seek the views of people who used the service and those acting on their behalf, it was unclear how this feedback was used to improve the quality of the service.

The service did not have robust recruitment procedures in place to ensure staff were suitable to work with vulnerable adults.

There were limited opportunities for people to engage in meaningful activities. Additionally, for people living with dementia there was a lack of information on how their dementia affected their ability to participate and to be supported in taking part in activities.

Assessments of people’s capacity were carried out in line with the Mental Capacity Act 2005 (MCA). Staff understood and complied with the requirements of the MCA and the associated Deprivation of Liberty Safeguards (DoLS).

People and their relatives told us that the service was a safe place to live. Individual risks to people’s safety had been routinely assessed and management plans were in place however improvements were required in record keeping in some areas of the service to mitigate risk or potential risk of harm for people using the service. Staff were trained in how to protect people from abuse and harm and how to raise an alert if they had any concerns.

Staff were kind and caring and treated people with respect and dignity. Feedback from people and their relatives about all aspects of the service was positive.

People’s nutritional needs were assessed and met and people were supported to maintain a healthy and balanced diet. People were supported to access health and social care professionals and services when needed.

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

We directly observed care within the service to help us determine what it was like for people living at Stafford Court. We found that staff interactions with people who lived at the service were positive. Staff were noted to have a good understanding of people's care and support needs. People told us that they liked living at Stafford Court and found staff to be kind and caring.

The provider had arrangements in place to ensure that there was appropriate equipment to support people and for the safe operation of the service. Equipment was regularly checked, serviced and repaired to ensure that it was safe and fit for purpose.

Staff told us that they felt supported in their role and had access to good levels of training to develop and update their skills.

Records in relation to people's personal information and other records necessary for the effective operation of the service were well maintained, accurate and up to date.

Where people were unable to provide a verbal response to tell us verbally their experiences, for example as a result of their limited verbal communication or poor thought processes, we noted their non verbal cues and these indicated that people living at the home were relaxed and comfortable and found their experience to be positive.

Five people spoken with during our inspection told us that they liked living at Stafford Court and they found the staff to be kind and caring. People told us that care staff maintained individual's privacy and dignity.

Four people spoken with suggested that they felt safe and that, if they had any concerns or worries, they would discuss them with their relative, a member of staff and/or the manager.

Two relatives told us that they were always kept informed if their member of family became unwell and/or required healthcare input. They confirmed that they found staff working at the home to be pleasant and courteous.

The provider told us that satisfaction surveys were sent out to all relatives in June/July 2011. The comments provided were very positive and suggested that people who use the service and their relatives were very happy with the quality of care provided. Comments included "The home provides safe 24 hour care and staff are always available and have time to speak to all residents whenever needed", "The home does not need to do anything to change. It works like clockwork." and "My relative has dementia and I can only be grateful for the constant care they recive. They are always happy and smiling. This would not happen if they were not well looked after."