Stafford Hall is one of a number of services owned by Runwood Homes Ltd. The service provides care and accommodation for up to 40 people who may need assistance with personal care and may have care needs associated with living with dementia. The service has two floors and there is access to these via a small staircase and a passenger lift. On the day of our inspection the service did not have any vacancies and the service does not provide nursing care.

The service had 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. The registered manager of the service had been in post for two years.

The service was remarkably responsive. Since out last inspection the service had continued to make further improvements that had a positive impact on people’s lives. Staff, relatives, professionals and people living at the service all felt the care at the service was exceptional and people were enabled to have a good quality life. Staff cared for people in a very kind and compassionate way, they knew them well and people were happy and relaxed at all times. Relatives were very positive about the care provided at the service and complimentary about staff and management.

The service was safe. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty and these were regularly reviewed. People’s medication was well managed and they received their medication as prescribed.

The service was effective. Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker. They also received regular support and felt well supported by management. Management and staff had a good understanding of the Mental Capacity Act 205 and Deprivation of Liberty and protected people’s rights and freedoms.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus. People were supported to maintain good healthcare and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

The service was caring. People had agreed to their care and had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Meetings had been held for the people living at the service, relatives and people felt listened too and that their views and opinions had been sought and the service had made appropriate improvements.

Detailed assessments had been carried out and care plans were developed around people’s individual needs and preferences. People were seen to receive very personalised care which was unique to them and their care records were person centred. People’s daily lives included activities and hobbies that interested them and their involvement in participating in activities they liked was seen to be important and that they enjoyed their days. The service was decorated and set out in a way that meant that all the people living there had a space that they enjoyed. The environment full of unique areas and ideas to keep people engaged.

People told us that they knew how to complain. The

The inspection took place on the 8 and 9 February 2016 and was unannounced.

Stafford Hall provides services for up to 40 people who need assistance due to old age or for people who may need care due to living with some form of dementia. It does not provide nursing care. On the day of our inspection the service had three vacancies.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager 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.

Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. During our inspection there were sufficient numbers of staff on duty.

People’s medication was well managed and people received their medication as prescribed.

Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker.

We found there were policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of what these meant and the implications for people living at the service. Where people had been deprived of their liberty, applications had been submitted to the local authority for a DoLs authorisation.

Suitable arrangements were in place that ensured people received good nutrition and hydration. People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus.

People were supported to maintain good healthcare. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

Meetings had been held for the people living at the service and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.

People were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Detailed assessments had been carried out and care plans were developed around people’s needs and preferences.

The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response.

There was a strong emphasis on promoting and sustaining the improvements already made at the service. The registered manager continually strived to improve the service and demonstrated that they knew which areas of the service needed attention. Since being in post they had introduced a number of systems to improve the quality of care and had enhanced people’s lives.

The unannounced inspection took place on the 8 April 2015.

Stafford Hall is one of a number of services owned by Runwood Homes Limited. The service is registered to provide care and accommodation for up to 40 people who need assistance with personal care and may have care needs associated with living with dementia. At the time

of our inspection there were 33 people living at the service.

The service did not have a registered manager, but a registered manager from another service in the group was providing interim management support. The organisation is in the process of taking appropriate steps to rectify this issue and an application for registration has been made. A registered manager is a person who has registered with the Care Quality Commission to manager 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 May 2014 we had concerns around infection control, staffing and the monitoring and quality of some of the services records. An action plan was submitted which showed how these concerns were to be addressed and this visit was to establish whether this had been implemented and the issues now resolved.

At this inspection we found that the service had improved in cleanliness and infection control and work had been done to improve the assessing and monitoring of the service. Staffing had been assessed by the organisation and since the last inspection the service had increased their staffing hours by one person each day. The increase had been used to improve the work force service during busier times of the day. Systems were now in place to ensure the service’s quality was regularly monitored and that staff were following the organisations correct policies and procedures. This helped to keep people safe and ensure they received the care and support they needed.

Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks.

People’s medication was generally well managed and the service had systems in place to help ensure people received their medication as prescribed. However, on the day of our visit people did not receive their medicines in a timely manner, which had a potential impact on their wellbeing.

Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of skilled and well trained staff on duty. Staff had been supported to carry out their work and had received regular supervision and training.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus.

People were supported to maintain good healthcare. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians.

People had agreed to their care and had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. The manager had a good understanding of MCA and DoLS and appropriate documentation had been completed. Mental capacity assessments had been carried out where people were not able to make decisions for themselves.

People knew how to complain. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response. We saw that complaints had been recorded and any lessons learned from them had been actioned.

The service had an effective quality assurance system. Meetings had been held for the people living at the service and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.

People we spoke with were happy with the care they received at Stafford Hall. Each person had an individual personalised care plan, which identified their care needs and choices. People spoken with stated that the carers provided any care they needed. Staff were observed speaking with people with dignity and respect and involving them in their care. People appeared relaxed with staff and were viewed helping them to make choices on how they wanted their care provided. During our visit at no time were people seen waiting for staff to support them.

People spoken with told us they were happy with the care they received from the staff and knew how to raise any concerns they may have. Comments received from thank you cards from the home included “I receive first-class support,” “From my experience it has clearly demonstrated a well-managed, motivated and happy home.” and “We would like to express our thanks for the kind caring attention given to ‘X’ whilst in your care.”

Stafford Hall provides services for up to 40 people who need assistance due to old age or dementia. At the time of our inspection there were 32 people living in the service. There is a registered manager in post.

People and staff told us that there was not enough staff working in the service. Although the service was fully staffed on the days of our inspection there were times when people’s safety was compromised. Staff told us that when they were supporting people with their personal care needs, this frequently meant that it was not possible to have a member of staff free to be with people in the lounge to ensure that they were safe.

The registered manager told us that a tool was used to assess people’s dependency levels; however there was no analysis of this to show how staffing levels were calculated to ensure that people’s needs were met effectively. All of the people who used the service interviewed and all the staff spoken with, stated that there were insufficient staff numbers, there was no audit or plan to address these concerns.

The provider had a good system in place that recorded the number of incidents and accidents that had occurred each month, however we found there was no overall analysis of trends, such as falls at night which had a significantly higher occurrence rate. This trend had not been reviewed as to why this was happening and if this was linked to staffing levels.

From discussions with the manager about the environment it was evident that there was little recognition of the differing needs of people with or without dementia and therefore no plan or procedures to address these. This was particularly relevant to those who chose to spend time in their rooms, because they preferred not to mix with people with advancing dementia, some of whom had behaviour that challenged.

Health charts showed that overall people’s health was being managed and monitored by staff. However bowel monitoring charts were not fully completed. The registered manager informed us that people’s bowel movements were also recorded in the daily records. This dual recording process resulted in difficulties monitoring people’s bowel movements appropriately and increased the risks to their health from constipation.

During the first day of our inspection we found areas of the home, equipment and appliances were dirty and unhygienic. When we returned the next day the registered manager had taken action to ensure that these items had been cleaned and were in working order. Although the provider had infection control audit procedures in place, the registered manager had not taken action to address previous issues relating to the provision of appropriate equipment and standards of hygiene.

The lack of robust quality assurance and governance of the service found at this inspection breached Regulations 10, 12, 15 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.

The provider had systems in place to manage safeguarding matters, behaviour that challenged and medication which ensured people’s safety. Staff had access to a safeguarding adult’s policy and procedures and had a good understanding of the procedures and how and when to follow them. Individual behaviour plans had been produced providing guidance to staff which ensured people’s behaviour was dealt with effectively and in a manner that respected their dignity and protected their rights. Appropriate arrangements were in place that ensured people who used the service received their medicines as prescribed.

People had been involved in discussions about what dignity meant to them. We observed that staff adhered to these principles during our inspection, recognising the diversity, values and rights of the people that used the service. Our observation of the interactions between people who used the service and staff were positive. Staff were respectful when talking with people, calling them by their preferred names and speaking discretely with them about their personal care needs.

The provider had systems in place which supported people and their relatives to manage end of life in a positive way. Documents showed that mental capacity assessments and best interests meetings had taken place, when decisions needed to be taken on behalf of someone who was deemed to lack capacity.

We found that staff were motivated, caring and well trained. Records showed that training had been provided to meet the specific needs of people who used the service, including dementia. Six staff had been trained to be dementia champions, which meant that they took a lead on promoting dementia care in the service.

People spoke positively about the range of activities in the service. The activities coordinator told us that their aim was to ensure that people had a pleasant and happy time. One relative said, "Activities are inventive and fun."

Staff and people who used the service told us that they felt the registered manager was approachable, and that they would feel confident to raise concerns with them and felt these would be addressed. We saw that people’s complaints were investigated in a timely fashion. The outcome of these had been used to make improvements to the service.

The registered manager had asked relatives of people who used the service to complete a satisfaction survey. These surveys showed positive results about the service. Where issues had been raised, for example about missing laundry these had been dealt with through the complaints process, which demonstrated that the registered manager had used this feedback to improve the service.