About the service: Stainton Lodge Care Centre is a care home that was providing personal and nursing care to 68 older people, people living with a dementia and people with a mental health condition at the time of the inspection.

People’s experience of using this service: Risks were monitored and action taken to keep people safe. Medicines were managed safely. Sufficient numbers of safely recruited staff were in place.

Staff were supported with regular training, supervision and appraisal. 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. Staff supported people with eating and drinking.

People received kind and caring support and were treated with dignity and respect. Systems were in place to arrange advocacy support where needed.

People received personalised support based on their assessed needs and preferences. A range of activities were in place for people to enjoy. The provider had an effective complaints process.

A range of quality assurance checks was carried out to monitor and improve standards. We received positive feedback on the management and leadership of the service.

Rating at last inspection: At the last inspection the service was rated Good (Report published 20 August 2016).

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 26 July 2016 was unannounced. This meant the registered provider did not know we would be visiting. A second day of inspection took place on 27 July 2016 and was announced.

The service was last inspected in July and August 2015. At that inspection we found the service did not ensure the requirements and principles of the Mental Capacity Act 2005 were followed and did not have effective checks in place to monitor and improve standards at the service. These were breaches of our regulations. We did not take enforcement action but required the service to submit a plan telling us how they would be compliant with the regulations. When we returned for this inspection we found the issues identified had been addressed.

Stainton Lodge Care Centre is a nursing home. It provides care and treatment for up to 73 people who either have complex mental health needs or are older people living with a dementia. The service is located adjacent to Stainton Way, another service operated by the registered provider. The service is divided into two units across two floors. People with complex mental health needs live on the ground floor and older people living with a dementia live on the first floor. At the time of our inspection 34 people were using the service.

There was a manager in place, and they were in the process of applying to be the registered 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.

People and their relatives told us the service kept them safe. Risks to people were assessed and plans put in place to minimise the chances of them occurring. These were reviewed on a monthly basis to ensure they accurately reflected people’s current support needs. Risks to people arising from the premises and equipment were also assessed and reviewed.

Systems were in place to record and monitor accidents and incidents. Where these occurred a report was completed setting out what happened and the remedial action taken. Plans were in place to support people in emergency situations. There was a business continuity plan in place to help ensure people received a continuity of care in emergency situations.

Medicines were managed safely. People were supported to take their medicines at their own pace, with staff explaining what the medicines were and what they were for. People were given a choice over whether they wanted their medicines. People we spoke with said they received the medicines when they needed them.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where issues had been raised records confirmed they had been investigated and dealt with appropriately.

The manager carried out checks to ensure there were enough staff employed to support people safely and recruitment procedures minimised the risk of unsuitable staff being employed.

The service was working within the principles of the Mental Capacity Act 2005. 32 people were subject to DoLS authorisations at the time of our inspection. Where this was the case this was recorded on the person’s care plan, along with details of the expiry date and whether the authorisation had any conditions attached.

Some of the care plans we looked at contained detailed information on people’s capacity, however, we also saw that some care plans lacked this detail.

Staff had not always received mandatory training but such training was planned. Staff also received additional training in specialist areas such as pressure sore care, stroke care and behaviours that challenge. Staff said training had improved since the manager joined the service. Newly recruited staff completed an induction process before they were allowed to sup

We inspected Stainton Lodge Care Centre on 22 July, 5 and 11 August 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. We commenced the inspection at 6am, as a part of this routine inspection, to meet night staff and observe practices. This was the first inspection since the care home had opened.

Stainton Lodge Care Centre is a nursing home. It provides care and treatment for up to 73 people who either have complex mental health needs or are older people living with dementia. The service is divided into four units across two floors.

On the first day of the inspection the manager was on leave. The home has not had a registered manager in place since June 2014. When we commenced the inspection there was a manager in post who had submitted an application to become the registered manager. The manager intended to add this home to their existing registration as manager for Stainton Way Care Centre, which is located in an adjacent building. However, prior to completing the inspection we were informed that the manager had resigned. 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.

Not having a registered manager is a breach of the provider’s registration conditions. To date the provider has not formally notified us of this change and this is a breach of regulation 15 of the Care Quality Commission (Registration) Regulations 2009. Both of these matters we will be dealing with outside of the inspection process.

We found that the service provided in the unit for people with complex mental health needs was very well organised and in line with expected good practice. Since opening in May 2015 the unit had gradually filled and there were seven people using this service. People had variety of mental health needs but we found that the clinical lead had carefully considered people’s compatability when determining who to admit. Staff on this unit clearly understood how to meet people’s needs and what to do if people lacked the capacity to make decisions. It was a very well organised and run unit.

We noted that the home has been open for over a year but remained a very sterile environment. All of the units were decorated in beige colour schemes and were reminiscent of branded hotel schemes. We saw that no consideration had been given to making the residential unit dementia friendly or to make this unit easy for people to navigate.

On the residential unit for people living with dementia we found that staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training but remained unclear about the requirements of this Act. We found that there was no information to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finances. No records were in place to show that staff completed capacity assessments where appropriate and made ‘best interest’ decisions.

We found that on the residential unit some people had difficulty making decisions, were under constant supervision and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, what restrictions people were subject to or if there were conditions attached to any authorisations. One person persistently asked to leave and banged on the door trying to get out but staff could not confirm whether an authorisation was in place for this person.

We saw that assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were well-developed on the nursing unit. On the residential unit we found that staff needed to ensure these were updated and altered as people’s needs changed. At times staff were not recording the review of people’s needs that they had completed. Staff were able to discuss in-depth the support each person needed and how they worked with people.

Throughout the day we observed care practices and saw that they were treated with respect and dignity when care was provided. However, we noted that on the residential unit staff left the bedroom doors open whilst people were asleep in their rooms. Staff could provide no explanation for this practice and we saw it compromised people’s dignity.

The home had a good system in place for ordering, administering and obtaining medicines. However some improvements were needed in the way the staff managed medicines. We saw gaps in the recording of medicines on this unit; staff did not make sure discontinued medicines were removed from the medicine and administration records (MAR). Charts and protocols for as required medicines were not always in place. We saw that no action had been taken to ensure the labels on medicines were intact, which meant staff could not be sure that the medicine given was correct. Also there was some overstocking of medicines, which meant staff were re-ordering medicines when plenty were already in the home. We saw that a medicines audit was carried out but these were not always dated and staff on the residential unit were not using them to look at how to improve their practice.

Albeit the provider had systems for monitoring and assessing the service over the last few months a care consultancy had undertaken them. During the inspection the provider told us that this arrangement had ceased and they would recommence overseeing the service. We also found that when the manager was away the staff on the residential unit failed to complete audits and monitor the performance. Staff on this unit were also unclear as to who they reported to, with some staff referring to the deputy manager from Stainton Way overseeing them whilst others told us they reported to Stainton Lodge’s clinical lead. The clinical lead told us they were not involved in overseeing the operation of the residential unit. We discussed this with the manager on their return from holiday and they informed us this was an issue they had identified and were taking action to ensure the home operated as a whole and appoint a lead for the residential unit.

We visited from the early hours of the morning and spent time with people in each of the units. We found that people required varying levels of support. We saw that staff provided people with support to manage their day-to-day care needs and staff had taken appropriate steps to ensure people received care and support, which was tailored to their needs. We did note that on the residential unit there were no activities taking place throughout our visit. One of the staff showed us rummage boxes they had been making but none of these were out on display on the unit.

Checks of the building and maintenance systems were undertaken to ensure health and safety and the provider was taking action to resolve problems with the temperatures in the treatment rooms being excessive.

People we met were able to tell us their experiences of the service. They were complementary about the staff and found that home met their needs. People told us that they felt the staff had their best interests at heart and if they ever had a problem staff helped them to sort this out. They told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that individual’s preference were catered for and people were supported to manage their weight and nutritional needs. We saw that people living at Stainton Lodge Care Centre were supported to maintain good health. A external catering company provided the chefs and assistant cooks at the home. They reported that there was always plenty of ingredients to hand and they made home-cooked food.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. The new manager had ensured this had been improved and concerns were now thoroughly investigated. People we spoke with told us that they knew how to complain and felt the manager would respond and take action to support them.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. The clinical lead, a nurse, a senior carer, and seven care staff were on duty during the day and a nurse, a senior carer and five staff were on duty overnight. The manager split their time equally between Stainton Lodge Care Centre and Stainton Way Care Centre. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who had diabetes. We found that the staff had the skills and knowledge to provide support to the people who used the service. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs.

We found that all relevant infection control procedures were followed by the staff at the home.

We found the provider was breaching two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to adhering to the requirements of the Mental Capacity Act 2005, and governance arrangements. You can see what action we took at the back of the full version of this report.