This inspection tool place on 16 and 17 July 2018. Our visit on 16 July 2018 was unannounced.

Stamford House 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.

During the last inspection of Stamford House in July 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to infection control, cleanliness of the environment and equipment, moving and handling, and monitoring of people’s dietary intake. The service was rated as requires improvement in the safe, effective, caring and well led sections of the report and good in the responsive section. The service was rated as requires improvement overall.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe?’, ‘is the service effective?’, ‘is the service caring?’ and ‘is the service well led?’ to at least good. At this inspection we found improvements in these areas and the service was no longer in breach of the regulations.

Stamford House provided a safe and secure environment. Environmental risks were assessed, people’s vulnerability recognised and safeguards to prevent avoidable harm were in place.

Appropriate measures were in place to prevent the spread of infection. A cleaning schedule showed attention to ensuring tasks were carried out in a timely fashion, and supervision notes and team meetings reminded staff of their duties to ensure a clean and hygienic environment.

People’s diets were closely monitored and records were kept to show people’s daily food and drink intake. There was a plentiful supply of hot and cold drinks, and people told us that they enjoyed the food provided.

Stamford House Care Home is an older type property situated in Rochdale, Greater Manchester. The home is registered to provide accommodation to 23 older people who require support with personal care. There are two passenger lifts to assist movement between the ground and first floor. En-suite facilities are not provided but there are assisted bathing facilities on both floors. At the time of our inspection there were 15 people living in the home.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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 manage and administer medicines helped ensure that this was done safely. Attention was paid to people’s health needs with close liaison with doctors, district nurses and other health professionals as the need arose.

There were safe recruitment procedures in place to ensure staff were of the right character to support vulnerable people. Training provided staff with ongoing opportunities to develop their learning. Staff were knowledgeable and knew the people they supported. Regular observation of their performance allowed for on the job supervision, and staff had opportunities to discuss their progress and work performance through supervision and yearly appraisal.

Individual choices were acknowledged and people who lived at Stamford House told us their choices were respected. Where people lacked capacity, the appropriate agreement to provide care and support had been authorised by the local authorities commissioning the service.

The needs and wishes of the people who lived at Stamford House were uppermost, and we saw staff showed genuine warmth towards them. There was a person-centred culture and personal belongings were treated with respect.

Care plans and daily notes provided sufficient detail to gui

This inspection was carried out on the 12 and 13 June 2017. Our visit on the 12 June 2017 was unannounced.

Stamford House is a large detached home located in Rochdale, which provides care and support for up to 23 people who require residential care only. At the time of our inspection there were 21 people living at the home. Facilities include single rooms with wash hand-basins, two communal lounges, dining room/conservatory and a garden.

At the time of our inspection there was a registered manager in place. 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.

We identified breaches of three of the Regulations of the Health and Social Care 2008 (Regulated Activities) Regulation 2014. These were in relation to infection control, cleanliness of the environment and equipment, moving and handling, risk to the environment of legionella and recording keeping. You can see what action we asked the provider to take at the back of the full version of this report.

Staff understood safeguarding procedures and what action they should take in order to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

We found that the home environment and some equipment were not cleaned to an adequate standard. The home had not been adapted to cater for the needs of everyone living there. For example people with mobility problems could not access the garden and there was little in the way of adaptations, such as pictorial signage, for people living with dementia.

Checks and servicing of equipment, such as for the gas and electricity were up-to-date. However work identified in a legionella risk assessment in November 2016 had not been carried out.

Medicines were stored correctly and staff who administered medicines had received the appropriate training.

Risk assessments had been completed to show how people should be supported with everyday risks, such as risks to their mobility or nutrition. However, we identified concerns in relation to the recording of people’s food intake.

Staff had undertaken training to provide them with the skills and knowledge required for their roles and received supervision to discuss any issues in relation to their work.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were complimentary about the caring nature of the staff. However, we found that peoples’ dignity was not always respected. Care plans, which were reviewed regularly, were detailed and reflected the needs of each individual.

An activities coordinator encouraged people to participate in a wide range of activities.

People spoke positively about the registered manager and the management of the home.

Complaints were managed appropriately.

There were a range of policies available for staff to refer to for guidance on best practice. There were quality assurance processes in place to monitor the quality of the service and ensure it was maintained and improved. However, these had not identified all the concerns we found during our inspection.

The purpose of this inspection was to check that the provider had made the required improvements following the last inspection of 28/05/2014. We discussed these improvements with the provider at a meeting on 25/07/2015 and an action plan was submitted which told us the issues had been addressed.

During our inspection visit we spoke with four people who used the service, two visitors, two care workers, the deputy manager and the registered manager. We also looked at medication and care records, staff training records and audits completed by the manager to monitor the quality of the service provided.

All the people we asked told us they liked living at the home. One person said, "The staff are very kind and treat me well. I have only been here a couple of weeks but it seems very nice. They provide things for us to do and I like to join in the activities. I am quite happy here up to now".

Comments from other people included, “The staff are all nice people”, “It is clean and tidy”, “The food is good and you get a choice” and “You could not ask for better care.”

Two visitors told us, "The care home is very good. They keep us informed of any changes and staff are very welcoming to us. Her room is kept clean and there are no offensive odours. The staff really make this place and after all it is good care we want not a fantastic looking place".

We found that a member of staff remained in the dining room at meal times to provide appropriate support for people to eat their meal in a safe and dignified manner.

We saw that all areas of the home including the kitchen were clean and tidy. Equipment such as hoists were stored in designated areas of the home. We saw that damaged furniture had been replaced or repaired.

We noted that records for the management of medication were clear and accurate. This helped to prevent mistakes from being made.

Discussion with two care workers and examination of records confirmed that regular supervision meetings were taking place with the registered manager. They said these meetings gave them the opportunity to discuss work related issues and training.

We found that the registered manager had put in place a system for monitoring the quality of the service provided. Audits completed regularly included infection control, care planning, the environment and health and safety.

We saw that care records for people who used the service were detailed and included directions for staff to follow in order to ensure people’s individual needs were met.

This inspection was carried out with a commissioning manager from Rochdale Council Adult Social Care Department as a result of concerning information we had received about how people’s money was being managed by the Registered Manager.

During our inspection visit we spoke with the Registered Manager and the Deputy Manager. We looked at the policies and procedures for supporting people who required assistance to manage their finances, the Statement of Purpose, the care files of three people who used the service, records of financial transactions involving the money of eight people who used the service and the insurance certificate for the safe.

We found that robust procedures in relation to financial matters were not in place. Although the Statement of Purpose included information about the safekeeping of valuable items there was no information about the arrangements in place for people to receive their personal allowance.

We saw that records of the financial transactions involving people’s money were up to date and accurate.

We were not shown any records to demonstrate that regular audits of financial matters were carried out. We therefore concluded that such audits were not carried out by the Registered Manager or the Provider.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping.

During our inspection visit we spoke with six people who used the service, a visiting physiotherapist, two care workers, the cook, the manager and deputy manager. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Two people who used the service told us they felt safe living at the home. One person said, “It’s a great place to live, you’ve got your security.” Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

Systems were not in place to make sure that managers and staff learn from events such as accidents and incidents. This increases the risk of harm to people and fails to ensure that lessons are learned from mistakes.

We saw that significant areas of the home were dirty. This included the kitchen and food storage areas, lounges, dining room and the room where medication was stored.

Although members of staff had received training in the management of medication we saw that medication administration records were not complete and accurate. Although there was no evidence of any medication errors a lack of clear records increases the risk of mistakes being made.

We looked at the care plans of five people who used the service. These plans did not clearly identify the individual care needs of people who used the service or provide clear directions for staff to follow in order to ensure people’s needs were met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and infection control and record keeping.

Is the service effective?

People’s health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Although care plans were reviewed regularly we saw that the review of one care plan was dated 01/06/2014 which was four days after the date of this inspection. This meant the record was inaccurate and could put the health and wellbeing of the person at risk.

Discussion with care workers and examination of records confirmed that a rolling programme of training was in place so that all members of staff were kept up to date with current practice. However, there was no evidence to demonstrate that members of staff had regular supervision meetings with the manager or had an annual appraisal of their work.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping and supporting workers.

Is the service caring?

People who used the service told they liked living at the home. One person said, “You won’t find many homes as good as this for looking after you.” Another person said, “Everyone is kind.”

However, at lunch time we observed that people in the dining room were left unsupervised by members of staff after each course of the meal had been served. We saw that one person was cutting food up for the person sitting next to them and then put cutlery into that person’s hands. Another person was using a spoon but had difficulty putting food onto the spoon which resulted in food going onto the table. This meant that people were not receiving the support they needed in order to ensure they ate in a safe and dignified manner.

People who used the service and their representatives were given the opportunity to complete annual satisfaction questionnaires.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare.

Is the service responsive?

We were told that a member of staff was employed for two or three days each week to organise activities in the home. These included playing skittles and doing arts and crafts. People were also encouraged to pursue their own interests and hobbies. One person told they enjoyed listening to CD’s in their own room.

People knew how to make a complaint if they were unhappy. One person told us they would definitely tell a member of staff if they were unhappy about something.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The quality assurance system required further development in order to ensure that all aspects of the care provided at the home were properly monitored. The manager had not identified and addressed the shortfalls we found during this inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

Stamford House is registered to provide accommodation and personal care for up to 23 older people. The home is situated in Rochdale close to shops and other amenities. This was an unannounced inspection which took place on 14 April 2015. There were 20 people living in the service at the time of our inspection.

We last inspected this service on 29 September 2014 and found the regulation we assessed was being met.

The home 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 was not on duty at the time of our inspection and the deputy manager was in charge of the home.

People who used the service told us that Stamford House was a safe place to live. Staffing levels were sufficient to meet the needs of people who used the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

We saw that people were supported to take their medicines as prescribed.

Appropriate procedures were in place for the prevention and control of infection.

Members of staff told us they were supported by management and received regular training to ensure they had the skills and knowledge to provide effective care for people who used the service.

The registered manager and deputy manager had completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they knew when an application should be made and how to submit one.

All the people we asked told us the meals were good. Snacks and drinks were available between meals. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We saw that care plans included information about people’s personal preferences which enabled staff to provide care which was person centred and promoted people’s dignity and independence.

Leisure activities were routinely organised within the home. These included various games, arts and crafts and reading and discussing newspaper articles.

A copy of the service user guide which included the procedure for making a complaint was provided in each bedroom. There had not been any complaints made to the CQC or local authority since the last inspection.

Members of staff told us they liked working at the home and found the manager and deputy manager approachable and supportive.

We saw that systems were in place for the registered manager and deputy manager to monitor the quality and safety of the care provided.

We spoke with a visitor, who also volunteered at the home, as well as briefly with two people who used the service. Everyone we spoke with was positive about the service provided. One person said “It’s very good, I enjoy living here”.

The visitor told us that the staff seemed to know the needs of the people and treated them with respect when offering care. They said “The staff seem to be caring, plentiful and look after the people well.”

Everyone we spoke with told us they felt safe at the home and the environment was pleasant.

We found that the provider had recruitment procedures in place and followed the appropriate guidelines in ensuring that permanent staff had the correct checks in place before being recruited.

We saw that general the policies and procedures were stored effectively, but there were some areas that required improvement.

We spoke with two visitors who were with their relatives at the home. They told us the staff were accessible, friendly good and treated their relatives well. One visitor said “The staff are brilliant, I have no issues with them.”

Both visitors confirmed staff asked their relatives for verbal consent before providing treatment and personal care. However, both visitors told us that they were not involved in the regular reviews of the care plans.

Neither visitor had any concern in relation to the medication process and felt their relatives were safe living at the home. Neither had any concerns related to the wellbeing of their relatives.

The visitors we spoke with told us they felt there were enough staff around to assist their relatives and other people. They told us that they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns or complaints.

We spoke with five people who lived at the home. Some people did have some mild degree of confusion. Three people were complimentary about life in the home, a fourth person told us that living there was nothing like living in your own home and a fifth person told us that he thought he was in prison. People told us that the staff were helpful, although one person said it depended on the staff member on how much help was provided. He said sometimes staff told him ‘to do it himself’ when he asked for assistance. People told us that they enjoyed the meals provided particularly the cooked breakfast.