The inspection took place on 25 September 2018 and was unannounced.

Stanecroft is a care home. 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.

Stanecroft is owned and operated by Care UK Community Partnerships Ltd. It provides accommodation and nursing care for up to 50 older people, who may also be living with dementia. There were 45 people living in the service at the time of our visit. A further two people lived at Stanecroft, but were in hospital on the inspection date. The service is arranged into five individual units. The service also has an onsite day service which is accessed by some of the people who live at Stanecroft, in addition to being open to the wider community.

The service had a 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. The registered manager was present during the inspection.

We last carried out a comprehensive inspection of this service on 23 August 2017 when we rated the service as Requires Improvement and made two recommendations about how the service could make improvements to the leadership and training of staff.

At this inspection, we found that the provider had allocated a regional support team to assist the registered manager in moving the service forwards. Through this process, the provider had maintained a strong oversight of the service in addition to mentoring the management support team. This has led to a much more open culture and a greater sense of personalisation across the service. The next step is for these new ways of working to be embedded and for the registered manager to take the service forward in a proactive way.

There were sufficient staff to safely support people. Appropriate checks were undertaken to ensure only suitable staff were employed and new staff completed a programme of induction. All staff accessed mandatory training and specialist training was ongoing.

People were safeguarded from the risk of abuse and staff understood their roles and responsibilities in protecting them from avoidable harm. Staff had a better understanding of people’s capacity and legal rights and took positive steps to gain valid consent.

People’s needs were appropriately assessed and care was planned in a person-centred way. Support was delivered in response to people’s changing needs. Advanced care planning enabled people’s end of life wishes to be known and respected.

People were supported to maintain adequate levels of nutrition and hydration and told us they liked the food provided.

Medicines were managed safely and people received their medicines as prescribed. Staff now worked in partnership to ensure people received holistic personal and health care support.

The service was clean and there were systems in place to appropriately manage infection control. There was an ongoing programme to improve the design and layout of the service to effectively support people living with dementia.

People received support from staff that were kind and compassionate towards them. People were involved in making decisions about their care and staff had a good knowledge of people’s individuality and preferences.

People had greater opportunities to participate in activities of interest and staff engaged with people in a way that was meaningful to them. There were better systems in place to ensure that people were listened to and concerns were addressed in a way that improved the quality of care.

Stanecroft is a care home providing accommodation and personal care for up to 50 older people, who may also be living with dementia. There were 42 people living in the service at the time of our visit. A further three people lived at Stanecroft, but in hospital on the inspection date.

The inspection took place on 23 August 2017 and was unannounced.

The home had a 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. The registered manager was present during the inspection.

We carried out an unannounced comprehensive inspection of this service on 21 October 2016 when we rated the service as Good. Earlier this year, we received some concerns about the service and these have been investigated through a large scale enquiry with our partner agencies.

On 26 April 2017, in response to the concerns raised, we undertook an unannounced focused inspection early in the morning. At that time we found that some people were lying in soiled bed clothes and linen. We also identified that records about the care people provided at night were not always an accurate reflection of the support they had actually received. On the basis of our findings, we issued a Warning Notice against the provider and registered manager that required them to improve the way records were maintained.

We have been in continuous contact with the provider since our focused inspection and they have been providing us with regular updates against their action plan. This inspection was carried out to follow-up on the Warning Notice and ensure that the information we had been given by the provider was an accurate reflection of people’s experiences of the service.

We arrived at this inspection at 5:45am and on this occasion found that most people were comfortably in their beds. It was clear that people had received appropriate care during the night and that the records completed by the night staff reflected the care that had actually been given. Our interviews with staff highlighted that they now understood the importance of the records they kept and that there were improved systems in place to enable them to do their jobs properly. As a result, the requirements outlined in the Warning Notice had been met.

Since our last inspection the provider had allocated additional resources to strengthen the management and leadership of the service. The feedback from everyone we spoke with confirmed that the individuals brought in to support Stanecroft had been positive in moving the service forward. Whilst the culture of the service was becoming more open, there was still more work to do in this area. Factions across the staffing and management team continued to impact on the way services were delivered.

Ongoing monitoring both internal and external to the service had led to improvements and an action plan for the way forward. Internal management now needed to start being more proactive in the way it assessed its own quality of services.

There were systems in place to train staff, but staffing shortage and other priorities meant that people did not always benefit from the support of familiar staff who knew their needs well. Delays in key training, such as moving and handling being completed caused staff to have to leave working on their units to support other parts of the service.

We have made two recommendations which highlight how the provider could make further improvements to the management of the service and the training of staff.

People were safeguarded from the risk of harm, because staff now understood their roles and responsibilities and knew where to go if they had concerns. Better systems had been introduced to assess and manage the risks to people.

The pro

Stanecroft is a care home providing accommodation and personal care for up to 50 older people, who may also be living with dementia. There were 46 people living in the service at the time of our inspection.

The inspection took place on 26 April and was unannounced.

The home had a 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.

We carried out an unannounced comprehensive inspection of this service on 21 October 2016 when we rated the service as Good. Since our last comprehensive inspection we have received some concerns about the service. In particular, we were informed that people may not have received appropriate support overnight and that records were not always an accurate reflection of the care provided at the service. Some concerns are still being investigated under a wider safeguarding investigation and as such we are not able to comment on these at this time. We are working in partnership with other agencies and will continue to respond to any new information which indicates that Regulations may have been breached.

Our findings from this inspection have been included under the key question: is the service Well-Led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stanecroft on our website at www.cqc.org.uk.

At this inspection we found that records about the care people provided at night were not always an accurate reflection of the support they had actually received. This was because when we arrived at the service at 6am, we found that some records had already been completed by night staff up until the end of their night shift at 8am. We were told by senior staff and care staff arriving on duty for the day shift that these records were used in order to plan people’s care for the day ahead.

The failure to maintain accurate records was a breach of Regulations. We have issued a Warning Notice against the registered manager and the provider for the service to improve the way records are maintained.

We also found that some people were in soiled bed clothes and linen. The staff on duty had not identified this. Some other staff told us that this was a situation they regularly found when they started work in the morning. The registered manager told us that this was not the case. Safeguarding investigations are ongoing in respect of this.

The culture amongst the staff team was not always positive. Some staff told us there were divisions amongst the team and that not all staff worked together to support people effectively. Concerns were also raised with us about how these issues were being addressed. The provider is currently looking into these issues.

The provider had a policy in place for the supervision of staff. This included regular one-to-one meetings between staff and their line manager. The registered manager was unable to show us how this policy had been followed, because records relating to some staff were not available. We also found that where concerns had been raised staff, there was no record regarding what had been done to address this.

Stanecroft is registered to provide accommodation and personal care for up to up to 50 older people, some of whom have dementia.

The home is arranged on one level and divided into 5 separate wings, with a maximum of ten people living in each. Each unit has its own kitchenette, dining and lounge area together with toilet and bathing facilities. Communal areas, for the use of people from all the units, include a large dining area, conservatory and secure gardens.

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.

The inspection took place on 21 October 2016 and was unannounced. At our last inspection in August 2015 we identified two breaches in the regulations. The breach in regulations around the deployment of staff was a repeat concern from an earlier inspection in July 2014. Enforcement action was taken and a warning notice was issued. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a positive experience living at Stanecroft. There was positive feedback about the home and caring nature of staff from people who live here.

People told us they were happy living here. One person said, “They get things done when I want things done, they really do their best for me.” Staff were happy in their work and proud of the job they do.”

People were safe at Stanecroft because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. The registered manager regularly reviewed staffing levels to ensure they matched with the needs of people. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. In the event of an emergency people were protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff received a comprehensive induction and ongoing training, to ensure they could meet and understand the care needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. Positive feedback was given by visiting healthcare professionals about the standards of

Stanecroft is registered to provide accommodation and personal care for up to up to 50 older people, some of whom are living with dementia. At the time of our visit 48 people lived here.

Care and support are provided on one level which is divided into five separate units. Each unit has its own kitchenette, dining and lounge area together with toilet and bathing facilities. Communal areas, for the use of people from all the units, include a large dining area, conservatory and secured gardens.

Modifications have been made to the home to meet the needs of people that live here. People were free to access all areas of the home. The front door was locked and operated by a button release so that people were kept safe.

The inspection took place on 12 August 2015 and was unannounced. At our previous inspection in September 2014 we had identified concerns in three areas at the home

Overall there was positive feedback about the home and caring nature of staff from people and their relatives. One person said, “Staff are very caring, nothing is too much trouble for them.” However there were two particular areas of concern they told us about, the lack of staff and lack of meaningful activities that interested them. Their concerns were borne out by our observations and discussions on the day.

The lack of staff to meet the identified needs of individuals had an impact across all five of the key questions that we looked at. It impacted on the safety of people as staff were not always available to give support that had been identified; It limited the effectiveness of the service to be able to provide person centred care, such as supporting people to eat; It affected the caring nature of the staff as staff had little time to spend with people to talk with them, as they were very task focused to try to do everything at once; It reduced the responsiveness of the service so that activities were not based around individual’s interests.

People were not always safe at Stanecroft. Risks to people’s health and safety had been identified and guidelines to minimise the risk were in place. However there were not enough staff in the home to ensure these risks were safely managed.

Not everyone could enjoy the food as staff were not always available to support them to eat in a timely manner, so when they did get the support to eat, the food was cold.

Everyone we spoke with praised the care and support they received from the staff and the registered manager. One person said, “I find it really good here. Anything I ask them, they get it done almost straight away.” Another told us, “I’m very happy here, they look after me very well.”

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.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). Decisions had been made for people with an appropriate assessment and review being completed. People told us that staff did ask their permission before they provided care. One person said that, "They always ask me, ‘can I do so and so before doing anything for me.”

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards to ensure the person’s rights were protected.

People told us that they enjoyed the food and had enough to eat and drink. The menu had been improved in the last few months and most meals were made with fresh produce.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received training to support the individual needs of people in a safe way.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. However people and relatives told us that they had not always been included in the development of their care plans, or involved in reviews. People did not always receive the care and support as detailed in their care plans, as staff were not always available to support them when they needed it.

The staff were kind and caring and treated people with dignity and respect. One person said, “They look after us very well.”

People were supported to maintain good health as they have access to relevant healthcare professionals when they needed them.

People did not have activities that met their needs. Although the home had a dedicated activities centre, people only accessed it on certain days of the week. Activities were not based around the individual interests of people, and activities for people living with the experience of dementia, such as one to one time with staff were not regularly organised. The equipment and environment was personalised to the people that used it. The staff knew the people they cared for as individuals.

People knew how to make a complaint. Feedback from people was that the registered manager and staff would do their best to put things right if they ever needed to complain.

People and staff had the opportunity to be involved in how the home was managed. Meetings were held and the registered manager posted the actions that would be taken as a result of these meetings.

We identified two breaches of the regulations. You can see what action we told the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. Two unannounced visits were made with one being on a Saturday morning. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to read the evidence that supports our summary please read the full report.

Is the service safe?

Staff understood how to protect vulnerable people in their care and knew how to report any concerns they had. They allowed people the freedom to be as independent as possible whilst recognising the need to protect them from harm. People received their medicines in a safe way.

Not all areas of the home were clean and some practices did not protect people from the risk of the spread of infection.

The numbers of staff on duty were not always adequate to meet the needs of the people living there. There were times when the deployment of staff meant vulnerable people were left unsupervised.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Staff had a good understanding of the policies and procedures regarding this and the required applications had been made where necessary.

Is the service effective?

People told us they were happy with the care and support they received. We saw that staff knew people well and treated them as individuals. The care and support provided included ensuring a range of opportunities for engagement in meaningful activity were provided. One person told us “we have a good time here, a good laugh.”

Is the service caring?

People who lived there told us “it’s very good here” and a relative said “the care is very good.” We saw staff were polite, kind and patient when they were assisting and supporting people. They treated people with respect in a friendly manner.

Is the service responsive?

People had their needs assessed prior to moving into the home. The plans of care included their likes, dislikes and specific needs with detail of how to meet these. Staff understood when there was a need to include other medical professionals in a person’s care. People’s care and support was reviewed to ensure any changes required were accommodated.

Is the service well-led?

The systems in place for monitoring the quality of the service delivered did not ensure all areas of the environment, care and record keeping were adequately reviewed. The views of people living there, staff and relatives were sought and changes made as a result of this. Staff said they were well supported by the manager and they had made some positive changes to the service.

We found that peopl's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Throughout this visit we observed that people’s privacy and dignity was respected. People who used the service and their relatives all said that they were happy with the care provided. Comments included, “I am very well looked after here”, “the staff are very caring” and “this is a comfortable and open home”.

We observed that staff provided good support to people with eating and drinking. People we spoke with said, “The food here is good” and “the food on the whole is enjoyable”.

The home provided a range of equipment to meet people's needs and safety checks were carried out to ensure that equipment was safe to use.

We found that the service had effective recruitment and selection procedures in place.

People who used the service were cared for by staff who were trained and regularly supervised to monitor their practice.

We found that the service had systems in place to ensure that there was sufficient numbers of staff to meet the needs of people who used the service

The service had quality monitoring systems in place to ensure that people who used the service received safe and appropriate care

The service responded to people’s complaints and people we spoke with said that they knew who they could speak with if they had any concerns.

We were able to speak to two people who use the service. They told us they liked being at Stanecroft and that they liked the food. One person said they liked to walk outside in the garden to get fresh air and they could go outside whenever they wanted to.

We spoke to some of the relatives of the people who use the service. They told us that they had limited involvement in the care planning process for their relative, but that any changes to their plans of care were always discussed with them and the home kept them up to date. They told us that they felt the home was a safe environment and that they had no problems raising concerns with the manager or staff.

We observed people who used the service eating nutritionally balanced meals; meals had also been provided for some residents in a soft or pureed form to better meet their needs.

One relative told us that staff were very supportive and gave them advice and guidance about how to help their relative to be more independent. For example, assisting and encouraging them to eat independently. They told us, “we are very happy with the staff and home”.

Another relative told us, “you can’t fault the staff they really are brilliant. They could do with more staff though. The staff are really dedicated and know the residents very well. I thank Stanecroft for looking after my relative”.

Staff told us that staffing levels were adequate but that, “a few more people on the ground would be good”. Staff felt that additional numbers deployed at busy times would enable them to spend more quality time with people using the service. They told us that, “the essentials get done, but there is no scope to really get involved with activities for people. We need at least two carers per shift, per unit”.

The people we spoke to said they liked the home and were very satisfied with the care and support they received, although a number of people were not able to directly give their view. Relatives and advocates were therefore contacted to provide some additional information to inform our judgements.

Carers of people using the service confirmed their involvement in deciding if the home could meet their relatives needs. They said that staff were good at keeping in regular contact with them and they felt well informed about the care their relative was receiving. Where there was a need carers also confirmed that they were involved in more complex decision making and that staff listened to their views and took them into account when considering how the service was to be delivered.

People using the service told us that they liked the food and if they didn’t want what was on the menu that day staff would cook them something else. They felt they were given lots of drinks and had access to snacks when they wanted them.

People said they felt safe and secure at Stanecroft and that staff were kind to them. Carers said that staff were very hard working. One carer in particular said, ‘Staff are amazing, sometimes they are rushed off their feet but they never complain and they never stop trying to do the very best they can’.