This inspection took place on 9 October 2018 and was unannounced. This meant no-one at the service knew we were planning to visit. At the last inspection in August 2018 the service was rated ‘Requires Improvement’.

Stella House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Stella House is registered to provide accommodation and personal care for up to 40 people. There were 36 people living there at the time of our inspection including five people staying on a temporary basis.

There was a registered manager at the service at the time of our inspection. 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 told us they felt safe. There were enough staff available to meet people's needs in a timely way and to keep people safe. Procedures for recruiting staff were safe.

Staff understood what it meant to protect people from abuse. They told us they were confident the management team would take any concerns they raised seriously. The registered manager made appropriate referrals to the local safeguarding authority when this was necessary.

Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

Staff received a range of training which the provider considered to be mandatory. Staff told us they were happy with the training they received and felt it supported them to do their roles. People living at Stella House told us the staff were well trained.

People told us the staff were kind and caring. During this inspection we observed the staff treat people with kindness, dignity and respect.

Staff were supervised and observed regularly by the management team, staff also received an annual appraisal. We saw evidence of this in the staff files in the home.

People were asked for consent before care was provided to them. Where people lacked capacity to make certain decisions for themselves, their care records contained evidence that decisions had been made in their best interests. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The service worked closely with community health professionals to support people with their health needs. People’s care records evidenced they received medical attention when they needed it, to promote their health.

People’s needs were assessed when they moved into Stella House and detailed care plans were in place to guide staff in how to care for each person. Care plans were reviewed regularly to make sure people received the correct levels of care and support. Care plans contained details of people’s life histories and their likes and dislikes. This assisted staff to provide person centred care.

There were activities taking place at the time of our inspection. We saw details of ongoing activities within and outside the home.

People, their relatives and the staff all spoke highly of the registered manager. Staff told us they could always approach the registered manager if they needed support or if they had any concerns. The registered manager, the deputy managers and the provider completed regular audits of the service to make sure action was taken and lessons learned when things went wrong. This meant systems were in place to support the continuous improvement of the service.

We spoke to the registered manager and provider in relation to the environment. Work had s

This inspection took place on 8 August 2017. The home was previously inspected in March 2017 and was in breach of regulations in relation to good governance, consent, safe care and treatment and meeting nutritional and hydration needs We asked the provider to take action to make improvements and at this inspection we checked to see the actions had been completed. We found improvements had been made in all the areas.

Stella House is registered to provide accommodation and personal care for up to 40 people. There were 35 people living there at the time of our inspection including five people staying on a temporary basis.

There was no registered manager at the service at the time of our inspection. However the manager had applied to the Care Quality Commission to become registered. 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.

At this inspection we found improvements in relation to identifying pressure damage to people’s skin and weight loss. We saw there were detailed care plans and staff were aware of how and when to seek outside health professionals advice.

We saw people were encouraged by staff to move safely round the home and aids and adaptions were in reach for people to do this independently.

The premises were well maintained and visibly cleaner overall. Maintenance checks were in place and an improvement plan for the home was active at the time of inspection. However one check in relation to hoist slings had been missed by the manager which was rectified on the day of inspection.

At this inspection we saw improvements in relation to the audits in the home. We saw the manager and area manager had a system in place for the purpose of assessing and monitoring the quality of the service. Monthly and weekly audits showed this was mostly effective.

Medicine management systems were in place. However some areas of written records were not accurate and mistakes in relation to times of certain medicines were possible if this continued. The management team stated this was going to be addressed through the GP straight away.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty

Safeguards (DoLS).

The service was meeting the requirements of the Mental Capacity Act 2005 (MCA). However one person we spoke with had not had their wishes recorded appropriately even though it was recorded in relation to fluctuating their capacity. We felt staff had confidence in using the MCA to make best interest decisions for people who lacked the capacity to make decisions in relation to their care.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

We saw the home had a list of activities in place for people to participate in. However the activity coordinator was not in the service at the time of inspection. Staff were enthusiastic and we saw staff trying to get people to participate in activities in the afternoon.

Staff we spoke with told us they received supervision every two months and had annual appraisals booked this year with the manager. We saw minutes from staff meetings which s

This inspection took place on 16 and 20 March 2017. The home was previously inspected in August 2016 and was in breach of the regulations in relation to good governance, consent and safe care and treatment. We asked the provider to take action to make improvements and at this inspection we checked to see the actions had been completed. We found some improvements had been made but there were still areas which had not attained the required standard of care.

Stella House is registered to provide accommodation and personal care for up to 40 people. There were 32 people living there at the time of our inspection including nine people staying on a temporary basis. There was no registered manager at the service during our inspection. The previous registered manager had not been at the service since July 2016 but they had not yet deregistered. A new manager had been appointed and had been at the home at the last inspection in August 2016 on a temporary basis. They told us they had accepted the position of registered manager and would commence the registration process. 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.

Staff had been trained and understood how they should ensure people were safeguarded against abuse and the procedure to follow to report any incidents. However, there was a culture of poor risk management at the home, so although staff had been trained in safeguarding people from abuse, the systems and processes were not adequate to support safe care and treatment.

Risks to the health and safety of people using the service were not always thoroughly assessed and effectively managed and this placed people at risk of otherwise avoidable harm. For example, the hot water from the taps accessible to vulnerable people in bedrooms and communal bathrooms were over the acceptable range, and radiators were scalding. This had not been highlighted by staff or management as an issue. Once we highlighted the issue the registered provider acted immediately to rectify the issue, but their own systems had not picked this up.

Medication was administered appropriately and all staff who administered medication had received training and had been assessed as competent to administer medicines. We found some minor issues with the management of medicines such as not dating eye drops on opening and not storing these in the refrigerator. In addition, not all ‘as and when required’ medicines had a protocol in place to guide staff on when to administer.

People at risk of malnutrition or dehydration did not have robust care plans and monitoring records in place. This had been an issue at a previous inspection and improvements made at the last inspection had not been sustained or improved further.

Staff undertook an induction when they first started working in the home and shadowed more experienced staff to gain confidence in their role. Staff completed the Care Certificate and their competencies were signed off by management.

The home was compliant to the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). The home had a record of registered powers of attorney and who could consent on behalf of people at the home. At our last inspection we found staff had signed consent forms on behalf of people when they did not have the lawful authority to do so. There were improvements in this area but we still found care files without a record of written consent.

We found all the staff to be caring in their approach to the people who lived at the home and staff treated people with dignity and respect. Staff knew the people they supported very well and were keen for people to feel they were at home. Staff recognised the importance of promoting and m

The inspection took place on 23 and 26 August 2016 and was unannounced. At the last inspection on 30 March 2015, we asked the provider to take action to make improvements around record keeping, activities and at this inspection we checked to see the actions had been completed.

Stella House is registered to provide accommodation and personal care for up to 40 people. There were 31 people living there permanently at the time of our inspection and one person staying on a temporary basis. There was a registered manager in post. However, the registered manager was not at the service at the time of our inspection and was due to leave the position. Temporary management arrangements were in place to ensure the home had management support whilst the registered manager was not present. 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.

Staff had been trained and demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. The home completed risk assessments when other risks such as choking, medication, fire and falls had been identified. However, one person who was at the home for a temporary respite stay had not had their risks adequately assessed and recorded in line with good practice guidance. Two people had managed to leave the premises without staff awareness which posed a risk to their health and wellbeing. We also found moving and handling risk assessments and care plans although in place lacked detail to ensure staff had an accurate plan to follow. These issues were raised with the area manager who agreed to act upon this information immediately. However, the failure to assess the health and safety of people using services and have plans in place for managing risk was a breach of Regulation 12 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medication was administered appropriately and all staff who administered medication had received training and had been assessed as competent to administer medicines. We found some minor issues with the management of medicines such as concerns regarding crushed medicines, which the GP had advised was acceptable without a clear indication from a pharmacist that this did not affect the efficacy of the medication or pose a risk to the people using it.

Infection control procedures had improved since the last inspection and staff were aware of the procedures to follow to ensure the risk of infection was minimised.

Staff undertook a thorough induction when they first started working in the home and we saw this was evidenced in the staff files we reviewed. Staff completed the Care Certificate and the registered manager was the assessor for the certificate.

The home was compliant to the Mental Capacity Act Deprivation of Liberty Safeguards. However, we did not find any recorded decision specific capacity assessments in the care files we reviewed for three people we identified as lacking capacity to consent which was a breach of Regulation 17 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although the service was in the process of identifying who had the relevant attorney to be able to consent on behalf of their relation, we found staff had signed consent forms on behalf of people when they did not have the lawful authority to do so. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found all the staff to be caring in their approach to the people who lived there

The inspection took place on 30 March 2015 and was unannounced.

Stella House is registered to provide accommodation and personal care for up to 40 people. 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.

However, a new manager had been in post since December 2014 and will take over as registered manager from the current manager once registered with the Care Quality Commission.

People who used the service told us they felt safe at Stella House and staff we spoke with recognised the signs of abuse and how to report this.

Risk assessments had been undertaken but these had not always been updated when a person’s needs had changed which posed a risk of the provision of inappropriate care and risks not being managed.

Medication was administered appropriately and all staff who administered medication had received training and were competent to administer. However, we found the systems in place for storing, auditing and controlling the stock of medication was ineffective and out of date cream was found in one bedroom. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 (2)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The home was very clean and carpets and flooring had been replaced as part of a refurbishment programme. However, there was a lack of paper towels in people’s rooms which meant that care staff could not dry their hands after supporting people with personal care. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 (2)(h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Preventing and controlling the spread of infection.

All new staff have undergone a 12 week induction which included both theoretical and competency based elements which were signed off by a senior carer. Staff received regular supervision and an annual appraisal.

The registered manager demonstrated a good understanding and knowledge of the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and had made six requests to the local authority. The care staff had not received specific training around capacity and did not demonstrate a good knowledge in this area.

People who used the service and staff told us the food was good and we observed people being offered second helpings. Choice was offered at mealtimes but staff were not experienced in offering choice to people who could not understand what was on offer such as showing people the options on a plate.

The home had a monitoring sheet to note the food and drink intake of people at risk of malnutrition and dehydration. However, this had not been inputted fully for two people whose care we reviewed, which meant the home had no evidence of what these people had eaten or had to drink.

This demonstrated a failure to protected people from the risks of inadequate nutrition and dehydration. This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us staff were very caring even commenting that one staff member comes in when they are on leave. We saw people’s privacy and dignity were maintained throughout the day and staff spoke kindly when supporting people.

There was a good range of equipment to promote independence in daily living tasks such as seating and adapted cutlery and crockery.

Daily records were not completed fully and when they were completed were task focussed rather than person centred and outcome focussed. We found some records had only been completed once each day. We have made a recommendation about person centred care planning. The lack of recording in a person centred way demonstrated a failure to protect people against the risks of unsafe or inappropriate care because up to date and accurate records had not been maintained. This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation17 (2)(c ) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a lack of meaningful activities. We have made a recommendation about meaningful activities for people who live in care homes.

Audits were not up to date. Medication audits had not been done since October 2014 and care plan audits undertaken by the staff had not picked up the issues with ineffective recording. The lack of recording in a person centred way demonstrated a failure to protect people against the risks of unsafe or inappropriate care because up to date and accurate records had not been maintained. This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation17 (2)(c ) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found -

Is the service safe?

The provider had safeguarding and whistleblowing policies in place to provide staff with guidance about protecting people from abuse. The staff we spoke with were aware of the different types of abuse and described how they would respond if abuse was suspected or happening.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw one application had been submitted to the Local Authority. We saw appropriate policies and procedures were in place and were followed.

Is the service effective?

We saw people were consulted and their verbal consent was obtained for aspects of their care and daily routine.

It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs.

Is the service caring?

We saw staff interacted with people in a polite and respectful way. We observed people were able to choose what activities they wanted to take part in. We saw staff took time to engage people in conversation. For example, one person was encouraged to talk about their family and memories from their past.

We spoke with six people who used the service. We noted one person had finger nails which required cutting. This person told us they had asked numerous times for their nails to be cut. We raised this issue with the manager. The same person was complimentary about their experience of living in Stella House and said: “I am happy here most of the time and the staff are nice.”

Two people told us they were happy living at Stella House and they found the staff helpful. Another person said: “I’m not grumbling; the staff are really kind.” One person stated: “I feel a bit cut off, there is no communication and I can’t phone anybody.” Another person told us they would like to go out more.

We spoke with three relatives who told us they were happy with the standard of care provided. Relatives told us their family members were happy and settled and they thought staff knew their needs well.

Is the service responsive?

We found the home was clean and tidy. We saw flooring had been replaced in the bathroom areas and the carpet on the stairs had been replaced since the last inspection.

A visiting Healthcare Professional told us the staff followed their instructions and they were complimentary about the staff.

The provider had a complaints procedure. There were no recent complaints recorded about the service from relatives or residents.

Is the service well-led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. This was demonstrated through staff and resident meetings.

There was evidence to show audits were being carried out in some areas. However, there was not an effective system in place to demonstrate the manager and provider carried out their own audits and checked that audits carried out by staff had been completed to a satisfactory standard. The issues in relation to the care records identified at the last inspection had not been addressed through a thorough auditing process.

During our visit to the service we spoke with a number of people who lived at the home and two people who were visiting their relatives.

Some of the people who lived at the home were unable, due to complex care needs, to give us their opinions of the care and support they received. Others told us:

"The staff are very good"

"The food is very good"

"Nothing is too much trouble" (for the staff).

These are some of the things relatives told us:

"It's fantastic"

"If I ask for anything it's done immediately"

"Staff are really kind"

One person told us that their relative had been very poorly but staff had given such good care that they had recovered completely. Another told us that when the time came to move into a care home permanently, their relative chose the home because they had previously had respite care there and were very happy with it.

We found that the home was mostly clean and tidy although some areas were in need of a deeper clean. Some carpets were worn and in need of replacement.

Staff told us that they enjoyed working at the home but felt that there were times when more staff were needed because they struggled to meet the needs of the people living there.

We saw that staff were kind and caring when supporting people.

People said they like living in the home. People we could not communicate with were relaxed and comfortable. One person said the home is wonderful and they have everything they need. Another said the food is very good and they are well cared for.

People said they like living in the home and that they feel safe. One person said the staff are very good and listen to what they say and if they have any problems the staff sort them out quickly.

People said they like living in the home and those caring for them. One person said the carers are very good and make sure they are well cared for.

People said they are very happy with the support they get from the staff working in the home. One person said they have their favourites but they are all nice really. Another said the carers are wonderful and couldn’t be any better.

People told us they are very happy living in the home and with those caring for them. One person said the staff are very supportive and listen to what they say. Another said they treated with dignity at all times and their wishes are respected.