This inspection took place on 25 and 29 September 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Stichell House provides care and accommodation for up to 35 older people. On the day of our inspection there were 34 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Stichell House was inspected by CQC on 14 July 2016 and rated Requires improvement overall and in the Responsive and Well-led domains. At the inspection in July 2016, we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 (Person-centred care) and Regulation 17 (Good governance). We carried out a focussed inspection on 9 January 2017 to look at the Responsive and Well-led domains. We found improvements had been made in these areas and re-rated the service as Good.

At this inspection we found accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

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

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Stichell House. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint but did not have any complaints about the service.

The provider had an effective quality assurance process in place. Staff said they felt supported by the manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

This focused inspection took place on 9 January 2017 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 14 July 2016. Breaches of legal requirements were found. Specifically the provider had breached Regulation 9 – Person Centred Care and Regulation 17 - Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Clear care plans with detailed guidance were not always in place. Care plans did not always include ways in which people could maintain their independence. The lack of detail in care plans meant they were not always up to date with changes to people’s needs and preferences. A complete and accurate record of each person’s care and treatment was not maintained. Systems to assess, monitor and improve the quality of care records were not always effective in identifying where quality was being compromised.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Stichell House is a care home without nursing and can accommodate up to 35 people. At the time of the inspection there were 35 people using the service. All bedrooms are single and have ensuite toilet and wash basin facilities. Accommodation is provided over three floors, all of which have tea bar facilities. There is a communal dining area and lounge facilities as well as attractive, landscaped grounds. Stichell House is situated on the edge of Greatham, a quiet residential village, in the Hospital of God estate.

A registered manager was registered with the Care Quality Commission at the time of the 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.

We found improvements had been made. The quality and detail in care plans had improved. Information about people’s history and preferences were recorded in a person centred way.

Detailed strategies were in place for staff to follow to ensure people received appropriate care. Records were reviewed on a monthly basis or in response to a person’s changing need.

A new quality assurance system for the audit of care records had been introduced. Since the last inspection every person’s records had been audited at least once, actions had been identified to improve the quality and consistency of information and checks had been made to ensure actions had been completed.

This inspection took place on 14 July 2016 and was unannounced. We last inspected Stichell House on 20 August 2014 and found it was meeting all legal requirements we inspected against.

Stichell House is a care home without nursing and can accommodate up to 35 people. All bedrooms are single and have ensuite toilet and wash basin facilities. Accommodation is provided over three floors, all of which have tea bar facilities. There is a communal dining area and lounge facilities as well as attractive, landscaped grounds. Stichell House is situated on the edge of Greatham, a quiet residential village, in the Hospital of God estate.

At the time of the inspection there were 34 people using the service and one person was due to move in.

A registered manager was registered with the Care Quality Commission at the time of the 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.

Care plans did not always contain detailed information about how staff should provide support with mobility and continence care, for example how to support people with the use of specialist mobility equipment.

Audits were completed but the care plan audits were not always effective in identifying the concerns we noted in relation to the lack of detail in care plans. When this was raised with the registered manager they immediately started work on a new audit tool which focused on the quality and content of care records.

Audits completed by the care service manager and proprietors were detailed and involved speaking with people, relatives and staff for feedback on the service provided. Actions were recorded and the registered manager was able to respond to the actions with either an explanation or confirmation that tasks would be completed.

There was a culture of openness and transparency within the service. A visiting healthcare professional said, “The home is open and transparent and the manager is receptive to comments / recommendations.”

Staff said they felt well supported and they received the training they needed to enable them to meet people’s needs. One person said, “I’m really lucky to be here, excellent staff I can’t praise them enough.”

People and their relatives told us they felt safe living at Stichell House. Risks were assessed and there were control measures in place to support staff to manage risks appropriately. Medicines were stored, administered and recorded in a safe way.

People told us there were enough staff to meet their needs and they did not have to wait for staff to respond if they needed any support. We observed staff spent time with people, and treated them with dignity, respect, compassion and care.

Staff understood the principles of safeguarding and mental capacity. People were actively encouraged to be involved in decision making about their care, and aspects of the home environment. Residents’ meetings showed people had been consulted about recent refurbishments and use of rooms.

The activities co-ordinator was active in people’s lives and spoke with people about their interests and hobbies, so activities could be meaningful for people. People were very complimentary about the activities and the efforts the activities co-ordinator went to with fundraising. One person said, “Special praise for the activity lady she keeps your mind going.”

Meals were freshly prepared and people had a choice, but if they did not like what was on the menu an alternative was offered to them. Specialist equipment was available to support people to maintain their independence during meal times.

Access to healthcare professionals was supported and a GP clinic was held at the home every fortnight. This enabled people to see a GP regularly but also gave

At the last inspection we found that records were not kept up to date because reviews and assessments were not always completed regularly. We had found that there were gaps in the recording of some information. We found care files contained information which needed to be archived and some information was not easy to locate.

At this inspection we went back to check the action staff had taken to ensure the records were being maintained appropriately. We looked at six of 35 (17%) care records.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate records were maintained.

We visited Stichell House to check that improvements had been made in the standard of record keeping within the service since our last inspection in April 2013. We found that some improvements had been made. For example, the service had introduced some new documentation to record risk assessments and people's dependency levels.

Despite these improvements, we remained concerned about the standard of record keeping within the service. We found that risk assessments and action plans were not always reviewed in a timely manner. We also found that some actions plans did not accurately reflect the care and support needs of people.

We also found that the service did not have a system in place to effectively archive records

People who lived at Stichell House and their relatives were happy with the care and support from staff. People who used the service told us: “It’s brilliant here, I couldn’t be happier. The staff are so laid back, friendly and helpful”, “They (staff) are great and take good care of me”, “The staff are very kind and helpful and they know exactly what help I need”, “If I need anything I just ask and I don’t have to wait very long”, “Staff will always help and I don’t have to wait long”.

There was sufficient equipment within the service to ensure the safety and comfort of the people who lived there and this had been maintained.

People who used the service were happy with the level of staffing. Staffing levels were flexible to meet the changing needs of people. Staff had received training, support and supervision to make sure that they were able to meet the needs of the people they supported, although the system for monitoring supervisions and training needed to improve.

The service had a system in place to monitor and improve the quality of care and support people received. Where improvements were indicated, the service took action to make sure they happened.

Some of the records held within the service needed to improve to demonstrate that risk assessments and care plans were written and reviewed regularly, thus ensuring that staff had access to the most up to date information about people’s health and care needs.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because the inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission inspector who was joined by a practising professional.

During the inspection we spoke with seven people who used the service and three relatives. We asked people if they were treated with dignity and respect. Comments made included:

"This is a marvellous home. I can't speak highly enough of it. The staff are always pleasant and always speak nicely to me. We often have a laugh and a joke."

"They give me time to get washed on a morning. The care staff then knock on my door and ask if I need help."

"I was asked if I preferred a female or male carer. I filled out a form and told them I didn't mind either. I'm not embarrassed if a male carer helps me and they are not embarrassed either."

"I like to lock my door on a night for privacy."

We asked people about the food that was provided. People confirmed that that they were always offered a choice of food and drink at each meal time. People said that the portion sizes were good and that snacks were available throughout the day. Comments made included:

"We always have lovely meals. I had lamb cutlet today, we always have vegetables and potato." Another person said, "We always have a choice. They ask us a week in advance what we would like for our meals. There is always fresh fruit, I just go into the dining room and help myself to fruit from the bowl." Another person said, "The food is good, but I don't like much on my plate. I tell them what I want and I get it."

During the inspection we asked people if they felt safe. People confirmed that if they were worried or had any concerns they would speak with the manager. People told us they had no complaints or concerns about the service. They said they found staff approachable and told us they could make any comments or raise concerns directly with staff. They said they were aware of how to make a complaint and were confident that if they needed to make a complaint, this would be addressed quickly and fairly.

We asked people if they thought there was enough staff on duty to meet people's needs and to support people at meal time. Everybody spoken with said that they were well supported by the staff team and that they were happy with the care and support that they received. Comments made included:

"I like my independence, but staff are always there when you need help."

"Staff come quickly when I need them. I think that there's enough staff on duty to help people. There's a few on holiday at the minute but I haven't been neglected."

The home has a registered manager in place.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records.

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

Is the service safe?

The service was safe. People had assessments of risks associated with their care. They were cared for by staff who had suitable training. The manager ensured that safety checks were carried out regularly.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that assessments had been undertaken in relation to examining two people’s access to the community. These were comprehensive and included relevant assessments and meeting records. The applications were approved by the local authority.

Is the service effective?

The service was effective. There were systems in place to determine improvements and there was evidence that these were put into practice such as changing what was available at meal times and what activities were on offer.

One person told us “I have been ill and am much better now because of the care I have received”. Another told us “I have got my life back now”

Is the service caring?

The service was caring. People living there reported the staff “really care”, and that “they do the little things as well as the big things” We saw staff supporting people during meal times, and at other times. We were told by one person “the staff are brilliant they really care”.

Is the service responsive?

The home was responsive; we saw records of meetings with people who lived there where the manager had acted to take action about requests made. During observations we saw staff responding to people’s needs quickly to give help. One person told us “When I ring my buzzer at night someone comes along very quickly”

Is the service well-led?

The service was well lead. The provider and the manager had systems in place to monitor the service provided within the home. One person told us “there have been a lot of steady improvements since the new manager came”. The staff reported that the manager is “approachable and knows what she is doing”. On person living there told us, “ the manager is always around you see her a couple of times a day and she always has time to chat and see if you are ok”