This inspection took place on 22 August 2018 and was unannounced. At the last five inspections the service has been rated as either inadequate or requires improvement. The last inspection was carried out in January 2018; we found the provider was in breach of four regulations and the service was rated as requires improvement. The regulations related to safeguarding people from abuse, staff support, management of medicines and governance. At this inspection we found the provider had made improvements and was no longer in breach of the regulations. However, their systems and processes around governance and management of medicines needed to continue to improve to ensure people consistently received a safe, quality service.

Stockingate Residential Home provides care for up to 25 older people. At the time of the inspection 19 people were using the service. People in care homes receive accommodation and 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.

A registered manager was 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 provider had improved their arrangements for managing people’s medicines but they needed to develop their systems further to make sure safe administration practice was always followed. Staff knew what to do to make sure people were protected from abuse. The home looked clean and checks were carried out to make sure the premises and equipment were safe. Risks to people had been identified, assessed and managed. There were enough staff and the same workers provided support so people received consistent care.

The provider had improved the support given to staff but they still needed to develop this further to make sure there was a consistent approach to training and supervision. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received support at meal times and enjoyed the meals. However, they did not have access to condiments, serviettes and tables were not laid prior to the meal being served. People accessed services which ensured their health needs were met. People were comfortable in their environment and freely walked around different communal areas of the service. Work to improve the environment was in progress.

Throughout the inspection we observed staff were friendly and caring in their approach. They knew people well and talked about things that were important and relevant to the person. Staff were confident people received a good standard of care.

Care records were being transferred to an electronic care recording system. Staff had received training to help ensure they could use the new system effectively and efficiently. Current care plans outlined people’s needs and covered key areas of care although some were basic. The management team were confident the new system would be more person centred. People enjoyed a varied activity programme which provided opportunities for them to engage in individual and group sessions. The provider had a system for investigating complaints and people told us they would raise concerns with staff and the management team.

We received positive feedback about the registered manager and saw they engaged with people who used the service, visitors and staff. Resident meeting minutes and surveys showed people were satisfied with the service they received. The provider had systems for monitoring quality and safety, however, some of these were basic and did not always drive improvement.

This inspection took place on 9 and 12 January 2018 and was unannounced. At the last four inspections the service has been rated as either inadequate or requires improvement. At the last inspection in November 2016 we rated the service as requires improvement. They were in breach of regulations which related to consent to care. At this inspection we found there were still issues around the provider’s systems and processes in relation to assessing people’s capacity, and progress was limited, although they were no longer in breach of the regulation.

Stockingate Residential Home is registered to provide care for a maximum of 25 people. The manager told us 22 people were using the service when we inspected. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection the service did not have a registered manager although a manager had been appointed and told us they would be applying to register as the manager of Stockingate Residential Home. 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 received positive feedback about the manager. The provider carried out a range of checks and audits but these were not always effective. Their systems and processes did not enable them to appropriately assess, monitor and manage quality and safety.

People felt safe but the provider did not have systems in place to safeguard people’s finances. Financial records were not robust and people were not provided with lockable facilities. The provider did not always follow safe management of medicine practice. Systems were in place to assess and manage risk to individuals although documentation was not always clear and this could result in risk being inappropriately managed. People lived in a safe and clean environment although one shower was very hot so put people at risk of scalding. The provider took swift action to rectify this.

There were enough staff to meet people’s needs and the same workers provided support so consistent care was provided. Recruitment checks were carried out but this was not always done robustly. Staff felt well supported but not all staff had received the agreed number of formal supervision support sessions during 2017. New care workers did not complete the Care Certificate which is a set of standards for social care and health workers.

People told us they were happy living at Stockingate Residential Home and staff were kind and caring. We saw people were treated with kindness. Everyone told us they enjoyed the meals and had pleasant dining experiences. The choice of activities was varied. People had opportunity to engage in group and person centred one to one activities within the service and accessed the local community.

People’s care records were person centred and detailed preferences, dislikes, history and what was important to them. However, care plans around management of falls, mobility and management of finances did not always provide sufficient guidance. Staff knew people well. Systems were in place to make sure people’s health needs were met.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: The provider was not managing medicines safely: Staff did not receive appropriate training and supervision: The provider’s systems and processes around safeguarding people’s finances were not established and operated effectively to prevent abuse of people who used the service. The provider’s systems and processes did not enable them to assess, monitor and improve the service. You can see the action we have told the provider to take at the end of this report.

This inspection took place on 16 November 2016 and was unannounced.

We previously inspected the service on 11 and 13 July 2016 and at that time we found the registered provider was not meeting the regulations relating to safe care, premises safety, consent, person centred care, safeguarding service users from abuse, meeting nutritional needs, complaints, staffing, good governance, safe recruitment and notifying CQC of specific incidents. The service was placed into special measures and we took urgent enforcement action to require the service to improve. The provider sent us an action plan outlining the improvements they would make. On this visit we checked to see if improvements had been made.

The service provides residential care for up to 25 people, some of whom are living with dementia. We placed a stop on admissions to the service following our last inspection due to concerns about the quality and safety of the service. At the time of this inspection there were 18 people using the service.

The service is required to have 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 had left the service on 4 April 2016 and a new manager had come into post on 11 April 2016. They left the service in July 2016 and the provider placed a temporary manager at the service. A new permanent manager was appointed in October 2016. They had applied to register with CQC but at the time of this inspection and the application had not been finalised.

People who lived at Stockingate residential home told us they felt safe.

Our inspection on 11 and 13 July 2016 found the registered provider was not meeting the regulations relating to safeguarding people from abuse because the manager of the service had not acted on safeguarding concerns raised by people who used the service, staff and relatives. On this inspection we found improvements had been made because the management team had acted on any safeguarding concerns raised. Staff had an understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Medicines were managed in a safe way for people. We found the registered provider was meeting the regulations relating to the management of medicines and medicines trained staff were deployed on the night duty rota so people were always able to access as ‘required’ (PRN) medicines at night.

Risk assessments were individual to people's needs and minimised risk whilst promoting people's independence. We found improvements had been made because risk assessments were comprehensive, up to date and reflective of people’s needs. Measures were also in place to reduce risks to people, for example where a person was at risk of choking.

People were protecting against the risks of unsafe or unsuitable premises because the necessary safety checks were regularly completed and emergency plans were in place.

We found sufficient suitably trained staff were deployed to meet people’s needs in a timely way and keep them safe.

Safe recruitment and selection procedures were in place to ensure staff employed by the service were suitable to work with vulnerable adults.

We found people were protected against the spread of infection. The service was free from odours and personal protective equipment (PPE) was available throughout the home.

Staff received training to enable them to provide effective support to people who used the service, for example staff were now up to date with training in managing behaviour that challenges and fire safety.

People’s capacity was not always considered when decisions needed to be made to ensure their rights were protected in line with legislation, for example when decid

This inspection took place on 11 and 13 July 2016 and was unannounced.

We previously inspected the service on 29 July 2015 and at that time we found the registered provider was not meeting the regulations relating to management of medicines. We asked the registered provider to make improvements. On this visit we checked to see if improvements had been made.

The service provides residential care for up to 25 people, some of whom are living with dementia. At the time of our inspection there were 19 people using the service, one of whom was a temporary admission.

The service is required to have 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 had left the service on 4 April 2016 and a new manager had come into post on 11 April 2016. They had applied to register with CQC but at the time of this inspection the application had not been finalised. The new manager of the service is no longer in post.

Some people who lived at Stockingate residential home told us they felt safe and three people we spoke with had concerns about safety.

Our inspection on 29 July 2015 found the registered provider was not meeting the regulations relating to the management of medicines because medicine to be returned to the pharmacy was not secured; so on this inspection we checked to see if improvements had been made.

We found medicines were not always managed in safe way for people and people were not always able to access as ‘required’ (PRN) medicines at night as there were no medicines trained staff on night duty. This was a breach of regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe management of medicines.

Staff had an understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse, however the manager of the service had not acted on safeguarding concerns raised by people who used the service, staff and relatives. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Individual risk assessments were not always comprehensive and up to date to reflect risks to people and measures were not always in place to reduce the risks. Risk assessments were not always updated or followed to ensure people’s safety when eating. This was raised at our last two inspections as a concern. This was a breach of Regulation 12 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found people were not always protected against the risks of unsafe or unsuitable premises because the necessary safety checks were not being regularly completed and emergency plans were not in place. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Sufficient suitably trained staff were not deployed to meet the assessed needs of people who used the service. This was a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at the recruitment records of four members of staff. We found all the necessary checks had not been carried out for three of these before commencing employment with the home. This was a breach of Regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found poor practice in the prevention and control of infections, which meant people were not protected against the spread of infection. This was a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had not always received training to enable them to provide effective suppor

The inspection took place on 29 July 2015 and was unannounced. The service provides residential care for up to 25 people, some of whom are living with dementia. At the time of our inspection there were 14 people living at Stockingate Residential Home.

There were several breaches of the legal requirements that we checked at the last inspection in January 2015. Following this previous inspection we took enforcement action because people who used services were not protected against the risks of receiving care or treatment that was inappropriate. We also asked the provider to send us an action plan to show how they were meeting nutritional and hydration needs, maintaining safe premises and equipment and ensuring good governance. The provider sent us an action plan which detailed the improvements they had made and we checked these at this inspection. We found the provider had made significant improvements to the service and to the monitoring of the quality of the provision.

At the time of our inspection there was a registered manager in post, although not present during our visit. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service was friendly and welcoming with a calm and relaxed atmosphere. People were supported through caring relationships with staff who understood their individual needs.

People were treated with respect and their dignity and rights were promoted.

Staff had a sound understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff worked together with one another and with visiting professionals to support people’s health care needs. Handover information was appropriately shared between staff shifts to ensure people’s care was properly maintained.

Staff had sufficient opportunities for regular training and professional development to enhance their skills and knowledge of working with people in the service.

People’s care plans were not always robustly followed by staff to enable them to support people’s individual needs safely.

Risk assessments were not always updated or followed to ensure people’s safety when eating. This was raised at our last inspection as a concern.

People were given good explanations about their medications and staff took time to make sure people were supported to take their medication when they needed to. However, storage of medication to be returned to the pharmacy was not secure.

Systems to monitor and review the quality of the provision were in place.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was unannounced and took place on 26 January 2015. At the last inspection on 18 June 2014 we found the provider was breaching regulation 9, care and welfare of people who use services, regulation 15, safety and suitability of premises and regulation 10 assessing and monitoring the quality of service provision. At this inspection we found some improvements had been made however, the provider was still in breach of regulation 9, 10 and regulation 15. We also found there was a breach of regulation 14 meeting nutritional needs.

Stockingate Residential Home is registered to provide accommodation and personal care for up to 25 persons. At the time of our inspection the home did not have 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 found areas of concern relating to the premises. The new windows at Stockingate Residential Home had window restrictors which could easily be disengaged by hand. We identified this issue to the manager and area manager at the time of our inspection. Since our inspection the window restrictors have been changed to comply with HSE guidance. The area manager said they had consulted others when they installed the new windows and restrictors. There was a trip hazard on the ground floor and repairs to the roof were required. The medication room was too hot and the drugs fridge was overheating.

We found some people’s risk assessments did not contain up to date information.

We looked at medication and saw there was a good system in place for the administration of medication. However, we found night staff were not trained to administer medication.

We looked at the recruitment records of four members of staff. We found all the necessary checks had been carried out before commencing employment with the home.

Staff were able to confidently speak about safeguarding and knew what to do should they suspect abuse. People we spoke with told us they felt safe living at Stockingate Residential Home. We found there were enough staff to keep people safe.

We observed the lunch time meal and found some people were not given their food as stated in their care plan. One person was given burger, chips and bread. The burger should have been pureed and the chips and bread cut into small pieces. The burger was not pureed and staff did not cut up the person’s food until they had eaten half of it. We found people’s food was not fortified if they had lost weight. Staff told us people did not get a choice of food.

We found staff had not received recent supervision meetings although the new manager had instigated a matrix for staff appraisals. Staff told us there was plenty of training and their induction was very comprehensive.

People’s care was delivered with consideration given to the mental capacity act and Deprivation of Liberty Safeguards (DoLS). This is where a person can be lawfully deprived of their liberties where it is deemed to be in their best interests or their own safety. Staff told us they had completed DoLS training.

We looked at the care plans of five people living at Stockingate and found documentation regarding obtaining consent from people in the back of their care records which in three cases had not been completed.

Staff spoke to people calmly and sensitively and seemed to know people well. We saw some good interactions between staff and people who used the service; however, we did see an example of a person having their fingers prised from their cup and fork.

We looked at the care plans of people who used the service and found they were lacking in detail and in some cases there was important information missing.

Staff and people who lived at the service told us they thought the new manager was good and had made some positive changes to the service.

You can see what action we told the provider to take at the back of the full version of the report.

This was a scheduled inspection, which also followed up on our last visit in which outcome 16 was non-compliant.

We carried out the inspection with our five questions in mind; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found:.

Is the service safe?

Staff had a clear understanding of how to ensure people were safeguarded from abuse and the procedures to follow to make sure people were protected if concerns arose.

However, due to the nature and number of safety concerns we found relating to the premises, we referred our findings immediately to Environmental Health and the Local Authority Commissioners. A senior Environmental Health Officer visited the home promptly following our visit and issued four Improvement Notices under the Health and Safety at Work Act 1974, which directly related to the concerns we had raised.

Is the service effective?

We saw interacted with people in a caring way. However, people’s care needs were not fully documented and care provided was not in keeping with information contained within the care plans. Systems and records to inform staff of people’s needs were not up to date

Is the service caring?

Staff were kind, patient and caring in their interactions with all people. When walking with people, staff supported them at people’s own preferred pace and care was not rushed or hurried. Staff tried to make sure people had what they asked for and they responded promptly to what people were saying.

Is the service responsive?

We saw some people who spent their day entirely in the small lounge. When staff spoke with them, it was friendly and kind. However, these people’s contact with staff was infrequent, offered limited stimulation and was therefore not responsive to their needs.

The manager had made some improvements in response to the previous inspection findings and safeguarding concerns, which had impacted positively on staff interactions with people.

Is the service well-led?

Staff were clear about the line management structure and who they would go to for support in their role. Staff said they thought the home was managed effectively and teamwork had improved.

However, systems for assessing and monitoring the quality of the provision were not robust and did not identify or address areas which required improvement.

We visited the home unannounced because we had received information of concern. Information suggested staff were not supported to care for people and people’s care was not based upon their individual needs. For example, care was not reviewed or managed effectively, care for people with diabetes was not adequate and people’s pressure care was not supported effectively. Information also suggested a lack of professionalism amongst the management and the staff team and discrimination towards people.

We were unable to speak with the manager as she was absent. Therefore we were unable to determine whether the requirements for outcome 16 (assessing and monitoring the quuality of the service provision), which was non-compliant at the last inspection, were met. This will be reviewed at the next scheduled inspection.

We spoke with a company management representative and the senior carer in charge. We also spoke with another senior member of staff and two care assistants.

We observed the care of people in the home and spoke with four people who lived there. We spoke with four relatives who visited during our inspection. People and their relatives told us they were happy with the standard of care.

We found people were respected and involved in their care and staff interacted with them in a kind and caring manner. We saw people’s care was managed in such a way that their individual needs and choices were promoted.

Staff we spoke with were clear about people’s individual needs and how to support them. Information about people’s care was displayed in the staff office as well as in their care records. We saw evidence of improvements to people’s care documentation and people or their relatives had been consulted and involved. We looked at two people’s care records and other documentation to support how people’s care was managed.

We found people’s care needs were appropriately met, staff behaved in a professional manner and were knowledgeable about their roles and responsibilities.

We carried out the inspection of Stockingate Residential following concerning information we had received about residents in the home being left unattended during the night shift.

We spoke with three staff members and identified risks with the laundry process during the night shift. This was discussed with the operations manager following the inspection.

We looked at care plans but were unable to see evidence of any involvement from residents or relatives.

We saw how staff maintained people's privacy and dignity, and maintained confidentiality when speaking to people and other staff.

We spoke with three residents who told us they like living at Stockingate. One person said; “we’re like one big family.”

People told us that they were happy with the cleanliness of their room and one person said; “yes, they do it for me without me even asking.”

People told us they were happy with the staff and comments included:

“Two of them make my day; I might as well be family.”

“Staff are kind, one of a kind.”

We spoke with three of the relatives of people who use the service who were happy with the care provided. One person said; “if he doesn’t want to go to bed until 10pm he doesn’t have to.”

When asked for any other comments about the service these included:

“They do have good meals but it would be nice to see a weekly menu.”

“The tea trolley should go round more often.”

“I would like them to make more of the garden; it’s a resource that’s going to waste."

One person said they like living in the home, they like their rooms and the people looking after them. Another said the staff are very good and they listen to what the have to say. One person said the meals are very good and they have a choice and get enough to eat and drink.

A visiting hairdresser said people always appear to be happy and well cared for. A visiting Social Worker writes in a Satisfaction survey “Staff are always pleasant and helpful’ and people are well cared for”. A visiting District Nurse satisfaction survey says “ As a team we have noticed great improvements to the home, The staff are very helpful and they carry out what we ask them to do”.

People say they like living in the home. One person said ‘If they have any concerns they can tell someone and its sorted’ Another says the staff listen to what they have to say and things get changed’

People say they like living in the home. One person said they like their bedroom and they have everything they need. People we could not communicate with were observed to be relaxing in comfortable surroundings that are clean and well maintained.

People say they like the people caring for them. One person said the carers are very good and very caring. Another says ‘there is always someone there when you need them.

People say they like the people caring for them. Some people we could not communicate with appeared to be happy and positive relationships were observed being fostered between those living in the home and those caring for them. One person said the staff are very good and listen to what they say.

People living in the home say they like the people caring for them. People we could not communicate with appeared to be relaxed and comfortable with those supporting them.

The satisfaction surveys completed by people living in the home, their relatives and visiting healthcare professionals, and staff show people are happy with the services provided. People are also impressed with the changes and improvements making life better for people using the service.