About the service:

We conducted an unannounced inspection at Stoke House on 1 and 2 May 2019. Stoke House is a nursing home and accommodates up to 46 people in one building over two floors, accessed by a passenger lift. On the day of our inspection, 31 people were present at the service. People had either nursing or residential care needs and some people were living with dementia.

People’s experience of using this service:

Action taken to assess and mitigate risks associated with people’s needs, were not consistently completed or responded to in a timely manner. People could not be assured they received their prescribed medicines as required. Guidance provided to staff to meet people’s individual needs was inconsistent or insufficiently detailed. The provider had not consistently submitted statutory notifications of reportable incidents.

Improvements were being taken in the process that reviewed, monitored and analysed accidents and incidents to protect people from harm. Staff had recently received training in understanding and managing behaviour and further training was planned. Staffing levels had increased and improvements around deployment of staff was ongoing.

Infection control practice was understood by staff and best practice guidance followed. Health and safety checks were completed of the premise and environment. Plans were in place to make some improvements to decoration, refurbishment and the use of communal spaces.

Staff needed to complete refresher training and the provider had plans to address this. Staff received opportunities to discuss their work, training and development needs.

The provider had up to date policies and procedures that reflected current legislation and used recognised assessment tools to support assessments of people’s needs. Improvements were required to ensure people were protected under the Mental Capacity Act. Inconsistencies were found in the use of assessments and best interest decision making. People were involved as fully as possible in day to day decisions, but communication and opportunities to be involved in review meetings about care and treatment were not happening.

Staff worked with external healthcare professionals in meeting people’s health care needs. People’s nutritional needs were known and understood, and people were happy with the choice of meals and drinks.

People received limited opportunities of activities, social inclusion and stimulation. The provider was in the process of recruiting dedicated activity staff.

People had access to the provider’s complaint procedure. People’s communication needs had been assessed and accessible information for people had been considered.

End of life care plans needed to be further discussed and planned with people, to ensure they received personalised care at the end of their life.

People received opportunities to share their experience about the service. The provider had an action plan that was detailed and confirmed the shortfalls in fundamental care standards we found during this inspection. The management team had started to make improvements at the service and further time was required for these to be fully developed, embedded and sustained.

The service met the characteristics of requires improvement in all areas we inspected. We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These included how risks were assessed and managed, how medicines were managed, how people received care based on their individual needs, how people were treated with dignity and respect and records maintained. Also, one breach of the Care Quality Commission (Registration) Regulations 2009 due to the provider not submitting statutory notifications as required. Details of action we have asked the provider to take can be found at the end of this report. More information is in the detailed findings below.

Rating at last inspection:

At the last inspection the service was rated Good (Publi

This inspection took place on 6 March 2017 and was unannounced. Stoke House Care Home provides accommodation over two floors for up to 46 older people who require residential and nursing care and treatment, some of whom are living with dementia. On the day of our inspection 29 people were using the service.

The service had a registered manager in place 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 were supported by staff who understood the risks they could face and knew how to keep them safe. Risks to people’s health and safety were identified and assessed and action taken to reduce risks were known by staff and recorded in people’s care plans. People received their medicines as prescribed and these were managed safely.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were supported to make choices and decisions for themselves. When people were assessed as lacking mental capacity most people had capacity assessments and best interest decisions in place.

People required more support to protect them from the risks of inappropriate nutrition and hydration and to help them maintain their healthcare needs.

People were cared for and supported by staff who respected them as individuals, staff had friendly relationships with people and respected their privacy and dignity. People were involved in planning and reviewing their own care and some people were supported by relatives in doing so.

People received individualised care and were provided with meaningful interaction and activities. People felt confident to make a complaint and were confident these would be responded to.

We saw that staff worked well as a team and were supported by management to drive improvements in the service. Quality monitoring systems were in place which were effective in identifying issues.

This unannounced focused inspection took place on 2 November 2016. Stoke House Care Home provides accommodation over two floors for up to 46 older people who require residential and nursing care and treatment, some of whom are living with dementia. At the time of our inspection 20 people were living at the service.

We carried out an unannounced focused inspection of this service on 3 August 2016 as we had received concerns in relation to how people were supported with their mobility. A breach of regulation was found and we issued a warning notice as we were concerned about people’s safety.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. 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 Stoke House Care Home on our website at www.cqc.org.uk.

The service had a registered manager in place 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.

At our last inspection on 3 August 2016, we asked the provider to take action to ensure people were protected from the risk of harm. This was because there was a lack of adequate risk assessment and monitoring in relation to peoples moving and handling support needs. We also found that staff had not received sufficient training and guidance in order for them to support people safely with their mobility. For this reason we issued a warning notice which required the registered provider to ensure they meet the legal requirements of Regulation 12 (1) of the Health and Social Care 2008(Regulated Activities) Regulations 2014.

During this inspection, we found that the required action had been taken by the provider to ensure people were supported with their moving and handling requirements safely.

This focused inspection took place on 3 August 2016 and was unannounced. Stoke House Care Home provides accommodation over two floors for up to 46 older people who require residential and nursing care and treatment, some of whom are living with dementia. At the time of our inspection 18 people were living at the service.

We had previously carried out an unannounced comprehensive inspection of this service on 11 and 12 May 2016. After that inspection we received concerns in relation to how people were supported with their mobility in the service. As a result we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stoke House Care Home on our website at www.cqc.org.uk.

The service did not have a registered manager at the time of our inspection. The service had been without a registered manager for approximately 21 months. A new manager had been at the service for approximately six months prior to our inspection and had made an application 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.

We found that people were at risk of harm due a lack of adequate risk assessment and monitoring in relation to people’s moving and handling support needs. We also found that staff had not received sufficient training and guidance in order for them to support people safely with their mobility.

Immediately after our inspection and feedback the manager confirmed the action they had, and would be taking to address our concerns.

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

This inspection took place on 11 and 12 May 2016 and was unannounced. Stoke House Care Home provides accommodation over two floors for up to 46 older people who require residential and nursing care and treatment, some of whom are living with dementia. On the day of our inspection 20 people were using the service.

The service did not have a registered manager at the time of our inspection. The service had been without a registered manager for approximately 18 months. A new manager had been at the service for approximately three months prior to our inspection and had made an application 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 our last comprehensive inspection of the service on 27 July 2015 we identified five breaches of legal regulations and deemed the service to be inadequate. The service was placed in special measures to be kept under review. We returned to the service on 26 November 2015 to follow up requirements resulting from three of these breaches and found that improvements had been made although further improvements were required in relation to the safe care and treatment of people. During this inspection we found that the service demonstrated further improvement and is no longer rated as inadequate for any of the five key questions, therefore the service will no longer be in special measures.

Following our last comprehensive inspection on 27 July 2015 we asked the provider to take action to ensure there were sufficient staff on duty to meet people’s needs. During this inspection we found that people were cared for by sufficient numbers of staff. However, improvements were required to ensure that recruitment processes were robust and ensured staff were safe to work with people.

Following our last comprehensive inspection on 27 July 2015, we asked the provider to take action to ensure that concerns for people’s safety were responded to appropriately. During this inspection we found that people were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening.

Risks to people’s health and safety were identified and assessed and action taken to reduce risks were recorded in people’s care plans, however, we found that risk assessments had not always been completed correctly. People received their medicines as prescribed and these were managed safely.

People told us they were not always asked for their consent prior to support and treatment being provided. Decisions were being made appropriately in people’s best interests in the event they lacked capacity. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were protected from the risks of inadequate nutrition and specialist diets were provided if needed. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were at risk of receiving support which did not reflect their individual preferences as staff did not always ask people how they wished to be supported and people were not routinely involved in care planning. We observed that staff had friendly relationships with people and respected their privacy and dignity.

People’s care records did not always reflect that they were receiving care and support in line with care plans. At times we witnessed a lack of staff interaction with people; however, improvements had been made to the stimulation and activities ava

We inspected this service on 26 November 2015. Stoke House Care Home provides accommodation for up to a maximum of 46 older people who require accommodation with nursing or personal care. On the day of our inspection 22 people were using the service.

We carried out an unannounced comprehensive inspection of this service on 27 and 28 July 2015 and 7 August 2015. Breaches of legal requirements were found. We issued three warning notices in relation to three of these breaches.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notices. 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 Stoke House Care Home on our website at www.cqc.org.uk.

The service did not have a registered manager in place 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 and associated Regulations about how the service is run.

We found improvements had been made in identifying risks to people arising from their care needs and in managing risks correctly to ensure people’s safety. Further improvements were still required in relation to the management of medicines, the management of people’s healthcare and monitoring the quality of the service.

We found that improvements had been made in relation to the service ensuring that people’s rights were protected. We found during this inspection that the requirements of the Mental Capacity Act 2005 were being adhered to. Applications had been made to the appropriate authority if this was required under Deprivation of Liberty Safeguards (DoLS). DoLS protects the rights of people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed.

Systems used to monitor the quality of the service provided were still not effective despite improvements made to these.

This unannounced inspection took place on 27and 28 July and 7 August 2015. Stoke House Care Home is run and managed by Stoke House Care Home Ltd. The service provides accommodation for up to a maximum of 46 older people who require nursing or personal care. On the day of our inspection 27 people were using the service.

The service did not have a registered manager in place 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 and associated Regulations about how the service is run.

Although people told us they felt safe at the service we found that processes were not robust and had not always been followed to protect people from the risk of abuse. We found that the provider was not always identifying risks to people arising from their care needs. When risks were identified they were not always being managed correctly to ensure people’s safety. There were not enough staff to meet the needs of the people who used the service and medicines were not managed safely.

People were not protected by the Mental Capacity Act 2005. People were not supported to maintain their on going healthcare.

People expressed mixed views on the interaction they had with staff and we observed that not all staff were caring towards the people they were supporting. People were not always routinely involved in decisions about their care.

People felt able to raise concerns but these were not always responded to or acted on. People’s preferences were not always taken into account when staff were delivering their care.

Although people and their relatives felt they could approach the manager with ideas and suggestions, the systems in place designed to capture this information on an on-going basis and bring about improvements to the service were not fully effective.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

There were 37 people living at the home at the time of our visit. We spoke with four people who used the service, one relative and two members of staff.

One person who lived at the home told us “I am happy here. They are looking after me well. The food is good and there are plenty of things to do and music to listen to”.

A staff member told us “It’s like my second home here. I love it. There is always enough staff on the duty rotas. The management always listen to any complaints of concerns we may have. We also have regular staff meetings”.

During our inspection we reviewed the files of ten people who used the service. We found comprehensive records of care showing that care was planned, delivered and assessed appropriately.

We spoke with three people who were using the service, three relatives and one friend of a person using the service during our visit to Stoke House Care Home. To help us understand the experiences of people living in the home we also used our SOFI (Short Observational Framework for Inspection) tool during the visit. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

The people we spoke with told us that their privacy and dignity were respected. One person said, "I am quite happy with them all [staff] here.”

We spoke to relatives of people who use the service and one person said, “I think the staff are brilliant here.”

People using the service and relatives told us they felt safe with the support they were being provided. One person said, “I feel safe and the staff are kind.” People told us that they liked the staff and staff were able to meet their needs. They also told us they felt they could speak to the manager or staff and they would be listened to.

We found that staff were supported to provide care that met people's needs. We also found that the provider took steps to assess the quality of the service being provided.

We asked one person about the activities provided at the home. They told us that they did not go downstairs to take part in the activities. They told us, “I see my visitors in my bedroom and invite them to come up to see me. I have a board that I use to remind me to do things on. The activities person writes on the board to keep me informed of what activities are taking place in the home. I work on my hobby in my room and will show others how to take part in my hobby.” During our conversation this person told us, they thought staff were very kind to them.

Three people who we spoke with told us their needs were met and they were happy living at the home.