About the service:

Stratford Court is a residential care home that was providing personal and nursing care to 30 people, some of them living with dementia. At the time of the inspection, there were 22 people living there.

People’s experience of using this service:

People told us they felt safe. Staff had an understanding of how to spot signs of abuse and how to report concerns within the organisation and externally. Risks to people were assessed and staff were aware of these risks and how to minimise them. People received their medication as prescribed. Staff wore Personal Protective Equipment (PPE) appropriately.

People were supported by staff who had the relevant skills to meet their needs. People had access to healthcare professionals when required. Staff gained consent before supporting people. Staff had an understanding the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were met.

People told us that staff were kind and caring in their approach. People were given choices and control over their care. People were supported to be as independent as possible. Staff protected people’s privacy and dignity when supporting people.

People’s needs were assessed and reviewed on a regular basis. People were encouraged and supported to engage in activities that they enjoyed. People and relatives knew how to raise concerns and felt comfortable doing so.

The provider had quality assurance systems in place and these were used to drive improvement. People’s feedback was sought via meetings and questionnaires and this information was used to implement actions and changes. People, relatives and staff spoke positively about the registered manager.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (07 August 2017). The overall rating for the service has improved to Good.

Why we inspected:

This was a planned inspection which took place on 12 February 2019. At the last inspection the service was not meeting the regulations and they were required to send us an action plan.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Stratford Court is registered to provide personal care and accommodation for up to 30 older people, and a small number of these people were living with dementia. At the time of our inspection 23 people were living at the home, and 2 people were in hospital. The inspection tool place on 24 May 2017. The home was previously inspected in May 2016 and at that time was found to be Good in the key areas of caring and responsive. It was also found to require improvement in the key areas of safe, effective and well led.

There was a registered manager in post who was present throughout 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.

People and their relatives told us that they felt safe with the staff who supported them. Staff were aware of the need to keep people safe and understood their responsibilities to report allegations or suspicions of poor practice. Assessments had been undertaken to identify any potential risks to people and guidance was available for staff to follow to minimise those risks. These records were not well maintained and this may pose a risk to people’s safety. Moving and handling transfers were carried out in a safe manner. Medicines were being given as prescribed and stored safely.

Staff were provided with training, but we could not be sure how this was kept up to date. Staff told us that they had received an induction when they commenced working at the home, and safe recruitment practices were in place. People were provided with a good choice of food and were supported to access relevant healthcare professionals when needed.

People were cared for by staff who knew them well and who they described as kind and compassionate. People expressed how they wanted their day to day care to be delivered, but staff did not have sufficient information to apply the principles of the Mental Capacity Act in all instances. People told us that they were treated with dignity and respect, and were supported to maintain their independence.

The provider had begun to consider how to improve and enhance the home to assist people living with dementia. We recommend that the registered manager considers using national guidance about how to improve in this area.

People and their relatives had been involved in the development of their initial care plans, but it was unclear how people continued to have input into their ongoing care planning. People were supported to participate in some social activities. People told us that they felt enabled to raise concerns and complaints and were confident that these would be investigated and acted upon.

People, their relatives and staff described the home as well-led and felt confident in the registered manager. People told us that they were asked their views about the care and support they received, but not about how the home was run or any improvements they might like to see. The registered manager did not have systems in place to monitor and improve the quality and safety of the service provided. The home uses CCTV and further consideration about its use is needed. We recommend that the registered manager considers national guidance in relation to this matter.

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

We inspected this home on the 10 and 11 May 2016. This was an unannounced inspection. Stratford Court provides accommodation for a maximum of 30 older people, many of whom live with dementia and who require support with personal care. There were 28 people living at the home when we visited although two of these people were in hospital.

At our last inspection in January 2014 we found that the provider was meeting the requirements of the law.

The service had a registered manager, and they were present throughout 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.

People living at the home told us they felt safe, and this was supported in our conversations with relatives. People were encouraged to raise any concerns they had. Staff knew how to recognise when people may be at risk of harm and how to report any concerns. Risks to people had been assessed and identified but the assessments and measures to reduce the risk for the person had not always been updated when people’s needs changed.

The home had a passenger lift and hoists that helped people get in and out of the bath. These had been serviced but not tested as is required by Health and Safety legislation to ensure they were safe to use.

People were supported by staff who knew how to meet their needs. We saw staff responding well to a wide range of people’s needs, although records did not support that all staff had been provided with the required courses or had updates to their training. There were enough staff on shift who were effectively deployed to meet people’s needs. Staff knew people well and could tell us people’s preferences for support, their likes and dislikes and about important people in their lives.

Medicines were given in a dignified and safe manner. Only staff who had received medication training were able to give medicines.

People spoke highly of the care they received and praised the compassion and kindness of the staff who supported them. Feedback from relatives and health professionals supported this. People had access to healthcare professionals and the service was proactive in seeking advice when people’s healthcare needs changed. When advice was given prompt action was taken.

People were offered a varied and nutritious diet. The menu had been planned taking into account people’s preferences and dietary needs. People told us they enjoyed the food.

Only some of the staff we spoke with had received training on the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Some of the staff we spoke with were able to describe how this legislation was applicable to the people they supported.

Some people we met were living with complex and advanced dementia and were approaching the end stages of their life. We have made a recommendation that the provider develops further in this area, to ensure people with these needs receive good care.

People had the opportunity to join in a range of activities both as a group and individually. The majority of people we spoke with told us they enjoyed these.

People and their relatives knew how to raise any concerns or complaints and felt assured that these would be dealt with promptly. We saw the complaints procedure was accessible to all people living at the home.

There were systems in place to monitor the quality and safety of the service, but these had not always been effective at identifying issues where attention was required. The registered manager and the home owner worked at the home each day and had an in-depth knowledge of the home, challenges and areas for future development.

At the time of our visit there were 29 people living in the home. Not all of the people in the home were able to share their views about the care they received so we used other ways to find out about people's experiences of care including observation. We spoke with four people living in the home, four staff, three relatives, the manager and deputy manager.

People told us they were very happy with the service they received at the home. One person told us, ‘‘I’m treated as a person’’ and another said, ‘‘The staff help me, if I ring my buzzer they come straight away.’’ People told us and our observations confirmed that people were consulted about their care and were asked for their consent to the care they were given.

Staff were aware of people's needs and plans were in place to deliver care in a personalised way. People's health care needs were met through community health services. There were systems in place to identify and manage risks to keep people safe.

We saw that people could choose to join in group activities or spend time on their own interests.

Staff were supported through training, staff meetings and supervision with senior staff to ensure that they could meet people's individual needs.

There were systems in place to ensure people’s views were listened to and acted on. Systems were in place to monitor the quality of the service.

There were twenty six people using the service at the time of our visit and two people were in hospital. We spoke with six of these people and the staff that were supporting them. We spoke with the relative of a person using the service and two college staff that were assessing staff at the home.

Most people using the service were able to tell us about the care and support they received. They told us that that they were comfortable living there and happy about how their care and support needs were being met. Comments included: “If we are not well the doctor comes” and “The staff help me to have a bath, I love feeling nice and warm.”

We observed the care and support received by a few people using the service that were not able to communicate with us due to dementia. Staff supported people in a respectful manner and offered choices of how and where they wanted to spend their time.

People told us about the quality and choice of food and drink available. They told us that they were satisfied with this. A person told us “There is always something available that I like to eat.”

People told us that they felt safe and that they would speak to the staff if they had any concerns. A person told us “If something bothered me I would talk to the staff.”

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They did not have any information to share with us about the quality aspects of the home.

There were twenty nine people living at the home at the time of our visit.

People told us that they had been involved in the decision to live at the home and that they were encouraged to make choices regarding their daily lives. One person that was living at the home told us “I came to have a look around before I came to live here. They always let people do that, it is only fair. For me it was a gamble that has paid off”.

People told us that they were happy living at the home and that their care needs were being met. They told us that they received care and support in the way they preferred and in a respectful and timely manner. People told us that they were supported by care workers who had a good understanding of their care and support needs. People told us “The staff know their job, they know what they are doing” and “If someone is not well, the doctor is called”. A relative of a person that was living there told us “The care here is wonderful. My relative has really improved since she has lived here. I cannot praise the home enough”.

People told us that they were happy with the food provided at the home. A person that was living at the home told us “The food is very good. They give us a menu and if we don’t like what is on it, we can tell them and they get us something else.”

People told us that they are encouraged to pursue any hobbies or interests that they may have. People told us that they are supported to maintain relationships that are important to them. A person that was living at the home told us “I go out to a day centre three times a week. I enjoy doing this so that I can chat with the people there”.

People told us that they felt confident to raise any concerns that they may have about the service and that actions are taken in response to these. People told us that they were happy with the cleanliness of the home and that they were comfortable living at the home.

During our review, we discussed the quality of the service provided at Stratford Court with local authority colleagues involved in monitoring the home. They said they had not been advised of any current concerns or complaints about the services being provided.