We undertook this unannounced inspection on the 19 and 20 July 2018.

At the last inspection on 28 January 2016 we found the service was Good.

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

Stratton House provides accommodation and personal care for up to 33 people. At the time of the inspection there were 32 people living at the Service. The Service had a dining area, lounge and sitting area, various quiet seating areas throughout the service and an outside garden where people could sit and enjoy various aspects of the outdoor space.

The service had a registered manager in place. 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 home had quality assurance systems in place however these did not always identify shortfalls relating to inadequate storage of contaminated laundry and poor staff practice administering medicines. Quality assurance systems did not always identified shortfalls and actions required.

There were adequate hand washing facilities available and staff used personal protective equipment such as gloves and aprons when required. People also had personal evacuation plan in place in case of an emergency. The service ensured people had an assessment before moving into the home. Care plans contained important information relating to peoples like and dislikes, their previous occupation, families and routines. Care plans contained risk assessments and support plans confirmed people’s individual needs.

The care plans contained consent document and assessment to demonstrate the service was working within the principles of the Mental Capacity Act 2005. Capacity assessments were in place including best interest decisions if required. People had choice and control over decisions that affected their lives. Both People and staff were happy in the home and all felt it was a homely positive environment which encourages them to be as independent as possible.

People and staff felt the registered manager was accessible and approachable. They had their views sought and improvements were made to the service following this feedback. Where complaints were raised these were investigated although the provider’s complaints policy needed updating.

People felt supported by staff who were kind and caring and who respected their privacy and dignity. They were given choice about what they would like to eat and were complimentary about meals provided. People were supported and encouraged to spent their time on activities of their choice and visitors were free to visit when they wished.

People had access to a variety of activities which suited different abilities and interests such as gardening, chair exercises, book club, knitting and expeditions. People were involved in organising and running some of the activities. The home was also an important part of the local community. Students and volunteers were able to gain by supporting people both in the home and in the community.

Staff had daily handover meetings and staff meetings to ensure they were up to date with any changes to people’s care needs. Where health needs had changed referrals where made to the appropriate health professionals. Notifications were made when required.

Staff had training to support them in their role. The service under took and supported staff to learn how to provide sensitive end of life care. People were also supported by the Chaplin to design their end of life plan if they wished to do so.

We found one breach of the Health and Social Care Act 2008

The inspection took place on 28 January 2016 and was unannounced. The care home was last inspected in September 2013 and met with legal requirements.

Stratton House is a care home registered to provide personal care for up to 33 people. There were 30 people living in the home on the day of our visit.

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.

There were enough staff to meet people’s needs. People felt safe and supported by staff. Staff were provided with regular supervision and training to help them meet the needs of the people living in the home.

People were cared for in a kind and respectful way. One person said, “They really care, nothing is too much trouble”. Staff were polite and showed respect to people.

People were provided with a varied diet. The menus took into account the likes and dislikes of the people living in the home.

The registered manager understood their responsibilities with regard to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This legislation is in place to protect the rights of people who lack capacity to make informed decisions, and to make sure people are only deprived of their liberty when it has been approved by an authorised body.

People’s care plans were detailed and provided guidance about how to meet the people’s care needs. The care plans provided detail about who had been involved. They were reviewed and updated regularly. This meant people’s records contained up to date and relevant information about how to meet their assessed needs.

There was a system in place to check, monitor and improve the standards of care and the quality of the service. Audits demonstrated that regular checks were completed.

We looked around the premises and saw people lived in a, mostly, clean and hygienic environment. We saw the majority of the home, where the building work to refurbish the property, had been completed were bright and clean. We were told there was a plan in place to complete the other areas as soon as possible. One person told us,” it’s nice here now but it took ages. We will all be glad when it’s finished.”

Nine people we spoke with were positive about the staff team. They thought there was enough staff on duty to meet their care needs.

We looked at three care files and saw each person had care plan. Information was recorded about people's personal goals and details about their physical, mental and emotional wellbeing. Peoples’ care plans described their preferences and routines. The information in the plans was well maintained and sufficient to assist staff to care for people safely.

We looked at the systems in place for the management of medicines and found there were appropriate arrangements in place.

We met three people who used the service and they told us they were included in some decisions about their care. For example, one person told us: “I choose what activities I want to do and what I want to eat.” We saw staff members supported people in a thoughtful and considerate way.

People told us the staff dealt appropriately with any complaints they had. They said the views of both people who used the service and staff were listened to, and valued.

We asked six people if they thought there was enough staff on duty. They all told us they thought there was not enough staff around in the mornings. For example, one person said: “it’s a rare and valued experience when staff have time to talk to me.” From our observations and review of care planning and care delivery we found there were not enough staff on duty at all times to support people safely.

We looked around the premises to see if people lived in a clean and hygienic environment. We saw areas of the home were not clean.

We looked at three care files and saw each person had care plan. Information was recorded about people's personal goals and details about their physical, mental and emotional wellbeing. Peoples’ care plans described their preferences and routines. The information in the plans was not, however, always sufficient to assist staff to care for people safely.

We looked at the systems in place for the management of medicines and found there were not appropriate arrangements in place.

We spoke with people who use the service and asked them what they thought about the refurbished bathrooms and toilets. They told us that they were very nice and a great improvement.

We spoke to people who use the service and they told us that there are activities every day some of which are run by the care staff and some by outside people. Some people were looking forward to going on a trip to a nearby garden centre. People told us that their families had copies of their care records and that they are involved in their care reviews.

Some people who use the service told us that their care records were kept in their rooms and could be kept in a locked cupboard or drawer. The manager had recently made changes to the way in which vegetables were served at lunchtimes due to feedback from people that they were often cold. New dishes were purchased that retain heat and this had been met with positive feedback and was noted during our visit.

People who use the service told us they felt there were enough staff during the day but that there were only two at night who seem to be busy. We observed that staff were busy, but ensured there was sufficient time for activities and assisting people with personal care.

There are shared bathrooms and shower rooms on each floor. We saw that one of the shared shower rooms had a shower out of use and in other toilets and bathrooms taps were dripping and the general environment required updating. There is a plan in place for refurbishment of three toilets, two shower rooms, a wet room and a bathroom during June 2011.

Staff we spoke to told us that they had undertaken a range of training including health and safety, mental health, first aid and mental capacity. They have also been supported to undertake further training at Diploma level.

We saw people being asked if they needed pain killers and that staff observe medication is taken.

People told us that they liked the food and that there was more than enough with good portion sizes.

At lunchtime people were seen to be sitting with friends and talking and socialising. There is a choice for lunch and all food was served hot with people being able to help themselves to vegetables from dishes on the tables.