Stacey Street provides nursing care to older adults with dementia and long term mental health difficulties. It should be noted that at the time of this inspection the service provider informed CQC of a planned programme for the closure of the home due to occur by the end of March 2019.

At our previous inspection on 4 July 2016 we found that the service was meeting the regulations we looked at and the overall rating was Good.

The inspection took place on 14 January 2019 and was unannounced. This inspection was carried out by one inspector.

At this inspection we found the service remained Good.

At the time of our inspection a registered manager was employed at the service. 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 thirteen people receiving personal care at the time of our visit.

From our observations of interactions between staff and people using the service and conversations we had with some people we found that people felt safe at the service. No concerns about people’s safety had been raised since our previous inspection.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. Records showed that the service was applying these safeguards appropriately and making the necessary applications for authorisations to deprive people of their liberty, as required.

On the day of the inspection we found suitable numbers of staff were available to meet people’s needs. The staff rota showed that suitable levels of staffing were also provided at other times of the day and despite the reduction of the number of people using the service, staffing levels had been maintained.

People’s social and health care needs were assessed, and care was planned and delivered in a consistent way. People using the service had enduring long term mental health conditions and care plans showed that the information and guidance provided to staff was clear and identified potential risks to people and how to minimise these risks.

Staff received training to enable them to understand people’s needs and how to provide safe and responsive care.

People were offered choice at meal times and were consulted about the menu. People’s nutritional and hydration needs were met.

Social and daily activities had continued to develop since our previous inspection and people were offered a variety of interesting activities and were free to choose if they participated or not.

People were able to complain or raise concerns if they needed to. The provider regularly reviewed the performance of the service to ensure that standards were maintained, and improvements were made. People’s views and preferences were considered, not least in terms of the current planned closure of the home and alternative places being identified for people to move to.

Further information is in the detailed findings below.

Stacey Street provides nursing care to older adults with dementia and long term mental health difficulties.

At our previous inspection of this service on 2 and 9 July 2015, the provider was in breach of Regulations 10 (treating people with dignity and respect) and 14 (choice of meals) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was limited choice of meals and people were not always being treated with dignity or respect in the way some staff spoke with them. The provider sent us an action plan after the inspection detailing how they would address the breach. At this inspection we found that progress had been made, far greater choice and options were available at mealtimes and staff engaged with people in a respectful and dignified way. The provider was no longer in breach of these regulations.

This inspection was unannounced which meant the provider and staff did not know we were coming. The inspection took place on 4 July 2016.

At the time of our inspection a registered manager was employed by the NHS Trust. 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 18 people in residence at the time of our visit. We received a small number of comments from people using the service as some people were not able to speak with us about their experience of the service, due to their healthcare needs. For this reason we used general observation as people were engaging positively and very regularly with staff in activities of different kinds, or sometimes choosing to be alone in their rooms, watching television or reading. We did not think it suitable to use (SOFI) on this occasion, although did do so at our previous inspection. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We saw there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. Records showed that the service was applying these safeguards appropriately and making the necessary applications for assessments when these were required.

People were supported in ways that were most appropriate to their needs and known wishes. On the day of the inspection we found sufficient numbers of staff were available to meet people’s needs. The staff rota showed that suitable levels of staffing were also provided at other times of the day.

We found that people’s health care needs were assessed, and care was planned and delivered in a consistent way. People using the service had endured long term mental health conditions and care plans showed that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to help keep people safe.

Staff had the knowledge and skills they needed to support people. They received training to enable them to understand people’s needs in ways that were safe and protected people.

We found that the choice offered to people at meal times had greatly improved and their involvement in deciding what should be contained in the menu and at each meal was offered and their choices were respected.

From our observations of interactions between staff and people using the service we found that people felt safe at the service. No concerns about people’s safety had been raised since our previous inspection and we found no evidence to suggest that people were anything but kept safe.

Social and daily activities provided had improved significantly and people were provided with

At this inspection we sought to answer one of the five questions, is the service safe? We looked at this as we had previously found at our inspection on 6th February 2014 that the service was not handling medications safely.

Below is a summary of what we found. The summary is based on our observations during the inspection and speaking with staff about medication and checking records..

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

Is the service safe?

At this follow up inspection we found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were 19 people in residence at the time of our visit and we found that they were cared for in a friendly, clean environment. We were not able to speak to people directly about their experience of the home, due to their healthcare needs, but we observed that they were relaxed and comfortable and quickly comforted by staff if they did show any signs of distress. We saw that people were well dressed and their hair and visible skin was kept in good condition.

People were routinely offered choices and everyone we saw enjoyed their lunch. Additional nursing and care staff, as well as an Activities Coordinator, had been appointed since our last inspection visit. A mix of Mental Health and General Nurses was now employed, ensuring that all aspects of people's complex healthcare needs could be attended to.

However, we found that the provider needed to make some improvements to the way medicines were managed.

This inspection was unannounced. The inspection took place on 2 and 9 July 2015. At our previous inspection on 28 May 2014 we found that the provider had made improvements regarding medicines management.

Stacey Street provides nursing care to 19 people with dementia and long term mental health difficulties. There were 18 people in residence at the time of our visit.

At the time of our inspection we found that a new manager had recently been employed at the service. The service had made an application to register this person with the Commission. 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 saw there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. We saw from the records we looked at that the service was applying these safeguards appropriately and making the necessary applications for assessments when these were required.

People were supported in ways that were most appropriate for their needs and known wishes. On the day of the inspection we found sufficient numbers of staff were available to meet people’s needs. The staff rota showed that suitable levels of staffing were also provided at other times of the day.

We found that people’s healthcare needs were assessed, and care was planned and delivered in a consistent way. People using the service had endured long term mental health conditions and from the care plans we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to help keep people safe.

Staff had the knowledge and skills they needed to support people. They received training to enable them to understand people’s needs in ways that were safe and protected people.

We found that the choice offered to people at meal times was limited. People were offered two menu choices but were not involved in planning the menu to ensure that people’s individual preferences were considered.

From our observations of interactions between staff and people using the service and from our conversations with a relative and health and social care professionals we found that people felt safe at the service. However, we did find that in some cases staff did not always engage and communicate with people in a way that respected their dignity.

Social and daily activities provided had begun to improve and work was being undertaken to ensure these met their individual needs.

People were able to complain or raise concerns if they needed to. We saw that where people had raised issues these were taken seriously and had been resolved appropriately. The provider also regularly reviewed the performance of the service to ensure that standards were maintained and improvements were made although more needs to be done to regularly seek views from people using the service.

We found breaches of regulations in relation to nutrition and dignity and respect. You can see what action we have asked the provider to take at the back of the full version of this report.

We have made a recommendation in relation to obtaining the views of people who use the service.

At this inspection there were two breaches of regulations relating to regulations 10 (treating people with dignity and respect) and 14 (choice of meals). We also made one recommendation which you can see in the Well-Led section of this report. You can see what action we told the provider to take at the back of the full version of the report.