This inspection took place on 19 and 20 February 2018 and was unannounced.

Stamford Care Home is a care home providing nursing care. People in care homes receive accommodation and nursing or 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.

Stamford Care Home is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people living with dementia. At this inspection there were 82 people living in the 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.

At our previous inspection of this service on 1, 2 and 3 February 2017, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns found we issued a warning notice to the provider and registered manager on 14 February 2017, requiring compliance with the Regulation by 1 March 2017. On 4 April 2017, we carried out a focused inspection to check if the provider had made the necessary improvements to how the service ensured medicines were safely managed. We found that the provider had made significant improvements. However we identified some areas for further improvement. At this inspection, we found that medicines were safely managed and improvements made following the February 2017 inspection had been embedded and sustained.

This service is now rated as Good.

Accidents and incidents were appropriately recorded and investigated, and risk assessments were in place for people who used the service that described potential risks and the safeguards in place to mitigate these risks.

People's needs had been assessed and personalised care plans developed. Care plans were evaluated to check they reflected people's needs.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

People received a nutritious diet and enough to eat and drink to meet their individual needs. Timely action was taken by staff when they were concerned about people's health. Referrals had been made to other healthcare professionals to ensure people's health was maintained.

Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure oversight of when staff training, supervisions and appraisals were due.

People and relatives were positive about the service and the staff who supported them. People told us they liked the staff that supported them and that they were treated with dignity and kindness.

People told us they felt safe living at Stamford Care Home. Staff understood the importance of safeguarding and the service had systems to help protect people from abuse.

The service was clean throughout and there were hygiene controls in place to ensure that the kitchens were kept clean and food was safely stored. Utilities such as electricity and gas and health and safety checks were undertaken regularly and records kept.

A complaints procedure was in place which was displayed for people and relatives. Staff, residents and relatives meetings were held regularly and surveys were completed by people and relatives.

People, relatives and staff spoke positively of the ma

At our previous inspection of this service on 1, 2 and 3 February 2017, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns found we issued a warning notice to the provider and registered manager on 14 February 2017, requiring compliance with the Regulation by 1 March 2017.

This inspection took place on 4 April 2017 and was unannounced. This inspection was carried out by a single pharmacist inspector. This report only covers our findings in relation to the safe management of medicines within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stamford Care Home on our website at www.cqc.org.uk

A registered manager was 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.

At this inspection we found that significant improvements had been made to how the service ensured safe medicines management. We found that medicines stocks balanced with what medicines administration records (MAR’s) stated and medicines were stored safely and securely. We saw that the administration of medicines was documented appropriately.

However, the management of people’s medicines administered via Percutaneous Endoscopic Gastrostomy (PEG) was not always in line with best practice guidelines and advice. The maximum fridge temperature used for storage of medicines was not documented; therefore we could not be assured that medicines inside the fridge were stored safely. Some staff who administer medicines had not their medicines training competency assessed.

Although the provider was no longer in breach of the medicines regulation, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we found that that improvement was required in aspects of medicines management.

This inspection took place on 1, 2 and 3 February 2017 and was unannounced. During the last inspection on 23 and 24 March 2016 we found the service was in breach of five legal requirements and regulations associated with the Health and Social Care Act 2008. We found that people who used services and others were not protected against the risks associated with their care and treatment. Care and treatment was not always provided in accordance with the Mental Capacity Act 2005 (MCA). We found there were deficiencies related to monitoring of people's nutrition and hydration. There was not a systematic approach to determine the number of staff and range of skills required in order to meet the needs of people using the service. The provider had not notified the Care Quality Commission about significant events affecting people's care and support needs in relation to the outcomes of Deprivation of Liberty Safeguarding (DoLS) outcomes.

Stamford Nursing Centre is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people living with dementia. At this inspection there were 87 people living in the home.

There was 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.

Medicines were not being managed safely. We found that some medicines were not stored and disposed safely. People’s Medicine Administration Records (MAR’s) were not always completed in full or accurately. Medicines were not always administered as prescribed. Medicine audits had failed to identify the issues that we found. We also found that the home improvement plan did not include the findings from an audit carried out by the registered manager.

At this inspection, we found detailed current risk assessments were in place for people using the service. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

Significant improvements had been made to ensure that consent to care was obtained from the appropriate person. Care plan specifying best interests needs were in place. Staff had received training on Mental Capacity Act 2005 (MCA) and staff understood the importance of obtaining consent from people.

People received a nutritious diet and enough to eat and drink to meet their individual needs and timely action was taken by the staff when they were concerned about people's health.

Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure a better oversight of when staff training, supervisions and appraisals were due.

There were enough staff to meet people's care needs safely and also to provide individualised support in and out of the service. Staff were safely recruited with necessary pre-employment checks carried out.

We found that improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from staff regarding the management structure in place and the support they received.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Care plans were person centred and reflected what was important to the person. Care plans provided appropriate guidance to enable staff

This inspection took place on 23 and 24 March 2016 and was unannounced. During the last inspection on 17 and 19 February 2015 we found the home was in breach of one legal requirement and regulation associated with the Health and Social Care Act 2008. We found that people who used services and others were not protected against the risks associated with unsafe or unsuitable premises because of inadequate maintenance and there was a need to review staffing arrangement on the second floor of the home. We also found there were deficiencies related to people’s care and nutrition.

Stamford Nursing Centre is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people with dementia. At this inspection there were 88 people living in the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection we found that appropriate checks had been made to ensure the premises was safe.

Some risk assessments were not updated to reflect people’s current needs and did not take into consideration people’s health needs. When a risk was identified it did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people from behaviours that challenged the service or people with high risk of skin breakdown.

During our observations, on occasions we noticed there was lack of interaction with people on the ground floor. People were either looking at the television or sleeping while staff were completing tasks. Some people required support when they were mobile with zimmer frames or during hoist transfers. Systems were not in place to calculate staffing levels contingent with people’s dependency levels.

People were given choices during meal times and their needs and preferences were taken into account. Nutritional assessments were in place for most people, which included the type of food people liked and disliked. We found food was not being monitored for some people with specific health concerns to ensure they had a healthy balanced diet. People’s weight were recorded regularly and there was an action plan in place should people were to lose or gain weight significantly.

Due to risks to their safety most people living at the home were not allowed to go outside without staff or relative accompanying them. Appropriate Deprivation of Liberty Safeguards had not been applied for people that required supervision when going outside.

Assessments had been made to check if people had capacity to make certain decisions. However, where people did not have capacity, we found instances when best interests meeting were not held with professionals or family members to make best interest decisions on people’s behalf.

Quality assurance systems had been implemented to allow the service to demonstrate effectively the safety and quality of the home. However, the provider’s quality assurance had not identified the shortfalls we found during our inspection.

Complaints were recorded and investigated with a response sent to the complainant. However, complaints were not analysed for common themes or learning identified and put into practice to improve the service. We made a recommendation that complaints are analysed to identify trends and use the information to improve the service.

Statutory notifications to CQC had not been made in respect to outcomes of Deprivation of Liberty Safeguards for people who used the service.

People told us they fel

This inspection was a follow up inspection to look specifically at the staffing arrangements and what changes had been made since our inspection of 17 May 2013. At that inspection we had identified that the provider did not take steps to make sure that there were always enough qualified, skilled and experienced staff to meet people's needs.

At this inspection we found that the staffing level had been increased in two of the three units and that more staff had been recruited so that it was easier to cover shifts. People using the service and relatives we spoke with told us that staff were "helpful" and "hard working". Staff told us that the staffing arrangements had "improved".

We saw that there were systems in place to check people's needs and we were told that staffing levels could be adjusted in line with needs. We also saw that the acting manager retained oversight of the staffing rota to make sure that staff cover could be provided when needed.

People using the service told us that they liked it at the home and that staff were helpful. One person said, “I’m well looked after.” Another person said, “the staff are good”. Relatives told us that they were happy with the home. One said, “the staff are really nice and patient.” Another said, “I trust the staff to take good care of my relative.” Many of the people using this service had dementia, or other cognitive impairments, so we spent time observing interactions with staff. We saw that staff were helpful and supportive to people using the service. We spoke to a visiting healthcare professional who told us that the home was prepared for their visits and carried out their recommendations.

We saw that there were comprehensive care planning documents which staff had kept up to date. This meant that people had been cared for as planned. We saw that the managers carried out regular audits of health and care practice which enabled them to take action to address concerns if they arose.

Staff told us they felt supported and we saw evidence that relevant training had been provided. However, we saw that staff were rushed, particularly at lunch time. We saw that staff did not always have time to devote to people or to provide regular positive interactions. Some of the staff and relatives told us that more staff were needed, particularly at mealtimes and to provide cover when colleagues were unable to work a shift. We were told that a dependency analysis of people’s needs had not been carried out in order to calculate how many staff were needed. This meant that people using the service could not at all times be confident there were enough qualified, skilled and experienced staff to meet their needs.

People who use the service told us that staff were kind and respected their privacy. They confirmed that staff treated them with respect and dignity. One person commented, “they know what they are doing.”

There was evidence that the manager and the operations manager regularly spoke with people using the service to gain their views about their care. People told us that they were offered choices in relation to how they wanted to be supported. They told us that they had regular meetings to talk about their care and could comment on how the service was run as well as make suggestions for improvements.

People were positive about the care and treatment they received from staff at the home. They confirmed that staff assisted them when they needed support with their care and that staff were helpful. One person commented, “They are wonderful. They smile and make you feel comfortable.” A relative we spoke with told us the staff were “very gentle.”

People told us that they felt safe with the staff who supported them. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the care worker if they needed to. One person told us, “I’m not worried about anything.”

We saw that the provider carried out regular checks at the home including health and safety audits to make sure people were being supported in a safe environment. Please note that the registered manager has left the employment of this organisation.

At this inspection we spent time with people using the service on the dementia unit.

We asked them what they thought about the care and treatment they received at the service. People who were able to communicate with us said they felt well cared for and that the staff were helpful. Because most people had communication difficulties due to their dementia, we spent time observing how people were being cared for and how staff interacted with them.

The atmosphere on the unit was relaxed and staff interactions were having a positive effect on people using the service.

People who use the service, who were able to communicate with us, indicated that they were happy with the staff who supported them.

At this inspection we spent time with people using the service on the dementia unit.

We asked them what they thought about the care and treatment they received at the home. People who were able to communicate with us said they felt well cared for and that the staff were helpful.

Because most people had communication difficulties due to their dementia, we spent time observing how people were being cared for and how staff interacted with them.

We observed an activity session in the main lounge on the dementia unit.

People in the lounge were enjoying the singing and exercises being organised by the activity coordinator.

Care staff were also being encouraged to take part and we observed kind and positive interactions between staff and people using the service.

There were a number of people who have challenging behaviour due to their cognitive impairment and communication difficulties. We observed that staff sometimes had difficulties in interacting and supporting those people with more severe cognitive impairment.

Staff at the home were ensuring that treatment plans in relation to pressure care management were being completed accurately.

We asked people who use the service what they thought about the care and treatment they receive at the service. They generally responded positively about the care they received. People told us that the staff were often busy but treated them with care and respect.

One person we spoke with said they would like to spend more time in the communal lounge with other people rather than being on their own in their room.

Staff we spoke with had a good understanding of the needs of the people they supported.

People who use the service indicated to us that they felt safe with the staff at the home. They told us that if they had concerns about their care they would speak with a relative or the staff if they needed to.

We observed kind and positive interactions between staff and people living at the home.

Staff we spoke with understood the need to protect people they support from abusive practises and were aware of the procedures for reporting suspected abuse to the manager of the service.

People who use the service indicated that they were generally happy with the staff who supported them.

Staff we spoke with were positive about the training provided by the service and the deputy manager told us about a number of training courses he had recently undertaken with staff at the service.

The service was not always ensuring that information about people who use the service in relation to care, treatment and risk assessment was being recorded accurately.

On the day of our visit there were seventy two people residing at the home.

A number of more able people were just leaving for a day trip to the seaside.

We met and spoke with most of the other people receiving a service. Where people had communication difficulties we spent time observing staff interactions with people to see what effect this had on peoples’ wellbeing.

People who use the service told us that staff were supportive and that they respected their privacy.

Comments about the staff included, “They treat me kindly” and “They do their best”.

We observed polite and supportive interactions between staff and people using the service.

People confirmed that staff included them in decisions about their care.

Prior to this visit we received information that a person receiving a service had not been appropriately assisted by staff to use the toilet which lead to an unnecessary incident that breached their dignity and comfort. This matter is currently being investigated by the local authority.

We asked people if staff attended to their care needs promptly and appropriately.

People told us that staff generally responded quickly if they were called for assistance and staff were respectful when carrying out personal care tasks.

Some people commented that staff appeared “Rushed” sometimes.

This was also a view held by some staff who told us that due to the high dependency levels and increased needs of people, they sometimes felt under pressure.

One member of staff told us that this had been recently discussed in a team meeting and that the regional support manager had assured staff that staffing levels at the home were being reviewed.

People who use the service were generally positive about the care and support they receive at the home.

People who use the service told us that staff were approachable and understood how they wanted to be looked after. Staff we interviewed had a good understanding of the care and treatment needs of each person they cared for.

People we spoke with were positive about the support and care they receive at the home. They told us that staff were kind and polite. Comments included, “The care has been tremendous”, “I’m happy here”, “The staff tell you what they are doing”, “Lovely kind people here” and “the care is very good”.

People told us they were satisfied with the food at the home. Comments included, “the evening meal is quite good”, “I love the food” and “It’s very good, very good indeed”.

People told us they felt safe in the home and knew how to make a complaint if they needed to. People told us they thought the environment was clean and well maintained. People said they liked their rooms and the newly decorated and refurbished areas of the home. People told us they felt involved in their care and the running of the service. Visitors to the service told us that the home communicates well with them and that they were happy with the quality of care provided. Health care professionals told us that communication between them and the service has improved considerably and that they were satisfied the home was able to meet the needs of the people being supported at Stamford Nursing Centre.

We undertook this unannounced inspection on 17 &19 February 2015 of Stamford Nursing Centre to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Stamford Nursing Centre is registered to provide nursing care and accommodation for a maximum of 90 adults, some of whom may have dementia. There are 27 bedrooms on the ground floor (Oakwood Unit); 30 bedrooms on the first floor (Broomfield Unit); and 33 bedrooms on the second floor (Woodside Unit), which is dedicated to people with dementia. The home is located in Edmonton in the London Borough of Enfield. Each person had their own room with ensuite bathrooms and shared communal facilities. At this inspection there were 86 people living in the home.

The home does not have a registered manager. The current manager had applied for registration and was awaiting the outcome of his application. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that staff were respectful and their care needs had been attended to. There was a varied activities programme and we saw people participating in various activities. People had been carefully assessed and their choices and preferences had been noted. Care plans were prepared with the involvement of people and their representatives. There was evidence that the personal and healthcare needs of people had been carefully monitored and reviews of their care and progress had been carried out with health and social care professionals. This ensured that they received treatment and support for their individual needs. However, we noted that some aspects of the service were not effective and have made recommendations for improving the care of people in areas associated with percutaneous endoscopic gastrostomy (PEG) feeds, pressure area care and nutrition.

There were suitable arrangements in place for protecting people from abuse. Staff had received training and knew how to recognise and report any concerns or allegation of abuse. Several safeguarding concerns had been reported to us and the local safeguarding department. The home had co-operated with investigations and agreed action plans had been responded to.

There were suitable arrangements for the recording of medicines received, storage, administration and disposal of medicines in the home.

Staff had been carefully recruited and provided with appropriate training. Regular supervision and support had been provided to enable them to care effectively for people. Feedback received from people and staff indicated that there was sufficient staff on most floors of the home, however, some staff and relatives informed us that there was insufficient staff on the second floor of the home.

The home had arrangements for quality assurance. This included audits and checks on medicines, health and safety and care documentation by the manager and senior staff of the company. Professionals who provided us with feedback stated that they were satisfied with the quality of care provided.

The home was well furnished and comfortable. The premises were clean and health and safety checks had been carried out. However, on both days there were unpleasant odours in some areas of the building. We further noted that there were deficiencies related to the maintenance and security of the home. These deficiencies place people at risk of living in premises which may be unsafe and not secure. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.