This comprehensive inspection took place on 11 April 2017 and was unannounced. We last inspected Stanbeck Residential Care Home in May 2016. At that inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found that the provider had complied with the requirement notices in relation to those breaches.

Stanbeck Residential Care Home is situated in a residential area of Workington. It is approximately half a mile from the centre of town and is on a bus route serving the town centre. The home has a large garden and patio areas and provides accommodation for up to 13 older people. Bedrooms, accessible by a lift or stairs, are for single occupancy with ensuite toilet facilities. There is a dining room on the first floor that leads out to a patio and a lounge is on the ground floor with direct access to the garden.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the (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 the inspection we saw there were sufficient numbers of suitably qualified staff to meet people’s needs and promote people’s safety.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

When employing fit and proper persons the recruitment procedures of the provider had usually been followed. However we saw for one person recently employed that one of the checks the provider usually completed had not been done in line with the company’s procedures.

We saw medicines were being administered and recorded appropriately and were being kept safely. However we found that supporting information or ‘protocols’ were not made clear to guide staff to administer medicines which were prescribed to be given “when required” or as a “variable dose”. Clear guidance is needed to help ensure people are given these medicines safely.

We have made a recommendation that written protocols for staff to follow would help ensure people are given these medicines safely and in the way they were prescribed.

People’s rights were protected. The staff team were knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to and was required to maintain their safety and welfare.

Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them. People living in and visiting the home spoke highly of the staff and told us they were very happy with their care and support.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access activities and pass times of their choice.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the home.

The inspection took place on 11 May 2016. The inspection was unannounced.

Stanbeck care home is situated in a residential area on the outskirts of Workington.

Accommodation is provided over two floors with a variety of communal lounges, dining room, patio and garden. All bedrooms are for single occupancy and have en-suite toilet facilities.

The service is registered for 13 people. On the day of our inspection there were 12 people living at Stanbeck.

At our last inspection of this service on 28 June 2013 we asked the provider to make improvements to the care planning and risk assessment processes that were in place at the home. This action had not been completed.

We also asked the provider to make improvements to make sure medications were administered safely. The registered provider had sent us an action plan detailing how and by when these improvements would be made but adequate actions had not been taken.

There is a registered manager at 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.

All of the people who used this service, who we spoke to during our inspection, told us that the staff were “very nice” and most said they were “treated kindly.” We did not receive any complaints about the service although one person did say that the staff could sometimes be “brusque.” However, they did not want to give us any further details about this.

A visitor to the home told us; “There seems to be plenty of things for people to do here. It is a small home and I think the people who live here get more attention.”

Care workers told us that they had; “Time to give care because it is a small home” and people who used the service all said that the staff “usually” attended to them “very quickly.” We saw that staff were respectful of people’s privacy and dignity and only intervened when necessary or when people requested their help.

On the day of our inspection the home was generally clean, tidy and there were no unpleasant odours. One of the people who used this service particularly commented on the good standard of cleanliness of their room.

The registered provider had safeguarding procedures in place but these were unclear, inaccurate and needed to be reviewed. More than half of the staff at the home had not received training to help them identify and effectively report abuse allegations.

In the sample of care records we looked at we found that people’s care plans and risk assessments were out of date and did not reflect their current support needs and preferences. There were inconsistencies in the way people were supported with eating and drinking.

The needs of people at risk of poor nutrition were not effectively managed. Assessments and reviews of people’s nutritional requirements had not been carried out as their needs changed.

Care workers told us that they found the electronic care records difficult to access and relied mostly on the handover book. This meant that people who used this service may not have received appropriate and safe care that met their wishes and expectations.

We found that there had been some improvements in the way medicines were managed and handled but there were inconsistencies in the safe administration and management of topical medicines such as ointments, creams and lotions. Information and staff understanding regarding the use of “when required” medicines was unclear. This meant that people who used this service may not always have received their medicines as their doctor intended.

Care workers told us that they were well supported by the registered manager. We noted that they received regular supervision and appraisals and that staff meetings took place. However, there were some shortfalls in the

During this short responsive inspection we spent time with the manager and deputy manager. We visited the service to check that it was now compliant with care and welfare of people who used the service and the administration of medicines.

Since our previous visit the provider had installed a new electronic recording system and we found that care plans were now reviewed each month. We found that the daily records written by staff were up to date and in good detail. This ensured people received the appropriate level of care to meet their needs.

The manager had reviewed the procedure for the administration of medicines. During this visit we found the records were correctly completed and up to date. There had been updates to staff training in the safe handling of medication to ensure staff were aware of their responsibilities.

We judged that that the service was now compliant.

We spoke to five people who lived at Stanbeck. Each person told us that they were happy with the levels of care and support provided by staff. One person said, "They (the staff) are lovely. They look after us well." We spoke to a relative who told us they were, “…extremely pleased with the support provided by the staff.” However, we found some care plans had not been adequately reviewed and updated to protect people from unsafe care.

We found there was sufficient and suitably skilled staff working at Stanbeck and that there was an effective complaints policy in place. One person told us, "I would just tell the manager if I had a complaint. But I don’t. It’s great here." Another person said, ”There’s always plenty of staff if I need them. They’re all great."

There was a medication policy in place and staff were trained in handling medicines. However, we found the policy was not always adhered to and did not cover the administration of the "when required" types of medication.

People told us they were happy living in Stanbeck.

"I love it here, it is like a hotel"

"I have been here for some years and like it very much. My friends visit me every Tuesday".

"It is great living here and we have now started to go out on trips".

"We just ask for what we want and they give it to us. The care we get here is wonderful".

"I can always speak to the manager and the other staff and they listen to me".

During the visit there were no visitors to the home who could speak on behalf of their relatives but comments on the survey questionnaires sent out by the provider all confirmed that the care their relatives received was good and met their needs.

We spent some time in this service talking to residents and staff and in discussion with the manager. We were told that people enjoyed living in Stanbeck and that they were happy with their accommodation. This was evidenced by observations and records kept.

Comments made included,

'I really enjoy living here'

'I like my room'

I enjoy all my meals'

'The staff are lovely and so kind