This inspection took place on 23, 24 and 26 April 2018 and was unannounced.

Stanholm Residential Care Home for the Elderly 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.

Stanholm Residential Care Home for the Elderly is located in an old detached building with the accommodation spread over two floors. Stanholm Residential Care Home for the Elderly is a dementia residential home. The ground floor has a dining room, lounge, small kitchenette, some bedrooms and the top floor is used for people’s bedrooms. There is a lift that services the two floors.

At our last inspection on 19, 23 and 24 October 2017, the service was rated Inadequate and placed in special measures. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that six of the eight breaches of regulation we previously found in relation to, medicines, safeguarding, dignity and respect, staff training and supervision, and person centred care had all been met and the service is no longer in special measures. However, despite some action being taken to address shortfalls we also found that two breaches relating to risk and quality monitoring that were continuing breaches, and we found one new breach relating to planning for people’s health needs. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager 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.

Quality monitoring systems required some improvements as they had not identified the shortfalls found at this inspection relating to care planning, risk assessment and implementation of activity plans. There had been some improvements since our last inspection in quality monitoring and a new system was being implemented.

People had access to healthcare professionals; however, some people were at risk of not having their needs met as care plans had not always been updated or made available to staff. Some people’s assessed needs did not have care plans written for them as the programme of updating care plans was not complete.

People were being kept safe from abuse. Staff understood their responsibilities in keeping people safe from abuse and had been trained. Staff knew how to report any possible concerns. People were supported safely around risks and were encouraged to take positive risks after control measures were applied. However, some risk assessments had not been updated on to the new format and were therefore lacking in detail. There was a plan in place to update all risk assessments. We have made a recommendation about this in our report.

Other risks such as environmental risks were being managed safely and there were protections in place in relation to possible hazards such as fire. Staffing levels met people's needs and people told us that they could find staff to help them when they needed to and we observed staff were not rushed when helping people.

People received their medicines safely and when they needed them by staff trained to administer them. Medicines were being stored and managed safely. The risk from infection was reduced by effective assessments and cleaning rotas and the housekeeping team kept the home clean. When things went wrong the

We inspected Stanholm Residential Care Home for the Elderly on 19, 24 and 26 October 2017 and the inspection was unannounced. Stanholm Residential Care Home for the Elderly (from here on in this report referred to as Stanholm) provides care and accommodation for up to 26 older people, some of whom have dementia. At the time of our inspection there were 22 people living at Stanholm. Stanholm is located in Edenbridge, in Kent, with 23 bedrooms over three floors, serviced by a lift. At the time of our inspection there were three shared bedrooms, two of which were being shared. Stanholm has its own gardens, a conservatory/lounge area, a quiet lounge and dining room.

The service had 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.

We previously inspected this service on 29 May and 01 June 2015 where we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and we rated the service as Requires Improvement with a rating of Inadequate in the safe domain. These breaches of regulation related to safeguarding people, safe care and treatment, maintenance of premises, good governance, safe staffing, consent, person centred care, and acting on complaints. The provider sent us an action plan stating that they would address all of these concerns by July 2015. We further inspected the service on 25 and 26 August 2016, and found that improvements had been made and nine breaches had been fully met. However, there were ongoing breaches of regulations relating to consent and person centred care. We also found a new breach of regulations in safe care and treatment. The registered provider sent us an action plan stating that they would address all of these concerns. At this inspection we found that although some improvements had been made, the registered provider continued to breach the regulations relating to safe care and treatment, consent and person centred care. We also found seven new breaches of regulations in relation to nutrition and hydration, dignity, display of ratings, requirements relating to the registered manager and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not being managed safely. Staff who were trained to give medicines did not have a check of their competence to administer medicines safely, stocks of one controlled drug were not accurate, the administration of creams was not being managed safely and not all people received their medicines on time.

Falls and other risks were not being managed safely. Risk assessments did not contain control measures to mitigate potential hazards and had not been updated following incidents. The auditing of falls had not been effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. For example, people had not been assessed to determine whether they had the capacity to make a decision. The requirements of the Mental Capacity Act 2005 had not been met.

Not all people’s healthcare needs were being met in a timely manner. One person had not been eating due to a medical condition. Staff had recorded this but had not taken any further action despite the person going 44 hours without food.

People’s dignity was not always upheld. Some practices around mealtimes were not empowering, and one person was left to watch a film in a chair where they could not see the television screen.

Activities were not person centred, varied or frequent enough and people who were at risk of isolation had no

We inspected Stanholm Residential Care home for the Elderly on 25 and 26 August 2016. The inspection was unannounced. Stanholm is a residential care home providing care support and accommodation for up to 26 older people some of whom had dementia. At the time of inspection there were 21 people living at the service. The service has a hair salon, one dining room and garden.

There was a registered manager in post who was registered with the CQC. 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 last inspection on 29 May and 1 June 2015, we found 13 breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. These breaches of regulation related to safeguarding people, safe care and treatment, maintenance of premises, good governance, safe staffing, consent, person centred care, and acting on complaints. The provider sent us an action plan stating that they would address all of these concerns by July 2015.

At this inspection we found that the provider had taken action on all these areas, and was fully meeting regulations in nine areas where breaches had been found, relating to maintenance, safe staffing and recruitment, notifications and acting on complaints. The provider had implemented an effective system to ensure that the home was maintained to an appropriate standard. There were effective processes in place to fully investigate any complaints, and the registered manager was informing the CQC of all notifiable events detailed in the regulations. People told us there was enough staff available to meet their care needs. The registered manager was using an approved agency list to ensure that there were no gaps in staff numbers during times of leave and absence. The provider was using appropriate methods and systems to recruit staff that was safe. The provider had produced a new budget for training that ensured that staff received all mandatory training and could take part in additional training if requested. Staff received regular supervision and a yearly appraisal.

We found that the provider had also taken action to improve safe care and treatment, and good governance. Individual risk assessments were being completed and included risk of falls, pressure areas, bathing, moving and handling. People had their own personal emergency evacuation plan in place to give guidance to staff. People’s confidential information was being stored in a locked room accessible to senior staff only. However, we found other areas in which regulations were not being fully met.

At our last inspection on 29 May and 1 June 2015, we asked the provider to action and make improvements on how medicines were administered to people. At this inspection we found that action had been taken, and staff were seen to be administering medicines to people in a safe and dignified way. However, the management of medicines was not always safe. There was no safe storage for medicines that required refrigeration and medicine room temperatures were not being recorded. The provider took immediate action to ensure the safe storage of medicines at the time of the inspection. Medicine records did not always contain clear directions for the application of patches, or were not always double-checked or clearly updated with changes in dosages.

At our last inspection on 29 May and 1 June 2015, we asked the provider to action and make improvements on protecting people from harm and abuse. At this inspection we found that action had been taken to ensure that staff knew how to respond to potential abuse. Staff had received appropriate training to identify the forms of abuse and were given guidance on how to report this. However, we found that one incid

We found people did not experience care, treatment and support that met their needs and protected their rights as the provider could not demonstrate that when people’s needs changed they were not recorded in their care plans.

We found that people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We found that the majority of windows did have appropriate restrictors. We also found that the home could not demonstrate that the home had regular fire inspections since 2005 or that risks assessments had been carried out to ensure fire exits within the home were suitable and safe.

We found the provider did not have an effective system in place to assess and monitor the quality of service that people receive. The provider could not demonstrate that results of feedback questionnaires on the quality of the service the home were collated, analysed and any necessary changes implemented.

We looked at the home's complaints system and found that the provider did not have

an effective complaints system available. The provider could not demonstrate that a complaint log was monitored and maintained.

People we spoke to told us that they were happy living at the home. Comments included “I am quite happy here” and “I am very happy with the food”.

People we spoke to told us that they liked the staff who cared for them. Comments included “The staff are lovely, they are so helpful” and “The staff here helped me to walk again”.

We spoke with two people who used the service, four relatives of people who used the service, two members of staff and the registered manager. We also spoke briefly with a health care professional who visited the home during our visit. We found that the atmosphere of the home was informal, relaxed and friendly. We saw that staff treated people with respect and promoted their dignity. Comments received from people using the service included “I am very happy here" and, “I am so grateful to be here now that I am not so able. They take good care of me” People told us that they had the opportunity to take part in meaningful activities and sometimes they were able to go on outings that they enjoyed. The food was of a good standard and alternative menu choices were available. Staff received a suitable range of training to ensure that they had the necessary skills to support the people who lived there. People told us that their views about the home were sought and were taken into consideration in relation to how the home was run.

People using the service told us they were given choices about their daily routines, such

as when to get up and go to bed, what to eat and what to do each day. They said that staff

listened to them and respected their wishes.

People said they received the care and support they needed each day in the ways that

they preferred and that staff were kind and caring. They told us that buzzers were

answered quickly during the daytime and at night.

People said there were plenty of activities and they chose what to do. Some people said

they liked to join in with activities, others who preferred not to join in or to spend most of

their time in their rooms said staff respected this.

People told us they felt safe at the home and that their care was given safely. If they had

any worries or concerns they would speak with the registered manager or staff and felt

confident they would be addressed.

Comments about the service from people living there included,

"Staff are wonderful"

"Staff come promptly when I use the buzzer, even during the night"

"I have a scooter and go out to the café and pub"

"I prefer to stay I my room, I watch the birds and squirrels from my window and like sitting

in the garden in good weather"

"Meals are very good"

" I have no complaints"

What we found about the standards

We inspected Stanholm Residential Care Home for the Elderly on 29 May and 01 June 2015 and the inspection was unannounced.

Stanholm Residential Care Home is located in Edenbridge and provides accommodation and personal care for up to 26 older people The home is set out over four floors and a basement. There is lift access between the ground floor and upper levels. At the time of our inspection there were 23 people living at the home. Some people received care in bed, some were living with dementia and/or had mobility difficulties and sensory impairments.

The home had a registered manager. 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 found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009.

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

People said they felt safe living in the home and relatives told us that their family members received safe care. However, we found that staff did not understand or have the necessary guidance and information to appropriately report and respond to allegations of abuse in the home.

People had some individual risk assessments. However we found areas of assessment missing and some assessments that had not been updated or reviewed when people’s needs changed. This meant staff did not have the information they needed to ensure people were safe.

We identified a number of maintenance issues that impacted on people’s wellbeing.

We found that where staff covered for absent colleagues and carried out cleaning, cooking and laundry, this meant there were not always enough staff to ensure that people’s care needs were met.

Safe recruitment procedures were not always followed. The registered manager had not always checked references, to make sure the staff employed were suitable to work with people.

Medicines were not always stored and administered safely in accordance with best practice guidance.

Staff knew people well but not all staff had received the appropriate training and appraisal to ensure they could deliver care and treatment to service users safely and effectively.

We observed that staff sought people’s consent before providing care and support. However when we spoke with staff and management they did not understand the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Assessments of people’s capacity to make decisions had not been carried out in line with the 2005 Act.

People told us the staff were respectful and kind. However records were not always stored securely and therefore people could not be assured that their personal information would be kept confidential.

The system for encouraging and managing people’s complaints was not formalised or recorded. We have made a recommendation to improve this.

Staff were caring in their approach. However we observed that the people who required the most care and support were not always given the support they needed to ensure they had meaningful occupation during the day.

People felt the home was well run and were confident they could raise concerns if they had any. However there were not robust systems in place to assess quality and safety.

The registered provider had not adequately monitored the service to ensure it was safe and had not identified areas where improvement was required.

The registered manager had an understanding of their role and responsibility to provide quality care and support to people. However we found that they had not always met their registration requirement in notifying the Care Quality Commission of key events including when people had died.

The home environment was not always suitable for people and we have made a recommendation about improving this.

People who spent time in the lounge did not have a means of summoning staff help and staff were not always deployed to meet their needs. We have made recommendations to improve these areas of care.

The care plans did not always give the staff the information they needed and staff relied on their knowledge and verbal handovers rather than documented plans of care. We have made a recommendation to improve this aspect of the care.

People were supported to eat and drink adequate amounts and completed questionnaires showed people were satisfied with the food provided.

Staff communicated well with people.

People received medical assistance from healthcare professionals including district nurses, opticians, chiropodists and their GP.

People were treated with respect and dignity.

Information about how to complain was displayed in the entrance lobby. People were supported and encouraged to maintain links with family and friends.

There was an open culture where people, their relatives and staff felt supported and were confident that they could discuss concerns.