About the service:

Stanley House is a nursing home registered to provide accommodation for up to 42 older people with needs relating to physical disabilities and dementia. At the time of our inspection there were 24 people using the service.

What life is like for people using this service:

People said Stanley House was a safe place to live because there were always staff available to support them. Staff were vigilant and knew how to protect people from harm. Staff understood what made people feel safe, for example, one person liked their bedroom door left ajar so staff ensured this was done. People said staff gave them their medicines when they needed them. All areas of the home were clean and fresh.

Relatives told us their family members were assessed before coming to the home. One relative commented on how sensitively this was done which helped them to come to terms with the situation. Staff were well-trained and experienced and understood people’s care and medical needs. They worked well with health and social care professionals in the local community. We observed lunchtime which was a lively and social occasion. People had plenty of choice and assistance with their meals if they needed it.

The premises were well-decorated and maintained and people and relatives commented on the high-quality of their surroundings. To make the home an interesting place for people themed corridors based on the seaside and the movies had been created. People had access to two large spa bathrooms with colourful murals, rise and fall baths, and a sensory sound and lights system so people could enjoy a relaxing bathing experience.

The staff were kind and caring and valued the people they supported. The atmosphere was relaxed and people felt at home. After lunch one person came into the small lounge and settled themselves onto the sofa for a nap. “Don’t mind me,” they said, “I always put my feet up here after lunch because it’s so comfy.” Visitors were welcome at any time. The home had a children’s reading corner where young visitors could gather and look at picture books dealing with topics like dementia in a way that children could understand.

People were encouraged to make choices about their daily routines and lifestyles and staff ensured they consented to any care provided. Staff were knowledgeable about people and understood their preferences. The home had an extensive programme of activities covering weekdays and weekends. We saw twelve people taking part in a quiz run by two of the home’s four activity co-ordinators. The co-ordinators ensured even the quietest answers were heard and celebrated. People enjoyed the quiz and reminisced and laughed together.

People and relatives said the home provided high-quality care and they would recommend it to others. The home had an open and friendly culture and people and relatives said if they had any concerns or complaints they would tell the registered manager or staff who were approachable and kind. People were consulted when changes were made to the home. For example, the new garden area incorporated the features people asked for including a raised fishpond, scented flowers at wheelchair-height, a pergola, and seating areas. The provider and registered manager monitored all aspects of the home to ensure it continued to provide a good service to people.

More Information is in the detailed findings below.

Rating at last inspection: Good (report published on 26 May 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Stanley House provides personal care and accommodation for up to 42 people. On the day of the inspection the registered manager informed us that 34 people were living at the home.

This inspection took place on 27 and 28 June 2016. The inspection was unannounced and was carried out by one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people and older people living with dementia.

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 and associated Regulations about how the service is run. The registered manager responsible for nursing was managing the service at the time of the inspection.

We carried out an unannounced inspection of this service on 1 April 2015. One breach of legal requirements was found. The provider had not ensured that people were protected against the risks of unsafe care being provided to meet people's needs. After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We checked that the provider had followed their plan, and to confirm whether they had now met legal requirements. We found improvements in these issues and the breach had been rectified.

People using the service and the relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely.

Staffing levels were usually sufficient to ensure people were safe though more staff cover was needed in the main lounge for a short time in the evening to ensure people were always protected from risks to their safety.

People using the service and relatives told us they thought medicines were given safely and on time. Some improvements were needed to the way medicines were recorded to evidence that medicines were always supplied to people.

The premises appeared safe with no tripping hazards observed.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs though more training was needed on relevant issues in order there was no risk of them not meeting people's needs.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests, though this was outstanding for one person.

People had plenty to eat and drink, everyone told us they liked the food served and people were assisted to eat when they needed help.

People's health care needs had been protected by referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly and caring way.

There was evidence that people and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs.

There were not always sufficient numbers of staff to ensure that people's needs were responded to in good time.

Activities were organised to provide stimulation for people.

Stanley House provides accommodation for people who require nursing and personal care. It is also registered to provide treatment for disease, disorder or injury and diagnostic and screening services.

This inspection took place on 1 and 2 April 2015. The first day was unannounced.

At our last inspection in March 2014 the service was meeting the regulations we inspected with regard to consent to treatment and record-keeping.

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 and associated Regulations about how the service is run.

Since our previous inspection in January 2014, we had received information from the local authority stating that a person living in the service did not have their dressings changed and that a staff member had abused another person.

The service was not following the guidance in people’s risk assessments and people were at risk of unsafe care. This evidence constituted a breach of Regulation 12 (1) (2) (b) of the Health & Social Care Act 2008 Regulated Activities Regulations 2014. You can see what we have told the provider to do at the end of this report.

Staff had received training on how to protect people who used the service from abuse or harm. They demonstrated they were aware of their role and responsibilities in keeping people as safe as possible.

The safeguarding authority and the Commission had not been informed of situations of potential abuse to people which meant that monitoring action to prevent these situations had not been comprehensive.

Staffing levels needed to be reviewed to ensure people's needs were always met.

We found people largely received their prescribed medication in a safe way by staff trained in medication administration though medication had not been supplied as prescribed for one person.

Detailed risk assessments had not always been undertaken to inform staff of how to manage and minimise risks to people's health from happening.

Improvements in some aspects of caring for people with dementia were needed in terms of providing more stimulating activities and improving the environment.

The provider supported staff by an induction and some ongoing support, training and development. However, comprehensive training had not been provided to all staff.

The Mental Capacity Act (MCA) is legislation that protects people who may lack capacity to consent to their care and treatment. We found examples where the registered manager was following this legislation which informed us that people’s capacity to consent to specific decisions had been assessed appropriately.

People who used the service had their dietary and nutritional needs assessed and planned for. People received a choice of what to eat and drink and staff supported them to maintain their health.

People who used the service and relatives told us they found staff to be caring, compassionate and respectful. Our observations largely found staff to be kind and attentive to people’s individual needs though there were exceptions to this when staff had not communicated what care they were going to provide.

People who used the service were, as far as possible, able to participate in discussions and decisions about the care and treatment provided.

People who used the service and their relatives had been to share information that was important to them about how they wished to have their needs met.

The provider had internal quality and monitoring procedures in place. These needed to be strengthened to prove that necessary actions had been implemented.

The manager enabled staff to share their views about how the service was provided by way of staff meetings and supervision, although these opportunities had been infrequent.

People we spoke with told us they received the right care and support and were complimentary about the service. One person told us “It’s absolutely marvellous” and said they enjoyed using the service. Another said “The staff are great, they always help when you need them”.

We found record keeping had been improved since our previous visit in June 2013 and that people’s care and support records were now up to date and the manager had been taking action to ensure this continued. This meant people were protected from unsafe care because the provider was taking steps to ensure care records were accurate and fit for purpose.

As part of this inspection we spoke to four people who used the service and five relatives. We also spoke with a visiting health professional and five members of staff including the registered manager.

One person who used the service told us the home was “always beautifully clean” another stated it was “very good”. A visiting health professional told us the home was “brilliant”. A relative told us that staff were “very attentive, very patient and have a nice sense of humour”.

People told us that the care provided was of a good standard and that their needs were met. People had access to health services such as GP’s.

Staff had completed training in how to keep people safe and where able to tell us what they would do if they had concerns.

The provider had carried out sufficient pre employment checks on staff.

Staff told us that they felt supported. There was evidence that the majority of staff had up to date training or were booked on to courses in key areas.

The provider had received two formal complaints in the last 12 months and there was evidence that these had been investigated and responded to in set time scales.

The provider had not ensured that all records were kept up to date or that they reflected people’s current needs.

On the day of the inspection the home had 32 people residing there. We spoke with five people who used the service, two relatives and three members of staff. We have also spoken with two health professionals who have contact with the home.

One person told us “we are not just residents, they treat you like friends”. Another person stated “as nursing homes go this is as good as anywhere”.

On person who used the service told us “I love it here. Nothing here that I haven’t wanted”. A relative stated that “staff are worth their weight in gold. They are amazing and wonderful people”.

The staff we spoke with all enjoyed their work and felt that the management team were very supportive and approachable. Staff felt that managers would always listen to them.

We asked people using the service and visiting relatives if they were involved in the planning and delivery of care. A visitor told us “They are always talking about the care plan on an ongoing basis anyway so we always know what is happening.”

We spoke to some people using the service and visiting relatives during our visit and asked their opinion on the care received. We were told “I am very happy so far, my relative’s health has stabilised a lot here.” Another person told us “This is one of the best homes in the area. The staff are quick and the nurses are helpful, my health is improving.”

We asked people using the service and visiting relatives if they felt people were safe living at the home. We were told by one visitor “I have not witnessed anything untoward. I am confident my relative is safe when I am not here.”