This was an unannounced comprehensive inspection carried out on the 09 May 2018, with a further announced visit on the 17 May 2018.

Stanley House is a ‘care home’. People in care homes received 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. Stanley House accommodates up to 21 people within one adapted building. It specialises in supporting people who have either Huntington’s Disease, acquired brain injury or people with mental health needs who also have physical disabilities. At the time of the inspection there were 18 people living at Stanley House.

There was a registered manager in post at the time of the inspection, who had been in place since December 2016. 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 comprehensive inspection of the service in June 2016, the overall rating for the service was judged to be ‘good.’ At this inspection we have rated the service as ‘requires improvement’.

During this inspection we identified three breaches of regulation. These were in relation to safeguarding people from abuse or improper treatment; concerns about good governance; and failure to notify the CQC of incidents involving alleged harm or abuse.

Allegations of abuse or harm had not been investigated effectively or appropriately. Allegations of abuse or harm had not been shared by the provider with the local authority, or with the Care Quality Commission. This meant people were not always protected from potential abuse. The management team did not demonstrate an understanding of their role and responsibilities in terms of investigating and reporting allegations of abuse and harm.

Registered providers are required by law to notify the CQC of incidents where people have suffered harm, injury, abuse or suspected abuse. The provider failed to notify CQC of two allegations of abuse that had occurred in December 2017, and February 2018. The provider had also failed to notify us of one serious injury notification in November 2017.

We found management systems were not always effective. We found the provider lacked a clear strategy in relation to the effective monitoring of the quality of services provided by staff. This was demonstrated by the failure of the provider to identify allegations of abuse, and to ensure that action taken to investigate and ensure people were safe. Though the provider had some management systems in place to record and monitor the standards of care delivered within the home, these were not always completed or were effective.

Care plans and risk assessments were not always accurate and contemporaneous, and did not always reflect people’s current care needs. We found that staff supervision had not been consistently undertaken.

The use of bed rails can act as potential restraint. Where people lacked mental capacity to consent to their use, there was no consistent evidence of best-interests decision-making.

We identified concerns regarding pressure area prevention and management. This related to the use of appropriate equipment and the lack of referral to other health care professionals. Risk assessments regarding pressures sore management, were not being consistently reviewed.

Relatives and visiting health professionals consistently told us they believed people were safe living at Stanley House.

The registered manager showed insight into the Accessible Information Standard, and we saw people’s communication needs had been assessed and recorded.

Relatives and health care professionals were satisfied with the overall competence and knowledge of the nurses and

This inspection was carried out on 16 June 2016 and was unannounced.

Stanley House provides nursing care for up to 21 people. It specialises in supporting people who have either Huntington’s Disease, acquired brain injury or people with mental health needs who also have physical disabilities. At the time of our inspection there were 21 people living at the home.

A registered manager was in post at the time of our inspection. 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.

Staff knew how to recognise and report any concerns about people’s safety. Staff understood risks associated with people’s needs and how to keep them safe. There were enough staff on duty to respond to people’s health needs at the times when they needed support. The provider completed checks to ensure staff were suitable and safe to work at the home.

People were treated with dignity and respect and staff were kind and caring in their approach with people. People had care and support that was centred on them as individuals and their independence and freedom of choice were promoted and supported.

People’s health needs were responded to effectively with people being supported to access doctors and other health professionals when required. People had daily access to health professionals like neurologists, psychiatrists, doctors, occupational therapists and physiotherapists. People were supported to have their medicines when needed. Medicines were stored and administered appropriately.

People had access to a varied diet of food and drink. People were supported to have their food and drink safely. Where recommendations had been made by other professionals regarding their diet or health needs these had been acted upon by staff.

Staff understood people’s individual communication styles and were able to communicate effectively with people. People’s permission was sought before any care or support was given. Time was taken to make sure that people could make choices and decisions about the care and support they received.

People were supported by staff that had the knowledge and skills to understand and meet their health needs. Staff had access to additional training to match people’s specific health needs. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance.

People and their relatives found the staff and management approachable, willing to listen to their views and opinions. People knew how to complain and who to complain to. Feedback from the people and their relatives was gathered on a regular basis and any areas identified for action were acted upon. Audits and checks were completed regularly to ensure that good standards were maintained.

The registered manager gathered and listened to the views and opinions of the people that lived there, relatives and staff. A range of audits and checks were also completed regularly to ensure that good standards were maintained.

We spoke with two of the twenty one people living at Stanley House. Most people living there were not able to speak with us due to their communication difficulties. We observed the daily life of the home discreetly so we did not disturb people. We met several staff and had detailed discussions with four of them, including the deputy manager. We spoke with three of the four directors. The fourth director who is the registered manager was not at work on that day.

The people we spoke with were positive about the service. One person smiled as they told us, “I love it here, I have my privacy” and added, “the staff are very nice and they look after me”. Another person said the home was, “absolutely brilliant, it's a privilege to be here” and praised the staff, commenting that some of the younger people working there were, "a credit to themselves”.

The care plans were detailed and reflected the different amounts of care and support that people needed. The content of the plans showed that as far as possible people were involved in planning their own care and making decisions about this. People were viewed as individuals and encouraged to make the most of their abilities.

The staff team was experienced and received training to give them the knowledge and skills they needed to do their jobs well. The company directors worked full time for the service, one as the registered manager. Together they provided a well organised structure for the provision of the service.

For the purposes of this review, we did not interview any people who used the service. When we arrived at the service, we met with the Registered Manager, a Director and the Nurse in Charge.

A person who lived at Stanley House told us living there was, “A pleasure and a joy”. They gave us examples of the caring way that staff supported people living there. The families we spoke with told us they were pleased with the care and support their relatives received. One person said, “We can see how much care and attention is given to everyone” and, “They look at the person, not the illness”. A health professional told us they considered that the care was, "Excellent".

The records of people's care were detailed and reflected people’s individual needs. We saw evidence that the staff monitored people’s care and involved other professionals where this was needed. The arrangements for the safe management of medicines were regularly monitored.

The staff team received training to give them the knowledge and skills they needed to do their jobs well. The registered manager acknowledged that opening another service had had an impact on staffing arrangements for a period of time. Families and professionals were positive about the staff and how they did their work. Staffing levels ensured that people received the care they needed.

The registered manager and other company directors provided effective leadership. They had well organised systems in place to support the safe delivery of the service. A health professional commented that the home was, “Well organised and well led”.