About the service: Stilecroft Residential Home provides accommodation and personal care for up to 44 people who had a range of support needs related to old age, those with complex healthcare needs and people living with dementia. At the time of the inspection there were 38 people living in the home.

People’s experience of using this service:

At the last inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not always meet people’s needs as there were insufficient staff; hazards in the environment were not sufficiently identified; and the service did not have effective quality assurance systems in place. We found this was because the service was not being well-led or properly managed. We rated well-led as inadequate and the other key questions as requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good.

At this inspection, March 2019, we found the breaches had been met and shortfalls had mostly been rectified. We found improvements had been made to the quality of the service and running of the home. A new manager had been in post for three months and along with the provider had driven up the quality of the service. Staff in the home had worked hard to bring about these improvements.

There was a strengthened senior leadership team in place and this along with improved quality assurance systems meant people now received good quality care. People were happier with how the home was being run. One person told us, "The new manager is lovely, really lovely, she comes in and sits down and talks to you sometimes, not just about the home but about everything and that’s really nice.”

People’s needs were now being better managed. This was due to more thorough assessments of people’s needs; care plans that were up to date; and more staff on duty who were deployed and managed to respond to people’s needs.

Care was person-centred, based around each individual’s personal care and health needs and met people’s social needs and interests. Care planning had improved with particular attention paid to including instructions from healthcare professionals.

We had made a recommendation at the last two inspections that the service seeks expert advice from a reputable source in developing a dementia care strategy for the home, that would encompass staff training, approach, the environment and activities. This had not been done. The new manager and provider made a commitment to doing this and sent us evidence of what action had been completed shortly after the inspection.

Staff knew how to keep people safe and this included having a good knowledge of safeguarding people from abuse. Risks to people were now well managed, with a particular focus on reducing people’s risk of falls and ensuring the environment was safe, especially for people living with dementia.

People's rights were respected and protected because the service had a good understanding of the Mental Capacity Act (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s consent and capacity to make decisions was understood and managed in line with the MCA.

People were treated with dignity and compassion. They told us the staff team knew them well, took a genuine interest and were kind and caring. People looked well-groomed and well cared for and staff displayed warm and positive relationships with people in the home.

There was an improved choice of meals and people said the food was very good and they liked that they had homemade cakes and puddings. Mealtimes had been restructured so that support was provided with food and drink when this was needed. People’s nutrition

This inspection took place on 21 & 23 May 2018 and was unannounced on the first day.

At the last inspection in July 2017 the service was rated overall as Requiring Improvement as we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to infection control, trip hazards and issues around evacuation in the event of a fire. We judged that the systems to monitor quality in the home had failed to identify these matters in a timely manner.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least Good.

At this inspection we found the actions required to address these particular issues of the July 2107 inspection had been completed with the exception of on-going issues in Regulation 17 set out below.

During this latest inspection of 21 & 23 May 2018 we found two further breaches. Regulation 18: Staffing as we found there were insufficient staff to meet people’s needs; Regulation 9: Person centred care as people were not receiving care that met all their needs and preferences. We also found that the service continued to be in breach of Regulation 17: Good governance because the provider and the service did not have effective quality assurance systems in place and Regulation 12: Safe care and treatment as hazards in the environment were not sufficiently identified.

The home continues to have the rating of Requires Improvement.

Stilecroft Residential Home (Stilecroft) 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. The home provides personal care and accommodation for up to a total of 44 people. On the day of the inspection there were 38 people residing at Stilecroft. Accommodation is provided over three floors and the Victorian building has been extended and adapted for the purpose. The ground floor unit specialise in supporting people living with dementia.

There was a registered manager in post. 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.

We found that there were insufficient staff available to meet people’s needs. We found that the registered person had not ensured sufficient numbers of suitably qualified, skilled and experienced persons were deployed in order to meet people’s needs. This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us that at times there were not enough staff available to answer their call bell and provide support when they needed it. We observed that staff were very busy and were working under pressure. Care and support was mainly based around completing tasks and did not always take account of people’s preferences or to meet their social and recreational needs. We found this to be the case in particular within the main house with staff also reporting being “over stretched” on this floor. At times some people had to wait to be given personal care, such as support to go to the toilet. The downstairs unit for people living with dementia we judged as having sufficient staff to meet people’s needs.

We found insufficient staff levels had a detrimental impact on other areas such as record keeping. While people’s health and support needs were documented in their care plans we found some records had not been fully updated or reviewed after changes to a person’s condition had occurred, such as after a fall. We also found this to be the case with records for supporting people with behaviours that were challenging to th

This was an unannounced inspection which took place on Friday 21 July 2017. The inspection was undertaken by two adult social care inspectors and an expert by experience.

At our last inspection in October 2014 we judged the service to be good.

Stilecroft Residential Home provides accommodation and personal care for up to forty four older people. The main accommodation is provided in the original Victorian building which has been adapted for the purpose. There is an extension to the main property that has been appropriately and purposely adapted to accommodate people who have dementia. The home is in a residential area on the outskirts of Workington.

The home had a suitably qualified and experienced 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. The previous manager remained registered at this location. We asked the area manager to deal with this matter.

We noted a number of issues in the home that potentially had a negative impact on the safety of people in the home. There were some matters in relation to infection control, trip hazards and potential legionella infection which needed attention. There were issues around evacuation in the event of a fire. Immediate action was taken on the day of the inspection to ensure people would be safe.

This is a breach of Regulation12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because these hazards posed a risk to vulnerable people and to visitors and staff in the home.

We judged that the systems to monitor quality in the home had failed to identify these matters in a timely manner.

This is a breach of Regulation17 of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the systems were not working effectively to identify the issues we identified during the inspection.

Staff understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training in safeguarding. The management team understood how to report any potential or actual abuse. Staff told us that there were 'whistleblowing' arrangements in place to support any concerns or complaints they had.

We checked on staffing levels and found these to have improved since our last inspection and were suitable to meet the needs of the people in the home, on the day of our inspection. The registered manager was developing deployment strategies to ensure staff were giving people good levels of support.

Suitable arrangements were in place to ensure that new members of staff had been suitably vetted and were the right kind of people to work with vulnerable adults. The registered provider had policies and procedures in place to ensure that any disciplinary matters could be dealt with in an appropriate manner.

Medicines were ordered, stored, administered and disposed of appropriately because the service had a very efficient system for supporting people who needed help with medicines.

Staff received suitable levels of training in subjects the provider judged to be appropriate. We noted that supervision and appraisal was in place in the home but that some of these meetings were out of date. We recommended that the systems for supervision and appraisal were reviewed and formal records kept in more detail.

The registered manager was aware of her responsibilities under the Mental Capacity Act 2005 when people were deprived of their liberty for their own safety. We judged that this had been done appropriately and that consent was sought for any interaction, where possible.

People told us they were happy with the food provided. Simple nutritional plans were in place.

Local health care practitioners were ca

We inspected on the service on the 6TH October 2014. The inspection was unannounced and carried out by two adult social care inspectors.

Stilecroft Residential Home is set in its own grounds and provides care to older people some of whom live with dementia. The home can accommodate up to 42 people. On the day of our inspection 38 people were in residence. 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.

We found the service did not breach the regulations outlined in the Health and Social Care Act 2008 there were areas that required improvement.

We judged there were not always sufficient staff to meet people’s needs in a timely manner. However we noted the manager had adopted good strategies to minimise the impact of this on people who used the service. The majority of people we spoke with told us that they were satisfied with the amount of staff within the home.

People told us they felt safe in the home. We found evidence that showed that staff were trained to spot and appropriately deal with all forms of potential abuse. Risks to people’s safety and welfare were managed well and monitored by the registered manager on a regular basis.

Medicines were administered safely and correctly by staff with appropriate levels of training.

Care was delivered by suitably trained and supported staff who were aware of people’s care needs. Staff knew about the Mental Capacity Act 2005 and how it applied to the people they supported.

The food in the home was popular with the people who used the service. We saw that people were having their nutritional needs met and those who needed support to eat were receiving appropriate assistance. The chef was very knowledgeable and had a good rapport with people.

We noted that some areas of the building required refurbishment but were given assurances that this work was on going. Some parts of the home had been decorated and furnished to reflect best practice in dementia care.

Throughout our inspection we saw evidence that staff had established good relationships with people who used the service. People who used the service told us, “I get on well with the staff.” And “The care staff are 100 per cent….I think they always listen.” A relative commented, “They’re lovely with my wife…..I go home from here knowing that she’s well looked after.”

We looked at 10 people’s records of care. We found that care plans were based on comprehensive assessments and correctly reflected people’s needs.

The manager listened to people’s comments and complaints and made changes based on people’s feedback.

The manager regularly made herself available to staff and people in the home and had systems and processes in place to measure the quality of the service.

Following the last inspection in June 2013 we set a compliance action for the provider to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.

The actions taken by the provider included reassessing dependency levels of all persons living in the home in order to calculate the number of staff required to meet their needs.

On the day of our visit there were 13 people on the dementia unit and the staffing had been increased by one during the day and by one at night. Staff we spoke with told us they could now meet people’s needs in a timely manner and supervise people in the communal lounge.

Some of the people who used the service had the capacity to give consent for their care and treatment. Where people did not have capacity the staff acted to promote people’s best interests. We saw evidence in care plans to show that relatives or advocates were consulted with and agreed the level of support being provided.

The care plans we looked at were person centred with information about life histories and personal preferences recorded. One relative we spoke with told us, ‘’ We are kept informed on a regular basis if changes occur, the staff are approachable and the atmosphere is relaxed.’’

People who lived in the home and their relatives we spoke with all thought both the building and the gardens were fit for purpose. One person told us, “The house is always nice and clean.”

We spoke with staff about their recruitment and when asked about their experience one person told us, ‘’ I felt they were very thorough. I had to do training first and then I was shadowed.’’

Staff told us that due to the recent reduction in staff levels the morning routine was more difficult and meant some people were not getting their needs met in a timely manner and that some of their choices and preferences could not be met.

People and their relatives had been asked for their views about the care they received. 60% of people asked commented that the standard of care was excellent, 40% said it was good and 20% said it was satisfactory.

We visited the home because we had anonymous information of concern that had been sent to us about the running of the home. This was mostly about the care of people in the morning being organised around staff shifts rather than people's needs.

We visited the home at 6.30 am to check on these matters of concern. We did not find any concerns in these areas. On the contrary we found people being supported to get up when they wanted to and the care they received was in line with what was recorded in their individual care plans.

When we arrived there were two people up and dressed sat in the lounge, another person was dressed and making their way into the lounge. We spoke with them and they said they were early risers and always had been. One person told us, "I'm always up at this time, me and the other lady are the first up. I usually start to dress myself and then staff come along and help out, they know my routine so they know I'll be awake. The staff do me a cup of tea and then I have breakfast about 8 o'clock." We found the majority of people were still in bed when we arrived and across our visit they started to get up at different times. When we left at just before 10 o'clock some people were still in bed as a matter of choice.

The atmosphere was calm and relaxed and we observed staff offering support to people that was both respectful and considerate.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We spent some time in the home conducting a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People we spoke with told us,

“I really like living here and my dog lives here with me”.

“At first I was nervous using the lift so staff came with me but I can use it by myself now”.

“I can lock my door at night if I want to”.

“I have a drawer with a lock for private things”.

“I attend the church service but we went out to church last week and I met friends I hadn’t seen for years”.

“I have phone in my room so I can talk to my daughter.

“I have a lovely room and like to spend most of my time here.

All those we spoke to were very happy with the care and support they received.

Comments included,

‘I was a physical wreck when I came in and look at me now’.

‘The staff are lovely and so kind’.

‘I am looked after wonderfully well’.

‘I only have to ring the bell once and someone comes to help me’.