CQC report explained · a nursing home
What the CQC found at Stocks Hall Nursing Home - Skelmersdale
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments were not always up to date, bed rails were not always risk assessed or checked, and medicines were not always managed safely. Inspectors also found gaps in medicine temperature records, missing guidance and expired medicines.
- Effective?
- Requires improvement
- People's needs and choices were assessed, and staff supported access to healthcare. However, there were gaps in documenting nutritional needs and in handing over changed instructions, including an incorrect level of drink thickener being given to one person.
- Caring?
- Good
- This question was not inspected during this focused inspection. The report records positive feedback about friendly, caring staff and people's experience of living at the home.
- Responsive?
- Good
- This question was not inspected during this focused inspection. The report says rooms were personalised and the home supported people's individual needs.
- Well-led?
- Requires improvement
- Management systems did not consistently identify risks, act on repeated medicines concerns or track safeguarding investigation outcomes. Inspectors also found a positive culture, with staff and relatives able to give feedback.
What inspectors found, February 2024
Rated Requires Improvement; inspectors found kind care and enough staff, but risks, medicines and management systems were not always safe.
This was an unannounced focused inspection on 17 January 2024. Inspectors reviewed Safe, Effective and Well-led only. They spoke with staff and relatives, observed care, and checked care plans, risk assessments, medicine records, recruitment files, rotas and audits.
The home was clean and comfortable. Inspectors found enough staff, safe recruitment, regular staff training and support for people's healthcare needs. People and relatives gave positive feedback about the care, food and staff.
However, some risks were not properly assessed or communicated. Medicines records and storage checks were not always safe. The systems used by managers did not make sure problems found in audits were corrected. The ratings for Safe, Effective and Well-led changed from Good to Requires Improvement.
Enough staff
Inspectors found enough staff to meet people's needs and safe recruitment checks were completed.
“People were supported by enough staff who had been recruited safely.” from the report
Clean environment
The home was described as clean, comfortable and homely. Infection prevention arrangements were in place.
“We were assured that the provider was using PPE effectively and safely.” from the report
Training and healthcare
Staff completed regular training and worked with health and mental health services to support people's wellbeing.
“Staff worked alongside mental health teams, frailty teams and made referrals to external agencies when required.” from the report
Positive relationships
People and relatives gave positive feedback, and inspectors found staff to be friendly and caring.
“People enjoyed living at the home and feedback from people and their relatives was positive.” from the report
Risk assessments and handovers
seriousSome risk assessments were incomplete or did not match care plans. A change to one person's drink guidance was not handed over properly, and the person received the wrong level of thickener.
“Although we found no evidence of harm, systems had not been established to identify and monitor risk.” from the report
Medicine safety
seriousMedicine fridge and storage temperatures were not always recorded. Some medicines lacked guidance, one medicine had been given daily for seven weeks without a review, and some creams and eye drops had expired.
“Although we found no evidence of harm, systems had not been established to make sure medicines were managed safely.” from the report
Repeated problems not fixed
seriousMedicine audits had identified similar concerns more than once, but improvements had not been made. Some issues had also been raised at the previous inspection.
“Staff undertook medicine audits and similar themes were identified in consecutive audits, showing improvements had not been made.” from the report
Incomplete monitoring
needs fixingThere was no system to track safeguarding investigation outcomes. This could mean that learning or recommended changes were missed.
“There was no system to monitor safeguarding concerns, or track outcomes of investigations.” from the report
- 01What have you changed to make sure risk assessments are updated when a person's nutritional needs change?
- 02How do you now check that thickener instructions and other important care guidance are handed over to every staff member?
- 03How are medicine fridge and storage temperatures recorded and checked each day?
- 04How do you check that staff are competent to administer medicines and that 'as and when required' medicines are reviewed?
- 05What action have you taken to make sure repeated audit findings and safeguarding outcomes lead to lasting improvements?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and the overall rating used the inspected findings alongside previous ratings. This explanation was written from the published report of 29 February 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2018
Rated Good; inspectors found kind, safe and well-organised care, but identified some medicines and record-keeping issues.
Inspectors visited without warning on 31 July and 7 August 2018. They spoke with people living at the home, relatives, staff and outside professionals. They observed care, checked eight care records, medicines, staff files, the building and quality checks.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough suitably trained staff, safe recruitment, good safeguarding systems, respectful care, suitable food and a wide range of activities.
There were some things to improve. Care plans did not always show changes in people's needs. There were gaps in some temperature records, and inspectors found several medicines recording and administration issues. The home took some action during the inspection and received recommendations rather than a breach at this inspection.
The previous inspection had rated Effective as Requires Improvement because consent had not always been obtained. Inspectors found this had improved, and the earlier breach of Regulation 11 had been met.
Kind and respectful staff
People and relatives spoke positively about staff. Inspectors saw staff communicate kindly, protect privacy and support people sensitively.
“During our inspection we observed staff approach people and speak with them in a kind and caring manner.” from the report
Staffing and recruitment
Inspectors found enough staff for people's assessed needs. Recruitment checks and induction arrangements were in place.
“We found new employees had been recruited safely. All relevant checks had been completed before they started to work at the home.” from the report
Activities and social contact
The home offered regular activities, outings, events, gardening and contact with family and friends using technology.
“A good range of interesting activities were provided for those who lived at the home and staff supported people to participate in order to prevent isolation.” from the report
Improved consent arrangements
The previous inspection found a problem with consent. This inspection found that consent had been obtained from the relevant people.
“Records showed that consent to care and treatment had been obtained from the relevant people.” from the report
Positive management and feedback
People, relatives and staff generally gave positive feedback about the management. The home used audits, meetings and surveys to monitor quality.
“In general, we received positive feedback about the leadership and management of the service from those who lived at the home, their relatives and staff members.” from the report
Medicine administration and records
seriousInspectors found doses given late, one delayed injection, incomplete allergy information and some medicines not given as instructed. The manager said the issues would be investigated or corrected.
“A number of people were prescribed a medicine that must be taken on an empty stomach and not with any other medicines.” from the report
Temperature monitoring
needs fixingThere were gaps in treatment room and medicines fridge temperature records on one unit. The recorded temperatures were within the recommended range when checks were made.
“There were some gaps in the recording of room and fridge temperatures on the Woodlands unit, but when they were done, the minimum and maximum temperatures were within the manufacturers recommended range.” from the report
Care plans did not always reflect changes
needs fixingCare plans were reviewed monthly, but some did not consistently record changes in people's assessed needs. Inspectors recommended clearer and simpler records.
“However, although care plans had been reviewed every month, some did not reflect all changes in needs and some terminology could have been simplified, so as to be understood by all.” from the report
Infection control practice
needs fixingSome staff did not always follow recommended hand-washing and clinical-waste practices. The manager said this would be addressed without delay.
“We noted some staff members did not always promote recommended infection control practices, such as regular hand washing and good management of clinical waste.” from the report
Quality audit records
minorThe home carried out many checks, but records did not always show dates or the actions taken. Inspectors said the checks could be improved.
“Although a wide range of internal checks had been conducted, these could have been further improved, had all been dated and actions taken recorded.” from the report
- 01How do you make sure medicines are given at the correct time and according to instructions about food?
- 02How do you check and record medicine fridge and treatment room temperatures every day?
- 03How quickly are care plans changed when a person's needs change, and how are families told?
- 04What action was taken after inspectors found gaps in hand washing and clinical waste procedures?
- 05How do you record the dates and follow-up actions for your quality audits?
This was an unannounced inspection covering all five key questions, and all five ratings were Good; the previous Requires Improvement rating for Effective had improved. This explanation was written from the published report of 28 September 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Stocks Hall Nursing Home - Skelmersdale
4 rated inspections over 9 years: the service has held its Requires improvement rating throughout.
- February 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Stocks Hall Nursing Home - Skelmersdale →
- September 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
Read what inspectors found at Stocks Hall Nursing Home - Skelmersdale →
- April 2016Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- March 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- May 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
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“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.