Archived: Stonehouse Manor

' Care and welfare of people who use services.

' Assessing & monitoring the quality of service provision.

' Records.

This visit was carried out by one inspector.

The evidence we looked at was limited as the provider and the acting manager were not present at the home on the day of our inspection. Therefore it was not possible to look at all areas which would normally be assessed when judging compliance. Subsequently, this report therefore only reflects the areas of non-compliance highlighted from our previous visit on 2 June 2014.

Sustainability will need to be fully tested during the next 3-6 months and will be reported on fully at the next inspection.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with relatives of people using the service, the staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

On the day of our inspection we looked at the communal areas and 12 bedrooms. We found them to be tidy and hygienic.

Is the service effective?

We looked at people's care files and saw their individual needs had been assessed.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well.

We saw that care assistants were patient and encouraging when supporting people.

Is the service responsive?

We saw the service had taken advice from another healthcare professional in response to a service user's changing health needs.

Is the service well led?

The provider had taken a number of steps to address the concerns raised at the last inspection and put measures in place to improve the service.

' Care and welfare of people who use services.

' Assessing & monitoring the quality of service provision.

' Records.

This visit was carried out by two inspectors and an expert by experience.

The inspectors also through observation and looking at records used the information they were given to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Four members of staff we spoke with were all able to describe different types of abuse. They told us that they would raise any safeguarding concerns they had with their manager. They were also aware they could make a direct safeguarding referral.

We saw in one person's 'night' care record, they were allergic to a specific antibiotic. However, we could not see this information had been included in the medication section of the care planning documentation.

Is the service effective?

We found most staff had completed their mandatory training. For example; fire, dementia and moving and handling. We saw the provider had a system in place to ensure staff received refresher training when required.

Is the service caring?

We saw people were suitably dressed and mostly clean and tidy. During our inspection we observed staff supporting people who had dementia. We observed staff were sensitive and patient in their approach.

There was evidence in each of the four care records we looked at that people had access to other health care professionals. For example; opticians and G.Ps.

Is the service responsive?

The service had not received any formal complaints since our previous inspection in January 2014. The manager told us they did not record verbal concerns. This meant there was no evidence to show that comments and verbal complaints people made were responded to appropriately.

Is the service well led?

We spoke with five staff who told us they felt supported in their role. Staff had received regular supervision

The service had a new manager in post. They told us they will be commencing their application for the post of registered manager at the service shortly.

We found the premises had improved since our last visit and offensive odours had significantly reduced. However, we noticed slight odours in some areas, such as the library area of the lounge.

Although the provider had sent us information stating that new accessible records were in place from October 2013, we found in fact they were not nor had been in place. This meant that care may not be delivered in a way that meets people's needs. Furthermore, the information we received from the provider was misleading and inaccurate.

We found the records the provider said were in place from October 2013 indicating people's individual risk of falls, potential triggers and any action were not in place and had not been acted on. This meant that it was unclear if action had been taken to ensure people's safety.

We observed staff interaction with people was limited, other than to carry out care tasks, such as assisting with moving, eating and using the toilet. Where people needed assistance with their meals we saw staff were kind and caring and patiently helped them at each person's own pace. Staff we spoke with did not know who people's key workers were.

We found that the Quality Assurance systems in place were incomplete, with a lack of reflection and analysis of incidents and accidents and actions taken.

We also found that the provider had failed to notify us about all reportable incidents or about all the deaths that had occurred.

We had also received information of concern about staffing levels and an offensive odour being present in the home. We found that on the day of the unannounced visit the staffing levels were appropriate. However we did find that there was an offensive odour in the home although on a tour of the home we observed suitable standards of cleanliness were maintained.

We spoke with the nurse on duty, four carers, the deputy manager, three relatives and four people who live in the home. We saw people were mostly happy and settled. People were appropriately dressed and had suitable footwear.

We spoke with four care staff and the registered nurse who told us they thought there were enough staff to care for people. The nurse said that having the second nurse also on duty in the mornings at the weekend had made a considerable difference in helping to support people. We saw staff engaged with people in conversation as well as in care tasks.

We saw people's care records were held on a computerised system, which although contained relevant information, meant information was not easily accessible to care staff as a working document.

We spoke with two people about their experience of the home. One person said: 'it's alright, it's peaceful I suppose' and the other person said 'it's not paradise but it's ok'.

anonymous source. The concerns raised were that the manager was only at the home one day a week, that there was a high level of falls amongst people who live in the home and that there was a lack of staff. We did not find evidence of all of the concerns but we found that there was a lack of staff specifically at weekends.

We used a number of different methods to help us understand the experiences of people using the service, because many of people using the service had various stages of dementia, which meant they were not all able to tell us their experiences.

We case tracked two of the people who live in the home which means we spoke with them, reviewed their care plans and records and spoke with the staff who support them. We spoke with five people in the home. Three people were able to comment about their experience of living at Stonehouse Manor and said they were happy with the care they received. Some of their comments were 'The staff are alright' and 'They look after me, they do'.

We carried out a period of observation in one of the communal areas. We also spoke with two relatives. One of their comments was 'They give excellent care.'

We spoke with the owner manager, the clinical lead, the administrator, and four staff members.

We spoke with four relatives and seven members of staff. These are some of the things they told us:

'I am very satisfied with the care and support my relative receives. The staff are very good. If I ask the clinical lead for anything I know it will be done. The home is always clean and tidy and the food is very good.'

'There have been improvements since the new clinical lead came. They organised new treatment for my relative and this has improved their physical well being. If I had any concerns I could go to the manager or the clinical lead and I know they would sort things out.'

'There's lots of activities going on in the home and they have activities that my relative really enjoys and can join in with.'

'I've worked in a lot of homes and this is one of the best.'

'It's the best place I have ever worked.'

'If a relative of mine need to be in a home I would be happy for them to live here. People get good care and support.'