Archived: Stoneyford Care Home

We found the following examples of good practice.

¿ People had remained in regular contact with friends and relatives using video calls. The outside space had been adapted to enable visits in a specified area.

¿ Activities in the service had been increased. Each day staff set time aside for one to one conversations with people or group discussions, games and activities.

¿ Staff had access to PPE and specific areas had been provided for staff to safely put this on and dispose of it after use. Hand washing and PPE guidance were displayed around the home to remind people of safe working practices. Appropriate use of PPE was observed during our visit to the service.

¿ Cleaning products had been changed to improve infection control. Cleaning equipment was colour coded for cleaning different areas within the service.

¿ Risk assessments had been completed for all staff and measures were in place to support staff who were at an increased risk. Staff were kept informed of changes within the service and provided with updated information. Staff well-being had been supported with supervision and teamwork.

¿ People and visitors were provided with information in a variety of formats. This included detailed written guidance and an easier to read version. Staff had conversations with people to help them understand the information in the most appropriate and reassuring way for them.

¿ The service communicated well with other health and social care services and professionals to ensure people were safe when accessing other services within the community.

Further information is in the detailed findings below.

At our last inspection the service was registered as a Nursing Home and rated as requires improvement. The home has since changed the registration to a care home without nursing.

People’s experience of using this service:

The service has made improvements since the last inspection in April 2018. There is a new registered manager in post who has a clear strategy and vision for the service and has already started to make change and improve the quality.

The service did not have enough staff to enable them to offer care and support to people with complex needs. The people living at Stoneyford Lodge required two people to support them with personal care and to use the hoist. Although there was senior on duty they were unable to support the staff during medication rounds.Therefore at these times, there were only two members available. This meant that staff were unable to support people adequately and would have been unable to respond to an emergency.

People received kind and caring support from staff who respected their dignity and privacy. They were encouraged to be as independent as possible and staff understood their needs well. Staff were skilled in understanding the needs of people living with dementia and engaged them in meaningful activities. Staff knew them well and understood how to care for them in a personalised way.

People were supported to maintain good health and nutrition; including partnerships with other organisations when needed. There were plans in place which detailed people’s likes and dislikes. People and relatives knew how to raise a concern or complaint.

People were protected from the risk of harm and staff had received training in safeguarding and how to protect people from abuse and avoidable harm.

More information is in the full report

Rating at last inspection: The service was last inspected on 24 April 2018 and was rated as requires improvement

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

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

Stoneyford Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Stoneyford Care Home is a nursing home that accommodates up to 60 older people with varying support needs, including nursing and people living with dementia. Accommodation is provided at the service over two floors. There were 23 people using the service at the time of our

inspection.

At our last inspection on 18 and 19 October 2017, we identified significant failings and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, need for consent, meeting nutritional and hydration needs, person-centred care and good governance. In addition a breach of the Care Quality Commission (Registration) Regulations 18 notifications of other incidents. CQC had not been notified of incidents the provider was required to inform us about.

Following the last inspection the provider sent us an action plan to tell us what action they would take to meet these breaches in regulation.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection, the registered manager had left the service and two registered managers within the organisation, separately managed the service for a period. A new manager was in place and they were in the process of submitting their registered manager application. We will monitor this. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection, the registered provider has announced that they wish to relinquish the regulatory activity that enables them to provide nursing care. The registered provider had taken all reasonable action to recruit and retain nurses to provide clinical care but was unable to achieve sustainability. At the time of writing this report, the management and staff team were working with commissioners (who fund care for people), people who use the service and their relatives and representatives to transfer people with nursing needs to alternative placements. The service will continue to be a care home providing accommodation and personal care.

Risks associated with people’s needs had been assessed and planned for. Improvements had been made to how some risks were managed such as wound care. However, further time was required for improvements in documentation and monitoring to be embedded and sustained. Audits and checks in relation to risks associated with the environment had been monitored and equipment was safe and met people’s needs.

Safeguarding procedures had improved. Staff were aware of their responsibility to protect people from avoidable harm and safeguarding incidents had been acted upon. Some people experienced heightened anxiety that affected their mood and behaviour, but information available to guide staff in relation to how to support people, lacked detail.

There were sufficient staff available to meet people’s needs and safe staff recruitment checks were in place and followed. Overall improvements had been made with the management of medicines; some shortfalls were identified that required further attention. Improvement had been made with infection control measures and cleanliness. Staff were knowledgeable about how to manage infections and understood the risk of cross contamination and followed best practice guidance. Accidents and incident were recorded, but these were not consistently completed or analysed to consider lessons learnt.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had not been consistently completed. People’s food and hydration needs were met and choices offered and respected. People’s health care needs were assessed, planned for and monitored, but information available to staff to support these needs were not always clearly recorded. Staff were working more effectively with healthcare professionals.

Staff received an induction; ongoing training and improvements were being made to the frequency of staff supervisions and appraisals. People lived in an environment that met their needs including any diverse needs, to ensure they were not discriminated against.

Staff were kind, compassionate and treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Advocacy information was available should people have required this support.

Some improvements had been made to information available to staff to assist them to provide a responsive and person centred service. However, information was not consistently recorded or easily found in people’s care records always. People and or their relatives received opportunities to be involved in review meetings to discuss the care and treatment provided. People received opportunities to participate in a variety activities and staff had time to spend with people. The provider’s compliant procedure had been made available. Some consideration and plans were in place in relation to people’s end of life wishes, but further action was required to complete end of life care plans.

A new management team was in place who had worked hard with the staff team to make improvements. They acknowledged further time was required for improvements to fully embed and be sustained.

Staff were positive about the new management team and reflected on the changes made to the service, this included improved communication and documentation. Staff were found to be more organised and had a clearer understanding of their role and responsibilities.

Systems and processes used to monitor the quality and safety of the service were completed more effectively and any shortfalls were added to the overall improvement plan to ensure action was taken to address these.

At our last inspection of the service on the 10 and 11 August 2016 the service was rated overall as ‘Good’. However, some improvements in safety were required. Risks were not always managed so that people were protected from avoidable harm. Robust systems were not in place to ensure that sufficient staff were on duty to meet people's needs. Medicines management and infection control practices also required improvement.

At this inspection we found ongoing concerns of how risks associated to people’s needs were assessed, planned for and reviewed. There were some continued shortfalls in the prevention and control of infections and medicine management. We also found further concerns which led to six breaches of the Health and Social Care Act 2008 Regulations (2014). You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in post and they were available during the inspection, they were currently being supported by a registered manager of another service within the organisation who was also present during the 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People could not be assured appropriate and timely action was taken when there was an allegation or concerns of abuse or avoidable harm. Where people had a Deprivation of Liberty Safeguard authorisation with conditions that required the provider to action, these were found not to have been completed. The principles of the Mental Capacity Act 2005 were not always followed. Some inconsistencies were identified in how best interest decisions had been made.

Risks associated to people’s healthcare needs had not always been appropriately assessed, planned for, monitored and reviewed. This impacted on people’s safety and welfare.

The deployment of staff required further review to ensure there were sufficient staff available at all times to support people’s safety, including oversight and accountability of clinical needs and risks.

Some issues were identified with the management of medicines in relation to storage and management. Action was being taken to improve audits and systems, oversight and accountability.

The checks and systems in place with regard to cleanliness and the prevention and control of infection control had improved but some shortfalls were identified.

People could not be assured their dietary and nutritional needs were consistently and effectively managed. Actions to follow external healthcare professional recommendations were not always acted upon or in a timely manner.

Improvements were required in how people’s healthcare needs were met. Further action was needed to ensure the service worked with external healthcare professionals in a collaborative way to meet people’s health needs and outcomes.

Staff received an induction, ongoing training and opportunities to review their work and development needs. Nurses employed to work at the service were appropriately registered with the Nursing and Midwifery Council. Staff had been recruited through safe recruitment procedures.

Some inconsistencies were identified in how staff provided a caring, kind and compassionate service. Whilst some positive staff engagement was observed, however people’s dignity and respect were compromised at times.

There was no advocacy service information available for people if they required this support. People and their relatives did not receive formal opportunities to participate in a review of the care and treatment.

Information to support staff to provide care and treatment that was person centred and reflected people’s needs and preferences lacked detail, guidance and support. People received limited opportunities to participate in meaningful activities that met their interest, hobbies and needs. We have made a recommendation about staff training on the subject of dementia.

People were aware of the complaint policy and procedure but the complaint’s information was not presented in an appropriate format to meet the sensory needs of all people.

The provider had failed to report some significant events that occurred in the service to us at CQC a registration regulatory requirement.

Over reliance on external professionals to identify what action was needed to meet people’s needs was identified, the provider had failed effectively to assess, mitigate risks and learn from past incidents and concerns. The service had shown limited progress of improvement in relation to how clinical risks were managed following regular feedback from quality monitoring visits completed by external agencies.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that provider’s found to have been providing inadequate care should have made significant improvements within this timeframe.

Accommodation for up to 60 people is provided in the service over two floors. The service is designed to meet the needs of older people living with or without dementia. There were 48 people using the service at the time of our inspection.

A registered manager was in post and she was available during the 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.

Risks were not always managed so that people were protected from avoidable harm. Robust systems were not in place to ensure that sufficient staff were on duty to meet people’s needs. Medicines management and infection control practices required improvement.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Staff were recruited through safe recruitment practices.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink.

External professionals were involved in people’s care as appropriate. However, the environment could be further improved to better support people living with dementia.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though care plans could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that appropriate action would be taken.

The provider and registered manager were meeting their regulatory responsibilities and there were effective systems in place to monitor and improve the quality of the service provided.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Equipment at the home had been well maintained and serviced regularly.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Staff personnel records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

Restraint policies were in place but practices did not safeguard people who used the service. The management of personal finances did not ensure that staff planning care had information about financial protection arrangements. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us. "I am very happy here, the staff are lovely.' Staff had received training to meet the needs of the people living at the home including training in Dementia care. External professionals involved in people's care told us the service has improved.

Is the service caring?

People were supported by kind and attentive staff. We observed that care workers showed patience and gave encouragement when supporting people. We observed staff asking people to make choices in relation to their day to day activities which included their food preferences and what activities they wanted to take part in. All observed interactions showed that the staff were proactive in obtaining consent from people who used the service and valued and respected their opinions. One person told us 'They help me to get up and dressed and I get to visit my family.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities. They said they felt the home had improved since the new manager had been employed. We found that staff meetings were performed on a regular basis and staff told us they were regularly supervised by the manager.

We found that the residential unit was not well lead. There were insufficient staff with the right knowledge and experience to safeguard the health and welfare of people who used the service.There was a new manager in post and they had immediate plans in place to improve the numbers of staff and employ staff in specific roles to manage the residential unit on a day to day basis.

We found that where other services, individuals or teams were involved in the care and treatment of people who used the service there was no identified person who was responsible for coordinating this. Information about changes in people's health or treatment was not always used to plan the care and support that people received.

People who used the service could not be confident that their medicines would be managed safely.