Stone Gables Care Home

Updated 28 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Stone Gables is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Stone Gables is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who works with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who used the service and 5 relatives about their experiences of the care provided. We spoke with 10 members of staff including the nominated individual, registered manager, deputy manager, activities coordinator and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records, which included detailed reviews of people's care plans, medicine administration records and we looked at medicines related documentation. We also observed medicines administration and checked their storage. We looked at 3 staff files in relation to recruitment and records relating to the management of the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 28 July 2023

About the service

Stone Gables is a care home without nursing care, providing accommodation for persons who require personal care for up to 40 people. The service provides support to older people, including people living with dementia. At the time of our inspection there were 23 people using the service. The care home accommodates people across 2 floors in 1 building.

People’s experience of using this service and what we found

The provider's oversight of the service was ineffective. Systems were not in place to support the monitoring and improvement of the service. Managers failed to provide evidential documents during the inspection process. There was a lack of measures in place to help drive improvements at the service.

Medicines were not managed safely. Guidance was not followed when changes were made to people’s medicines and time specific medicines were not given at the correct times. Risks were not being appropriately assessed and managed around challenging behaviours and people’s health. People’s risk assessments were not readily available for staff to read and follow. Referrals to the local authority safeguarding team had been made appropriately. However, follow up actions had not been completed by the provider.

People, staff and relatives did not feel there were enough staff on shift to meet people’s needs. We observed people at lunch time not receiving the support they required. Staff did not receive regular supervisions or appraisals. We were not assured that competency assessments were completed with staff. We observed staff to be kind and respectful to people, but they were very busy and task orientated.

We received positive feedback about the activities on offer and the activities coordinator. During the inspection, we observed people and their relatives participating in activities throughout the day. Relatives were complimentary about the care staff.

Assessments were completed with people before they moved in to Stone Gables and care plans included information on how to support people to meet their needs. People received health and social care support from a range of professionals including GP's, district nursing and social work teams.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 November 2019).

Why we inspected

The inspection was prompted due to concerns received about medicines and staffing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to risk management, management of medicines, staffing and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.