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Inspection carried out on 25 January 2019

During a routine inspection

About the service:

Stoneleigh is a residential care home registered to provide accommodation for up to 11 people, including people living with a mental health condition. There were eight people living at the service at the time of the inspection.

People’s experience of using this service:

• People and their families told us they felt the home was safe. There were enough staff to support people in a timely manner. However, we identified that some pre-employment checks had not been completed when two staff members started working at the service.

• Medicines were managed in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately.

• Individual and environmental risks were managed appropriately, which meant people were kept safe from avoidable harm.

• Staff received a variety of training and demonstrated knowledge, skill and competence to support people effectively. Staff were supported appropriately by the provider and the registered manager.

• People were supported by staff with their nutritional and hydration needs. People were offered choice at mealtimes and menus contained a variety of nutrition and healthy foods.

• People had access to health and social care professionals where required and staff worked together co-operatively and efficiently.

• Staff treated people with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what mattered most to them.

• People had a clear, detailed and person-centred care plan in place, which guided staff on the most appropriate way to support them.

• People, their relatives and staff members commented positively about the leadership of the service and felt that the service was well-led. The provider was engaged with the running of the service and was approachable to people and staff.

• There were appropriate auditing systems in place, which ensured that issues were acted upon and ideas for improvement were responded too.

Rating at last inspection:

The service was rated as good at the last full comprehensive inspection, the report for which was published on 10 August 2016.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Inspection carried out on 8 July 2016

During a routine inspection

Stoneleigh is a care home registered to provide accommodation for up to 11 people, including with a history of poor life choices and people living with a mental health condition. At the time of our inspection there were 10 people living in the home.

The inspection was unannounced and was carried out on 08 July 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. The registered manager carried out regular medicine audits and was in the process of updating records in line with ‘good practice’. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire. They were also supported to raise complaints should they wish to.

People and their families told us they felt the home was well-led and were positive about the provider and the registered manager who understood the responsibilities of their roles. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the care provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

Inspection carried out on 9 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer to answer 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?

This is a summary of what we found:

Is the service safe?

The manager had identified the risks and hazards associated with providing care within the home. These included risks associated with electrical equipment, kitchen, the use of step ladders, smoking and fire safety. We also saw risk assessments associated with specific elements of people’s care, such as psychological risks, falls and financial mismanagement.

Systems were in place to ensure the manager and staff learn from events such as complaints, concerns, or safeguarding events. This reduced the risk to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications have been made. Relevant staff had received training to enable them to understand when an application should be made. This meant people would be safeguarded as required.

When the manager sets the staff rosters, they take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure there were enough staff to meet people’s needs.

Is the service effective?

The care plans we looked at were personalised to reflect the individual needs and people’s likes and dislikes. The people we spoke with told us 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 the staff that they had a good understanding of the people’s care and support needs and they knew them well. A person we spoke with told us staff “seem to know what my requirements are. When I came here they already knew what I needed. They were ready to look after me”.

Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists. A care manager said, “Staff have a very good understanding of his [the person they were supporting] needs”. Therefore people’s needs were known and met.

Staff received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who did not always treat them with respect and dignity. We observed care in the communal areas of the home and saw staff interacting with people in a supportive way. However, during our observations we over heard two members of staff engaged in inappropriate banter between themselves and then later with one of the people using the service. Staff did not always consider how their behaviour may impact on others.

People told us they “liked the home” and staff “looked after them”. One person said “I like it here. I like the staff and the way they treat us”.

The home provided an opportunity for feedback through regular service user’s meetings and annual surveys.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People using the service had a high level of independence and were all mobile and had the freedom to go out into the community on their own. Their care plans and the support provided by staff reflected their individual abilities.

There was an effective compliments and complaints policy in place, which was included in the service user’s guide. All of the people spoken with said they knew how to complain but had not done so as there was no need. One of the people we spoke with told us, “I would complain to staff if I have a problem”. The manager showed us their complaints file and told us they had not received any formal complaints during the last year.

Is the service well-led?

We saw there was a structured quality assurance process in place to regularly assess and monitor the quality of the service people received. These included cleaning and infection control audits; medication administration record (MAR) audits; call bell alarm tests and fire safety equipment audits. We found some of these audits were also carried out by external professionals. Where remedial action was identified we saw that this had been completed.

There was a staff meeting structure, where staff could raise any issues or concerns. The staff we spoke with told us the staff meetings were an opportunity to raise any concerns or issues they had. One member of staff said, “We have regular meetings, the last one was about a month ago but you don’t have to wait for a meeting you can raise an issue at any time with the [manager] or [provider]”.

Inspection carried out on 9 August 2013

During a routine inspection

We spoke with five of the ten people who used the service. They all told us staff sought their consent before they delivered any care. They said they were very happy with the level of care provided and staff understood their needs. One person said “staff are good. They help me if I need help”. We looked at four care plans and saw they were individual and included the necessary information to inform staff as to the specific care people required. They reflected the fact people at the home had a high level of independence and had the freedom to go out into the community on their own. We observed care in the communal areas of the home and saw staff interacting with people in a positive way.

We saw the home had an infection control policy and the provider told us the manager was the infection control lead for the home. We spoke with two members of staff and the provider, all of whom said they had received infection control training. Everyone we spoke with told us the home was always clean. One person said “staff are always cleaning, it’s well managed. We help to keep it clean”.

We saw staff had received the appropriate training and the skills required to meet people's needs. We found the provider had an effective quality assurance system in place and sought the views of the families of people who use the service through regular surveys. We spoke with a visiting health professional who told us staff “were very conscientious”.

Inspection carried out on 13 December 2012

During a routine inspection

We spoke with three people and observed care throughout the home. People confirmed that they felt safe and that staff were available when they needed them. They said that the food was good and a choice was available. We observed the staff encouraging people to take responsibility for managing the own lifestyle. People were encouraged to take part in household activities and were supported by staff when necessary. One person said “I like it here. The staff are nice and I can go out and come back when I want but have to let the staff know”.

We also spoke with three staff who told us that they had received induction training and were aware of the safeguarding policy and who to contact. They felt there were sufficient staff available to meet people’s needs. We spoke with two external health and social care professionals, who told us they were happy with the care that was provided at the home. They told us that there was good communication and they were kept informed about any changes in people’s condition. They were positive regarding the care provided and said that “Staff at the home follow our advice and guidance”. One said a person had “thrived since being at Stoneleigh”.