Stonebow House Residential Home

Stonebow House Residential Home is a residential home providing personal care to older people aged 65 years and over. At the time of our inspection 25 people were living at the service.

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

Improvements were required to ensure all aspects of medicines were managed safely, particularly with further knowledge being needed regarding medicine types and side effects.

The providers infection control measures required further enhancing to ensure all areas of the home had been cleaned to good standard.

The provider had a consistent management team and governance systems were in place. Internal audits were completed but required further oversight to ensure they had identified where areas of improvement were needed.

The provider had systems and processes in place to protect people from the risk of abuse. Staff had received training and shared good knowledge of how to raise concerns. People and relatives told us they felt safe and would be listened to if they raised concerns. The provider had risk assessments in place to help reduce risk and keep people safe.

People were not always supported to have maximum choice and control of their lives. Further consideration of documentation was required in relation to people leaving the property.

People were supported by staff who knew them well. We observed staff were kind and caring in the approach. Staff had completed an induction process, followed by shadowing shifts and had their competencies assessed by senior staff or managers.

Effective systems were in place to gather feedback from people, relatives, staff and professionals which was used to drive improvements and positive outcomes.

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

Rating at last inspection

The last rating for this service was good [published 21 August 2021].

Why we inspected

The inspection was prompted in part due to concerns received about management of risks and oversight. 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.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stonebow House Residential Home on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stonebow House Residential Home is a residential care home providing personal care to older people.

Stonebow House Residential Home accommodates up to 30 people in one adapted building. People living at the home had access to communal facilities including dinning room, library, lounge and gardens areas. There were 22 people living at the home at time of inspection.

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

Improvements had been made to the safety of the home and people’s views on the way the home was decorated had increased their well-being. Further improvements were being driven through, to promote good infection control.

Staff knew what action to take if they had any concerns for people’s safety and were confident senior staff would take action to protect people. Systems for reporting any safety concerns to the registered manager and provider were working well; learning had been taken from incidents, so risks to people were reduced.

Advice provided by other health and social care professionals was followed, this promoted the safe administration of medicines. There were enough staff to care for people, and staff were supported to provide good care. New and staff returning from a period of absence from work were supported to care for people and staff were encouraged to make suggestions for improving people’s care.

People’s needs were assessed, and care plans were developed based on preferences to meet their needs. This included people’s nutritional needs and health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were at ease with the staff caring for them, and relatives were complimentary about the care provided to their family members.

The registered manager and provider checked key areas of the quality and safety of the care provided and used the findings to drive through improvements in the care provided to people. Relatives said communication with staff was good, and they valued the care provided because of the way the home was managed. Staff gave us examples of how people were encouraged to contribute to life at the home and increase their independence.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an unannounced comprehensive inspection of this service on 04 and 05 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance arrangements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions safe, and well-led which contain those requirements.

During this inspection we found improvements had also been made in the Key Questions of effective and caring, so we have re-rated these.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stonebow House Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Isolation and zoning procedures were in place to manage the outbreak of COVID-19 in the home in line with current guidance. The home designated a separate staff entrance where staff could change their uniform and record their temperature and blood oxygen levels prior to commencing or leaving their shift.

People’s laundry and soiled waste was transported through the nearest exit to reduce the risk of transmission of Covid-19.

Visitors were not permitted at the home at the time of inspection due to the outbreak of COVID-19. Each person living at the service had a ‘visiting’ care plan in place to reduce the risk and spread of infection when visits could safely resume.

People were supported by staff to participate in activities to promote their social and emotional wellbeing. People were encouraged to engage in socially distanced activities such as baking, growing vegetables and reading. Telephone and video calls, as well as a secure social media portal, were used to support people to keep in contact with families and friends.

Staff worked in teams led by a senior member of staff who provided individual support to the staff in their team. The provider also utilised an employee assistance helpline for staff to use should they require.

Further information is in the detailed findings below.

Stonebow House is a residential care home providing accommodation and personal care to for a maximum of 30 people. There were 20 people living there at the time of inspection.

People’s experience of using this service:

• Risks associated with the home environment had not been assessed.

• There was not an effective system in place to identify, action and learn from identified risks.

• People were not always treated with dignity and respect.

• People were not always consulted with about aspects of their home and the management of risks.

• Staff had relevant training to perform their roles effectively.

• Staff felt supported by the registered manager.

• There were systems in place to protect people from the risk of abuse and harm.

• People were supported with their nutritional needs and had choices with meals.

• Medicines were managed safely.

• People were able to access external health professionals and were supported with their needs when required.

• More information is in the Detailed Findings below.

• We identified two breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Rating at last inspection:

• At the last inspection on 18 April 2018 the service was rated ‘Requires Improvement’. At this inspection, the rating for the service has remained at ‘Requires Improvement’.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Stonebow House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. A maximum of 30 older people can live at the home. There were 30 people living at home on the day of the inspection, a number of whom were living with dementia. Nursing care was not provided.

There was no registered manager in post. The provider was recruiting a new manager. 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.

At the last inspection in March 2017, the service was rated Good. At this inspection we found the service required improvement overall.

Staff were available to provide advice or guidance that reduced people’s risks. Care records did not reflect guidance needed to support people.

People received their medicines as prescribed and at the correct time. However, we found systems and processes needed to be improved to ensure creams were applied as prescribed. Staff had not always followed safe practices and left medicines unattended during the medicine round.

Staff had been provided with training that reflected the needs of people who lived at the home. The training information showed that staffs knowledge was being updated. People told us and we saw their privacy and dignity were respected and staff were kind to them.

People had not always have accurate records of their care kept. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People had not always been supported to maintain their hobbies and interests or live in an environment that supported their needs. The provider had not reviewed any concerns raised as no records had been kept. Information was available for the provider to improve the service.

Regular checks had been completed to monitor the quality of the care that people received and look at whether improvements may be needed. The current management team were approachable and visible within the home which people and staff liked.

People told us they felt safe and free from the potential risk of abuse. Staff told us about how they supported people’s safety. People told us there were enough staff to support them. Staff told us they had time to meet the needs of people living at the home.

People told us they liked the staff and felt they knew how to look after them and were included in day to day decisions about their care and support. People were supported to eat and drink enough to keep them healthy.

This inspection took place on 9 February 2017 and was unannounced.

A registered manager was in post at the time of our 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.

People told us staff cared for them in ways which helped them to feel safe. Staff understood what actions to take to protect people from the risk of potential abuse. Staff knew the risks to individual people’s safety and communicated information with other staff so people’s safety needs would be met. There were enough staff employed to care for people and people told us staff knew their care and safety needs well.

Staff had received training and understood people’s individual care needs so they would be able to care for people and meet their needs. People’s rights and freedoms were respected by staff. Staff encouraged people to have things they enjoyed to eat and drink so they remained well. People’s health was monitored and staff acted on advice they obtained from health and social care professionals. People told us staff acted quickly when they asked for help to maintain their health.

Staff had developed caring relationships with people living at the home and understood what was important to them. People enjoyed spending time with staff and sought out staffs’ company. People were encouraged to make decisions about their daily care and staff respected the choices people made. People needs for independence and their rights to dignity and privacy were understood by staff, who took action to promote these.

People had developed plans for their care with support from relatives, staff and other professionals where needed. Plans were regularly reviewed and care adjusted as people’s needs changed. People had opportunities to do things they enjoyed both within and outside of the home. People were supported to keep in touch with relatives and friends who were important to them. People knew what to do if they needed to make a complaint or raise a concern and staff knew how to support people to do this. There were systems in place so if a complaint was made prompt action would be taken by the registered manager to address the concern and improve the service further.

People found the registered manager and senior team approachable and were encouraged to make suggestions about the care they received through discussion with staff and at residents’ meetings. There was clear and open communication between the registered manager, people, their relatives, and staff so the home would be further developed. Regular checks on the quality of the care people received were undertaken by the registered manager and actions were taken where development or suggestions had been identified.

Consent had been obtained from people before care and treatment had been provided. Alternatively, arrangements had been made to support people who were unable to consent to their treatment or support.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were aware of each person's needs. Staff demonstrated that they knew how to give care and support to meet those needs to ensure people's health and welfare was maintained.

People we spoke with said: 'The care is wonderful here, the staff are superb.' 'Cannot fault the service, they are all so good'.

Staff at Stonebow had established working relationships with other agencies to make sure that people received appropriate health and social care support.

We saw that staff had a kind and caring approach towards people they supported. People appeared happy, comfortable and relaxed in their home. Staff were given the training and support they needed to develop their knowledge and skills. This ensured that staff provided appropriate care and support to people who lived at Stonebow.

At the previous inspection we found that the provider had not assessed and monitored the quality of service that people received. This meant the providers could not be sure that people received a quality service due to the lack of a consistent formal review of their service. During this inspection we found improvements had been made and this compliance action had been met.