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Inspection carried out on 3 October 2017

During a routine inspection

The inspection took place on 3 and 4 October 2017.

Stoneleigh House is registered to provide accommodation and personal care for up to 12 people in a residential area of Wimborne. At the time of our inspection there were nine older people living in the home.

There was a registered manager in post who is also one of the Directors of Stoneleigh House (Residential Home) Limited. 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, the service was rated Good overall. At this inspection we found the service remained Good overall.

People were protected from harm because staff understood the risks they faced and how to reduce these risks. They also knew how to identify and respond to abuse. They knew which agencies they should report concerns about people's care.

Care and treatment was delivered in a way that met people's individual needs and staff kept records about the care they provided.

People received their medicines when required. We have made a recommendation about the management of some medicines.

Staff were consistent in their knowledge of people's care needs and supported people to remain independent.

They told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. They understood how the Mental Capacity Act 2005 provided a framework for the care they provided and encouraged people to make decisions about their care.

People had access to health care professionals and were supported to maintain their health by staff.

People were supported and encouraged to follow their own personal interests and had opportunities to attend social events and outings arranged by the home.

People described the food as good and there were systems in place to ensure people had enough food and drink.

People were positive about the care they received from the home and told us the staff were kind and caring.

The registered manager took responsibility for quality assurance in the home. Where improvements were identified action was taken. People spoke highly of the registered manager and were confident in her abilities to manage the service.

Inspection carried out on 14 15 and 17 July 2015

During a routine inspection

The inspection took place from 14 July 2015 to 17 July. Further phone calls and contact were completed by 24 July 2015. This inspection was announced to ensure there was a senior staff member or the registered manager at the service when we visited.

The service is a residential care home for older people. It has twelve beds and currently supports ten people.

The service had a registered 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.

People felt safe and well cared for and had their needs met. They felt part of the home and involved in the service provided. They enjoyed the homely and friendly atmosphere and shared positive comments about the service and most of the staff. One person told us that a staff member had, on one occasion, been discourteous and we fed this back to the registered manager. However, we were unable to explore this further.

People were comfortable and at ease in the presence of staff and there were opportunities during activities and meal times for people to engage with staff and others living at the home.

While there were sufficient staff to meet people’s needs, several people and staff felt that there was insufficient time to spend with people because of the wide scope of duties care staff were tasked with carrying out which included cleaning, quality checks, cooking and some catering.

Our observations showed that staff took an interest in each person and understood their specific needs and wishes, supporting them with a person centred approach. People spoke about the positive relationships and friendships they had made with others living at the home, including some of the staff.

People had care and support plans which took account of their level of independence and staff regularly discussed people’s needs with them to identify changes. We heard staff seek verbal consent before providing support and observed people being assisted to maintain their safety. Care plans showed that people had been consulted and where able, had signed their consent to decisions made within the plan.

While risks to people were reviewed it was not always clear how this process was carried out. There was limited information in some care plans regarding how risks were effectively reviewed and documented.

People received their medicines on time and the staff we spoke with understood how to administer medicines safely. They told us what actions they would take in the event of errors or omissions.

The service was not effective. While some training was made available to some staff and some development opportunities were provided, the approach was inconsistent. All new staff were given opportunities for shadowing more experienced members of staff. New staff that had social care experience was not always offered in-house training to develop their skills. Staff new to care work were provided with an induction and comprehensive training, yet existing staff did not have specific training to support their learning and development needs. Some staff had not received moving and handling or safeguarding adults training and most staff were not aware of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. There were inconsistencies in how staff received supervision and appraisal.

People had mental capacity to make decisions about their care and treatment and we were informed that no one living at the service was subject to a Deprivation of Liberty Safeguard. Where people do not have mental capacity to consent to their care or where their freedom of movement is restricted or they are subject to continuous supervision, decisions about some aspects of their care might have to be made within the framework of the Mental Capacity Act 2005 (MCA). We were told by the registered manager that no one living at the home lacked sufficient capacity or would require an MCA referral.

People enjoyed their meals and drinks and had sufficient amounts to eat. People were involved in growing food from the garden and this was used to make fresh and nutritious meals. People had a choice of soft drinks and alcoholic beverages with their main meal and could choose an alternative if they did not like the main meal of the day.

People were referred to healthcare professionals appropriately and in a timely way to ensure that changes to their health were monitored, treated and addressed. Staff worked with a variety of health professionals to implement care and treatment for each person.

People were cared for by staff that interacted in a caring and considerate manner. They provided meaningful and individualised care, demonstrating patience, understanding and an awareness of people’s needs when delivering care and support. Staff engaged responsively with people and enjoyed appropriate humour to add to the friendly and homely atmosphere. People were encouraged to express their comments and wishes about their care and treatment through open dialogue and informal discussions with the registered manager and staff. We heard discussions between staff and people about future health appointments and changes to their treatment. These discussion took place in private or quiet areas of the home.

People’s preferences were recorded in their care plans. There was guidance on how people wanted to maintain their own independence and have their aspirations valued and respected. This included how staff would meet the expressed needs of people who had limited vision and hearing.

People were encouraged to complete feedback surveys and share their experiences and comments about the service. People’s views were taken into account and used to improve the service. Feedback from relatives was positively received, addressed and used as an opportunity for learning, development and to improve people’s experience.

People were supported and encouraged to follow their own personal interests and to continue enjoying community activities and maintain their hobbies. These included poetry groups, gardening and visiting local shops and places of interest.

The service had an internal whistle-blowing policy and had recently updated several other policies. Medicine and fire checks were completed although general health, safety and maintenance checks were not evident or routinely carried out but there were safety and service-level contracts in place.

The registered manager was aware of the day to day culture within the service and fostered team values, communication and tailor-made care for people. Where staff fell short of delivering the service values these were challenged and addressed.

Staff expressed confidence in discussing matters of concern openly with the registered manager. People and relatives felt that the registered manager would address their concerns and was reliable in making the necessary changes when issues were identified. There was an open door policy for staff, people and relatives and this contributed to the transparent culture of the service.

Inspection carried out on 11 March 2014

During an inspection to make sure that the improvements required had been made

Our inspection of 5 June 2013 found that the provider had not made suitable arrangements to protect people from the unsafe use and management of medicines. The provider wrote to us and told us that they had made changes to meet the requirements of this essential standard. During this inspection we found that improvements had been made.

Inspection carried out on 31 July 2013

During an inspection to make sure that the improvements required had been made

Our inspection on 5 June 2013 found that the provider had not made sufficient improvements in relation to people’s care records. We found that people were not protected from the risks of receiving unsafe or inappropriate care as accurate records in relation to their care and treatment were not always kept. We required that the provider made improvements by 11 July 2013. During this inspection we found that improvements had been mad

Inspection carried out on 5 June 2013

During an inspection to make sure that the improvements required had been made

There were nine people accommodated at the home at the time of the inspection.

People told us there care needs were met. One person told us, “The staff give me all the help, they are very good.” We found that people accessed healthcare professionals when necessary.

People felt safe and the provider had a safeguarding policy which provided staff with appropriate guidance. One person told us, “I am very safe here. I do not worry, everything feels safe.”

People told us that there medicines were administered on time. However, we found that the provider had not made suitable arrangements to protect people from the unsafe use and management of medicines.

The provider had an effective recruitment process and ensured that appropriate checks were carried out prior to staff commencing work.

People were not protected from the risks of unsafe or inappropriate care as care records did not contain sufficient or accurate information.

Inspection carried out on 22 September 2012

During a routine inspection

People told us they were treated with consideration and their privacy was respected. One person told us “I have all the privacy I want. The staff knock on my door and wait to be invited in”. Another person told us “The staff have a quiet kindness about them. They are more like family”.

People told us their care needs were met. One person told us “All the staff seem to know how I need to be supported and cared for. I feel the staff are competent at their jobs”. However, we found that people did not always have an assessment of their needs and care plan’s were not regularly reviewed.

People felt safe at the home. Staff had received training in safeguarding adults from abuse. However, procedures for the reporting of allegations of abuse to the local safeguarding authority were inadequate.

People told us they felt the right people were employed to care and support them. One person told us “I feel the manager chooses the staff very carefully. I think the staff are seriously vetted to make sure they are suitable”. We found that some appropriate checks were conducted prior to staff starting work. However, staff files did not always contain all of the information as required by the standards, for example, details of staff full employment history.

Records were kept securely. However an accurate record in respect of people’s care and treatment was not always maintained. This means that there was a risk that people may have received inappropriate or unsafe care.

Reports under our old system of regulation (including those from before CQC was created)