Stoneacre Lodge Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents and incidents were reviewed, and a quarterly analysis was carried out to identify themes and trends. The provider had made improvements to their systems and processes and there was an emergent culture of learning in place within the service. The new systems and processes needed to be embedded and sustained into practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The provider ensured hospital information packs were regularly updated so accurate information about people could be shared as and when required.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way for this to be achieved. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider had made improvements following our previous inspection and they shared concerns quickly and appropriately with the local authority. We discussed notifying CQC about all instances where referrals to the Local Authority’s safeguarding adults team had been made and the management team identified where they could make changes and improvements to their reporting processes. People told us they felt safe. One person said, “I feel safe because there are people around.”

We saw evidence the provider followed the principles of the Mental Capacity Act 2005 (MCA) to review people’s capacity and understanding around receiving care and support. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and, if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs which was safe, supportive and enabled people to do things which mattered to them. The provider had made improvements to people’s care plans so information better reflected people’s specific care needs and were more person-centred. We did identify some areas where further improvement was required. For example, 1 person’s care plan identified they needed to be re-positioned to manage their skin integrity, however, there were inconsistent time intervals for re-positioning which meant it was difficult for members of staff to deliver the appropriate care and support. We spoke to the management team about this and they told us they were in the process of reviewing and updating all care plans. We recognised care plans had improved but there needed to be a continued focus on sustaining and embedding these improvements alongside robust monitoring, auditing and reviewing processes.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had systems in place to record and monitor compliance and safety checks for the care environment. Information and evidence were well maintained and recorded.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care which met people’s individual needs. Member of staff were deployed effectively and attentive to people’s needs. Call bells were responded to in a timely manner. Members of staff were recruited safely and pre-employment checks were completed to ensure new starters were safe to work with people. One person told us, “I think there is enough staff and they treat me with respect and dignity.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. We spent time observing people’s experience at mealtimes and we found improvements were required. The lunchtime experience was, at times, chaotic and, whilst everyone received their food and they were supported by members of staff appropriately, the overall organisation of the mealtime could be improved.

Medicines were administered safely. Members of staff involved people in planning, including when changes happened. The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had policies and procedures in place to ensure people received their medicines as prescribed. Members of staff were trained and competent to administer medicines. People had a front sheet in place which included a current photo of the person, a record of any known allergies and instructions about how to support people to take their medicines. People who were prescribed medicines on an ‘as and when’ required basis, often referred to as PRN, had protocols in place to ensure safe and appropriate administration. People confirmed they received their medicines safely. One person told us, “They give us our tablets and stay while we swallow them.”