Stoneleigh House

Stoneleigh House is a residential care home providing accommodation and personal care for up to 31 people within a large stone-built property, which has been converted and extended. There were 22 people living at the home on the day of inspection.

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

We found improvements were required with the management of medicines, the audit and governance process and the system for ensuring appropriate and safe staffing levels were deployed based around people’s needs.

People’s medicines were not managed safely, this included the management of stock and record keeping. People told us there seemed to be enough staff and requests for help were met in a timely way. However, the providers system for determining how many staff were needed to meet people’s needs, showed not enough staff had always been deployed. Staffing levels had been reduced in the afternoon and overnight. This reduction in staffing had not been risk assessed, to ensure it was safe.

We have made a recommendation about how the provider determines whether safe staffing levels are deployed.

The home had introduced a detailed audit and governance system, with a clear schedule in place explaining what would be assessed and when. However, the audit process had not identified any of the issues we found during inspection. There was no overarching action or improvement plan in place, to enable greater oversight of what needed to be addressed, who by and when.

We have made a recommendation about how the provider identifies and addresses actions and improvements.

People told us they felt safe living at Stoneleigh House. Risk assessments explained how staff could support people in line with their wishes, whilst keeping them safe. Staff knew how to identify and report safeguarding concerns, with training provided and refreshed. Accidents and incidents had been documented and reviewed to identify trends and help prevent reoccurrence. The necessary employment checks had been completed, to ensure staff were suitable to work with vulnerable people.

People and staff’s views were captured via meetings and questionnaires. People and staff spoke positively about the support they received and how the home was managed. Staff told us they enjoyed working at the home and had noticed improvements since the current manager had been appointed.

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 25 January 2021).

Why we inspected

We carried out a focused inspection of this service in November and December 2020 when breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do to improve safety and governance within the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The local authority had also requested we inspect, in order to increase care home bed capacity within Oldham. The report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements. 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 remained requires improvement. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the reports from our last focused inspection and the previous comprehensive inspection, by selecting the ‘all reports’ link for Stoneleigh House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to the management of medicines and the audit and governance processes at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stoneleigh House is a large stone-built property which has been converted and extended. Stoneleigh House provides accommodation and personal care for up to 31 people. There were 18 people accommodated at the home on the day of the inspection.

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

The registered manager had been absent from work for several weeks. An acting manager was in place and a provider support manager had been recruited. The provider support manager had identified several areas where improvement was needed and they were supporting the acting manager to implement new systems.

We found improvements were required in staffs understanding of controlled drugs and the recording of people’s dietary requirements and daily records. Further support was needed in enabling staff to identify and speak up about improvements that could be implemented.

Quality assurance audits were not completed appropriately or carried out in accordance with the provider’s policy. Several policies needed further development, although the provider support manager had begun to address this.

Staff had not been recruited safely, references were not always requested and DBS checks had been carried out several months after staff had been recruited. Newly recruited staff had not received a robust induction programme. Staff training had not been completed appropriately and several staff were out of date with mandatory training courses.

Daily records were not always completed accurately, were often disorganised and missing important information such as people’s names, dietary intake and dates.

We have recommended the provider promote accurate record keeping and implement more organised systems.

We discussed improvement with the management team and they felt new appointments within the management structure, would promote transparency and staff feeling able to speak up, about improvements which could be implemented.

We have recommended the provider embed and promote an open and transparent culture at the home.

People received their medicines safely, however, staff’s understanding of controlled drugs needed to be strengthened.

We have recommended the provider retrain staff and strengthen their understanding around the management of controlled drugs.

Care plans had recently been updated by the provider support and acting manager to accurately identify risks to people and how these could be managed. Accidents and incidents had been reported to the appropriate bodies. We received limited feedback from people, due to them isolating in their rooms. However, relatives felt care was provided to a high standard and praised the staff team for their work during the coronavirus pandemic.

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 10 April 2019).

Why we inspected

We received concerns in relation to staff conduct and poor governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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 coronavirus and other infection outbreaks effectively.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to governance and staffing at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stoneleigh House is a large stone built property which has been converted and extended. It is located approximately three miles from Oldham town centre. Stoneleigh provides accommodation and personal care for up to 31 people. There were 27 people accommodated at the home on the day of the inspection.

People’s experience of using this service:

We found the service had improved safety by ensuring all radiators were covered to prevent possible burns.

We examined three staff files. Two files contained all the documents to show the service recruited safely. However, for one file we saw there were no references which the manager said must have been mislaid. The day after the inspection the registered manager found one of the references. We recommended the provider recruited staff safely and ensured two references were always provided for inspection, as detailed in their policy.

Staff had received safeguarding training and knew how to identify and report any concerns. Accidents, incidents and falls had been documented consistently, with audits completed to look for trends and help prevent a reoccurrence.

We recommended that the provider looked at best practice for the use of signage to aid people with dementia better understand their surroundings.

Staff had received sufficient training and ongoing support to help them carry out their roles.

Care plans were sufficiently well developed to provide care staff with sufficient details to deliver care.

People who used the service told us food served at the home was good and there was a choice of meals.

The equipment at the home was well maintained and the home was warm, clean and in reasonable decorative order.

People told us staff were caring and responded to their needs.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection (report published 26/03/2018) the service was rated as good with a breach of the regulations for unsafe temperatures of some radiators.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. As the home was in breach of a regulation we returned within 12 months to check the necessary improvements had been made.

Follow up: We will continue to monitor information and intelligence we receive about the home to ensure care remains safe and of good quality. We will return to re-inspect in line with our inspection timescales for good services, however if any information of concern is received, we may inspect sooner.

At this inspection we found that in some parts of the building radiators were left uncovered and were hot to the touch. This presented a risk to people using the service, visitors and staff. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: the registered person must ensure that premises are safe. We found no other areas of concern at Stoneleigh House so have rated safety at the service as good overall.

Stoneleigh 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.

Stoneleigh house is a large stone built property which has been converted and extended. It is located in the Springhead area of Oldham, approximately three miles from Oldham town centre. The service is registered to provide accommodation for people who require nursing or personal care, and can accommodate up to 31 people. At the time of our inspection there were 26 people living at Stoneleigh House.

The service had a registered manager in place. 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.

Risks in relation to people's daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Meals were appetising and people were offered a choice in line with their dietary requirements and

preferences. Staff were available to support people with their meals.

The service had identified the minimum numbers of staff required to meet people's needs and these were being met.

Care plans were well organised and contained clear information. Care planning was reviewed regularly and people's changing needs were recorded.

Risks in relation to people's daily life were assessed and planned for to minimise the risk of harm. People were supported by staff who knew how to recognise abuse and how to respond to concerns.

The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

The manager was supported by an assistant manager, senior carers and a team of motivated care staff. There were regular audits of many aspects of the service delivery in place and the provider monitored the progress of the service against desired objectives.

The service is registered to provide accommodation for persons who require nursing or personal care, and can accommodate up to 31 people. At the time of our inspection there were 22 people living at Stoneleigh House.

Stoneleigh House is a large stone built property which has been converted and extended. It is located in the Springhead area of Oldham, approximately three miles from Oldham town centre. Most of the bedrooms were single, but there were two shared rooms. However, at the time of our inspection one of these rooms was unoccupied, and just one person occupied the second. All bedrooms had sinks and ensuite toilets.

The home had a manager registered with the Care Quality Commission (CQC) who was present when we inspected. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the lack of security on entering the building, as we were able to gain entry without the knowledge of the staff, and walk throughout the whole of the building. You can see what action we asked the provider to take at the back of this report.

The home was well maintained. Bedrooms, dining rooms, lounges, bathrooms and toilets were clean and warm. Communal areas and corridors were kept free of any clutter to minimise the risk of accidents.

People who used the service told us they felt safe. When we spoke to staff, they were able to tell us how they ensured that people were protected from harm. We saw that recruitment procedures were sufficiently robust to help ensure that people were protected from the risk of unsuitable staff being recruited.

People were supported by a stable staff team who were knowledgeable and well trained. They had worked together for a number of years and knew the people who used the service well. We saw that there were enough staff and people told us that the staffing ratio reflected the needs of the residents. The staff we spoke with had a good understanding of people’s individual needs and the support they required.

Where risk was identified, plans were put into place to minimise harm. Plans were detailed and subject to regular review. We saw that actions taken had reduced or eliminated risk, but this was not always reflected in care plans.

There were appropriate systems in place for the safe administration of people’s medicines.

People who used the service told us the food was excellent. Attention was paid to dietary requirements and we saw the food looked and smelled appetising.

We saw that arrangements were in place to assess whether people were able to consent to care and treatment, and people were offered choices about how their care was delivered.

Where health needs were identified, the staff at Stoneleigh liaised with appropriate health personnel, such as doctors, district nurses and dieticians to ensure that health needs were not neglected.

People were treated in a caring and compassionate manner, and were complimentary about the care they received at Stoneleigh House. One person told us, “The staff really know how to look after us. All of them are kind and caring, and always smiling”, however, they told us that there was often little for them to do.

Systems were in place to ensure that people at the end of life received appropriate care in accordance with their wishes, and were supported with the relevant healthcare as needed.

Care plans documented people’s interests and what they enjoyed doing. Staff were encouraged to help people to maintain their interests. However, people who used the service told us that there was not a lot for them to do.

The service had a complaints policy, but there were few complaints. One person told us, “I sometimes have an issue but I will talk to the staff and they will put it right. Things have never got to the point where I have needed to complain”.

People told us the manager was approachable and would listen and respond to any issues raised. The home regularly sought feedback, and took action to improve the quality of the service.

Prior to our visit, we contacted the local authority safeguarding and commissioning teams, and no concerns were raised by them about the care and support people received at Stoneleigh House.

People had written individualised plans of care that were regularly reviewed. People told us they were involved in discussion about the way they wanted their care needs to be met.

The home had appropriate procedures, which were followed, in connection with the receipt, storage and administration of medication.

Staff were vetted as part of the recruitment process to help minimise the possibility of employing people who may be unsuitable.

There were checks on the quality of the service provided and written plans to rectify any areas of weakness and further improve the care and support provided.