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Stilecroft Residential Home Inadequate

Inspection Summary

Overall summary & rating


Updated 16 June 2021

About the service

Stilecroft Residential Home (Stilecroft) is an older property that has been extended and adapted to provide personal care for up to 44 older adults and people living with dementia. There were 25 people the living at the home at the time of our inspection.

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

We found shortfalls in the way the service was led. The provider’s governance systems had failed to identify the issues we found on inspection. This included management of risk, maintaining a safe living environment, staffing levels not meeting people’s needs, incomplete assessments, deficits in care planning, and not abiding to the requirements of the Mental Capacity Act. Auditing systems were not effective in monitoring and improving the service.

Risk was not always appropriately identified, assessed and managed in a timely manner. During the visit we identified several concerns regarding risk which were escalated to the registered provider who then took action. Safeguarding procedures aimed to keep people safe were not consistently implemented and when people had been exposed to risk of harm, incidents were not always reported to the local authority safeguarding team for review. Infection prevention control (IPC) measures were not robust with lapses in practice observed. People were receiving their medicines safely however the provider agreed to review how medicines were stored.

We made a recommendation the provider reviews IPC practices in the home.

Staffing levels, and the way staff were deployed did not always ensure people were safe and their needs were met. The oversight of people who required additional support to remain safe was inconsistent. We raised these issues with the provider who reviewed their staffing levels and very quickly arranged for additional extra staff hours.

People were not always supported by staff who had the training and skills to meet their needs. This was particularly the case when supporting people whose behaviours challenge the service, and those people living with dementia. Plans of care were not always reflective of people’s needs and one person did not have a care plan or risk assessments in place for a high-risk need.

We made a recommendation about improving the support given to people living with dementia.

People’s rights were not always protected by the actions of the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We saw people had been moved to different areas of the home without the appropriate best interests reviews and consultations.

We observed some positive interactions between staff and people who lived at the home. However, people did not always receive care in a timely way and that was personalised to meet their preferences and choices. Staff shortages, and the lack of an activity co-ordinator, had meant that people had limited support with their interests or to be engaged in meaningful activities. People told us they enjoyed the food and their dietary needs were monitored.

People told us staff were kind and caring. Relatives also praised the caring attitude of the staff team. They gave us positive feedback about how they were supported to maintain relationships across the pandemic and lockdown.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at

Rating at last inspection

The last rating for this service was good (published 24 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about infection control and leadership of the service. A decision was made for us to inspect and examine those risks.

We inspected and found there were further concerns, so we widened the scope of the inspection to become a comprehensive inspection

Inspection areas



Updated 16 June 2021

The service was not safe.


Requires improvement

Updated 16 June 2021

The service was not always effective.


Requires improvement

Updated 16 June 2021

The service was not always caring.


Requires improvement

Updated 16 June 2021

The service was not always responsive.



Updated 16 June 2021

The service was not well-led.