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Archived: Stonedale Lodge Care Home Requires improvement

Reports


Inspection carried out on 3 February 2016

During a routine inspection

Situated in the Croxteth area of Liverpool, Stonedale Lodge Residential and Nursing Home offers personal and nursing care for one hundred and eighty people. The provider is BUPA Care Homes (CFC Care) Ltd. Accommodation is provided on six units, each with 30 beds. Dalton and Anderton units provide personal care for people living with dementia, Clifton unit provides nursing care for people living with dementia, Blundell and Townley provide general nursing care and Sherburne unit provides general personal care.

This unannounced inspection of Stonedale Lodge Residential and Nursing Home took place over three days from 3 – 5 February 2016. At the time of our inspection 117 people were living in the home.

There was a registered manager in post. 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 previous inspection 9-12 June 2015 the provider was found to be inadequate and the service was placed in ‘special measures’ by CQC. We found breaches of regulations in all key questions we inspect (safe, effective, caring responsive and well led).

The purpose of 'special measures' is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in 'special measures' are inspected within six months of the publication of the inspection report.

At this inspection we found improvements had been made. This meant the service was no longer rated inadequate and could be removed from 'special measures' by the Care Quality Commission (CQC).

Following the inspection in June 2015 we also issued an urgent statutory notice requiring the provider not to admit any further people to Stonedale Lodge Residential and Nursing Home. In light of the improvements we found at the February 2016 inspection we have now lifted this statutory notice which prevented people being admitted to the service.

The breaches of regulations we identified in June 2015 were now met. We have revised the rating for the home following our inspection though the service cannot be rated as ‘good’. To improve the rating to ‘good’ would require a longer term track record of consistent good practice.

Following the last inspection staffing numbers were found to be adequate so that people were supported safely; thus promoting better consistency of care and improving staff morale Our observations and feedback from people who were living at the home and relatives indicated people were now supported by sufficient numbers of staff to provide safe care and support in accordance with individual need.

The staff we spoke with were aware of what constituted abuse and how to report an alleged incident. The registered manager demonstrated they were keen to liaise and work with the local authority safeguarding team and agreed protocols had been followed in terms of reporting and ensuring any lessons had been learnt and effective action had been taken.

We found that the home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Although care practices were consistent and this indicated staff were generally following good practice we found some hesitancy around fully understanding the use of the ‘two stage mental capacity assessment’ and when this should be used.

We made a recommendation in the report regarding this.

Staff involved people in discussions about their care an

Inspection carried out on 9-12 June 2015

During a routine inspection

Situated in the Croxteth area of Liverpool, Stonedale Lodge Residential and Nursing Home offers personal and nursing care for 180 people. The provider is BUPA Care Homes (CFC Care) Ltd. Accommodation is provided on six units, each with 30 beds. Dalton and Anderton Units provide personal care for people living with dementia, Clifton Unit provides nursing care for people living with dementia, Blundell and Townley Units provide general nursing care and Sherburne Unit provides general personal care.

This was an unannounced inspection which took place over four days on 9, 10, 11 and 12 June 2015.

The service had a registered manager in post at the time of this 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.

Prior to our inspection we received information of concern regarding staffing levels at the home, standards of care and the cleanliness and hygiene of the home. The registered manager for the home also informed us [CQC] that seven staff had been suspended from one of the units in the home.

When we carried out our inspection we looked at these areas. We found evidence that supported the concerns around staffing and standards of care. We also found the management of medication in the home to require improvement. The health and wellbeing of people living at the home was placed at risk by these factors.

During this inspection, we looked to see if there were systems in place to ensure the proper and safe handling of medicines. We found there were risks to people. Medicines were being given late or missed, people’s pain relief was not being managed, nutritional supplements were missed as they were not available, medications records were poor, medication administration did not always follow professional advice, ‘give when required’ medicines and creams were poorly recorded and monitored, medicines were left unattended and some medicines including a controlled medicine, were out of date. This placed people at risk of not receiving their medicines safely.

On the inspection we visited each of the six units in the home and checked on levels of staffing for each shift. As part of these checks, we looked at the skills and experience of care staff and how any staff absences were covered by the provider. We found there was insufficient numbers of staff for the home over a long period of time which meant some units had experienced staffing levels below the provider’s stated safe levels. This had potentially placed some people at risk of harm.

We found the review of some people’s health care needs was not consistent. This related mainly to people living on Blundell unit where we spent most of our inspection. For example wound care management had been missed in terms of on-going review, people were experiencing pain and this had not been managed effectively. We spoke with one visiting health care professional who told us that staff were not always consistent in carrying out planned or prescribed care.

We looked at the care record files for people who lived at the home. We found that some care plans and records were individualised to people’s preferences and reflected their identified needs but many were not. We found examples were staff had not updated care plans and records as care needs had changed and examples where care planning had not been individualised with respect to people’s individual care needs.

We were advised that currently a number of people living at the home had developed pressure ulcers following admission to the home. At present the routine programme for people needing assistance for pressure relief was not individualised and was carried out routinely four hourly. We were advised by the unit manager that many people needed attention two hourly but there was not always enough time and staff to carry this out.

On occasions we saw staff respond in a timely and flexible way. This was not, however, always the case and depended on numbers of staff. We saw a marked deterioration in the ability of staff to respond so people did not have to wait if they needed support.

When we spoke with staff they felt supported by their unit managers and they told us they felt there was an open culture and they were confident to report any concerns. They did not feel well supported by the site management however and felt there was a lack of communication overall. Staff did not feel their concerns about staffing were being listened to and acted upon. They felt as there had been a number of registered managers the frequent change was not good.

You can see what action we took at the back of this report.

We found the home was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions. Where people had lacked capacity to make decisions we saw that decisions had been made in their ‘best interest’. We saw this followed good practice in line with the MCA Code of Practice.

We found the home supported people who were on a deprivation of liberty authorisation [DoLS]. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

On this inspection we found the service had failed to notify the Care Quality Commission [CQC] of people who had been placed on Deprivation of Liberty authorisations.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

Staff we spoke with had a good understanding of the importance of maintaining people’s safety in terms of reporting any concerns, including alleged abuse, to the manager of the home. We found the home had effective policies and procedures on safeguarding which staff were aware of.

We found during our inspection that people were assessed for any risks regarding their health care needs. The quality and consistency of these assessments varied on different units. We found some people’s health care needs needed closer assessment and monitoring.

Prior to the inspection we received concerns around the cleanliness and hygiene in the home. At this inspection we found that the management of infection control had been an issue at one time but there had been improvements made. On the inspection we visited all of the units in the home and found them to be clean. Staff were seen to adhere to basic infection control practice when attending to people and serving meals. We saw there were hand wash facilities available in all bathrooms and toilets including liquid soap and paper towels for use.

We found there was training and support in place for staff. New staff we spoke with said they had attended and felt the induction prepared them for their role. Extra training was included for nursing staff and senior carers if needed. Staff felt well supported on the units in all areas except for staffing.

We discussed with staff and the people living at the home how meals were organised. We recorded mixed opinions but generally people told us the meals were good and well presented. We saw that people who needed support to eat had sufficient staff time allocated and that staff took time to talk to and socialise with people. However, we saw examples on some days, on residential units who lacked enough staff, or nursing units who had no hostess for the day, where meals were late or rushed.

We observed the interactions between staff and people living at the home. We saw there was a rapport and understanding. When staff were involved in delivering care we saw they took time to ensure they communicated well and reassured people. Most of the people living at the home we spoke with gave positive feedback regarding staff approach and attitude. We saw good examples of staff maintaining and prioritising people’s sense of privacy and dignity.

Not all staff we spoke with had a good knowledge of people’s needs. The managers on units told us of the value of building consistent relationships and having continuity to the care provided but felt this was an area that needed improving with more consistent staffing.

We asked people who lived at the home how they spent their day. We found variations between units as to the level of daily activities for people. On some units we found activities were taking place. People appreciated the activities they took part in and the hobby therapists displayed good skills in encouraging people to be involved.

A complaints procedure was in place and most people, including relatives, we spoke with were aware of this procedure. We spoke with the registered manager who showed us how complaints were recorded and responded to.

Special measures.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 16 December 2014

During an inspection looking at part of the service

We visited Stonedale Lodge Residential and Nursing home to review our findings of non-compliance in one outcome at our inspection in July 2014. The inspection team who carried out this inspection consisted of two adult social care inspectors.

We considered all the evidence we gathered under the outcome we inspected. We used the information to answer the five questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

As part of this inspection we visited four of the six units on site, spoke with six people who use the service, the Registered Manager, 18 staff, and one relative. We looked at some people�s personal care records and staff duty rosters.

Below is a summary of what we found:

Is the service safe?

We last inspected Stonedale Lodge Residential and Nursing home in July 2014. At that time we found there were not enough staff to meet people's needs, to ensure their care was delivered in a timely manner. Following the inspection the provider sent us an action plan which detailed how the service was to meet the requirements. On this inspection we checked to see whether improvements had been made.

We found the number of staff working throughout the home had increased since our last inspection. The registered manager advised us that they reviewed staffing levels daily with each house manager to ensure there were sufficient numbers of staff on duty to meet people's needs. The home was now operating with additional staff.

We spoke with people who lived at the home. A person told us,� I am very happy, I get well cared for. Another told us, �If I press the buzzer the staff come fairly quickly. Sometimes you need to wait but you know they are busy with someone else.�

Is the service effective?

People who lived at the home and staff told us that staffing levels were sufficient to ensure people received the care and support they needed. We observed people had staff support with eating and drinking.

Is the service caring?

People who lived at the home described staff as 'lovely' and 'kind hearted'. People's comments included, "I know I get very well looked after" and "Everyone is very nice with me." Relatives we spoke with told us, "This home is like a family. The staff are very good."

We saw that staff were respectful and warm in their interactions with people who lived at the home.

Is the service responsive?

Activities were provided on each house by four dedicated activities coordinators. We saw activity boards in the houses we visited. Activities were provided six days a week. Some people who lived in the home told us they would like more activities. A visitor we spoke with felt the home should have a minibus to take people out into the community. On the day of your inspection we saw staff accompanying someone to a birthday lunch with their family as they needed assistance. One person also was supported to support their local football team.

Is the service well led?

The service was managed in a way that aimed to protect people's health, safety and welfare. The manager had taken action to improve the service through providing greater staffing levels. Staff we spoke with felt supported by their house manager and the registered manager. Their comments included, "Everything works so well now, we have really turned a corner", �We did have problems in the past but things flow smoothly now. We get time to sit with the residents� and "We get really good support from the manager. Anything we need we just have to ask.�

Inspection carried out on 30 July and 1 August 2014

During a routine inspection

The inspection team who carried out this inspection consisted of three adult social care inspectors. This was an unannounced inspection of Stonedale Lodge. The inspection also set out to answer our five questions:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

As part of this inspection we spoke with 13 people who use the service, the Registered Manager, 13 staff, the chef, five relatives and a visiting professional. We reviewed 12 care plans and staff duty rosters. Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home was well maintained and serviced regularly.

We spoke with people who lived in the home and some relatives who felt staff were always rushed. We spoke with staff. They told us they felt that they were under pressure most of the time to deliver care but particularly mornings as this was seen as the busiest time. We observed that some people had food debris on their clothing left over from breakfast and some people were observed to have had poor attention paid to hand hygiene and their nails were not clean. A relative told us that standards of personal care were not always maintained; for example lack of attention to denture care. They put this down to lack of time for staff to attend to people.

The Registered Manager told us they assessed staffing need each day and moved additional staff where and when they were needed. They told us they did not use a dependency rating assessment tool to determine the number of staff required. We saw staffing rotas which showed staff were moved from one unit to another to meet individual people�s needs or staff shortages.

People we spoke with told us staff were caring and treated them with kindness and respect. They told us they felt safe and well cared for at Stonedale Lodge Residential and Nursing Home.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection an application for a Deprivation of Liberty Safeguard to keep a person safe had been completed and sent to the local authority. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. Records showed all staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people�s care and support needs and that they knew them well.

People�s health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People�s care plans reflected their current needs.

Where specialist support was needed, for example, with a person�s nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people�s health, well-being and independence.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. The staff ensured people�s comfort and dignity at all times. The people we spoke with told us the staff were kind and helpful. People�s comments included, "I am looked after well�, �If I need the doctor staff organise it right away�� and �Staff are very caring, nothing is too much trouble.� A visitor told us, �The staff here are fantastic.� Another said, �The staff go above and beyond for my relative.�

Staff had a good knowledge about people�s care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirements.

People who lived at the home and their relatives had the opportunity to participate in regular satisfaction surveys and could also provide feedback via the resident�s and relative�s forum.

Is the service responsive?

People�s needs had been assessed before they moved into the home. Records confirmed people�s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

From our discussions with staff and looking at a number of care records we could see that people�s plans of care were revised to meet any change in need, for example, deterioration in a person�s medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

Staff we spoke with said they received good quality training and support.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey.

During a check to make sure that the improvements required had been made

During our inspection of 3 February 2014 we found that night time staffing levels were insufficient to meet people�s needs on Clifton and Blundell units. We have reviewed records as part of this review and have found that staffing levels have been increased and maintained on both units. This increase will help to ensure there are sufficient staff available to meet people�s needs in a timely manner.

Inspection carried out on 3 February 2014

During an inspection in response to concerns

We carried out this inspection in response to information of concern which we had received about night time staffing levels at the service. The concerns we received related in particular to Clifton unit.

We started this inspection at 8.15 pm so that we could spend time observing the care and support provided to people. We initially visited Dalton and Clifton units and spent time observing the care provided to people as they had supper and got ready for bed. We then visited the other four units, spoke with staff and where possible with the people living there. As part of the inspection we spoke with 15 members of staff who held different roles. We spoke with eight of the people living at Stonedale Lodge Residential and Nursing Home. Because some of the people living there had complex needs they were not able to tell us their experiences. Due to this we used a formal way to observe people in this review to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI).

We found that there were insufficient staff on Clifton and Blundell units to meet the needs of the people living there safely and well. This meant that people had to wait for the support they required. It also meant that staff were not always available to support people who required reassurance or became agitated. We found that there were sufficient staff on the other units to meet the needs of people as they prepared for bed.

Inspection carried out on 14 November 2013

During a routine inspection

During this inspection we used a number of different methods to help us understand the experiences of people using the service. We spoke with twenty one of the people living at Stonedale Lodge and with eight of their visitors. We also interviewed fourteen members of staff. Some of the people using the service had complex needs which meant they were not able to tell us their experiences. Due to this we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI).

The people living at Stonedale Lodge told us that they had been happy with the support they had received. Their comments included, �I find it very good,� and �I am delighted to say it�s friendly. They treat you like their mother or father.� We observed that staff respected people�s dignity. Staff interacted with people as well as providing support with their care needs. One person told us, �Staff have good manners I am really impressed with them.�

We found that people had received the support they needed with their care and welfare. Records of people�s support needs were up to date and staff had the skills and knowledge to provide the support people needed. There were sufficient staff available to meet people�s needs.

Systems were in place to deal with concerns or complaints raised and people told us that they would feel comfortable raising a concern if they needed to.

Inspection carried out on 7 September 2012

During a routine inspection

During our visit to Stonedale Lodge Residential and Nursing Home we spoke with eighteen of the people living there. We also spoke with eleven visitors and with twenty one members of staff who held different roles within the home. We examined a sample of records and spent time observing the support staff provided to people living at the home.

People told us that they had received the support they needed with their health and personal care. Comments included, �They don�t tell you what you need, they discuss� and �We are looked after". They told us that they liked the staff team, with one person describing them as, �Kind and caring�.

We asked about the meals that had been provided and comments varied from, �Lovely� to �It�s not bad�. Several people commented that they had had �A lot of chips� on the menu.

People told us that they had felt safe living at the home. They said they would not have hesitated to discuss any issues they had had with staff. One person explained, �I would go to the staff, without a doubt they would help you�.

Visitors and the people living there told us that they had been consulted about the care that had been provided, with one person explaining, �A manager came, asked if you are satisfied with everything�.

Inspection carried out on 29, 31 December 2010

During an inspection in response to concerns

One service user was able to express their views of the service. One relative was willing to express their views. Discussion was also held with some of the care staff to obtain their views, and information was obtained from Liverpool Social Services.

The comments received included,

�The staff are lovely and they are caring. They help me to live the way I want to. I like to use my room a lot as there is no-one in the lounge that I can chat to. I can watch the television programmes that I want to in my room. The staff respect this.�

�The staff always make me feel welcome. They look after my relative really well, especially when she is difficult to deal with. I visit every day and I am happy that my relative is getting the best of care.�

The majority of people living in the houses that were visited at Stonedale Lodge have communication barriers. As a result, we observed people during the day in their interactions with staff and with each other. The results of this were mixed, with some staff not meeting peoples� needs and others being supportive in their interactions with people.

Social services informed us of their concerns relating to a high number of altercations that had taken place between service users.

Staff spoken to confirmed that they had been given training in the protection of vulnerable adults and in the care of people who had dementia. Staff said that they felt that they provided a good level of care but needed additional staff to enable them to meet the needs of all the people who lived at the home.