Stoneygate Ashlands

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

Staff deployment did not consistently meet people's individual care needs. This had impacted on the length of time people had to wait for assistance. People repeatedly told us this caused them frustration and distress.

The provider’s systems and processes were not fully robust or effective in taking action to make improvements. There was no current action plan to drive forward improvements. Care documents were not accurately maintained. This raised concerns about management, leadership and oversight.

The service was not always person centred or inclusive. Social opportunities and activities including people enjoying interests, hobbies and pastimes were limited or not available. People did not feel listened to or valued. They had repeatedly raised concerns about the choice and quality of foods. Whilst the management team were addressing this, this had been ongoing for a long time with still no specific date for change.

A new manager and regional support manager had recently commenced. They showed a commitment in making improvements and developing the service and had started this work. As a result of this inspection, they took direct action in relation to documentation that needed improving to ensure people’s safety. A review of care records was ongoing.

People received their prescribed medicines safely. Medicine were stored and managed in line with best practice guidance and staff had received training and their competency assessed.

Staff had received safeguarding training and were knowledgeable about their responsibilities to protect people from avoidable harm.

The environment was clean and hygienic and infection prevention and control best practice guidance was followed.

Lessons were learnt when things went wrong, and actions were taken to reduce further risks. The provider was compliant with their duty of candour requirements.

Resident meetings had recently been reintroduced to enable people to share their views and to receive information about the service.

The service had developed positive relationships with external health and social care professionals.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was good (published 19 February 2020).

Why we inspected

This focused inspection was prompted by a review of the information we held about this service.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. Two breaches were identified in relation to good governance and staff deployment. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Stonygate Ashlands is a residential care home providing personal care to up to 37 people. At the time of the inspection, the service was supporting 31 people.

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

People and their relatives told us they continued to receive safe care, and staff we spoke with understood safeguarding procedures and how to raise concerns. Risk assessments were in place to manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Medicines were stored and administered safely.

Staff were provided with sufficient training which was kept up to date. Staffing support matched the level of assessed needs within the service during our inspection. People told us there were generally enough staff, and call bell logs we saw showed that people were responded to promptly.

Staff acknowledged there had been several changes in management, but told us they were supervised well and felt confident in their roles.

People had mixed feedback on the quality of the food, but told us they had a good choice and had snacks and drinks as they required.

Healthcare needs were met, and people had access to health professionals as required. People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with kindness, dignity and respect and spent time getting to know them. People were supported in the least restrictive way possible. Care plans reflected people likes, dislikes and preferences.

An activities programme was in place and activities staff were deployed throughout the home on a daily basis.

People and their families were involved in their own care planning as much as was possible. A complaints system was in place and used effectively.

There was not a registered manager in place. The management team were open and honest, and worked in partnership with outside agencies to improve people’s support when required.

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 08 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stoneygate Ashlands provides accommodation and personal care for up to 37 people. The service specialises in caring for older people including people living with dementia or those who require end of life care. The accommodation comprises individual en-suite rooms, and there were 36 people living in the service at the time of our inspection visit.

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.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Most of the relatives we spoke with were also complimentary about the staff and the care offered to their relatives. People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. People’s care and support needs had been assessed and people were involved in the development of their plan of care. Staff had a good understanding of people’s care needs; access to people’s care plans and received regular updates about people’s care needs.

People were provided with a choice of meals that met their cultural and dietary needs. The catering staff were provided with up to date information about people’s dietary needs, and sought the opinions of people to tailor their individual meal choices. Medicines were ordered, stored and administered safely and staff were trained to provide the medicines people required.

Care plans included the changes to peoples care and treatment, and people attended routine health checks. Staff sought medical advice and support from health care professionals. There were sufficient staff available to meet people’s personal care needs and we saw staff worked in a co-ordinated manner.

There were sufficient activities provided over five days of the week, with additional volunteers helping in the ‘gardening club’. The provider had engaged with a group from learning for the forth age (L4A) to identify and provide appropriate activities and pastimes. People were able to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the service. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

Staff told us they had access to information about people’s care and support needs and what was important to people.

Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew these would be acted on.

The provider had a clear management structure within the service, which meant that the staff were aware who to contact out of hours. The registered manager undertook quality monitoring in the service, which was overseen by a director of the company.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives. We received positive feedback from visiting professionals with regard to the care offered to people and professionalism of staff. Staff were aware of the reporting procedure for faults and repairs and had access to emergency maintenance information to ensure emergency repairs were arranged promptly.

Stoneygate Ashlands provides accommodation and personal care for up to 37 people. The home specialises in caring for older people including people living with dementia or those who require end of life care. The accommodation comprises individual en-suite rooms, and there were 37 people living in the service at the time of our inspection visit.

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.

The administration of medicines was not consistent. Checks undertaken to ensure medicines were administered safely, were not robust which meant a number of shortfalls not being identified or addressed. Medicines were safely stored, however we noted aspects around the administration and recording of medicines which needed to be improved.

Care planning and risk assessments recognised people’s individual needs, and care plans provided detailed information about people’s individual preferences. People were encouraged to take part in meetings to review their care plans. Records and observations provided evidence that people were treated in a dignified way which encouraged them to feel valued. Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the home. The home had sufficient suitably recruited and trained staff to care for people safely. The environment of the home was safe for people and safety checks were regularly carried out. Staff had received up to date training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They understood that people should be consulted about their care and the principles of the MCA and DoLS. People were protected around their mental capacity.

People’s nutrition and hydration needs were met, most people enjoyed the meals, however some were given choices that they previously indicated they did not like. Risks to people’s nutrition were assessed and specialist advice was followed. People were treated with kindness and compassion and we saw staff had a good rapport with people, treating them with dignity and respect. Staff had knowledge and understanding of people’s needs and worked together well. People were encouraged to engage in activities though some felt there was not enough to do and were bored. Some people would benefit from one-to-one support which was not being offered at the time we inspected. Staff were responsive to people’s needs and understood people’s individual requirements so that they could support them in the way they preferred.

People told us they were aware how to make complaints and who they could complain to. The results of complaint investigations were clearly recorded.

The registered manager did not have an effective quality assurance system in place. Records were not reviewed thoroughly or issues picked up by the current auditing system. The registered manager had an understanding of their role and they consulted with people who lived at the service, people who mattered to them, staff and health care professionals, in order to identify required improvements. Staff were supported and trained for their role.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We asked people if they felt their care needs were being met as they wanted them to be. Some people told they were most of the time but sometimes call bells were not always answered as promptly as they would like as staff were very busy. We spoke with the manager who told us their staffing levels were designed to meet the needs of people using the service and they were reviewed regularly to ensure that there were enough staff. We did not find evidence to suggest people were not having their needs met such as increase in falls or pressure care.

We looked at how the home protected people from abuse. People told us that staff were kind and they felt safe, visitors said they felt they were leaving their relatives in a safe environment. We saw that staff received safeguarding training. We saw that they responded to allegations of abuse promptly.

We asked people if they felt staff were well trained and they said that staff know what they are doing. Although we were told by visitors that they felt that not all staff had the same knowledge based on their experience. We saw records that showed staff receive ongoing training and supervision.

Most of the people we spoke with thought there were enough staff to meet their needs, although one person commented: 'The staff ' they have no time to talk.' During our inspection, we saw that care workers took time to talk with people whilst they delivered care.

The provider was introducing new systems to monitor the quality of the service. People using the service were encouraged to contribute their views by attending meetings or completing satisfaction surveys. Two of the people we spoke with were not aware of this, but we saw that people had been offered support to give their views. One of the people we spoke with commented: "The care has been to the uppermost and very best. It is lovely here.' A relative of a person using the service also contacted us following our inspection and told us: "The staff treat my wife with dignity in a friendly atmosphere, which is now only being enhanced by the recent arrival within the past year of the current manager, who is determined to maintain and improve the appropriate standards of care my wife and the other residents require."

We did not ask people about how they were protected from abuse, but we saw the provider had systems for identifying and reporting abuse. Staff were aware of reporting systems. We found the provider had not ensured that all incidents were reported to the appropriate bodies.

People told us they liked the food and there was plenty available. However, visitors told us people were not given food that was suitable for their nutritional needs. We found that staff had not been given adequate information or training about protecting people from malnutrition and dehydration.

Visitors told us there were not enough staff to meet people's needs. People who needed additional support or who had changing or complex needs did not receive the support they needed, because there were not enough staff.