Archived: Stone Gables Care Home

Why we inspected: This inspection was prompted by a serious incident and information of concerns we received.

People’s experience of using this service: During the inspection, we identified many concerns relating to people’s safety. This included the service not having appropriate fire evacuation equipment in place. Also, a lack of training and guidance for staff on how to support people in the event of a fire. There were insufficient staffing levels during the day and at night which all put people at significant risk of harm.

We found the premises and equipment used to support people were not safe or clean. Issues relating to the environment, which we identified at our last inspection, had not been addressed. This included carpeting and flooring being very dirty and smelling of urine. Furniture including beds, armchairs, tables and dining room chairs were dirty and stained. Bedding and towels were very worn, some had holes and were stained. Mattresses were stained, smelled strongly of urine and were wet.

Staffing levels had not been calculated in line with people’s needs. This meant staff struggled to meet people’s needs. Poor standards of care were observed; people had dirty fingernails and some people had food stains on their clothing.

Medicines were not managed safely. Staff did not always have guidance to ensure they administered ‘as required’ medicines to people. Medicines were not stored safely and stock levels of medication were not recorded. Topical cream administration records were not always completed by staff.

Risks to people were not always properly assessed. This included moving and handling, nutritional needs, use of equipment and falls risks. The management team had failed to address this which meant people were at risk of harm.

Assessments of people’s needs were not up to date which resulted in people’s needs not being met.

Systems were not in place to monitor accidents and incidents.

Staff demonstrated a limited understanding of safeguarding and records showed they had not received appropriate training in this area. During our inspection, we reported our concerns to the local safeguarding team. This means external professionals will look into our concerns.

The provider did not always maintain appropriate records relating to the requirements of the Mental Capacity Act 2005 (MCA). There was a failure to properly oversee and make applications for authorisations under the Deprivation of Liberty Safeguards (DoLS). People had not been included in decisions about their care.

People living with dementia did not have their care provided in line with best practice. This impacted on their quality of life and wellbeing. We have made a recommendation about this. People spent lengthy periods of time in the communal area; in the same chairs, only moving to attend for their meals in the adjoining room or to use the toilet.

An activity staff member was in post, but they had not received any training on how to plan and facilitate meaningful activities for people. Activities were often attended by the same people leaving others unstimulated.

People’s nutritional needs were not always met and advice from health care professionals was not always followed. This put people at risk of receiving inappropriate and unsafe care.

Staff did not always receive an induction, or complete mandatory training to ensure they had the skills they required for their roles. Staff did not always receive supervision and appraisal of their performance.

In August 2018, the registered provider went into administration. The administrators had employed a care company to run the home while a buyer was sought and had oversight of their management.

The governance of the service was poor. The provider had an awareness of the issues we identified, but had not mitigated risks within the provision associated with issues we found.

After the first day of the inspection, we requested an urgent action plan from the provider to tell us how they would address the concerns we found. They responded with a plan which gave timescales for the completion of works. We visited the service again to follow this up and found that not all of the actions had been completed. We found there were no plans in place as to how these would be met. We continued to monitor the service regarding the improvements they were making.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 4 April 2018). This service has been rated Requires Improvement at the last three inspections.

Enforcement: The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

At our last inspection on 13 and 16 March 2016, we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found staff did not receive appropriate supervisions or training in accordance with the provider's policy. At this inspection, we found the service had made improvements in this area. However, we found overall, other elements of the service had deteriorated resulting in three breaches of Regulation.

Stone Gables Care Home 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. Stone Gables Care Home provides care and support for up to 40 older people. The service provides support for people who may be living with dementia. At the time of our inspection, 34 people were using the service.

The manager of the service was not registered with the Commission at the time of the inspection. However, they had applied and attended an interview to be registered. We will refer to them as the home manager throughout this report. 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.

We found concerns with poor care and support delivery at the home that necessitated a referral to the local authority commissioning and safeguarding team to ensure people's health and wellbeing. These shortfalls had not been identified by the current management team.

The environment of the home was not well maintained, clean or hygienic. We saw furniture was not clean and people were at risk of infection. The registered provider had failed to take action in response to concerns raised about the environment.

Risks to people's health and wellbeing were not always appropriately assessed and reviewed. Care plans were not sufficiently detailed to provide an accurate description of people's care and support needs.

People's health care needs were not consistently assessed, monitored and recorded. People had regular contact with health care professionals however, we saw records were not always updated to reflect this. Referrals to professionals were not always followed up .

Medicines were not always managed safely at the home. People were at risk of not receiving their 'as required' (PRN) medicines when they needed them due to the lack of protocols in place to guide staff.

All staff had completed training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The home manager had submitted applications to the local authority for all people using the service to lawfully deprive people of their liberty. Assessments of people's mental capacity had not been carried out in relation to their ability to give consent.

We received mixed feedback on the availability of activities. We observed that people living with dementia were at risk of not having their social needs met. We have made a recommendation about this.

Staff were recruited safely with appropriate checks completed to ensure they were suitable to work with vulnerable people. Induction training was completed by staff but this was not based on the Care Certificate. We have made a recommendation about this.

Supervisions were completed regularly. However, none of the staff had had an appraisal. We have made a recommendation about this.

The registered provider had systems in place to seek the views and opinions of people, their relatives and staff. However, they had failed to take action in response to concerns raised.

Systems in the service that were meant to monitor and identify improvements were not effective and records were not always maintained and completed in full. The lack of effective governance led to people not receiving safe and consistent care.

During this inspection, we found the provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These are Regulation 11 Need for consent, Regulation 12 Safe care and treatment and Regulation 17 Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Stone Gables Care Home provides care and support for up to 40 older people. The service did not have a registered manager. A manager had been recently appointed on 30 January 2017 and told us they would be applying to register as the manager of the service. 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.

Staff supervisions were not always completed by the manager. We found gaps throughout the training matrix where some staff had not received supervision for over six months. Since the new manager had started in January 2017 we found most staff had received supervision. Appraisals had taken place.

We found gaps throughout in staff training which included safeguarding and food hygiene. The manager told us they were aware of these gaps and these had been identified in the audit. A meeting had been booked with the owners to look and book staff on these training courses.

We did not see many activities taking place during both days of our visits. The home was in the process of recruiting a new activity person due to a vacancy from the end of December 2016. The manager and deputy manager had arranged for the care staff and outside entertainers to support activities until this process had been completed. However, some staff told us they did not always have time to do this.

People told us they were happy living at the home and enjoyed the company of staff and others they lived with. People were supported to make decisions and received consistent, person centred care and support. They received good support that ensured their health care needs were met.

Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Risk was well managed and were the least restrictive for people. There was enough staff to keep people safe.

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People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff who administered medication were trained in medicines management.

Health, care and support needs were assessed. The new care plans we looked at reflected these changes and the manager and staff were in regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. We observed some good interactions between staff and people who used the service and the atmosphere was relaxed.

The service had good management and leadership in place. Even though the manager and deputy had only been at the home for around six weeks we had noticed improvements in the home since the last inspection. People had the opportunity to comment on the quality of service and influence service delivery.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People we spoke with told us they were aware of the complaints procedure and would have no hesitation in making a formal complaint if they had any concerns about the standard of care provided.

People were supported with food as and when they required this. Snacks and refreshments were observed throughout the day for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see what action we have told the provider to take at the end of this report.

Stone Gables Care Home provides care and support for up to 40 older people. The service did not have a registered manager. A manager had been recently appointed and told us they would be applying to register as the manager of the service. 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 we spoke with told us they were well cared for and were complimentary about the staff who supported them. They told us they felt safe, enjoyed the food and received good support with their health needs. Staff were friendly and kind. Visitors were happy with the standard of care and told us the service was caring. During lunch there were interruptions which were unnecessary and affected the meal experience for people.

Checks were carried out to help make sure some areas of the premises and equipment within the service were safe. However, we found there were some areas of risk that had not been checked, assessed and managed. People’s medicines were usually managed effectively.

Staff understood how to safeguard people from abuse and were confident that the management team would deal with any concerns appropriately. Staff felt well supported and received a variety of training sessions including DVD’s, external training providers and distance learning workbooks to help their development. However, knowledge around the Mental Capacity Act 2005 (MCA) was varied. Assessments and decision making processes where people did not have the mental capacity to consent did not always meet the requirements of the MCA.

The management team were improving social activities and the care planning process to make sure people’s needs were identified and care was appropriately planned. People were being involved in reviewing their care needs.

There were enough staff to keep people safe although sometimes they were sat for long periods with little stimulation; the management team were monitoring staffing levels to make sure they were appropriate. We saw checks were carried out before staff worked at the service but the recruitment policy could not be located so it was unclear what procedure should be followed.

People were complimentary about the manager. The management team were being supported by an external organisation to help make sure they understood their role and responsibilities. Systems were being developed for monitoring the quality and safety of the service. People were informed how to make a complaint if they were unhappy with the service they received.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.