Stonecross Care Centre

Stonecross Care Centre is a residential care home registered to accommodate up to 32 people in need of personal care. Accommodation is provided over 3 floors with some rooms having en-suite facilities. On the days of the inspection there were 20 people living at the home.

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

Aspects of staff recruitment were not completely effective at ensuring staff members were always suitable to work with vulnerable people. Some essential safety checks had not been made. This was a breach of regulation at the last inspection and we found this was a continuing breach at this inspection. There was no documented provider oversight of these processes.

Care, support and environmental risks to people were not always appropriately identified, assessed or managed. At the last inspection, there were significant fire safety issues. The local fire service intervened. Although we noted some improvements in that position and other environmental concerns, issues were still outstanding and the provider had no active plan to resolve matters.

People received their medicines as prescribed by health care professionals. Some medicinal cream use required attention but these were addressed at inspection.

Infection, Prevention and Control (IPC) processes were appropriate and we were assured about the service's ability to mitigate the transmission of infections. The service had recently been visited by a local authority specialist and we noted most recommendations had been acted upon.

Staff were competent with safeguarding processes and knew how to protect people from abuse. Relatives said their loved ones felt safe in the home and were trusting of staff and management. We observed good practices and interactions between staff and people during the inspection. The service's safeguarding processes were robust.

Staff supported people to have access to healthcare professionals and specialist support and the service worked with external specialists. Professional's views on the service were mixed but those we spoke with at inspection said that the service was improving.

People were confident in the management team at the home and praised how approachable they were.

The service made appropriate notifications to CQC and other authorities of safety incidents to ensure these incidents received appropriate oversight.

The manager and registered provider was responsive to concerns noted during the inspection and started to take action to make improvements and promote safety within the home.

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 30 June 2022) and there were breaches of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

At this inspection, we found there were only limited improvements and the provider continued to be in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains 'requires improvement' based on the findings of 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.

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

Enforcement

We have identified breaches in relation to risks to people, unsafe recruitment processes and the governance of the service at this inspection. In this connection, the provider was issued with 2 Warning Notices. This means we may take further action if the provider does not comply with the Notice and the breaches are continuing.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority and other partner agencies to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stonecross Care Centre (Stonecross) is a residential care home providing personal care and accommodation to older people. At the time of the inspection, 28 people were receiving regulated activities at the home. The service can support up to 32 people. The home is an adapted building with two lounge areas and a dining room on the ground floor. Bedrooms are based over three floors.

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

People were not always safe. People were not safe in the event of a fire or a fire alarm sounding at the home. Risk was not appropriately identified, assessed or managed in a timely way. During the inspection, we identified substantial and widespread failings in respect of fire safety arrangements and in the leadership and governance of the service. Not all staff had been trained in fire safety and had not received instruction or had experience of using equipment which was central to fire evacuation processes.

During the inspection, the fire service inspected the home and issued immediate enforcement processes against the provider for a number of fire safety issues.

People could access materials that were harmful to them and, on occasions, an empty kitchen. These were safety issues for some of the people who lived in the home and supported that governance systems were not robust and had failed to identify key concerns. Oversight within the home was inconsistent with a number of managers being appointed in a short space of time. This contributed to people being exposed to the risk of harm.

Recruitment and staff disciplinary processes did not meet current legislation and guidelines. They were not effective at ensuring staff members were always suitable to work with vulnerable people. Some essential safety checks had not been made and, in one case, staff disciplinary action had not been scrutinised at the right level or had any provider or expert oversight. A temporary staff member who was not providing direct care to people was working and there were no records available to support any checks had been made about whether they were appropriate for the role.

People received medicines as prescribed and visiting professionals were complimentary about the care and support people received.

Infection, Prevention and Control (IPC) processes were appropriate and we were assured about the service's ability to mitigate the transmission of infections.

Staff were competent with safeguarding processes and knew how to protect people from abuse. Relatives said their loved ones felt safe in the home and were trusting of staff and management. We observed good practices and interactions between staff and people during the inspection. The service's safeguarding processes were robust.

Staff supported people to have access to healthcare professionals and specialist support and the service worked well with external specialists.

The provider and managers acted during and immediately after the inspection to address the risks we found. This included improved monitoring, checks and reviews.

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 4 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we carried out a focused inspection to review the key questions of safe and well-led only. 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.

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.

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

You can see what action we have asked the provider to take at the end of this full report.

The registered provider has been responsive to concerns noted during the inspection and has started to take action to make improvements and promote safety within the home.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stonecross Care Centre 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 of the regulations in relation to management of risk, recruitment of staff and governance at this inspection.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority and fire service to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Visitors were able to spend time seeing and speaking with loved ones in a suitable safe space by arranged appointments. Families had been supported to spend time with people at the end of their lives in a safe and dignified manner. The socially spaced layout of furniture and designated different uses of areas ensured good practices of infection prevention and control were carried out.

People who required isolating were supported in designated rooms and areas of the home. A dedicated team of staff were also allocated who could support all their needs. People had access to and were supported in the use of technology for Zoom or Facetime calls to keep in touch with friends and family.

Regular home testing was in place and any admissions to the home were made following current guidelines and recommended practices.

Staff had been trained in infection control practices as part of their induction and further training had been completed with an external trainer to include any changes relevant to Covid-19. The home had a designated cleaning staff team and audits on cleanliness and infection prevention and control were completed.

People had been supported to access their own GP via a virtual call as and when they needed to. People had also been supported to be seen by the community nurses to receive care and treatment as they required.

Stonecross Care Centre is a residential care home that provides accommodation and personal care for up to 32 older people, some of whom are living with dementia. At the time of this inspection there were 28 people living there. The home is a period property that has been suitably extended and adapted for it’s purpose and there is a large secure garden.

People’s experience of using this service:

There were sufficient numbers of suitably qualified staff to meet people’s needs in a timely manner. People and their relatives told us there were always enough staff available to assist them. One person told us, “There’s plenty of staff about and they come when you need them to.” Staff had completed training that enabled them to deliver good care and support to people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Medicines were stored and managed safely and people received their medicines as they had been prescribed.

People’s privacy and dignity was respected. One person told us, “If I don’t want to go downstairs, staff pop up and check if I need anything.” We saw kind and caring interactions taking place. We were told, “The staff are very nice, very helpful, good mannered and very polite.”

There was a varied and individualised activity programme in place that ensured people lived a fulfilled life of their choosing. The service has strong community links including hosting a regular mother and toddlers’ group.

There was a particularly strong emphasis on continuous development and improvement of the service with staff gaining additional qualifications and the implementation of electronic care records.

A variety of audits were in place that demonstrated the service was monitored and safe for people to live in. Feedback about the service was consistently good especially from health professionals we spoke with. One health professional said, “They [staff] work exceptionally hard with people they have referred to us. They follow our instructions and it shows in that those people no longer require our service.”

Rating at last inspection:

At the last inspection the service was rated good (published October 2018).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received we may inspect sooner.

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

Stonecross Care Centre is a residential care home that provides personal care and accommodation for up to a total of 32 people. Accommodation can be provided over three floors and there is a lift to access each level. The home is located close to the town centre of Kendal. There is a large accessible outdoor area which is well furnished for people who wish to spend time outside. There is a raised bed gardening area that was being developed by people who live at the home and ample car parking space. There were a variety of communal areas available throughout the home and these were well equipped with items of interest to the people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the (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 2008 and associated Regulations about how the service is run. On the day of the inspection visit the registered manager was on annual leave and the home was being overseen by the deputy manager.

When employing fit and proper persons the recruitment procedures of the provider were not always followed.

We made a recommendation that the provider follows their own policy and procedures when employing people to ensure that all the checks of suitability made were robust.

Medicines were being administered and recorded appropriately and were being kept safely.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

People’s rights were protected. The management team was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body and was required to maintain their safety and welfare.

Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access meaningful and individually tailored activities and pass times of their choice.

More formal audits and quality monitoring systems had been implemented to allow the service to demonstrate effectively the safety and quality of the home.

There was a registered manager in post. A registered manager is a person who has registered with the (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 2008 and associated Regulations about how the service is run.

During this inspection we found breaches of Regulation 12 Safe care and treatment and of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that some of the incidents should have been reported to us (CQC) but the provider had not done so. This is a breach of Regulation18 of the Care Quality Commission (Registration) Regulations 2009. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

Stonecross Care Centre is a residential care home that provides personal care and accommodation for up to 32 people. Accommodation is provided over three floors and there is a lift to access each level. The home is located close to the town centre of Kendal. There is a secure garden that was being developed at the time of the inspection for people living there to use and some car parking.

There were sufficient numbers of suitable staff to meet people's needs and promote people's safety. The level of staffing observed on the day of the inspection ensured that people had their needs met in a timely manner.

Medications and the management of them was not always done in a safe manner.

People living in the home and relatives spoke highly of the staff and were happy with their care and support.

Staff displayed a caring and interactive approach with people and they were treated with respect. People dignity and privacy were promoted.

Some staff had commenced working without all of the required training skills to meet peoples needs safely. We recommended that the induction training was delivered in line with the company’s training policy and procedures. We also recommended that further training on the requirements relating to the MCA and DoLs is provided.

Assessments made prior to people being admitted to the home lacked vital information about peoples individual care needs.

Care plans and risk assessments made were not always accurate about the needs of people’s health and support that they required.

People were supported with their nutritional needs but where someone had significant weight loss referrals to healthcare professionals were not always made.

People were given opportunities to be involved in hobbies and interests that were important to them.

The provider had a complaints procedure available for people who used the service. People who used the service and their families felt able to raise any concerns they might have with the registered provider, registered manager or any other staff members.

‘You can see what action we told the provider to take at the back of the full version of the report.’