Stonedale Lodge Care Home

Updated 28 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 4 inspectors, 2 medicines inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Stonedale Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Stonedale Lodge Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a manager in post who had submitted their application to register, this had not yet been processed. .

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 December 2023 and ended on 20 December 2023. We visited the service on 7 and 12 December 2023 and worked remotely on 18, 19 and 20 December 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 12 members of staff including the manager, the governance managers, the maintenance person, registered nurses and care staff. We spoke with 7 people and 3 relatives about their experiences of care.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records including 19 people's care records which included medication administration records, and 4 staff personnel files in relation to recruitment. We also reviewed a variety of records relating to the management and governance of the service, including policies and procedures.

After the inspection, we continued to review evidence that was sent remotely as well as seeking clarification from the provider to validate evidence found. We looked at audit and governance data, as well as infection prevention and control policies and procedures.

Updated 28 February 2024

About the service

Stonedale Lodge Care Home is a residential care and nursing home in the Croxteth area of Liverpool, providing personal and nursing care to people aged 65 and over. The service can support up to 150 people across 5 units, each specialising in either residential or nursing care for older people, including those living with dementia. At the time of our inspection there were 122 people using the service.

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

Governance and quality assurance systems were in place however they remained ineffective. This meant people were exposed to unsafe care. There remains a repeated failure from the provider to ensure the delivery of safe, high quality care.

People were exposed to risk of harm as some of their risk assessments were either not reflective of their current needs or contained insufficient detail to help guide staff with how to support them safely.

Medications were not always given in line with best practice guidance and exposed people to the risk of harm.

There were systems and processes in place to help identify and report abuse, however they were not always being used effectively and there were some missed opportunities to safeguard people from harm.

People were not always being cared for in a dignified way. Some people looked unkempt, and some language used in care plans was not respectful.

People told us they liked the staff and they felt safe at the home. They described the staff as ‘kind and ‘caring’ Staff liked the manager and felt they had given 'structure' to the home. The manager understood their duty to share information in an open and honest manner. There was enough staff identified to support people safely, however some staff told us they ‘made do’ with the numbers due to the level of support some people required.

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.

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 31 May 2023).

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

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 Regulated Activates (Regulations) 2014, and we identified a breach of Regulation 10 and Regulation 13 of the Health and Social Care Act 2008 Regulated Activates (Regulations) 2014.

Why we inspected

This inspection has been prompted in part by an increase in concerns around staffing and person centered care since our last inspection. This report only covers our findings in relation to the key

questions safe, caring and well-led which contain those requirements. We also checked whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, it had not.

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 has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stonedale Lodge Care Home on our website at www.cqc.org.uk.

We have identified breaches in relation to risk assessments and safe care, medication administration, governance and dignity and respect and safeguarding.

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

The overall rating for this service is ‘Inadequate’ and the service has been placed in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.