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Stonedale Lodge Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 29 September 2020

During an inspection looking at part of the service

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 141 people aged 65 and over at the time of the inspection. The service can support up to 180 people across six units, each specialising in either residential or nursing care for older people, including those living with dementia.

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

When we inspected Stonedale Lodge Care Home to assess the safety and quality of people’s care, we took into consideration the significant pressures the COVID-19 pandemic had put on this service in particular. We also considered what people, relatives and staff told us, as well as the information we found, regarding care provided across the six different units, to arrive at balanced and proportionate judgements for the service as whole.

It was clear that the service had had an unsettled period, with the outside pressures of the COVID-19 pandemic adding to internal difficulties. The provider had addressed this, and the service was receiving ongoing support, including from the provider’s regional team. Detailed improvement plans were in place to help achieve progress. Staff and the provider were honest that there had been improvements, but there was more work to be done, to recover and provide consistently good care for people and support for staff.

We highlighted particular areas for improvement, to achieve greater safety and consistency, and have made recommendations regarding risk management and records, staffing and quality assurance. We have also signposted the provider to resources to develop their infection prevention and control approaches, including updating audits and working closely with local specialist teams. The service had addressed the issues from the last inspection, however we found medicines were not always managed safely across the home.

However, there were also particularly positive aspects, such as continued staff dedication to people using the service during the pandemic and on balance encouraging feedback from people, relatives and staff. When people had needed to be isolated on their unit to prevent the risk from further spreading of COVID-19 infection, staff had “moved into” the unit with them. People felt safe living at Stonedale Lodge Care Home, spoke well of the staff and told us, “[The staff are] first class, I get on well with them” and “Staff are lovely, they do anything for me, I get spoilt.”

We had received some concerns from relatives prior to inspection, which the provider was addressing. However, relatives we spoke with during the inspection gave very positive feedback about the service. They felt their loved ones were safe living at Stonedale Lodge Care Home, describing it as a “home from home”, and one said, “The home was recommended to me and I have never regretted the decision. They have made everything so easy.”

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 rating following the last comprehensive inspection for this service was requires improvement (published 25 June 2019). We also published a report following a targeted inspection, which did not change the rating for the service (published 5 December 2019).

At the last comprehensive inspection, we found a breach of regulations regarding good governance. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of regulations; however, we made recommendations for the provider to make further improvements or maintain progress.

Why we inspected

Based on the service’s previous rating of requires improvement and the breach of regulation we found at the last inspection, we undertook a focused inspection to review the key questions of sa

Inspection carried out on 31 October 2019

During an inspection looking at part of the service

About the service:

Stonedale Lodge is a purpose-built ‘care home’, situated within a residential area of Croxteth in Liverpool.

Stonedale Lodge has six separate ‘units’; it has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were 159 people living at the home.

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

At this targeted inspection safe systems and processes were in place to ensure people received a safe level of care. Chef manager, domestic staff and laundry assistants told us that stock levels were well managed and there was a clear ordering and supply system in place.

Environmental risk assessments and management procedures ensured that people were living in a safe, comfortable and well-maintained home. People told us there was ‘plenty of food’ and the temperature of the home was appropriately monitored.

Staffing levels were safely managed. A recent recruitment drive meant that the use of agency staff had reduced, and people were receiving support by a regular and consistent staff team.

Infection prevention control procedures were in place. Staff were provided with personal protective equipment (PPE) and there were adequate cleaning products available throughout the home. We did note a distinct mal-odour on one unit which the managers were aware of.

An on-line digital platform ensured that all accident, incidents and significant events were recorded, monitored and analysed. This helped to establish trends and identify if lessons could be learnt to mitigate risk.

Rating at last inspection:

The service was rated ‘requires improvement’ at the last inspection (report published 25 June 2019). We identified a breach of regulation in relation to 'good governance'. The provider submitted an action plan following the last inspection explaining how they would follow up on the concerns we identified.

Why we inspected:

The inspection was prompted due to concerns received about the provision of care people received. We undertook this targeted inspection to ensure the service was meeting legal requirements. To do this we examined risks relating to systems and processes, areas of risk management and safety monitoring and provisions that were in place to ensure people were living in a safe and well-maintained environment. This targeted inspection only focused on specific concerns and did not cover all key lines of enquiry, as a result the ratings for this service have not been changed. The ratings for this service will be reviewed as part of our next comprehensive inspection.

We found no evidence during this targeted inspection that people were at risk of additional harm from the concerns we had received since we last inspected.

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

Follow up:

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

Inspection carried out on 6 June 2019

During a routine inspection

About the service

Stonedale Lodge is a purpose-built home comprising of six separate units, situated within a residential area of Croxteth. The service has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were

158 people living at the home.

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

At our last inspection in November 2018, we found the home was in breach of regulations in relation to safe care and treatment and good governance. During this inspection we found the service was no longer in breach of safe care and treatment, however remained in breach of good governance.

Some records were not always accurate, fully completed or reviewed. We also saw that some audits required improving as they had not highlighted some of the concerns we found during our last inspection. There was a manager in post who had not yet registered with the Care Quality Commission (CQC). Staff had team meetings and people told us they felt engaged with.

People were mostly 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. We did see however, that some practices in relation to the implementation of the Mental Capacity Act required further development, and we have made a recommendation regarding this.

Staff were trained, inducted and supervised, and people were referred to external healthcare professionals when needed. People had their food and fluid intake monitored where needed, however we did raise that this could do with improving in some areas. There was mixed feedback with regards to the food at the home.

The registered provider had made improvements to the environment; however, we saw that some fire doors did not close properly. There were risk assessments in place for people depending on their physical and clinical needs, we saw that some risk assessments had not been reviewed, which we raised at the time with the manager. Medication and staff recruitment were managed safely, and there was enough staff on shift to be able to support people safely.

Care plans were viewed varied in their presentation of person-centred information. It was not always clear what people enjoyed doing or if they had been consulted with regarding how to spend their time. We have made a recommendation regarding this. There was a complaints process in place and people said they knew how to complain. Some records were lacking with regards to end of life care, however, staff were knowledgeable about this, and people told us they had been well supported by the service.

Everyone we spoke with commented on the kind and caring nature of the staff. Staff gave us examples of how they respected people’s dignity and privacy and there was information in care plans with regards to promoting independence.

Rating at last inspection and update: The last rating for this service was requires improvement (published 19 December 2018) there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not made but the provider was still in breach of regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive time.

Why we inspected

The inspection was prompted in part due to concerns received about oversight and management structure. A decision was made for us to inspect and examine those risks.

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

Follow up

We will meet with the

Inspection carried out on 26 November 2018

During a routine inspection

This inspection took place on 26, 27 and 29 November 2018. The first day of inspection was unannounced.

Stonedale Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Stonedale Lodge is a purpose-built home comprising of six separate units, situated within a residential area of Croxteth. The service has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were 151 people living at the home.

This is a large setting and to achieve a fair and proportionate rating for the service as a whole, we inspected all six units, then compared findings to make our judgements. This means we identified what the service did well overall, but also where there were themes of improvement needs or concerns. We also checked whether any individual examples of the care people received were particularly good or equally put the person at risk.

At this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to themes we found in different parts of the service, regarding the safety of the home’s environment, as well as record keeping and auditing aspects. You can see what actions we told the provider to take at the end of the full report.

The service had no registered manager when we visited, as the previous manager had left the provider’s employment prior to our inspection. A registered manager is a person who has registered with 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.

In the absence of a registered manager, the two deputy managers were leading the home, together with the provider’s improvement manager for the North West. We found all three demonstrated passion about the quality of people’s care in the way they engaged with people, relatives and staff. Their focus was to achieve improvement by promoting a caring, dedicated culture within the service. From development plans it was clear that there was much to do in the way of improvement, but it was also clear that the team had worked hard over the last months towards making those improvements.

This was our first inspection of the service since Advinia Care Limited became its registered provider. We found that the service was still being developed under the new provider and was in a ‘step-by-step’ transition when we inspected, to introduce changes gradually.

We found that the personalisation of people’s care varied across the service. This was both in the planning, as well as the delivery of care. Information in people’s care plans was not always clear or correct. At times, information needed to be more accessible for people.

We considered that the adaptation of the service to make it dementia-friendly, as well as activities on offer to meet people’s needs and provide stimulation also varied and needed improvement.

We found that recorded complaints were managed well. However, we considered that at times the service needed to develop how they listened to those who had an improvement wish, but did “not want to complain”.

There was enough staff to meet people’s needs and keep them safe. The service had taken measures to significantly reduce the use of temporary workers and create greater stability.

Safeguarding concerns had been recorded and investigated appropriately. Staff were aware of their responsibilities to keep people safe and had confidence t