Archived: Stonedale Lodge Care Home

Updated 17 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place from 3 – 5 February 2016. The inspection team consisted of two adult social care inspectors, a pharmacist inspector, a specialist advisor in older people/ dementia care and a pharmacist specialist advisor. A specialist advisor is a person who has experience and expertise in health and social care.

Before our inspection we reviewed the information we held about the home. We looked at the notifications the CQC had received about the service and we contacted the commissioners of the service to obtain their views.

During the inspection we visited all six of the units (houses) that make up Stonedale Lodge Residential and Nursing Home. These included three units supporting people living with dementia. Some of the people living at in these houses had difficultly expressing themselves verbally. 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 were able to speak with fourteen people in total who were living on the units in the home. We spoke with seven visiting family members.

As part of the inspection we also spoke with three health professionals who were able to give some feedback about the service. We liaised and spoke with a local safeguarding team who had been involved with the service over the last six months.

We spoke with members of the management team (registered manager, area manager, quality assurance manager, clinical services manager, clinical care manager and training manager), 30 staff (including care staff, trained nurses and unit managers) and ancillary staff (head chef, ‘hostesses’, laundry assistants, housekeepers and activities co-ordinators/hobby therapists and maintenance person).

We looked at the care records for 19 people who lived at the home, two staff personnel files, medicine charts and other records relevant to the quality monitoring of the service. We undertook general observations, looked round the home, including some people’s bedrooms, bathrooms, the communal rooms and external grounds.

Updated 17 March 2016

Situated in the Croxteth area of Liverpool, Stonedale Lodge Residential and Nursing Home offers personal and nursing care for one hundred and eighty people. The provider is BUPA Care Homes (CFC Care) Ltd. Accommodation is provided on six units, each with 30 beds. Dalton and Anderton units provide personal care for people living with dementia, Clifton unit provides nursing care for people living with dementia, Blundell and Townley provide general nursing care and Sherburne unit provides general personal care.

This unannounced inspection of Stonedale Lodge Residential and Nursing Home took place over three days from 3 – 5 February 2016. At the time of our inspection 117 people were living in the home.

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.

At the previous inspection 9-12 June 2015 the provider was found to be inadequate and the service was placed in ‘special measures’ by CQC. We found breaches of regulations in all key questions we inspect (safe, effective, caring responsive and well led).

The purpose of 'special measures' is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in 'special measures' are inspected within six months of the publication of the inspection report.

At this inspection we found improvements had been made. This meant the service was no longer rated inadequate and could be removed from 'special measures' by the Care Quality Commission (CQC).

Following the inspection in June 2015 we also issued an urgent statutory notice requiring the provider not to admit any further people to Stonedale Lodge Residential and Nursing Home. In light of the improvements we found at the February 2016 inspection we have now lifted this statutory notice which prevented people being admitted to the service.

The breaches of regulations we identified in June 2015 were now met. We have revised the rating for the home following our inspection though the service cannot be rated as ‘good’. To improve the rating to ‘good’ would require a longer term track record of consistent good practice.

Following the last inspection staffing numbers were found to be adequate so that people were supported safely; thus promoting better consistency of care and improving staff morale Our observations and feedback from people who were living at the home and relatives indicated people were now supported by sufficient numbers of staff to provide safe care and support in accordance with individual need.

The staff we spoke with were aware of what constituted abuse and how to report an alleged incident. The registered manager demonstrated they were keen to liaise and work with the local authority safeguarding team and agreed protocols had been followed in terms of reporting and ensuring any lessons had been learnt and effective action had been taken.

We found that the home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Although care practices were consistent and this indicated staff were generally following good practice we found some hesitancy around fully understanding the use of the ‘two stage mental capacity assessment’ and when this should be used.

We made a recommendation in the report regarding this.

Staff involved people in discussions about their care and encouraged them to make decisions.

We observed staff gaining people’s consent before supporting them with care and daily tasks. People’s consent, or relatives if required, was not always documented in the care files we saw to evidence their inclusion. This had been picked up in recent managerial audit and the registered manager discussed ways this would be implemented.

People living at the home were protected against the risks associated with the safe management of medicines. Staff received medicine training and their competencies were checked to ensure they were able to administer medicines safely.

Recruitment procedures were robust so that staff were suitable to work with vulnerable people.

Arrangements were in place for checking the environment to ensure it was safe. A series of health and safety audits were completed on a regular basis.

On the inspection we visited all of the units in the home and found them to be clean. Staff were seen to adhere to basic infection control practice when attending to people and serving meals.

Staff told us they were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff clearly knew their roles and what was expected of them. Formal qualifications in care were on-going for the staff along with more specific clinical training for senior and nursing staff.

People’s nutritional needs were monitored by the staff. Menus were available and people’s dietary requirements and preferences were taken into account. We received mainly positive feedback about the quality and choice of meals from people we spoke with.

Our observations showed good adherence to ensuring people’s rights were respected and people were cared for in polite and dignified way. Dignity champions were appointed on the units to oversee these standards and implement ‘best practice’.

Health checks were undertaken on a regular basis and staff were vigilant in monitoring people’s general health. People were able to see external health care professionals to help monitor and maintain their health and welfare. Risks to people’s safety were also recorded and measures were in place to keep people safe.

The staff interacted well with people and demonstrated a good knowledge of people’s individual care, their needs, choices and preferences. During the course of our visit we saw that staff were caring towards people and they treated people with compassion, warmth and respect.

A process was in place for managing complaints and the home’s complaints procedure so that people had access to this information.

Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff said they were able to speak with the registered manager if they had a concern.

Arrangements were in place to seek the opinions of people and their relatives, so they could provide feedback about the home. This was carried out by satisfaction surveys, day to day contact and formal meetings.

Staff told us the overall management of the home had improved greatly since the last inspection. Staff told us they felt supported and that the culture of the home was now open and positive and this was due to the staff working as a strong team under the leadership of the registered manager.

Systems, processes and audits were in place to assure the service provision and drive forward improvements. The registered manager and management team had expanded these to capture a full picture of the home and to meet the challenges the service faced in ‘moving forward’. It was evident that the introduction of these more robust measures had helped to promote effective and safe standards of care and improve staff morale. We found the overall leadership to have greatly improved under the new registered manager.