Archived: Stonedale Lodge Care Home

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.

We considered all the evidence we gathered under the outcome we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

As part of this inspection we visited four of the six units on site, spoke with six people who use the service, the Registered Manager, 18 staff, and one relative. We looked at some people's personal care records and staff duty rosters.

Below is a summary of what we found:

Is the service safe?

We last inspected Stonedale Lodge Residential and Nursing home in July 2014. At that time we found there were not enough staff to meet people's needs, to ensure their care was delivered in a timely manner. Following the inspection the provider sent us an action plan which detailed how the service was to meet the requirements. On this inspection we checked to see whether improvements had been made.

We found the number of staff working throughout the home had increased since our last inspection. The registered manager advised us that they reviewed staffing levels daily with each house manager to ensure there were sufficient numbers of staff on duty to meet people's needs. The home was now operating with additional staff.

We spoke with people who lived at the home. A person told us,' I am very happy, I get well cared for. Another told us, 'If I press the buzzer the staff come fairly quickly. Sometimes you need to wait but you know they are busy with someone else.'

Is the service effective?

People who lived at the home and staff told us that staffing levels were sufficient to ensure people received the care and support they needed. We observed people had staff support with eating and drinking.

Is the service caring?

People who lived at the home described staff as 'lovely' and 'kind hearted'. People's comments included, "I know I get very well looked after" and "Everyone is very nice with me." Relatives we spoke with told us, "This home is like a family. The staff are very good."

We saw that staff were respectful and warm in their interactions with people who lived at the home.

Is the service responsive?

Activities were provided on each house by four dedicated activities coordinators. We saw activity boards in the houses we visited. Activities were provided six days a week. Some people who lived in the home told us they would like more activities. A visitor we spoke with felt the home should have a minibus to take people out into the community. On the day of your inspection we saw staff accompanying someone to a birthday lunch with their family as they needed assistance. One person also was supported to support their local football team.

Is the service well led?

The service was managed in a way that aimed to protect people's health, safety and welfare. The manager had taken action to improve the service through providing greater staffing levels. Staff we spoke with felt supported by their house manager and the registered manager. Their comments included, "Everything works so well now, we have really turned a corner", 'We did have problems in the past but things flow smoothly now. We get time to sit with the residents' and "We get really good support from the manager. Anything we need we just have to ask.'

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

As part of this inspection we spoke with 13 people who use the service, the Registered Manager, 13 staff, the chef, five relatives and a visiting professional. We reviewed 12 care plans and staff duty rosters. Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home was well maintained and serviced regularly.

We spoke with people who lived in the home and some relatives who felt staff were always rushed. We spoke with staff. They told us they felt that they were under pressure most of the time to deliver care but particularly mornings as this was seen as the busiest time. We observed that some people had food debris on their clothing left over from breakfast and some people were observed to have had poor attention paid to hand hygiene and their nails were not clean. A relative told us that standards of personal care were not always maintained; for example lack of attention to denture care. They put this down to lack of time for staff to attend to people.

The Registered Manager told us they assessed staffing need each day and moved additional staff where and when they were needed. They told us they did not use a dependency rating assessment tool to determine the number of staff required. We saw staffing rotas which showed staff were moved from one unit to another to meet individual people's needs or staff shortages.

People we spoke with told us staff were caring and treated them with kindness and respect. They told us they felt safe and well cared for at Stonedale Lodge Residential and Nursing Home.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection an application for a Deprivation of Liberty Safeguard to keep a person safe had been completed and sent to the local authority. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. Records showed all staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

People's health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's care plans reflected their current needs.

Where specialist support was needed, for example, with a person's nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people's health, well-being and independence.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. The staff ensured people's comfort and dignity at all times. The people we spoke with told us the staff were kind and helpful. People's comments included, "I am looked after well', 'If I need the doctor staff organise it right away' and 'Staff are very caring, nothing is too much trouble.' A visitor told us, 'The staff here are fantastic.' Another said, 'The staff go above and beyond for my relative.'

Staff had a good knowledge about people's care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirements.

People who lived at the home and their relatives had the opportunity to participate in regular satisfaction surveys and could also provide feedback via the resident's and relative's forum.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

From our discussions with staff and looking at a number of care records we could see that people's plans of care were revised to meet any change in need, for example, deterioration in a person's medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

Staff we spoke with said they received good quality training and support.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey.

We started this inspection at 8.15 pm so that we could spend time observing the care and support provided to people. We initially visited Dalton and Clifton units and spent time observing the care provided to people as they had supper and got ready for bed. We then visited the other four units, spoke with staff and where possible with the people living there. As part of the inspection we spoke with 15 members of staff who held different roles. We spoke with eight of the people living at Stonedale Lodge Residential and Nursing Home. Because some of the people living there had complex needs they were not able to tell us their experiences. Due to this we used a formal way to observe people in this review to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI).

We found that there were insufficient staff on Clifton and Blundell units to meet the needs of the people living there safely and well. This meant that people had to wait for the support they required. It also meant that staff were not always available to support people who required reassurance or became agitated. We found that there were sufficient staff on the other units to meet the needs of people as they prepared for bed.

The people living at Stonedale Lodge told us that they had been happy with the support they had received. Their comments included, 'I find it very good,' and 'I am delighted to say it's friendly. They treat you like their mother or father.' We observed that staff respected people's dignity. Staff interacted with people as well as providing support with their care needs. One person told us, 'Staff have good manners I am really impressed with them.'

We found that people had received the support they needed with their care and welfare. Records of people's support needs were up to date and staff had the skills and knowledge to provide the support people needed. There were sufficient staff available to meet people's needs.

Systems were in place to deal with concerns or complaints raised and people told us that they would feel comfortable raising a concern if they needed to.