Stone House Nursing Home

Stone House Nursing Home is a residential care home providing accommodation for up to 35 people requiring personal or nursing care. The service provides support mainly to people over the age of 65 years. At the time of our inspection there were 33 people using the service.

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

This was a targeted inspection that specifically reviewed the safety of medicines management in the service.

People were supported to receive their medicines safely, consistently and as prescribed.

Medicines were safely managed. There were known systems for ordering, administering and monitoring medicines. Staff were trained and deemed competent before they administered medicines.

The provider maintained a system to monitor and audit people’s medicines and medicines related incidents on a regular basis and made improvements where necessary.

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

Rating at last inspection

The latest rating for this service is good. Our last report was published on 10 April 2019. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care.

We also inspected the service on 16 February 2022 looking at the infection prevention and control measures the provider had in place as part of our programme of themed inspections. No concerns were identified.

Why we inspected

This targeted inspection was prompted in part due to concerns received about medicines management. A decision was made for us to inspect and examine those risks.

We use targeted inspections to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern.

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

Follow up

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

Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow device test result, proof of vaccination against COVID-19, hand sanitisation and wearing personal protective equipment (PPE). We were able to observe a visiting professional going through this process.

The service was clean and fresh, staff carried out a regular cleaning schedule. Regular infection control audits took place and actions had been followed up when required. An additional cleaning schedule had been introduced to ensure robust measures to reduce infection risks, including additional tasks such as cleaning of any regular touchpoint surfaces.

The provider had robust systems to ensure safe admissions, including only allowing new admissions after a confirmed negative result of the Covid-19 test. The provider had also assessed the environment, with consideration given where to allocate people should they need to isolate.

Staff had received training on infection prevention and control guidance. This included updates on the use of PPE and how to put it on, take it off and dispose safely. Staff's competency around infection control and PPE was checked regularly to prevent staff complacency. There was a designated area for donning and doffing PPE. There was signage all around the service on donning and doffing PPE and handwashing.

The provider ensured there was a sufficient stock of personal protective equipment (PPE) and the vetted supplier ensured it complied with the quality standards.

The provider participated in the Covid-19 regular testing programme for both people and staff.

There was a comprehensive contingency plan of what to do in case of an outbreak. The management team completed risk assessments to assess and mitigate risks in relation to COVID-19. Managers were supported by a regional quality and assurance manager who regularly supported quality and assurance audits on the service.

People’s experience of using this service:

•The provider continued to provide a good service. People told us they liked living at Stone House and they felt safe. One person told us, “Yes I do (feel safe) and I can trust the staff.” One relative told us, “I have never seen a member of staff get impatient in the two years I have been coming here.”

The service met the characteristics for a rating of “good” in all the key questions we inspected and achieved a rating of ‘outstanding’ in responsive. Therefore, our overall rating for the service after this inspection was “good”.

• People were always protected against avoidable harm, abuse, neglect and discrimination.

• People’s risks were assessed and strategies put in place to reduce the risks.

• People experienced positive outcomes regarding their health and wellbeing.

• Staff received good supervision and training, which provided them with the knowledge and skills to enable them to provide good care.

• Care was exceptionally person-centred and focused on ensuring people with dementia lived as independent lives as possible. The care was designed to ensure people’s maximum independence was encouraged and maintained.

• There was a workplace culture that was open and honest. Staff told us they felt supported by the manager and they could speak with them at any time.

• 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.

More information is in our full report.

Rating at last inspection:

At our last inspection, the service was rated “good”. Our last report was published on (5 July 2017).

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

Stone House Nursing Home provides accommodation and nursing care for up to 35 predominantly older people. This includes people with dementia. At the time of our inspection there were 34 people using the service. Stone House is set in six acres of tranquil gardens with superb views across the Chiltern Hills. The main dining room has spectacular views of the gardens; people can sit and relax and enjoy the views or gather in the main gathering point of the conservatory. Most of the rooms have en-suite facilities and people are able to bring their own pieces of furniture and personal belongings with them.

The service has a registered manager supported by a care manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they were well cared for. One person said “All the staff here are very kind and nothing is too much trouble, they give one hundred and ten per cent”. Relatives told us that all the staff were caring and that everyone was treated with warmth and kindness. Other comments included “Every single member of staff cares and the attention to detail is outstanding”.

Care plans were personalised and accurately reflected people’s care and support needs. The care plans included information about people’s interests and life history which provided staff with sufficient information to enable care to be provided effectively. We observed people were cared for compassionately and with respect. People told us they were respected by staff, “It’s very good here they [staff] do everything for us”.

People were cared for by an established staff team. Managers and directors provided effective leadership to the service and regular residents meetings ensured people were involved in the running of the home.

The atmosphere in the home was inviting and friendly. We saw staff spending time with people at a pace that was dictated by those they were supporting. Staff told us “We work as a team here to support people; everyone is treated with respect and dignity”.

Staff supported and encouraged people to engage with a wide variety of activities available within the home. The service employed three activity coordinators. People commented positively about the activities. “There are plenty of people to talk to, we have enjoyable times here”.

There was good local community involvement with local schools and churches. Visiting professionals to the service were positive about the care provided.

We met and spoke with five people who used the service, two relatives, the registered manager, the deputy manager, the head for delivery of care, two activity coordinators and two care staff. We looked at six people's care records and five staff files.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, 'The staff are wonderful, very caring.' One relative told us, 'The care is good, nothing is too much trouble.'

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found the provider had appropriate arrangements in place to manage medicines.

We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

Since our visit in November 2012 we saw an air conditioning unit had been fitted to the home's food storage area. Records of the temperature of dry food were being recorded to ensure they were safe and satisfactory. This meant people living in Stone House were protected from any risks associated with food being stored at inappropriate temperatures.

The storage of stock medication had been moved to a specifically designated, secure storage room. The temperature of this room was monitored daily and recorded. We saw storage of refrigerated medication had been monitored daily and recorded. When we checked the temperatures recorded we found they had been within the recommended temperature range. This meant medication was now stored appropriately.

We reviewed medication records. These were accurate and subject to regular checks. This showed people's health, safety and welfare was now being safeguarded by a robust system for the recording of their medication.

We spoke with staff who told us they had received safeguarding training. All of the staff we spoke with had a good understanding of what constituted abuse and what to do if it had been seen or suspected. People we spoke with did not raise concerns about staffing numbers and praised the quality of the staff team.

We found the temperature of medication storage had not been recorded. We checked the temperature of medication storage in one area of the home and found it was higher than recommended. This may have compromised the effectiveness and safety of the medication concerned. We found the temperature of some dry food storage had not been monitored and some records had not been stored securely

People told us staff had always responded promptly to requests. They said they had received satisfactory responses to any questions they had raised.