Stonecroft

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There were some shortfalls in completion rates of training. The registered manager was taking action to address this. When concerns had been raised, these had been used as an opportunity to put things right. There were effective systems, processes and practices to ensure people were safe from risk of harm and abuse. The majority of staff had completed safeguarding training and safeguarding policies and procedures were available. Rotas were planned to ensure that staff were on duty who had undertaken advanced training to meet people’s more complex needs. Recruitment was safe. There were clear processes in place to assess, plan for and review risks to people. People’s care plans contained detailed and personalised risk management plans that discussions with staff confirmed they were aware of and understood.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

When concerns had been raised, these had been used as an opportunity to put things right, learn and improve. For example, when 1 person started to decline assistance with personal care, the team at the Chaos Hotel collaborated with the person, their family, and the staff team to review their personal care routines and preferences. In addition rotas were amended to ensure that preferred members of staff were available to support the person. This had had a positive impact. Records relating to a recent incident demonstrated the provider took appropriate action to keep people safe. This included working with the local authority, the Care Quality Commission (CQC) and the person’s relative. In response to this incident, the service had employed a registered nurse to support with training and development of the staff team. Staff supervision was used as a tool to reflect on learning from safety related incidents that had occurred within the service and to reinforce best practice.

People were not able to comment on the safety culture within the service. A relative told us any concerns raised were investigated fully and resulted in changes that would help ensure similar concerns did not happen again.

Staff told us they were encouraged to make suggestions about how people’s care and support could be improved. One staff member said, “We had a team meeting 3 weeks ago, we talk about what we could improve on”. The registered manager used complaints or concerns to makes positive changes. He was able to talk at length about recent learning from a safety related event that had occurred within the service. This provided assurances that they understood the importance of using such events as an opportunity to learn and improve. The incident had been reflected on with staff and practical measures put in place to help prevent similar incidents from happening again. The registered manager also told us about how they worked with staff to agree amended rotas which helped to ensure preferred staff were available allowing 1 person’s support to be provided more effectively and in line with their wishes.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Chaos Hotel is a respite service. When we completed our assessment no one was using the service and so we were unable to complete any observations for this quality statement.

People told us they felt safe. One person said, “Yes I feel safe” and a second person said, “I have never felt scared…. They treat me nicely.” Relatives were confident their family members were safe and protected from harm. One relative said, “Oh yes, I very much feel [Person] is safe there. They seem to understand him. He likes it there. When I say ‘Chaos Hotel’ to him, he laughs and laughs. His smile speaks volumes when I bring him home.” Another relative told us, “Yes, [person] is safe there, I have seen the steps they take with them.”

There were effective systems, processes, and practices to ensure people were safe from risk of harm and abuse. The majority of staff had completed safeguarding training and safeguarding policies and procedures were available. When a safeguarding incident had occurred, this was appropriately escalated and investigated in line with the provider’s policies and procedures.

Staff understood their responsibilities in relation to safeguarding people from abuse. One staff member told us the signs that might indicate potential abuse saying, “You can tell by people’s body language. They may have marks; they may be looking dishevelled. All sorts of things. I would report straight to [Registered manager]. I would go higher if they didn’t do anything about it, but I know they would.” The manager had a good understanding of local safeguarding procedures and told us how they had investigated a recent safeguarding incident and worked with other agencies in a collaborative way to keep the person safe.

There were clear processes in place to assess, plan for and review risks to people. People’s care plans contained detailed and personalised risk management plans that discussions with staff confirmed they were aware of and understood. This included detailed risk management plans for needs such as epilepsy, choking, low and high blood sugars. One person’s care plan contained detail information about the signs which would indicate they might have an infection and in another there was guidance for staff on how they should adjust care and support to reduce the risk of falls. The provider had an effective communication system in place to be updated by parents about changes in people’s care needs in between respite stays. This was confirmed by relatives to be helpful.

Staff were able to describe how they supported people in a positive way to manage distressed behaviours. One staff member said, “We know people’s behaviour triggers, everything is in their care plans and risk assessments. It could be a colour, not being listened to, not being given time to process things.” Another staff member told us there were effective risk management plans for responding to seizures. The registered manager spoke knowledgeably about the needs and risks of people using the service. For 1 person who lacked capacity to understand risks relating to their health, the registered manager described how they consulted with the person’s family and their GP to agree a best interest’s approach which helped to mitigate risks rising from their epilepsy. The registered manager told us that due to the nature of the service, it could be weeks or months before they saw a person again, they said, “So we have an email address we share with parents and use this to communicate any changes in care needs or new risks.”

The 2 people we spoke with told us they participated in discussions about any risks associated with their care. One relative told us they were regularly involved in the development and review of their family members care plans and risk assessments. People’s relatives were overall confident that risks were assessed, and that staff understood these. One relative told us, “They know about [Person’s] food issues and his swallowing… they never leave him unattended in the bath.” Relatives were also confident that risks associated with epilepsy were well managed. Another relative said, “I think the care is well coordinated, well organised and appropriate for [Person] I get a report back within a day of him returning from respite telling me everything.”

Chaos Hotel is a respite service. When we completed our assessment no one was using the service and so we were unable to complete any observations for this quality statement.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff completed training in a wide range of subjects. This included, safeguarding, the Mental Capacity Act 2005, equality and diversity, and infection control. The provider maintained a matrix to monitor the completion of training. Overall, training completion rates were good, however, the matrix contained a small number of gaps where we were not assured staff had completed required training or completed relevant competencies. The registered manager has taken action to ensure staff are booked to attend the training they have not completed. To ensure more effective scrutiny and oversight of training compliance, the registered manager was developing a more effective way of recording the training completed by staff so they could easily identify when refresher training was required, or a competency needed to be updated. Rotas were planned to ensure that staff were on duty who had undertaken advanced training to meet people’s more complex needs. We reviewed the training requirements for 3 people who visited the service. They all required support with enteral feeding and insulin administration. Completion rates of this training were good. There were safe recruitment processes in place. This included the completion of a check with the disclosure and barring service and the gathering of references. Supervision was used to reflect on performance issues, but this was done in a supportive and constructive way. The registered manager explained that people were invited to meet with prospective new staff and to ask them questions as part of the interview process.

Chaos Hotel is a respite service. When we completed our assessment no one was using the service and so we were unable to complete any observations for this quality statement.

People were not able to express in any detail to us their views about the skills of the staff that supported them during their respite, but 1 person was able to tell us, “I like spending time with [Staff member] …. they do a good job.” A second person told us “I absolutely love coming here, its like a family, staff are like my mates, we have parties, and we have a disco. I feel like I am on holiday…I think the staff look after everyone real good.” Relatives told us there were enough staff and that they were suitably trained and knowledgeable. Comments included, “There is a stable core of staff…there seems to be enough staff, I’ve never had concerns about that” and “They [Staff] have enough time to spend with him.” Most relatives felt that the staffing levels allowed their family members to lead a safe and fulfilling life where their independence was promoted. For example, 1 relative said, “[Person] is able to do what he wants, they will go into Havant to the shops, tea shop, and the park…He does help with the cooking. I picked him up ones and he had a chef’s hat on” and another said, “They give [person] opportunities to improve… she has been unable to walk, but her walking is now improving so they no longer use the wheelchair but enable her to walk as well.” One relative felt that more could at times be done in the evenings. We talked to the registered manager about this. They explained that because most people had been at the day centre all day, often in the evenings, they want to relax, but that staff supported with cooking together, watching movies and there was also a sensory room on site that people could use.

Staff told us there were sufficient staff available to meet people’s needs. One staff member said, “This is done through planning service users' stays and ensuring we have the correct ratio of staff to service users.” The registered manager told us there was always adequate staff and agency staff were not used. The registered manager told us staff rotas were carefully planned based upon who was staying, and what support and processes they might need. They said, “Staff don’t do set hours, we sit down a few months in advance with the diary, knowing who is in, and work with staff to make sure that the right people are on the right shifts to deliver the support that’s needed… We know internally who works well with who, and who needs which training, and I can say with absolute certainty that every process or procedure is completed by someone with the appropriate training.” The registered manager told us training was tailored to people’s individual needs. For example, the service had worked with a positive behaviour support trainer to devise bespoke training for 1 person.… We do Makaton training… we have courses on ‘someone’ rather than general courses.” The registered manager told us staff were provided with supervision every 4-6 weeks. They said, “It’s a dedicated time set aside. I will have things that may have happened, good and bad, trends are discussed, general conversation, it’s a 2-way street, we look at their development, any training needs, such as communication or a particular process or maybe a competency assessment is required for medicines. We are ambitious and we like staff to take on responsibility.” A staff member was positive about supervision saying, “The last supervision I had was in November or December time.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.