This inspection took place on 26 June 2018 and was unannounced. We last inspected this service in April 2016 and rated the service as Good. We found the provider was meeting the regulations, but improvements were needed in the management of medicines and risk assessments lacked the detail required to mitigate risks. Stonesby Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Stonesby Lodge accommodates up to 12 people who have mental health needs. The accommodation is an adapted residential property and is provided over two floors. At the time of our inspection, there were nine people using the service.
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.
The provider had not alerted potential safeguarding incidents to relevant agencies or made appropriate notifications. This meant external agencies were unable to take action to assess and evaluate potential or actual risks in order to ensure appropriate action was taken to keep people safe.
There was a lack of effective systems and processes to monitor the quality of the service and identify where improvements were needed. Informal systems were in place but were not effective in making improvements in the service.
Risk assessments were not sufficiently detailed to demonstrate effective assessment and evaluation of risks. Records did not provide the guidance and information on the actions staff needed to take to mitigate potential risks for people.
Medicines were in the main managed safely. However, further improvements were needed to ensure records relating to stock management were completed accurately and correctly.
There was a system in place to monitor accidents and incidents. However we found no analysis of these was done which would identify any trends to prevent further re-occurrences.
The people we spoke with said they felt safe as a result of the care and support they received and trusted staff who looked after them.
Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people using the service.
There were sufficient numbers of staff available to meet people's needs. Most staff had worked in the service for many years and knew people well, which supported consistent care.
Recruitment files did not demonstrate staff had always been recruited safely as key documents, such as employment references, had been archived and could not be located. The registered manager was in the process of updating these files.
People told us staff were well trained and provided effective care and support. We observed staff were confident and skilful in their interactions with people. The provider's training matrix, a central record of staff training, had not been kept up to date and there were gaps in records showing what training staff had undertaken. Staff told us they had completed a range of training which gave them the skills and knowledge they needed.
People were supported to eat a balanced diet and specific dietary needs were met. Staff encouraged people to make drinks and snacks if they were able. Staff ensured people had enough to eat and drink.
People were supported to access a range of health professionals to maintain their health and well-being. The service worked in partnership with other agencies and was pro-active in ensuring people had the care and treatment they needed.
People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and sought consent before providing care and support. At the time of the inspection, there was nobody using the service who was subject to a Deprivation of Liberty Safeguard (DoLS) authorisation.
People were treated with kindness, respect and compassion. Staff encouraged people to be as independent as possible. Staff supported people to express their views and be involved in making decisions about their care.
Staff were knowledgeable about the people they supported and knew their likes, dislikes, hobbies and interests. Care plans included information about people's life history, preferred routines and people or item that were important to them. This information supported staff to provide personalised care.
Care plans were reviewed and these were signed by people. People had been supported to write down their key aims and objectives and staff ensured care was provided to support people to achieve these. Improvements were needed to ensure care plans were updated in a timely way to reflect changes in people's needs and information in daily handovers supported effective monitoring of people's wellbeing.
There were opportunities for people to be involved in interesting activities, both inside and outside the service. People were able to choose how they spent their time and supported to be involved and a part of their local community.
The provider had an appropriate complaints procedure in place and people were confident to raise concerns or make complaints if they needed to.
People were supported to share their experiences of the service and discuss ideas and suggestions to improve the service. People, a relative and staff spoke highly of the leadership and support of the registered manager and the registered provider.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.