Stonesby House

Stonesby House is a residential care home that provides personal care for older people, and people with learning disabilities and/or mental health support needs. At the time of our inspection there were 9 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection there were 5 people receiving personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Equipment was not always used for its intended purpose and was not always safe. The provider failed to ensure the environment was kept clean and properly maintained. The service was worn and in need of renovation.

People were supported by enough staff and safe recruitment checks were in place. People received their prescribed medicines safely. New staff completed an induction program which included completion of The Care Certificate. People were supported by trained and competent staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Assessments were completed and people told us they felt included in decisions about their care. People were supported to eat and drink enough. The service worked in partnership with health and social care professionals.

Right Culture: Quality assurance systems and service oversight was not always effective. The provider was not proactive and ensuring people had a suitable living environment.

The atmosphere in the service was relaxed and friendly. Staff received regular supervision. Staff and people living at the service had opportunity to raise concerns or make suggestions. The deputy manager and provider were open to feedback during the inspection and took immediate action when concerns were raised.

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

Rating at last inspection

The last rating for this service was good (published 19 July 2019)

Why we inspected

We received concerns in relation to staff conduct, medicines practices and management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement, based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to premises and equipment, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stonesby House is a care home that provides care for up to eight older adults. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection eight people were living at Stonesby House.

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

People told us they felt safe living at Stonesby House. Staff understood how to protect people from the risk of harm and understood potential signs of abuse. Potential risks to people’s safety were assessed to keep them safe.

People received their medicines safely and as prescribed. Staff followed good food hygiene and infection control practices to protect people from the risk of infections.

There were enough staff available to meet people’s needs in a timely way. The provider followed safe recruitment practices to ensure only suitable staff were employed to work at the service. Staff undertook training that supported them to build on the knowledge and skills to do their job well and effectively meet people’s needs.

People were provided with good nutrition and hydration and they had access to healthcare services to maintain their health and wellbeing. 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 practice.

Staff knew the people using the service and their families well. They had built positive relationships which helped to ensure good communication and support. Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

People were at the centre of their care and support and involved in decisions about their care. Their care plans provided guidance for staff to follow. Staff were responsive to changes in people's needs and they took prompt action to maintain people’s health and well-being.

People were supported to maintain relationships and engage in meaningful activities, hobbies and interests. The service had good links with the local community.

People spoke positively about the management and leadership of the service as being open and transparent. People knew how to raise any concerns or complaints and their feedback was used to make improvements to the service. Staff were encouraged to share ideas about how to develop the service. The service worked in partnership with external agencies to ensure people achieved the best possible outcomes.

Quality audits were carried out on all aspects of the service and used to drive continuous improvement.

Rating at last inspection

Good (report published 2 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

This inspection took place on 28 September 2015 and was unannounced.

Stonesby House is a care home for a maximum of nine people with a range of different needs. These include mental health needs, dementia, and learning disabilities. Most of the eight people who lived at the home at the time of our visit had mental health needs. One person arrived on the day of our visit for emergency respite support.

The service had a registered 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection the registered manager had started to manage another home for the provider as well as Stonesby House. Some management responsibilities had therefore been delegated to other senior staff but we found these had not always been carried out. The provider and registered manager did not have sufficient checks to know these responsibilities had not been undertaken. The lack of checks had not led to any negative impact on people.

The registered manager was a strong advocate for the rights of people who lived in the home and staff worked to the same principles.

Staff understood the risks related to people's mental and physical health as well as their well-being and followed people’s individual risk assessments to ensure they minimised any identified risks.

The registered manager and most staff understood the local authority's safeguarding policies and procedures. Checks which reduced the risks of employing unsuitable staff were carried out prior to staff working at the home. Staff received training to meet people’s needs effectively.

The provider understood the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards and the service complied with these requirements. People had good access to health care professionals when required, and their medicines were administered to them as prescribed.

There were enough staff to meet people’s needs. People were supported to live their lives as independently as possible and enjoyed activities within the home. People had choices about what meals were provided and enjoyed the food made available to them.

People who lived at Stonesby House liked the staff who supported them. They felt staff were kind, and we saw staff treat people with respect and dignity.

We found one person was receiving positive interventions as directed by a clinician to encourage them to maintain personal hygiene. Staff were working closely with the individual to help support them. The manager confirmed this had starting to have a positive impact on the person and other people who use services. We saw staff were caring and well led. New training around food hygiene had been identified for all staff to attend. We saw a new housekeeper had been appointed since our last inspection and was making a difference in the standards of cleanliness and hygiene at Stonesby House. We found some shortfalls around the environment where maintenance work had been overlooked but managers responded immediately with actions to ensure positive outcomes for people.

The expert by experience interviewed five people who used services and two relatives. People who use services told us : Two people felt they were treated with dignity and respect. Another person said: "I have a keyworker. More time with her would be very nice." One person said: "Haven't been to church lately, but would like to if someone would go with me." A relative told us: "Yes, more safe here than the other place (previous care home)." The person described in detail how staff had on a number of occasions handled accidents safely and in a timely fashion with care.