Stoneyford Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Since our last inspection the provider had made improvements to the effectiveness of the care people received. People’s nutritional requirements were met and recorded appropriately, people praised the food prepared and served in the home. The new manager was looking for ways to upskill staff in current guidance and best practices and had undertaken additional training to facilitate this. We received mixed feedback from people regarding personal care such as showering and bathing. Some stated this was not always delivered as often as they requested. The manager acknowledged this and was proactive in addressing people’s concerns and monitoring this going forward. The provider met their requirements in line with the Mental Capacity Act and submitted all appropriate legal authorisation documents and included family where appropriate.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since our last inspection improvements had been made to care plans and assessments. A range of national assessment tools were now used consistently to understand people’s needs and how best to support them. We saw evidence of care plans being updated and modified in line with people’s changing needs. For example, where other professionals such as district nurses or GPs had made recommendations, these had been updated clearly within people’s care plans and communicated to staff effectively during handover meetings.

Staff had input into care plan reviews and felt confident to raise changes and concerns about care planning to senior members of staff. One staff member said, “Care plans are reviewed monthly now but if I notice someone’s needs have changed, I tell the manager and this is updated really quickly.” The new manager described how care planning and updating had been a priority since the last inspection, they said, “Having comprehensive accurate care plans allows us to meet people’s needs, without them we don’t have the right staffing levels or training needs, so this is where improvements started. Staff now have clear guidance and understand people’s needs and wishes.”

People and their relatives were involved in care planning and their needs were reviewed on a regular basis. One relative said, “I had been asking for a care plan review for months, once the new manager started this process began and it was comprehensive and gave me confidence in the care being delivered.” Another relative said, “My [relative] recently came back from hospital, the care plan was done with us before they returned so everything was already in place, it was very good.”

Since our last inspection we saw improvements in how the service recorded people’s care in line with the guidance in care plans. For example, where people’s nutritional intake needed to be monitored this was clearly recorded on daily fluid and nutritional charts which were also audited daily to identified gaps or changes in people’s health. We observed staff providing one to one support where appropriate in line with current guidance within people’s care plans. The new manager was working with the local authority to partake in additional training for staff covering best practices such as RESTORE2 which support staff to identify when people may be deteriorating or at risk of physical deterioration and to act accordingly.

Everyone we spoke with praised the food offered by the home. One person said, “The food is excellent and there is always so much choice, but I ask for something off the menu if I want.” Where people required support with nutrition in line with their health requirements, people told us this done effectively. A person living at the home said, “I’m lactose intolerant and staff are very good and produce excellent meals for me.” Some people commented that the dining room experience could be busy and noisy however were happy they had the option to eat in other areas of the home or within their own rooms.

Staff were knowledgeable about people’s needs including their fluid and nutritional requirements and preferences. We spoke with the chef who said, “Mealtimes are important for people’s health in so many ways so it’s crucial to me that we offer choice and respect people’s wants, likes and dislikes. I get the time to spend with people getting their feedback on the food and ideas for meal options.” Another staff member said, “We now get the time to update people’s notes so we accurately record things like food and personal care, we struggled to do this before.”

People and their relatives told us they had positive experiences and outcomes from the service working alongside other professionals such as GPs and District Nurses. For example, one relative told us, “My [relative] had a pressure sore when she came to the home, they have treated it and it has totally cleared up.”

Processes had been put in place to ensure people’s needs were assessed and documented prior to being admitted to the home. The new manager had implemented one page care summaries that were available in people’s rooms for visiting professionals and care staff to ensure people’s needs were communicated without people having to repeat their story, needs or wishes to multiple professionals. Care plans now contained updated hospital passports to assist people when they moved between services. Due to the restrictions placed on the service since the last inspection we have been unable to assess the effectiveness of these new strategies and more time is needed to ensure they are fully embedded within the home.

The new manager told us how they were networking and building relationships with local professionals who supported the service to improve relationships and the effectiveness of their recommendations and responsiveness. This included GPs, pharmacy and visiting professionals such as district nurses and occupational therapists. The manager said, “By developing these relationships we hope to be able to fully assess people’s needs and pre-empt potential risk or likely deterioration in their health, this could reduce people’s need for admission to hospital.” As the staff team was relatively new to home since the last inspection staff were unable to comment on the effectiveness of this style of working currently.

The local authority told us the provider and new manager had been responsive and effective in making improvement since our last inspection and in line with their recommendations and while improvements were ongoing they were pleased with the progress. However, we received mixed feedback from emergency services who attended the home. For example, one ambulance crew found staff's knowledge of a person condition to be lacking whilst another attending paramedic told us during the assessment, "Staff are attentive and knowledgeable and very supportive of us." Since our last inspection professionals working with the service told us improvements in care planning, assessing and staffing had been made which had resulted in positive outcomes for people living at the home. One professional said, “Staffing levels are now consistent and stable with different areas of the home working effectively together, this has meant a reduction in call bell waiting time and how long people wait for support.”

Staff and managers were knowledgeable about people’s needs and supported people to communicate these needs appropriately. The deputy manager said, “The biggest change we have made is the time we spend with people to understand their needs and what outcomes they want to achieve.” The chef told us, “We work hard to make sure people have options and choices, [for example] if people are diabetic we get sugar free options so people don’t miss out.”

People were included in their care planning and their choices and wishes were clearly detailed. Where people were living with conditions such as diabetes there was guidance for staff on promoting choices in line with health requirements whilst respecting people’s right to choose. We saw evidence of people being supported to attend routine health appointments such as outpatient appointments and recommendations were clearly recorded within care plans.

People told us they were supported to access other services as and when required such as GPs and Dentists. One person said, “Staff are very good if I request to see the doctor.” Relatives told us they had seen positive improvements in the service and felt their loved ones were now supported to access services appropriately. A relative said, “I know they are making the referrals now as I get updates on progress and outcomes of visits.”

People's experience and feedback were mixed. While people told us they were supported effectively with personal care such as toileting other people told us they had experienced inconsistencies with requests for personal care such as showers. For example, one person said, “I have a bladder condition and staff support me with a commode and offer this regularly.” However, another person said, “Showers are very inconsistent despite asking and chasing my [relative] often doesn’t get one for 2-3 weeks.”

Since our last inspection the new management team had implemented audit processes to ensure care delivered was effective and recorded accurately. For example, the manager completed reviews of daily notes and records like turning charts and nutritional intake to ensure people’s care was consistent and in line with their wishes. Where gaps or errors were identified, we saw records of staff receiving feedback and guidance on these processes in team meetings and individual supervisions. Although improvements had been made, more time was needed to ensure all people living at the home received the same consistent effective care.

Since our last inspection staff’s knowledge about the importance and understanding of recording care notes accurately had improved. However, staff and the new manager acknowledged there was still progress to be made. The manager said, “We had issues with staff not filling in records or doing later so records were not accurate, we have trained staff on why this is important and standards have improved, but I am continuing to monitor and feedback where gaps are identified.”

Staff we spoke with were knowledgeable about the Mental Capacity Act and understood the importance of seeking consent to care. Staff were able to describe how they supported people who had varying capacity. For example, one staff member said, “If someone declines medicines or care we always try again later, if they still refuse another staff member will try. If we are really concerned through, we report it to the manager.”

Care plans contained evidence of people’s consent to care and clear guidance for staff on how to support people to gain consent prior to delivering care or where people had varying capacity. Where people lacked capacity, we saw evidence of consistent and effective family involvement which included care planning as well as best interest decisions. Care plans contained evidence the service was working within the principles of the Mental Capacity Act, and appropriate legal authorisations were in place when needed to deprive a person of their liberty, and conditions were met where these were in place.

People told us staff were respectful and sought their consent prior to assisting them with their care. One person said, “They always knock on my bedroom door before coming in.” Another person said, “I get choices, staff ask me what time I want to go to bed and things like that.” Where people did not have capacity to consent relatives told us they were included in this process. A relative said, “Staff phone me if they want to change anything before they do to make sure I agree, it gives me confidence when I can’t be there.”