Stoneleigh House

People’s experience of using this service:

People were not consistently provided with choices. People’s dignity and privacy was not always respected.

Risks to people were not always managed in a safe way. Staff were recruited safely, although people did not always feel there were enough staff to support them in social activities. Medication was managed safely and there were effective infection control procedures in place. People were supported by staff who knew how to safeguard them from abuse.

Staff did not always receive training prior to commencing work at the home. Staff understanding of how to support people in line with the Mental Capacity Act varied. People’s dietary needs were met and people had access to healthcare services where required.

People were supported by staff who knew them well, although people felt that their social needs were not consistently met. There were systems in place to respond to any complaints made.

Systems to monitor the quality of the service had not been effective in identifying the areas for improvement found at this inspection. Records maintained about people’s needs were not always accurate. People had been given opportunity to feedback on their experience of the service.

Rating at last inspection: Good (Report published 20 June 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We identified breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around Dignity and Respect and governance. Details of action we have asked the provider to take can be found at the end of this report

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

Stoneleigh House is registered to provide accommodation and support for 24 people who may have a learning disability. On the day of our inspection there were 21 people living at the home. 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.

We found that the provider had taken sufficient action to ensure the quality of the service was assessed and monitored to an appropriate standard. The provider was carrying out checks on the service that were written down with any actions identified. We found that improvements to how records were being kept had been made. Records were also more consistent and clear so staff were able to understand how people were to be supported.

Care staff knew how to keep people safe and where people were at risk of abuse staff knew who to report any concerns to. There were sufficient staff to ensure people were supported safely and people had their medicines administered as prescribed.

Care staff were supported to ensure the skills and knowledge they needed were in place to meet people’s needs appropriately. People told us that staff were kind and caring toward them. We found the atmosphere within the home to be relaxed, warm and welcoming.

People were not supported without being able to give consent. Where people were unable to verbalise their consent the provider had appropriate systems in place to be able to know that people’s consent was given. People’s human rights were protected as required within the Mental capacity Act (2005). We found that staff received training to ensure they knew how not to deprive people of their liberty.

People were able to live their lives as independently as they were able and their dignity and privacy was respected by staff. People made choices as to how they lived their lives, what they ate and drank and how they socialised. People were able to access health care support as required and health care professionals were approached as and when needed.

We found that people’s support needs were assessed and care plans were in place to identify how people would be supported. The provider had the appropriate systems in place to carry out regular reviews of people’s needs.

The provider had a complaints process in place which people knew how to use. People were also able to share their views on the service. The provider had a quality assurance system in place to ensure the service was delivered to people at the right standard.

From our previous inspection some action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were 18 people living at the home on the day of the inspection but most people were out on a day trip or at the local day centre. We met people as they were leaving for the day trip and they expressed genuine in the activity that were planned. During our inspection we met three people who used the service and observed how they were cared for. We spoke with two members of staff who supported people, the manager and the provider who was supporting the inspection process and two relatives by phone after the

inspection. We looked at three people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that there were systems in place to support learning from events like accidents, incidents and complaints. We spoke with relatives who told us if they had a concern they would speak with the manager who was very approachable. We saw evidence that trends were being monitored as part of service improvement. This meant that the provider had a system in place to ensure trends could be monitored.

We found that risk assessments were being carried out to identify potential risks to how people were supported. Risks we saw with the environment where people lived had been rectified during our visit, which ensured people were safe from harm. This meant that people would be kept safe.

We asked relatives whether they felt people were safe living within the home. One relative said, "Yes they are definitely safe".

The home had proper policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. Staff were able to explain the action they would take and this meant that people would be safeguarded as required.

We found that while people were being supported appropriately care records were not always consistent. We found that records were not always fully completed, for example someone's hospital passport was not completed. This could potentially mean that the information needed was not available to support people. The manager told us that people would be accompanied to hospital in an emergency. Staff did however know how to keep people safe. Staff we spoke with were able to tell us what action they would take where they saw people at risk of harm. This meant that people were supported in an environment that ensured their safety.

We discussed with the provider a safeguarding alert that was being investigated by the local safeguarding team within the local authority. The provider confirmed that the investigation had been completed and found to be unsubstantiated.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

We found that care plans were in place to identify how people's care needs should be met. Staff we observed were caring and supportive to people. Staff we spoke with had a good understanding of people's needs and knew how to support them. We found that care plans were not always being followed by staff. For example on one person's care plan there was a requirement for staff to be trained in epileptic seizures, however we found this had not been carried out. This meant that the training staff were suppose to have to support the person in the event they had a seizure was not in place and left people at potential risk.

We found that where people needed support from health professionals this was available. Records showed that people were able to see a doctor, optician or a chiropodist when needed. This meant that there was a system in place to ensure people's care and welfare were being met.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

Our observations of interactions between staff and people using the service confirmed that staff knew how to support people. There was sufficient numbers of staff in place to meet people's needs. One relative said, "There is enough staff to meet people's needs". Staff we spoke with confirmed they felt there was enough staff. We did not see any evidence to show that people were not being cared for or supported due to a lack of staff. Records showed that over a period of weeks the staff rota had a consistent amount of staff working on all shifts. This meant that people were not at risk as a result of there not being enough staff.

Where people needed support to ensure their safety while in bed, we saw bedrails being used and the appropriate consent in place with risk assessments taking place to identify any risks. This meant that people's safety was an important part of how there care needs were met.

Staff we spoke with had not received any training in falls prevention and were not aware of the procedure. Some staff were able to explain how they would support people who were suspected of having a fall. The manager confirmed training was not currently being provided but this would be implemented and the procedure would be re-issued to staff. this would mean that where people had a fall in the future staff would be able to support people consistently.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is caring in meeting people's needs.

Is the service responsive?

We found from our previous inspection that the provider had taken some action to rectify concerns identified. We found that there were still areas of concerns to be actioned. The manager told us that the concerns still outstanding would be actioned immediately.

Relatives told us that any concerns they had would be discussed with the manager. We found that questionnaires were being used by the provider to gather the views of relatives, staff, and people who used the service. Not all people who used the service were able to respond to the questionnaires and in such circumstances their relatives or representatives would respond on their behalf. The provider had a system in place to analyse the information gathered to make improvements to the service. This meant that people were able to influence the quality of the service they received.

The provider had a complaints process in place that was displayed so visitors to the home and people or their relatives would be aware of how to share any concerns they had. We found that complaints were logged and trends were analysed.

Is the service well-led?

The service was led by a registered manager, who was supported by the provider. We met both of them who were both present at the time of our inspection and assisted us with any information we needed.

We found that since our previous inspection records had not improved sufficiently. Concerns we had about records being kept in more that one place and not being archived when records were no longer in use had not been actioned .This could potentially lead to confusion where staff are trying to find particular information.

Appropriate arrangements were not in place for people who lacked capacity. We observed consent being sought from people before care and support was delivered. One person said, 'Yes, they ask me.'

People's care was planned and delivered appropriately. One person said, 'It is okay here.' Records showed that people received care from other healthcare professionals when needed.

The management of medicines was appropriate and people received their medicines as prescribed. One person said, 'I get my medicine.'

We found that selection and recruitment processes were suitable to ensure that people were looked after by appropriate staff.

We found that people's care records were not always fit for purpose and detailed.

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We saw staff encouraging people to be independent throughout the day. People we spoke with told us they made choices about different aspects of their care. One person said, "I choose my clothes, food, and what to do."

We found that people's care records were detailed and staff delivered care that met people's needs and preferences. We found that people received advice from other health professionals when needed. This meant that people's needs were met in a timely manner.

We found that arrangements were in place to ensure that people were safeguarded from abuse.

We found that staff were supported through supervision, appraisals, and training to carry out their role appropriately.

We found that systems to monitor the quality of services were effective at identifying shortfalls in the home and action was taken to make improvements. One person said, 'I'm happy with everything.'