Stonedale Lodge Care Home

Stonedale Lodge Care Home is a residential care and nursing home in the Croxteth area of Liverpool, providing personal and nursing care to people aged 65 and over. The service can support up to 150 people across 5 units, each specialising in either residential or nursing care for older people, including those living with dementia. At the time of our inspection there were 122 people using the service.

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

Governance and quality assurance systems were in place however they remained ineffective. This meant people were exposed to unsafe care. There remains a repeated failure from the provider to ensure the delivery of safe, high quality care.

People were exposed to risk of harm as some of their risk assessments were either not reflective of their current needs or contained insufficient detail to help guide staff with how to support them safely.

Medications were not always given in line with best practice guidance and exposed people to the risk of harm.

There were systems and processes in place to help identify and report abuse, however they were not always being used effectively and there were some missed opportunities to safeguard people from harm.

People were not always being cared for in a dignified way. Some people looked unkempt, and some language used in care plans was not respectful.

People told us they liked the staff and they felt safe at the home. They described the staff as ‘kind and ‘caring’ Staff liked the manager and felt they had given 'structure' to the home. The manager understood their duty to share information in an open and honest manner. There was enough staff identified to support people safely, however some staff told us they ‘made do’ with the numbers due to the level of support some people required.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 May 2023).

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

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 Regulated Activates (Regulations) 2014, and we identified a breach of Regulation 10 and Regulation 13 of the Health and Social Care Act 2008 Regulated Activates (Regulations) 2014.

Why we inspected

This inspection has been prompted in part by an increase in concerns around staffing and person centered care since our last inspection. This report only covers our findings in relation to the key questions safe, caring and well-led which contain those requirements. We also checked whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, it had not.

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 Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stonedale Lodge Care Home on our website at www.cqc.org.uk.

We have identified breaches in relation to risk assessments and safe care, medication administration, governance and dignity and respect and safeguarding.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service has been placed in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Stonedale Lodge Care Home is a residential care and nursing home in the Croxteth area of Liverpool, providing personal and nursing care to people aged 65 and over. The service can support up to 180 people across six units, each specialising in either residential or nursing care for older people, including those living with dementia. At the time of our inspection there were 110 people using the service.

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

Governance and quality assurance systems had improved in some parts since our last inspection however they still remained ineffective. This meant people could be exposed to unsafe care. There remains a repeated failure from the provider to ensure the delivery of safe, high quality care.

People were exposed to risk of harm as some of their risk assessments and records were either not reflective of people's current needs or contained insufficient detail to help guide staff with how to support them safely. Medications were not always given in line with best practice guidance. Accident and Incident logs had improved since the last inspection; however they had not always highlighted patterns or trends.

Most of the units had been redecorated as well as some people’s rooms. However, 1 person remained at risk due to a large gap in their bed between the frame and the mattress. This had not been reported or acted upon. Infection control prevention was improved, and the units looked and smelled cleaner. There were enough suitably qualified staff to support people.

People's privacy was respected. People told us they liked the staff and they felt safe at the home.

Staff liked the new manager and deputy manager and felt they had made good progress in the short time they had been at Stonedale lodge.

The manager understood their duty to share information in an open and honest manner. Safeguarding systems and policies were in place and staff could describe the action they would take if they felt people were at risk of abuse.

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.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 26 September 2022).

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

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of Regulations 12 and 17, however were no longer in breach of Regulation 10 and Regulation 18.

This service has been in Special Measures since 24 September 2022. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements. We also checked whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk assessments and safe care, medication administration and governance and records.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stonedale Lodge Care Home is a residential care and nursing home in the Croxteth area of Liverpool, providing personal and nursing care to people aged 65 and over. The service can support up to 180 people across six units, each specialising in either residential or nursing care for older people, including those living with dementia. At the time of our inspection there were 140 people using the service.

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

Inadequate governance and quality assurance measures meant that people were exposed to unnecessary risk and avoidable harm. There has been repeated failure from the provider to ensure the delivery of safe, high quality care.

People were exposed to risk of harm as their care needs and associated risks had not been managed appropriately. Risk assessments were either not reflective of people's current needs or detailed enough to guide staff on safely supporting people.

Accident and incident processes were inadequate. The service did not look for safety related themes and trends reliably and robustly. There was little evidence of learning from events or action taken to improve safety.

People were at risk because measures to prevent and control the spread of infection were ineffective.

There were not enough suitably qualified staff to support people. Records showed actual staffing levels had fallen below assessed safe staffing numbers placing people at risk of unsafe care.

People's privacy was not always respected. The provider had neglected to adequately maintain the environment in two of the units and this meant people were living in undignified conditions.

Staff did not feel that their feedback was used to improve the service, and some told us that management did not respond appropriately to the concerns they raised.

Safeguarding systems and policies were in place and staff could describe the action they would take if they felt people were at risk of abuse. The registered manager understood their duty to share information in an open and honest manner.

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.

Overall medicines were safely managed. The service was working alongside the local authority medicines management team to roll out a consistent system across the whole home.

Staff approached people well and were generally being attentive to their needs. However, many interactions were task orientated. People told us that staff treated them with kindness and respect.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 October 2020).

At our last inspection we made recommendations for the provider to review the quality and consistency of information in people's care records, staff planning and deployment and to ensure improvement plans were acted upon so actions relating to people's safety were addressed quickly and effectively. At this inspection we found the provider had not effectively acted upon recommendations and the provider was in breach of regulations.

Why we inspected

We received concerns in relation to risk management and an increase to the number of accidents and incidents that were occurring in the home. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led. Due to concerns we identified on the first day of the inspection, a decision was made to widen the inspection to include the key question of caring.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 requires improvement to inadequate based on the findings of this inspection.

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 Stonedale Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, privacy and dignity and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Stonedale Lodge Care Home is a residential care and nursing home in the Croxteth area of Liverpool, providing personal and nursing care to 141 people aged 65 and over at the time of the inspection. The service can support up to 180 people across six units, each specialising in either residential or nursing care for older people, including those living with dementia.

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

When we inspected Stonedale Lodge Care Home to assess the safety and quality of people’s care, we took into consideration the significant pressures the COVID-19 pandemic had put on this service in particular. We also considered what people, relatives and staff told us, as well as the information we found, regarding care provided across the six different units, to arrive at balanced and proportionate judgements for the service as whole.

It was clear that the service had had an unsettled period, with the outside pressures of the COVID-19 pandemic adding to internal difficulties. The provider had addressed this, and the service was receiving ongoing support, including from the provider’s regional team. Detailed improvement plans were in place to help achieve progress. Staff and the provider were honest that there had been improvements, but there was more work to be done, to recover and provide consistently good care for people and support for staff.

We highlighted particular areas for improvement, to achieve greater safety and consistency, and have made recommendations regarding risk management and records, staffing and quality assurance. We have also signposted the provider to resources to develop their infection prevention and control approaches, including updating audits and working closely with local specialist teams. The service had addressed the issues from the last inspection, however we found medicines were not always managed safely across the home.

However, there were also particularly positive aspects, such as continued staff dedication to people using the service during the pandemic and on balance encouraging feedback from people, relatives and staff. When people had needed to be isolated on their unit to prevent the risk from further spreading of COVID-19 infection, staff had “moved into” the unit with them. People felt safe living at Stonedale Lodge Care Home, spoke well of the staff and told us, “[The staff are] first class, I get on well with them” and “Staff are lovely, they do anything for me, I get spoilt.”

We had received some concerns from relatives prior to inspection, which the provider was addressing. However, relatives we spoke with during the inspection gave very positive feedback about the service. They felt their loved ones were safe living at Stonedale Lodge Care Home, describing it as a “home from home”, and one said, “The home was recommended to me and I have never regretted the decision. They have made everything so easy.”

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

Rating at last inspection and update)

The rating following the last comprehensive inspection for this service was requires improvement (published 25 June 2019). We also published a report following a targeted inspection, which did not change the rating for the service (published 5 December 2019).

At the last comprehensive inspection, we found a breach of regulations regarding good governance. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of regulations; however, we made recommendations for the provider to make further improvements or maintain progress.

Why we inspected

Based on the service’s previous rating of requires improvement and the breach of regulation we found at the last inspection, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. This is the third consecutive time the service has been rated as requires improvement.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering if enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stonedale Lodge is a purpose-built ‘care home’, situated within a residential area of Croxteth in Liverpool.

Stonedale Lodge has six separate ‘units’; it has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were 159 people living at the home.

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

At this targeted inspection safe systems and processes were in place to ensure people received a safe level of care. Chef manager, domestic staff and laundry assistants told us that stock levels were well managed and there was a clear ordering and supply system in place.

Environmental risk assessments and management procedures ensured that people were living in a safe, comfortable and well-maintained home. People told us there was ‘plenty of food’ and the temperature of the home was appropriately monitored.

Staffing levels were safely managed. A recent recruitment drive meant that the use of agency staff had reduced, and people were receiving support by a regular and consistent staff team.

Infection prevention control procedures were in place. Staff were provided with personal protective equipment (PPE) and there were adequate cleaning products available throughout the home. We did note a distinct mal-odour on one unit which the managers were aware of.

An on-line digital platform ensured that all accident, incidents and significant events were recorded, monitored and analysed. This helped to establish trends and identify if lessons could be learnt to mitigate risk.

Rating at last inspection:

The service was rated ‘requires improvement’ at the last inspection (report published 25 June 2019). We identified a breach of regulation in relation to 'good governance'. The provider submitted an action plan following the last inspection explaining how they would follow up on the concerns we identified.

Why we inspected:

The inspection was prompted due to concerns received about the provision of care people received. We undertook this targeted inspection to ensure the service was meeting legal requirements. To do this we examined risks relating to systems and processes, areas of risk management and safety monitoring and provisions that were in place to ensure people were living in a safe and well-maintained environment. This targeted inspection only focused on specific concerns and did not cover all key lines of enquiry, as a result the ratings for this service have not been changed. The ratings for this service will be reviewed as part of our next comprehensive inspection.

We found no evidence during this targeted inspection that people were at risk of additional harm from the concerns we had received since we last inspected.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stonedale Lodge on our website at www.cqc.org.uk.

Follow up:

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

Stonedale Lodge is a purpose-built home comprising of six separate units, situated within a residential area of Croxteth. The service has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were

158 people living at the home.

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

At our last inspection in November 2018, we found the home was in breach of regulations in relation to safe care and treatment and good governance. During this inspection we found the service was no longer in breach of safe care and treatment, however remained in breach of good governance.

Some records were not always accurate, fully completed or reviewed. We also saw that some audits required improving as they had not highlighted some of the concerns we found during our last inspection. There was a manager in post who had not yet registered with the Care Quality Commission (CQC). Staff had team meetings and people told us they felt engaged with.

People were mostly 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. We did see however, that some practices in relation to the implementation of the Mental Capacity Act required further development, and we have made a recommendation regarding this.

Staff were trained, inducted and supervised, and people were referred to external healthcare professionals when needed. People had their food and fluid intake monitored where needed, however we did raise that this could do with improving in some areas. There was mixed feedback with regards to the food at the home.

The registered provider had made improvements to the environment; however, we saw that some fire doors did not close properly. There were risk assessments in place for people depending on their physical and clinical needs, we saw that some risk assessments had not been reviewed, which we raised at the time with the manager. Medication and staff recruitment were managed safely, and there was enough staff on shift to be able to support people safely.

Care plans were viewed varied in their presentation of person-centred information. It was not always clear what people enjoyed doing or if they had been consulted with regarding how to spend their time. We have made a recommendation regarding this. There was a complaints process in place and people said they knew how to complain. Some records were lacking with regards to end of life care, however, staff were knowledgeable about this, and people told us they had been well supported by the service.

Everyone we spoke with commented on the kind and caring nature of the staff. Staff gave us examples of how they respected people’s dignity and privacy and there was information in care plans with regards to promoting independence.

Rating at last inspection and update: The last rating for this service was requires improvement (published 19 December 2018) there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not made but the provider was still in breach of regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive time.

Why we inspected

The inspection was prompted in part due to concerns received about oversight and management structure. A decision was made for us to inspect and examine those risks.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for 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 return to visit as per our re-inspection programme.

Stonedale Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Stonedale Lodge is a purpose-built home comprising of six separate units, situated within a residential area of Croxteth. The service has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were 151 people living at the home.

This is a large setting and to achieve a fair and proportionate rating for the service as a whole, we inspected all six units, then compared findings to make our judgements. This means we identified what the service did well overall, but also where there were themes of improvement needs or concerns. We also checked whether any individual examples of the care people received were particularly good or equally put the person at risk.

At this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to themes we found in different parts of the service, regarding the safety of the home’s environment, as well as record keeping and auditing aspects. You can see what actions we told the provider to take at the end of the full report.

The service had no registered manager when we visited, as the previous manager had left the provider’s employment prior to our inspection. A registered manager is a person who has registered with CQC 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.

In the absence of a registered manager, the two deputy managers were leading the home, together with the provider’s improvement manager for the North West. We found all three demonstrated passion about the quality of people’s care in the way they engaged with people, relatives and staff. Their focus was to achieve improvement by promoting a caring, dedicated culture within the service. From development plans it was clear that there was much to do in the way of improvement, but it was also clear that the team had worked hard over the last months towards making those improvements.

This was our first inspection of the service since Advinia Care Limited became its registered provider. We found that the service was still being developed under the new provider and was in a ‘step-by-step’ transition when we inspected, to introduce changes gradually.

We found that the personalisation of people’s care varied across the service. This was both in the planning, as well as the delivery of care. Information in people’s care plans was not always clear or correct. At times, information needed to be more accessible for people.

We considered that the adaptation of the service to make it dementia-friendly, as well as activities on offer to meet people’s needs and provide stimulation also varied and needed improvement.

We found that recorded complaints were managed well. However, we considered that at times the service needed to develop how they listened to those who had an improvement wish, but did “not want to complain”.

There was enough staff to meet people’s needs and keep them safe. The service had taken measures to significantly reduce the use of temporary workers and create greater stability.

Safeguarding concerns had been recorded and investigated appropriately. Staff were aware of their responsibilities to keep people safe and had confidence that managers would address any concerns.

The provider had introduced new risk monitoring systems, including for people’s falls. These were used to learn lessons from previous accidents, with an aim to protect people against reoccurrence. At times, the actions taken to respond to risk needed to be recorded more clearly.

The service overall managed people’s medicines well, including complex prescriptions. We identified a few areas for improvement.

The management team had worked to improve the application of the Mental Capacity Act throughout the service, to protect people’s rights regarding decision making. Overall, we found good evidence of this, but a few areas needed clarification.

Residents’ and relatives’ meetings were sporadic and we considered that especially at times of change these needed to take place more often, to keep people and their families involved and informed. The provider had recently carried out surveys to obtain the views of people using the service, relatives and visiting professionals.

Team meetings were also infrequent, however staff praised managers and felt well supported. Staff received induction, training and supervision to guide them in their role. However, this was not always robust and it was an area the management team were focusing on improving.

The service worked effectively with a range of other professionals to achieve good outcomes for people. This included a very good example of project working with the North West Ambulance Service.

People had enough to eat and drink. People overall thought the food was satisfactory. We considered support for people with special nutritional requirements at times needed to be clearer, but staff were knowledgeable about this.

Throughout our inspection and across the units, we observed kind, caring and patient interactions between people and staff. Many staff had been at the service for a long time and knew people well.

There was evidence that people and their relatives had been involved in the planning of their care. The service clearly advertised advocacy services for those who needed an independent person to protect their best interests.

Staff treated people with dignity and respect. We discussed with the team at times they needed to have confidence to ask external staff to also maintain people’s dignity, especially in communal areas.

The service planned to provide care to people at the end of their life in a dignified and respectful way. People’s own wishes needed to be documented more clearly.

Staff used the word “family” to describe Stonedale Lodge and we observed this culture of closeness. The majority of people’s and relatives’ comments were positive.

Managers had submitted relevant statutory notifications to CQC in line with their legal requirements.