Stonesby House LTD

Updated 9 June 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors.

Service and service type

Stonesby House Limited is a 'care home'. 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection as well as recent safeguarding concerns that had been raised. We reviewed the providers action plan and sought feedback from the local authority and other professionals who worked with the service.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection-

This inspection took place over two days. On the first day two inspectors undertook a site visit. We spoke with two people who used the service to gain feedback about their experience of the care provided. We had discussions with the registered manager, one of the directors and two care and support staff on site.

We reviewed a range of records. These included four people's care records and risk assessments. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including quality assurance checks and safeguarding information were also examined during the inspection.

On the second day of our inspection we spoke with four relatives and a further four staff by telephone to gain feedback about their experience of the care provided and also about working at the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. Records of staff meetings, staff rotas and medicines information were also examined.

Updated 9 June 2021

About the service

Stonesby House Ltd is a residential care home registered to provide accommodation and personal care for up to 14 adults who may be living with mental health needs and/or learning disabilities or autistic spectrum disorder. At the time of our inspection, 12 people were using the service.

The home is divided into two separate units, each of which has separate adapted facilities.

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

Further improvements were needed to the risk assessments and care plans to make sure they contained detailed guidance for staff to follow. The registered manager told us they were still working on these, so they had not been reviewed for everyone living at the service.

Although improvements had been made to the infection control procedures, we found some areas that still needed to be addressed to ensure people were safe from the spread of infection. Further improvements were needed to the systems in place to administer medicines safely to make sure people received their medicines safely and as prescribed.

Improvements had been made to the provider's governance systems and they carried out a variety of internal audits to check the quality and safety of the support people received. However, these needed to be strengthened because they were not always effective at identifying areas where improvement was needed.

We found numerous items of food that were out of date and some foods that had been opened but with no opening date recorded on them. Pre-cooked meals had been frozen with no date of when they were frozen. Environmental audits had failed to identify that the first aid kit contained out of date products such as

bandages and a burn shield.

Staff interactions had improved, and we saw some staff who had a good rapport with people. However, we found that many staff interactions were still task focused and lacked a person-centred approach.

Systems in place to safeguard people from avoidable harm had been reviewed and enhanced to ensure people were protected. Staff told us they had completed training about safeguarding and whistle blowing to support people to stay safe. Staff had completed Non-Abusive Psychological and Physical Intervention (NAPPI) training to ensure they had the knowledge, skills and confidence to prevent, decelerate, and deescalate crisis situations so that restrictive practices could be avoided.

The provider and the registered manager had improved their recruitment procedures to ensure people were protected from staff that may not be suitable to support them. Systems in place to assess people's needs and determine staffing numbers had been reviewed and improvements made. We found there were sufficient staff to meet people's needs.

The systems in place regarding the management of Legionella had improved. We saw that some staff had completed training around Legionella management and records of water temperatures were in place.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was not able to fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People did not always receive person-centred care and treatment that was appropriate to meet their needs and reflected their personal preferences. Their care and support did not always promote enablement, independence, choice and inclusion.

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 02 April 2021) and there were four 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 we found enough improvement had been made so the provider was no longer in breach of two regulations. However, enough improvement had not been made in some areas and the provider was still in breach of a further two regulations.

This service has been in Special Measures since 09 December 2020. 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 carried out an unannounced focused inspection of this service on 21 October 2020. Four breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe Care and Treatment, Staffing, Good Governance and Safeguarding service users from abuse and improper treatment.

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 and Well-led.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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.

We found evidence the provider still needs to make further improvements. Please see the Safe and Well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to the Safe Care and Treatment of people, Infection Prevention and Control and Good Governance and quality monitoring.

Follow up

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. If we receive any concerning information we may inspect sooner.