Stonesby House LTD

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We found numerous items of food that were out of date and some foods that had been opened but with no opening date recorded on them.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 Environmental audits had failed to identify that the first aid kit contained out of date products such as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

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, thirteen people were using the service.

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

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 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. The systems in place to prevent and respond to crisis situations, including training in positive behaviour support, and learning from incidents was not always used safely and effectively.

People were not always protected from the risk of harm or abuse because the systems and processes in place to safeguard people were not effective. Incidents of potential abuse were not always identified or reported to the relevant authorities.

Care plans and risk assessments did not contain adequate information for staff to know how to support people safely when they became distressed. There was a lack of effective training for staff to support people when they became distressed which put them at increased risk of harm. Staff had developed inappropriate and unsafe strategies to manage incidents when people had become distressed and anxious.

There was no effective system in place to monitor maintenance and health and safety aspects of the service, including the management of Legionella.

People’s care did not support them to learn new skills, become more independent and achieve good outcomes. Care plans did not record people’s goals or celebrate their achievements.

Infection control procedures were not sufficient to reduce the risk of infection, particularly in the time of the current pandemic. Government guidance to protect people living in care homes during Covid 19 were not adhered to. Systems in place to ensure the proper and safe management of medicines were not robust and did not ensure people received their medicines as prescribed.

Robust recruitment checks had not been completed to ensure only suitable people were employed to work at the service. The provider did not use a systematic approach to determine staffing numbers. Staffing numbers were insufficient to meet people’s needs and keep them safe.

There were no lessons learned protocols in place so the provider could learn from incidents and accidents, safeguarding concerns and complaints to improve the quality of the service. Following incidents where staff had supported people when they became distressed, there was no debrief for staff so that lessons could be learned, and new strategies introduced to improve care.

There was a lack of effective quality assurance processes in place to monitor the quality and safety of the service.

We found that oversight and leadership of the service was not effective. Staff told us they were not encouraged to raise concerns with management and did not feel supported in their roles. Feedback from people and staff was not acted upon and the provider had failed to act upon people’s concerns to drive improvements at the service.

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 Requires Improvement (published 28 June 2019)

Why we inspected:

We received concerns in relation to insufficient staffing numbers, poor practices regarding infection control, a lack of staff training, poor and unsafe environment and poor leadership and management. As a result, 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 changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

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 Stonesby House Ltd 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 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 breaches in relation to safe care and treatment, safeguarding service users from abuse, staffing and good governance.

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

Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report. In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service. 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.

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 of 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.

People's experience of using this service:

The provider's systems and processes had not consistently protected people from harm. Staff had not identified potential neglect or taken appropriate action when people regularly declined their care and support. The registered manager had mitigated future risks through implementing robust documentation and monitoring, refreshing staff training and knowledge and improved working with relevant external agencies to ensure people were safe.

The provider had made some improvements to quality assurance systems to support the monitoring of care and support provided. However, further improvements were needed to ensure systems were sufficiently robust and effective in identifying improvements to ensure people received consistently good quality care.

There were systems in place to monitor people's safety through risk assessments. Care plans provided staff with clear guidance on the measures they needed to take to support people safely. People received their medicines safely and as prescribed and were protected against the risk of infection.

There were enough staff available to meet people's needs. The provider did not use a systematic approach to determining staff deployment within the service. The registered manager told us they would implement this following our inspection.

People's needs were assessed before they began to use the service. Staff had received training relevant to their role and this was in the process of being updated and developed. Staff felt supported in their role.

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. Staff enabled them to access routine and specialist healthcare to maintain their well being. People were supported to have sufficient amounts to eat and drink and protected from the risk of malnutrition.

People were treated kindly and respectfully by staff who encouraged them to make choices and decisions about their care and support. People's independence was promoted wherever possible.

Care plans provided the information and guidance staff needed to ensure people received personalised care. People were able to access a range of activities, though these were not consistently available throughout the day. People were confident to raise concerns or complaints and felt these would be listened to and resolved.

The registered manager and staff were clear on their roles and responsibilities and were committed to improving and developing the service to ensure people received a safe, high quality service.

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

Rating at last inspection:

At the last inspection we rated this service as requires improvement (report published on 29 June 2018).

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.

At our last comprehensive inspection in May 2017 we rated the service as 'Requires Improvement'. We found although the provider had made improvements to the service, further improvement were needed to ensure adequate staff were deployed in the service at all times and quality assurance systems were effective in driving improvements in the service.

At this inspection, we found the provider had made improvements in the areas of staffing, but further improvements were needed to ensure care records were accurate and completed consistently, staff were effectively deployed and people were provided with personalised care. The overall rating for this inspection remained 'Requires Improvement.'

Stonesby House LTD is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Stonesby House LTD accommodates up to 14 people across two buildings, one of which has been purpose built to support people to maintain and develop their daily living skills. Many of the people using the service have mental health needs.

The service had a registered manager who was new to the service. 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.

There were limited systems in place to monitor the quality of the service. Some improvements had been identified and actions taken in response to concerns. However, there were no formal systems in place to monitor the quality of the service. The provider was not ensuring people received good care that was sustained and embedded in staff working practices as a minimum standard.

Staff demonstrated a good understanding of the actions they needed to take to keep people safe. Records showed potential risks to people had been assessed and provided guidance for staff on the actions they needed to take to keep people safe. Further improvements were needed to records to ensure staff were provided with the information and guidance they needed to manage behaviours that can challenge.

People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. The registered manager was in the process of organising and indexing staff files to ensure all recruitment information was organised and easily accessible. There were enough staff available to meet people's needs but they were not always deployed effectively to ensure people were safe.

Systems were in place to support staff to follow safe infection control procedures to prevent the risk of infection when providing care and support.

Accidents and incidents were reported and monitored. There were no formal systems to support the effective analyse of these to ensure lessons were learnt and appropriate action taken to improve safety across the service.

Staff were supported to complete the training they needed to provide effective care. They received on-going support and supervision to enable them to develop in their role. The registered manager had reviewed and evaluated training to ensure it was effective and based on best practice.

People's needs were assessed before they began to use the service. People were supported to make decisions and choices about their care. Staff understood the need for people to consent to their care and respected people's right to decline care and treatment in line with the Mental Capacity Act 2005. Staff ensured people's freedom was not restricted without appropriate legal authorisation.

People spoke of staff as being caring and kind. Staff felt they did not have the time they needed to spend with people other than when undertaking planned tasks. Staff understood their role in protecting people's right to dignity and privacy.

Sections of care plans were more detailed than others and records were not consistently updated to ensure information was accurate throughout the care plan. Care plans did not always include the information staff needed to provide personalised care.

People were offered a limited range of activities and were provided with few opportunities to engage in meaningful activities and stimulation with staff. The registered manager had identified a change in culture within the service was required to support staff to move away from a task focussed approach.

People felt confident if they needed to raise concerns or complaints, these would be listened to and acted upon.

The registered manager was promoting a positive culture in the service that was focussed on achieving good outcomes for people. They had identified where improvements were required and had taken steps to makes some changes and develop the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Stonesby House Ltd provides accommodation and personal care for up to 14 adults, many of whom have mental health needs. Accommodation is provided across two buildings, with many bedrooms providing private en-suite facilities. At the time of our visit, there were 13 people living at the service.

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.

People felt safe in the service. Staff knew people well and understood their responsibilities to protect people from the risk of harm. There were usually enough staff to provide people's care, but arrangements to cover in the event of unplanned staff absence were not always sufficient to ensure staff provided care in a timely way. Action taken to recruit into vacant care staff posts, plans for a revised management structure and use of agency staff helped to mitigate the risk to people's safety from insufficient staffing arrangements.

People's medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them.

Staff were trained and supported to perform their role and responsibilities. The provider was in the process of supporting all staff to update their skills and knowledge and had developed a revised induction programme to ensure new staff were safely inducted to the service.

The service ensured people's rights and best interests by working within the principles of the Mental Capacity Act 2005 (MCA). Mental capacity assessments required further development to ensure staff were clear in how to support people to make specific decisions about their care and well-being.

People were positive about the food provided; they enjoyed their meals and were supported to eat and drink sufficient amounts. People were supported to maintain and improve their health and well-being. People were supported to access a range of external health professionals when they needed to.

People were appreciative of staff who were caring and helpful. Staff knew people well, treated people with respect and promoted their dignity, privacy and rights when they provided care. Staff ensured people's independence, known wishes and choices for their care was upheld.

People had their care needs assessed and care plans were put in place to meet their needs. Staff used the information in care plans to tailor their support to individual preferences. This meant that people received personalised care that reflected their wishes and met their needs.

A range of activities were organised for people in the service and within the local community. People spoke positively about being able to choose what they wanted to do when they wanted to do it and were happy with the opportunities provided.

People and relatives were confident they could raise any concerns with the registered manager and felt their complaints would be listened to and acted upon.

People, relatives and most staff had confidence in the management of the service. The registered manager undertook checks and audits to assure themselves that people were receiving good care. However, outcomes of quality assurance were not consistently recorded to demonstrate that effective systems were in place to ensure people received safe and effective care.

Stonesby House Ltd has a registered manager in place. 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 a breach of regulation in relation to the management of medicines. We found that systems for recording, auditing and storing medicines were not robust and had the potential to put people at risk. . This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe in the home and that they trusted staff to look after them. They told us how the staff included them in decisions about the running of the home and how their care was provided. Throughout our inspection we saw examples of good care that helped make the home a place where people felt included and comfortable. People were treated with dignity and respect.

There were enough staff to provide safe and effective care for people. Staff working in the home understood the needs of the people who lived there. We saw that staff and people living in the home communicated well with each other and that people were enabled to make choices about how they lived their lives. People living in the home told us they were happy with their care.

People were supported to take part in a range of activities to meet their social needs. People had been asked what was important to them and how they liked to spend their time. Staff used this information to plan the activities provided. This meant that people were able to spend their time in the way they preferred.

The risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people's safety. This meant that people were protected from risks to their welfare whist being supported to be as independent as possible.

People were supported to have their mental and physical healthcare needs met and encouraged to maintain a healthy lifestyle. Staff made appropriate use of a range of health professionals and followed their advice when provided.

Staff told us they felt supported in their roles and the registered manager provided staff with clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care. Staff were clear in their roles and confident they could raise concerns with the registered manager. The registered manager had shown how they had learnt from incidents in the service and responded by making changes and improvements to improve care. This showed that the service was well-led.