Archived: Stoneham House

The inspection took place on 8 March 2017 and was unannounced. A further visit took place on 17 March 2017 to continue with the inspection. We returned on 7 April 2017 to meet with the provider as since our previous visits the circumstances of the service had changed as the registered manager had left and we had received new information of concern. We shared information with Hampshire County Council who commission care at the service and who take the main lead in safeguarding people living at the service. Since our meeting with the provider on 7 April 2017 we received further information of concern and so visited the service again on 22 May 2017 and 25 May 2017. When we visited in March 2017 the evidence we gathered reflected a service which had continued to make some improvements.This report reflects evidence from all of these visits but focusses more on evidence gathered during the visits in May 2017 and information gathered following our visits in March 2017 as this more accurately reflects the current position of the service.

We last inspected the service in December 2015. At that time we found significant improvements had been made since our previous inspection in June 2015 but we judged the service required improvement overall.

Stoneham House is a private residential care home without nursing set on the outskirts of Southampton. It is registered to provide accommodation and care for up to 37 people who may be living with dementia. At the time of our most recent visit in May 2017 there were 14 people living at the service.

At the time of our visits in March 2017 a registered manager was 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. At the time of our visits in April and May 2017 the registered manager had left and the service was being managed by an acting manager who knew people living at the service well.

Our main concern was the lack of structure within the service. Since the registered manager had left some of the provider’s family had taken over aspects of management, but they did not have the skills or experience to do this effectively. This meant for example, accountancy processes were unclear and responsibility about who should conduct audits of the service was vague. It was not clear who should be responsible for each aspect of the service.

There were not sufficient staff employed with the right skills and experience to lead a shift safely. Risk to people's care and welfare and environmental risk was not always properly addressed. The environment was excessively hot and some rooms had a malodour.

People were not always provided with care which focussed on their needs and wishes. The procedure to address complaints and safeguarding concerns was not robust. The culture of the service was not open and inclusive which meant staff did not always report or act upon concerns in a timely way.

We did however witness kind and caring interactions by staff and activities provided had improved since our last visit.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There were eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We last inspected the service in June 2015. At that time we found seven breaches of the Health and Social care Act 2008 (regulated activities) regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The overall rating of the service was inadequate and the service was therefore in ‘Special measures’. As such we kept the service under review and inspected again within six months.

Stoneham House is a private residential care home without nursing set on the outskirts of Southampton. It is registered to provide accommodation and care for up to 37 people who may be living with dementia. On the days of our inspection nine people were living there.

There was a new manager in post who was applying to become registered. 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 significant improvements had been made since our last inspection although further improvements were still needed for the service to demonstrate it provided consistent safe, effective and responsive care.

Overall, we found medicines were safely managed, but improvements were needed to ensure safe storage for some medicines and more guidance was needed to ensure staff understood how people liked to take their medicines.

Risk to people’s health and wellbeing was clearly assessed and although staff were provided with guidance about how to minimise the risk of harm which could be caused by the identified risks some more information was needed at times to ensure staff provided consistent care.

Staff were well supported and had received more training since our last inspection. There were still a few gaps in some staff knowledge and further training and support had been arranged. Although people’s care and support needs were known and acted upon further work was needed to ensure people followed their interests and to ensure they could take part in social activities if this was their wish.

Staff had a better understanding of the systems and processes in place to investigate any allegation of abuse. Staff were appropriately deployed and staff recruitment processes were thorough. People were supported to have enough to eat and drink and to maintain a balanced diet. Staff worked cooperatively with health care professionals to ensure people received on-going healthcare support.

People were treated with kindness and respect and they were encouraged to be involved in the planning of their care and support. The new manager demonstrated a very clear understanding of their role and responsibility and was well supported by the owner to help them to achieve the improvements needed. As they had only been in post for six week at the time of this inspection the improvements made had yet to have maximum impact upon the quality of people’s lives. The manager had a clear vision about how they wanted to service to develop. We were satisfied that, whilst some improvements were still needed, there were appropriate plans to put these in place.

We looked at the care records for all people living in the service. These were all very similar and lacked essential information about medical conditions such as diabetes and epilepsy. These were not personalised, accurate or fit for purpose.

We found staff had received training in safeguarding but this had not been updated for longer serving staff. Important information concerning pressure sores had not been notified to the appropriate bodies.

We found medicines were being obtained and administered appropriately and as directed. We found the service was not disposing of medicines appropriately and this led to large numbers of medicines being stored in the medicine cabinet. Medication prescribed 'as required' was not recorded when delivered. Stock checks were not being carried out to monitor the quantity of each 'as required' medicine held in the cabinet. Staff did not have a record of when they were assessed as being competent to administer medicines.

We spoke with two staff who told us they did not receive regular supervisions. Records of supervisions showed staff had not received supervision in over two years.

People were positive about the support they received and told us the staff were 'helpful'. People told us they were happy with the care and support they received. They felt the staff were approachable and supportive.

Care plans were detailed and person-centred, and supported staff to meet people's different needs. Staff were observed to be respectful and responsive to those different needs. The home appeared clean and well maintained.

The provider had in place effective recruitment and selection processes, and appropriate pre-employment checks were undertaken.

People were asked for their views and opinions and the provider took them into account when making changes to the way in which the service was provided.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.