The Care Quality Commission
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Archived: Stonehaven Residential Home

Overall: Requires improvement read more about inspection ratings

23 Carter Street, Sandown, Isle of Wight, PO36 8DG (01983) 402213

Provided and run by:
Mr & Mrs R Cowen

All Inspections

3 April 2017

During a routine inspection

This inspection took place on 3 April 2017 and was unannounced. The home provides accommodation for up to 27 people, including some people living with dementia care needs. There were 11 people living at the home when we visited. The home was based on two floors connected by a passenger lift; there was a choice of communal spaces where people were able to socialise; most bedrooms had en-suite facilities.

There was 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.

At our last inspection, in April 2016, we identified breaches of five regulations. People did not always receive personalised care that met their needs; people were not always treated with consideration; staff did not follow legislation designed to protect people’s rights; some areas of the home were not clean and smelt of urine; and quality assurance systems were not effective. We took enforcement action and imposed a condition on the providers’ registration to prevent them from admitting new people to the home without written permission from CQC.

At this inspection, we found action had been taken and improvements made. No breaches of regulations were identified, although some areas still required further improvement.

We found staff did not always follow appropriate infection control procedures; they did not always wear protective clothing when handling soiled clothing or wash their hands afterwards. However, the home was significantly cleaner than at our last inspection and smelt fresh.

Essential safety checks of equipment used to support people to move had not been completed, although these were done following the inspection. Staff did not always apply the brakes to wheelchairs when supporting people to transfer to them; this put them at risk of falling. Other risks to people, however, were managed appropriately.

Medicines were managed safely, although guidance was not followed to help ensure one person received their ‘as required’ medicine when needed.

Staff received appropriate support and training. Some staff did not always apply their training in practice when supporting people living with dementia, although other staff demonstrated a sound understanding of how to meet people’s dementia care needs.

People were complimentary about the food. Their dietary needs were met and they received appropriate support to eat. However, staff did not always maintain a suitable atmosphere in the dining room that encouraged people to eat well.

Improvements had been made to the environment. These supported the needs of people living with dementia and helped them navigate around the home. However, the call bell system was loud and intrusive and had the potential to impact adversely on people.

There were enough staff to meet people’s needs. Appropriate recruitment procedures were followed. People were protected from the risk of abuse and staff had received safeguarding training.

Staff followed legislation designed to protect people’s right. They sought consent from people and acted in their best interests.

Staff had built positive relationships with people and treated them with kindness and compassion. They protected people’s privacy and dignity, involved them in decisions about their care and encouraged them to remain as independent as possible.

People received personalised care from staff who understood and met their needs. Staff were led by people’s wishes and supported them to make as many choices as possible. People were supported to access healthcare services when needed.

Care plans contained information and guidance to staff to help ensure people received consistent care. They were reviewed regularly and staff responded appropriately when people’s needs changed.

People had access to a range of activities to meet their social needs. The registered manager sought and acted on feedback from people and people knew how to raise concerns.

People were happy living at Stonehaven and had confidence in the management. Staff understood their roles, worked well as a team and were encouraged to make suggestions for improvement.

There was an open and transparent culture. The registered manager had engaged with a health and social care specialist from the Clinical Commissioning Group to enhance the service. Positive links had been developed with the community to the benefit of people.

An appropriate quality assurance system had been developed to help ensure the service remained compliant with the regulations.

7 April 2016

During a routine inspection

This inspection took place on 7 April 2016 and was unannounced. The home provides accommodation for up to 27 people, including some people living with dementia care needs. There were 14 people living at the home when we visited. The home was based on two floors connected by a passenger lift; there was a choice of communal spaces where people were able to socialise; most bedrooms had en-suite facilities.

There was 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.

At the last inspection in August 2015, we asked the provider to take action to make improvements in relation to person-centred care; the need for consent; safe care and treatment; quality assurance and staffing. We took enforcement action and imposed a condition on the provider’s registration to prevent them from admitting new service users without prior written permission from CQC. We rated the service as inadequate and placed it in Special Measures

At this inspection we found some improvements had been made and the service has been taken out of Special Measures. However, the provider was still not meeting all fundamental standards of safety and quality.

We found continuing concerns with infection control arrangements. The laundry and main bathroom were not clean and some people’s bedrooms smelt strongly of urine.

People told us they felt safe and staff had received training in safeguarding adults from abuse. However, the local safeguarding authority did not have confidence in the provider’s ability to conduct effective and prompt investigations.

Most staff treated people with consideration, kindness and patience, interacted positively with people and supported them to build caring relationships. However, one staff member did not treat people in a considerate or compassionate way.

Medicines were managed safely and people received them as prescribed, although action was not taken when storage temperatures dropped to unsafe levels. Measures had been put in place to reduce the risk of people developing pressure injuries, but special pressure-relieving mattresses were not set correctly according to people’s weights, so may not have been effective.

The provider had not taken action to ensure that legislation designed to protect people’s rights and freedoms was followed. However, staff sought verbal consent from people before providing care and support.

Activity provision for people had not improved. This was very limited and did not always meet people’s social needs. Records of activities people took part in were not accurate. One person’s personal care needs were not being met and people were not always supported appropriately when they became anxious or upset.

Other people received personalised care from staff who understood and met their needs. Most people were supported to make choices about their daily routines. They had access to healthcare services, although staff did not follow-up on the need for one person to be re-seen by a doctor when their arm was swollen.

The provider operated a comprehensive quality assurance system, but this was not always effective. The systems and processes had not ensured that all fundamental standards of quality and care were met.

Individual risks to people were managed effectively and people were supported to move safely. Emergency procedures were in place and staff had been trained to administer first aid.

People said the quality of the food had improved with the recruitment of a new chef, although a choice of drinks was not offered at lunchtime and visual prompts were not used to help people choose their meals.

People had mixed views about how well the home was run. There was a high turnover of staff and people were not cared for by a stable staff team. With the exception of mealtimes, which were disorganised, staff worked well together, understood their roles and felt supported by managers.

Staff were suitably trained and said they felt supported in their roles. Induction procedures were comprehensive and staff were encouraged to gain vocational qualifications. There were sufficient staff to meet people’s needs and recruitment procedures helped ensure only suitable staff were employed.

People’s privacy and dignity were protected and they or their families (where appropriate) were involved in planning the care and support they received. There was an appropriate complaints policy in place and the provider sought and acted on feedback from people.

The provider notified CQC of all significant events and had displayed the ratings from the last inspection in the reception area of the home. The registered manager was working with other professionals to help improve and develop the service.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

11 & 17 August 2015

During an inspection looking at part of the service

This inspection took place on 11 and 17 August 2015 and was unannounced. The service provides accommodation and personal care for up to 27 people, including people living with dementia. It also provides short-term respite care for people. There were 16 people living at the service when we visited.

At our last inspection, on 28 November and 1 December 2014 we identified breaches of seven regulations. We issued three warning notices and four requirement notices. The provider wrote to us telling us they would take action to become compliant with all regulations by 14 May 2015.

At this inspection we found some improvements had been made, but the provider was still not meeting all fundamental standards of quality and safety.

The home had 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.

People’s safety was compromised in some areas. Infection control guidance was not always followed by staff operating the laundry. Disposable gloves and aprons were not available in the laundry. The laundry and medicines rooms were not clean and some areas of the home smelt of urine.

One person told us two staff members mistreated them. This led to the provider taking disciplinary action against two senior staff members for abuse. However, prompt action was not taken when the person reported a lost watch. We observed a range of interactions between people and staff, some of which were patient and caring and some of which showed a lack of consideration.

There were not always enough staff available to meet people’s needs and staff were not organised well. The staff member administering medicines was interrupted seven times to support people or other staff. This increased the risks of making mistakes with people’s medicines and a delay in people receiving their medicines.

We received mixed views from people about the quality of the food. A range of drinks was available throughout the day, although only water was available at lunchtime. The service of meals was disorganised and people did not receive appropriate support to encourage them to eat well. Accurate records of people’s food and fluid intake were not maintained.

Staff did not follow legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests. However, they did follow legislation to make sure people were not deprived of their liberty unlawfully.

New members of staff did not always receive appropriate supervision or support. There was no effective process in place to make sure staff were competent before being allowed to work unsupervised. Experienced care staff received appropriate training, supervision and appraisal, although some senior staff were critical of the preparation they received for their role. Non-care staff were not trained or skilled at communicating with older people or people with dementia care needs. They did not receive supervision or appraisal to assess their performance or their training needs

Sedatives were not always administered appropriately. Alternative, more suitable strategies to support people when they became anxious were not always used. Charts designed to help identify triggers that caused people to become agitated were not always completed by staff so that appropriate strategies to support people could be developed.

Care plans did not contain sufficient guidance about the support people needed to maintain healthy skin, to regain their mobility after surgery or to support them when they experienced seizures.

Activities were provided, including events to which family members were invited. However, these were limited to times when the activity coordinator was working.

The provider conducted a range of audits. The medicines audit had been effective in ensuring compliance with the regulation, but the audit of infection control procedures and reviews of care plans had not picked up the concerns we identified.

Some staff described management as “supportive” and “approachable”, but others described a culture of blame and bullying. There was high turnover of care staff, including three members of staff who had been dismissed for misconduct. As a consequence, people did not receive care from a motivated, consistent staff team.

However, most people and their relatives told us they were satisfied with care provided. A clear management structure was in place and relatives felt the home was run well. Family members were welcomed and described the home as “homely”.

Some aspects of care planning had improved, including information about people’s continence needs and pain management. A compliance manager had been employed to improve quality assurance arrangements.

Risks posed by the environment were managed effectively. Recruiting practices were safe. Suitable arrangements were in place to manage medicines safely. Staff knew what action to take if the fire alarm activated.

People were involved in discussing and planning their care and treatment. The provider had appropriate policies in place to protect people’s privacy.

Following the inspection we discussed our concerns with the Isle of Wight Council’s safeguarding adults team.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the enforcement action we have taken at the back of the full version of the report.

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.

28 November and 1 December 2014

During a routine inspection

This inspection took place on 28 November and 1 December 2014 and was unannounced. The service provides accommodation and personal care for up to 27 people, including people living with dementia. It also provides short-term respite care for people. There were 22 people living at the service when we visited.

The home had 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.

People’s safety was being compromised in some areas. There was not enough staff to meet people’s needs. People frequently had to wait for staff to support them, for example to transfer them from wheelchairs into lounge chairs. When people tried to move without support, it put them at risk of falling. For periods of up to 20 minutes, people were left unsupervised in the lounge with no means of calling for assistance.

All required medicines were in stock and people received most medicines as prescribed. However, there was a lack of information for staff about when ‘as required’ medicines, such as laxatives and sedatives, should be given. Consequently, people may not have received these medicines when needed. The fridge used for storing medicines that had to be kept cool was not working and the arrangements for the disposal of unused medicines were not robust.

Risks relating to the use of bedrails, the management of pressure injuries and supporting people to move safely were not always managed in a way that ensured people’s welfare and safety.

There were mixed views from people about the food and drink provided and some people told us there was little choice. The lunchtime menu did not offer a choice of meals. An alternative was available but this was usually a plain omelette. The amount people ate and drank was not monitored effectively, which meant people were not protected from the risk of losing weight or becoming dehydrated.

Most people using the service were living with dementia. Any restrictions placed on people were properly authorised and appropriate safeguards were in place. However, people’s ability to make decisions was not assessed. There were no records to show why certain decisions, such as the use of bedrails, had been made on behalf of people. This meant people’s rights were not protected.

The provider’s induction and training programme followed national standards and staff had completed most essential training. However, they had not received training in how to support people who displayed behaviours that challenged and were not knowledgeable or skilled in this area.

People told us they were cared for by kind and compassionate staff, although two relatives said staff could be “short” or “off hand” with people. We observed occasions where staff interacted well with people, but also some instances where staff showed a lack of consideration and understanding of people living with dementia.

Care was not always personalised to meet people’s individual needs. For example, staff organised a range of activities for people, but these were not tailored to meet people’s interests. Care plans did not contain enough information about people’s continence needs and pain assessments were not conducted to make sure people received pain relief when needed.

People told us staff were good and worked hard; however, two relatives and a visiting doctor were critical of how the service was organised. Staff were focussed on tasks rather than people’s needs and staff shortages meant they were frequently called away before completing the task they had started.

The systems used to monitor and assess the quality of service were not effective. Audits had not identified the concerns we found, such as lack of information in care plans or the inadequate monitoring of what people ate and drank.

The provider had appropriate policies in place to protect people from abuse and people told us they felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Recruitment processes were safe and the provider carried out pre-employment checks to make sure staff were of good character.

People’s preferences, likes and dislikes were recorded in care plans, and staff were aware which people liked to sit together; they supported them to do this and used their preferred names. Staff took practical steps to ensure people’s privacy was not compromised and kept confidential information securely.

People’s care was reviewed regularly and they or their relatives were involved in the reviews. The provider conducted surveys to seek feedback from people, families and visitors through the use of questionnaires. Recent questionnaires provided positive feedback and the provider had made improvements as a result of the feedback. Staff told us they enjoyed working at the service and felt supported by the registered manager.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

18 November 2013

During an inspection in response to concerns

People told us they were satisfied with the quality of service they received. One said, 'It's very comfortable. I have not been here very long, but it is quite good'. They told us they received care and support which met their needs and was delivered according to plans they had been involved in creating. They said the staff were friendly and responsive, and there were enough staff to provide support promptly if they needed it. Their preferences were respected: for instance they could go to bed when they pleased and one said, 'Whatever time I get up, breakfast is always ready for me.'

We observed care and support that was effective and responsive, and delivered in a caring manner. Processes and procedures were in place to ensure the safety and welfare of people using the service.

People using the service were treated with respect, and their privacy and dignity were maintained. Steps had been taken to ensure vulnerable people were protected against the risk of abuse. Staff received appropriate training and were supported to deliver care to the required standard.

At the time of our inspection the provider did not have a registered manager in post.

2 July 2013

During a routine inspection

Our previous inspection in February 2013 identified concerns in relation to the way people were treated and cared for, the cleanliness of the home and the management of medicines. There were also concerns about the environment, recruiting procedures and the way records were maintained. We visited the service and found that improvements had been made since our last visit.

We used a variety of methods to help us understand the experience of people using the service. We spoke with eight people, two family members and one visiting friend. We observed care and support being delivered and looked at six care plans. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed staff interacting warmly with people. One person said, 'It's free and easy here, I'm quite happy'. Care and treatment met people's needs. One family member told us, 'Overall, the care is very good'.

People were cared for in a clean, hygienic environment and the home was maintained in a good state of repair. Medicines were managed effectively and people received their medication when they needed it.

There were effective recruitment and selection processes in place. A range of audits were undertaken and records were accurate and fit for purpose.

8 February 2013

During an inspection in response to concerns

We spoke with seven people who used the service, two relatives and two visiting health professionals. We reviewed five care plans, three staff files and spoke with five members of staff, including the deputy manager. The people we spoke with expressed a wide range of views regarding their experience of the service provided. Two people told us 'staff are all right' and 'they are very good at helping'. Another person told us 'most staff are all right' some of them 'make you feel like a nuisance' and a fourth person said 'I am very unhappy here'. We spoke with two relatives who told us they were happy with the care provided to their relatives. One said 'I can't complain they look after her extremely well'.

We found people's privacy and dignity was not respected and care was delivered in an institutionalised way. There was a toileting regime which required all people to be taken to the toilet before lunch whether they needed to go or not. One person who needed the toilet during breakfast told us 'you just have to wait'.

We saw staffing levels were sufficient to meet people's needs.

We found parts of the home and some bedrooms were not clean, there were bad odours in two of the bedrooms and some of the sheets and mattresses were stained with urine. We also identified problems with the management of medicines and the way records were managed.

5 December 2011

During an inspection in response to concerns

People told us they liked living in the home and they could talk with the manager and the staff if they had any problems. They said that they had visited the home prior to their relative moving into the home. Some people said that the meals that were provided were very good and that choices were available to them. Others told us that the food was 'to a satisfactory standard.' One person said that they did not like curry and an alternative was provided.

People said that they felt safe and that the staff respected their privacy. They told us that the care staff were kind and helpful. Relatives told us that people were always dressed appropriately and the staff supported their relatives to maintain their personal care.