Stoneyford Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe living at the home and had seen positive improvements since our last inspection. We observed consistent and safe staffing levels with a staff team who had undergone appropriate employment checks. Staff were trained appropriately and supported by regular team meetings and supervisions. The new management team had reviewed all care plans and risk assessments and these were now person-centred and provided staff with clear guidance on best practices and methods to kept people safe whilst promoting independence and positive risk. The new manager was responsive and acted on feedback we gave during the assessment regarding manual handling practices and minor maintenance issues.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since the last inspection people and their relatives told us the new manager had been proactive and open with communication and providing updates. Relatives described regular relatives’ meetings where they were able to raise concerns and questions as well as receiving updates. One relative said, “The meetings are now regular, have an agenda and a lot more professional. I have seen improvements based on feedback and feel my [relative] is now safe living at the home.”

The new manager explained since the last inspection there had been a new management team employed. There was now a manager present at the home at weekends for support and this change had been made following feedback from people and staff. Staff supported this and told us they were given opportunities to provide feedback and were confident to do so. Staff said they welcomed the management support at weekends. One staff member said, “Having this means people are safer as we can refer concerns or issues quickly.”

The provider had robust and effective processes in place to monitor and analyse identified risks. Incidents and accidents were reviewed, and lessons learned were completed and communicated to staff to reduce the risk of incidents reoccurring. For example, lessons learned had been communicated to staff to show the importance of updating daily notes promptly to ensure people’s health condition was accurate and consistently recorded and showed the care they had received. There were policies and processes in place which were now being followed and monitored which meant we saw improvements in the logging and response to people’s complaints and concerns.

People and their relatives told us where people had returned to the home following a period of stay in hospital the management team had ensured a new care plan had been developed which they had been included in. One relative said, “My [relative] recently went to hospital as an emergency, when they were due to be discharged the manager sat with us and did a new care plan to make sure all my [relative’s] new needs were known and recorded.”

Since the last inspection there had not been regular admissions to the service however the manager was able to describe processes which were now in place to ensure once admissions commenced staff knew how to assess and record people’s needs accurately and safely. The manager said “Ensuring we correctly assess people’s needs is essential. If we cannot support them appropriately it places so much pressure on staff and increases risk.”

We received mixed feedback from professionals who worked with the service. Recently paramedics who attended the home stated care staff were not knowledgeable about people’s conditions or their medicines and this had delayed decision-making and admission to hospital. The manager had acted on this feedback and implemented a process which ensured people’s transfer of care was dealt with by a senior member of staff. However, another professional working with the provider told us they had seen improvement in the quality of information being recorded about people’s needs. One professional said, “The provider completes 1-page profiles that are really detailed and make immediate or serious risk known.” This ensured risks to people were mitigated if their care needed to be transferred.

Care plans contained a detailed summary of people’s care needs and their individual wishes. This meant that in an emergency this information could be shared with another medical professional. Since our last inspection the manager had made improvements in handover processes between staff members. For example, improvements had been made in the storage of documentation which meant staff had quick access to documents such as ReSPECT forms to assist emergency services and ensure people received care safely.

People told us they did not always feel safe especially in communal areas of the home at times. One person said, “Other residents can get agitated, and this makes me very uncomfortable when there are no staff about to calm things down.” A relative said, “There are times, especially in the evenings when there are no staff in communal areas, and it can be bedlam.” However other people told us staff availability and knowledge had improved since our last inspection and they now felt safe living at the home and were confident in staff’s ability to keep them safe.

Staff were knowledgeable about safeguarding and could describe the types of abuse people could be at risk from. Staff told us they had regular meetings to discuss any safety concerns they had and were confident the manager would respond appropriately and swiftly. One staff member said, “I believe the manager would act straight away but if they didn’t, I would report my concerns to the local authority or even the police if I thought it was that serious.”

We observed people were not always protected from the risk of harm when staff undertook manual handling practices. For example, we observed staff supported a person to transfer into a wheelchair without applying the brakes. We fed this back to the manager who responded immediately and took appropriate actions including increased spot checks of staff performance.

Policies and guidance were in place to support staff in identifying and raising their concerns regarding people’s safety. We saw management had a log that monitored when these concerns were raised and actions that had been taken to mitigate risk to people. We saw evidence that these logs were evaluated by the manager and appropriate notifications to the local authority and CQC were made.

People told us staff were knowledgeable about their needs and how to support them whilst keeping them safe. One person said, “I use a rotunda but if I am really tired, I use a hoist and the equipment is always available. Staff help me to use whichever is more appropriate at the time.”

Staff told us they were aware of risks to people and felt confident the guidance within care plans enabled them to support people appropriately to remain safe. One staff member said, “Care plans have really improved, and we now get chance to read them to make sure we know the care people need. We have handover meetings everyday so if there have been any urgent changes or someone is unwell, we know straightaway.” The manager described how they were attending handover meetings on a regular basis to upskill staff’s knowledge and confidence in identifying and communicating risk effectively which ensured people remained safe.

People were not always safe from risks. We observed some inappropriate manual handling techniques as described in safeguarding; we also saw people some of whom were living with dementia wandering the home without supervision. However, we also witnessed staff having person-centred conversations with people and promoting people’s choices. For example, one person was offered the choice of moving from their room to the main lounge with mobility equipment or with support from staff.

Care plans contained person-centred risk assessments and provided clear guidance for staff on a person’s mental, physical and social needs. Staff knew how to support people to manage risk. For example, where people were at high risk of falls care plans contained information on how to mitigate risks whilst encouraging the person to be as independent as possible.

People told us they felt safe living at the home as improvements to the environment had been made. People told us they were supported to personalise their rooms in a way they chose, and cleaning of the home was now more consistent. One person said, “[Staff member] is amazing. They make sure I always have clean sheets and room and they look after my clothes.”

Staff told us improvements had been made since our last inspection. Staff described cleaning schedules for all areas of the home which gave them clarity over their responsibilities and what was expected from them. One staff member said, “We now have more staff on the domestic team and someone dedicated to laundry so we can ensure everywhere is cleaned consistently.” Another staff member said, “Management have been very supportive and if we need help because someone if off sick or on holiday they will step in so standards don’t slip.”

Since our last inspection the appearance and cleanliness of the home had improved. Communal areas were now free of dirt and debris and aids such as pressure cushions were labelled and clean. Where people used equipment such as hoists and wheelchairs these were clean and well maintained. The home was safe in the event of fire. Corridors were clear of any blockages allowing people to follow easy to read escape routes. Staff had access to fire-fighting equipment which was maintained and inspected on a regular basis. We observed one broken window restrictor on a ground floor window. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and safety executive. We notified the manager and the maintenance team replaced it immediately.

The environment was kept safe by regular checks and maintenance. We saw there had been regular checks to ensure the home was safe in the event of a fire (for example, by checking the alarm systems). Systems were in place to ensure water quality was maintained to reduce the risk of water-borne bacteria (like legionella.) The gas heating system was regularly serviced to prevent harm to people. Improvements had been made to the call bell system and people had access to call bells to call for support if needed. Documentation showed these call bells were regularly checked to ensure they were working and effective.

We received mixed reviews from people. While most people stated they felt safe there were still some concerns with consistent staffing in the evenings. One person said, “They are a bit understaffed but it’s better than it was. Sometimes they are under pressure.” A relative said, “Evenings can be an issue as people need support to go to bed and there are only 3 staff, so people end up unsupervised or waiting.” We fed this back to the management team who advised they would review evening staffing levels to ensure people were safe.

The manager described how agency reliance had been reduced since our last inspection which ensured people received care from a consistent staff team now. Staff told us that staffing levels had improved and training was now consistently delivered. Staff also said they felt supported by the new manager and felt they were offered opportunities to give feedback through regular meetings and 1-2-1s.

We observed improved staffing levels since our last inspection. This meant staff were now able to spend more time with residents and we observed staff socialising and supporting people to undertake activities; however, there were times communal areas were unsupervised. We observed improvements in call bell waiting times during our assessment. When people pressed their call bell staff were co-ordinated and effective in responding and assisting people.

The management team had completed a full review of all recruitment processes and records since our last inspection and ensured all staff had the required employment checks in place, including DBS and reference checks. Staffing levels were regularly reviewed with the support of a dependency tool which accurately reflected people’s needs. This ensured safe staffing levels consistently. New staff received induction training and shadowed a senior member of staff prior to working with people independently. There was now management cover over the weekends and an on-call system so staff had access to support and advice out of hours.

People told us that staff consistently wore PPE and people said they were offered PPE as needed, for example at mealtimes. One person told us there were occasions were staff forgot and still wore jewellery that was inappropriate but felt overall standards had improved and managers were more vigilant when observing staff and practices in the home. One relative said, “Staff now look more professional and I have seen managers doing spot checks, it’s very reassuring.”

Staff told us they were provided with IPC training and managers undertook competency checks on the home and staff practices to ensure compliance and safety. One staff member said, “We have a lot more spot checks now and this is really good, as we get feedback. Before I didn’t know if I was doing something right or not but now it’s very clear and it helps you feel valued.”

We observed staff wearing PPE appropriately whilst supporting people and disposing of this in line with best practice guidance. This ensured people were protected from the risk of catching infections. All staff were proactive in ensuring the home environment was clean and tidy and we witnessed care staff supporting by cleaning communal areas after activities and mealtimes. Best practice guidance was on display. For example, there was hand washing guidance in bathrooms.

The provider had an infection control and prevention policy and completed regular audits to ensure the organisation’s compliance to this policy. The manager completed daily walkarounds as well as auditing departmental reports such as domestic cleaning schedules and spot checks. The provider had been responsive to feedback from the last inspection and had worked in partnership with other professionals such as the local authority to ensure standards throughout the home and staff knowledge through training and development.

Everyone we spoke with said there had been improvements in medicine administration. People told us staff were responsive if they requested pain relief and no longer experienced excessive wait times for this medicine. One relative praised the staff for the innovative ways they supported their relative, “My [relative] can resist medicines but the staff are really good, they try different staff members and do it covertly only as a last resort, I’m really pleased with the support and care they show.”

The manager described how the home was moving to electronic monitoring and recording of medicines to help reduce error in medicines administration such as missing signatures on MAR charts. The manager had ensured the supplier would provide 24-hour support whilst staff were learning the system to ensure people remained safe. Staff told us senior care staff were responsible for medicines but stated they felt confident in raising concerns to seniors and managers if they felt people needed medicines for pain or illness. A senior staff member said, “Management support has really improved, they work with us as seniors to make sure all our medicine practices are fit for purpose and support us to audit processes to make sure people are safe and well cared for.”

Staff kept clear records of when they had given prescribed medicines. We saw medicines were given as prescribed. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place and more medicine could be ordered from the pharmacist as needed. Some people required ‘as needed’ medicine and staff had clear written guidance on how this should be administered. Although senior staff were responsible for administration of this medicine, guidance was clearly written in care plans so all staff know how and when to help someone request an ‘as needed’ medicine. A recent inspection by the Integrated Care Board Medicines team also supported the changes and improvements seen with the safety of medicines administration.