Stoneyford Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were not accurately reflected within care plans which meant staff did not have clear guidance on how to support people. People and their relatives told us they were not included in care plan reviews and had not been given access to their care plan. We observed staff failing to engage, communicate or seek consent from people whist supporting them and assisting them with their care needs. Where quality monitoring checks and reviews were completed by management, they did not identify the concerns people had raised and were not effective in supporting people or promoting positive outcomes.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care plans did not support people with their needs or fully reflect people’s conditions. For example, one person’s care plan stated their skin integrity was healthy and intact and the person was fully and independently mobile. However, after speaking to the person, it was established that they had active wound care management and as a result were unable to mobilise without the support of two staff members. This placed the person at risk of receiving inappropriate care and support.

Staff we spoke with told us care plans were not consistently updated however they used staff meeting and daily handovers to communicate people’s support needs and provide updates to other colleagues about people’s care requirements. One staff member told us that the management team were aware of this and were supporting senior staff with additional training and upskilling. They said, “I have recently started training to look at care plans and update them, the manager is supporting me to do this.”

Care plans did not accurately reflect people’s needs and did not contain clear guidance for staff on how to support people effectively. Care plans we examined showed members of the management team had reviewed the care plans on a monthly basis but had not identified the conflicting or inaccurate information we found during the assessment.

People told us they did not always receive care and treatment in line with their wishes or in ways that promoted and supported improvements in their condition. For example, one person told us that due to a back injury they experienced pain when lying down and had discussed this with staff. They said, “The mattress is rock hard. They promised to change it for me, but they still haven’t. I can’t sleep because of the pain.” A relative we spoke with told us their relative had not been supported with a nail infection appropriately. “They identified the issue but nothing more, [Name’s] nails haven’t even been trimmed.”

During the assessment we observed the lunchtime meal service. People were not supported appropriately to eat and drink and waited excessive amounts of time for support. We reviewed records staff competed after the meal and records did not match what we observed people eating. For example, one person’s notes stated they had eaten a full meal, however we observed the person declining the meal as they stated they didn’t like it and they were not offered an alternative. Staff we spoke with told us they had received appropriate training; however, staff felt they lacked guidance over their daily priorities and clear direction on how to support people.

Care plans and daily notes we reviewed showed people did not receive care in line with identified best practice. For example, one person’s care plan stated they were more likely to experience a seizure if personal care was undertaken in a morning, therefore the person should only be supported in an afternoon with any personal care needs. Daily notes we reviewed showed consistently that the person was assisted with personal care in the morning. The care plan had been reviewed monthly by the management team but had not identified the concern described above. This placed the person at ongoing risk of a seizure from a known trigger.

Not everyone we spoke with was able to comment on how the home worked with other services. The people we did speak to told us they were supported appropriately by district nurses and saw a chiropodist on a regular basis, however other people said they were not fully supported to access help with their continence and physiotherapy needs.

Staff told us that senior care staff were responsible for this aspect of care and attended the weekly GP home visit. Staff were aware of people’s advance wishes such as ReSPECT forms but told us they had to wait for senior staff to provide this information to other professionals in an emergency. ReSPECT forms contain a summary of personalised recommendations for a person’s clinical care in a future emergency when they do not have capacity to make or express choices.

We observed a letter within one person’s care plan from a specialist who had raised concerns that the service was not supporting the person with their daily physiotherapy exercises appropriately or consistently. Their care plan had been updated to guide staff on how to provide this support, but daily notes did not clearly reflect whether staff consistently provided this support.

Processes and recommendations were not always followed. For example, staff were trained in the use of and used RESTORE2 which incorporates the National Early Warning Score (NEWS2) to identify if a service user is becoming unwell. There were no records in place to determine whether staff had received updates or had their competency assessed to ensure they were competent in using both tools. During the assessment we observed a person who appeared unresponsive, staff had not followed guidance as set out in RESTORE2 and this delayed the person receiving emergency medical treatment.

People and their relatives told us they were not supported to live healthier lives. Some people stated their care needs had increased since moving to Stoneyford Care Home. One person said, “I’ve lost my freedom and can’t walk as well as I used to now. I don’t walk anywhere now.” A relative said, “[Name] was mobile and continent before they came here, they aren’t now. Last week when we came, they [relative] were sitting at the table, and they had soiled themselves. We had to tell the staff; they hadn’t noticed.”

Care plans stated how people wanted to be supported, for example one person’s care plan said they liked to spend time in the garden, and this decreased their anxieties. We saw no evidence of staff supporting this activity. During the assessment we observed this person trying to access the garden and tried to access and climb through an open window to go into the garden by climbing on a chair. Despite staff being present they did not intervene, CQC assessment team staff had to support the person to safety.

While care plans were reviewed on a monthly basis, since our last assessment there was no evidence that people, their relatives or those important to them had been included in these reviews. This meant that management did not have clear oversight of whether people were being supported to live healthier lives in line with their wishes. We spoke with the management team about the concern seen with a person trying to access an open window and they immediately spoke to staff involved.

Most people we spoke with told us they had not experienced improvement or positive outcomes since living at the home. One person said, “I haven’t been here very long but it’s like living in a cemetery. I’m not supported to do anything.” Another person said, “I used to be able to use the toilet but now I don’t. I was also covered in mess for several days and they had to hose me down every morning and then they realised they were giving me laxatives, I don’t know why, I didn’t need them.”

We spoke with staff about improving outcomes for people. One staff member told us about a new massage therapy bed the provider had purchased and made available to residents to help with joint stiffness and mobility, however they stated, “I understand the logic but there is a charge for £1 per minute to use the table and I don’t know who is suitable to use it and who isn’t, I honestly don’t know if it would be safe to let some people use it when they haven’t been assessed.” The provider confirmed the massage bed was not currently in use whilst they undertook research and evaluation of the benefits and suitability of people to use the item.

Processes and systems were not in place to monitor whether people were achieving their goals and outcomes. Whilst goals and wishes were recorded in care plans these were not assessed during routine monthly reviews. This meant the management team did not have clear oversight of whether people’s care was safe, effective or meeting their needs.

People told us their needs and wishes were sought initially when they moved into the home but this did not continue. People and their relatives told us they did not have access to their care plans. One relative said, “I don’t know if the care plan matches what we agreed to, I requested access as my [relative] gave permission, but management told me to have access I need to be a legal power of attorney but my [relative] has capacity.”

While some staff sought consent prior to supporting people with care needs we consistently observed other staff not engaging or communicating with people prior or during the support they provided. For example, we observed a staff member supporting a person to move from the communal lounge to their bedroom to prepare for bed. The staff member approached the person and started to put on their shoes without telling them what they were doing or why. Furthermore, we observed two staff members continually ask a person if they were ready for bed. This person clearly stated they did not wish to go to bed but staff continued to follow the person around and repeated the same question causing the person to become frustrated and agitated. The manager intervened after 15 minutes and advised staff to respect the person’s decision. We conducted a short follow up visit to observe the immediate changes the provider and management team had put in place following our assessment. We observed staff obtaining consent from people prior to supporting with care. Staff were more knowledgeable about how to achieve this and how to promote decision making for those who lacked capacity.

The manager confirmed that staff had received training in consent to care and treating people with dignity and respect but acknowledged that competency checks were not undertaken to ensure staff compliance and performance. This meant management were not aware of whether people were consistently treated with respect or included in consenting to their care and had not identified the issues we observed.