Stoneyford Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

During our assessment of this key question, we found concerns around person-centred care which resulted in a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive responsive care and care was not always delivered in a person-centred way. People and staff were reluctant to raise concerns or complaints and told us about their concerns regarding the security and confidentiality of their information. Care continuity and integration was not always done safely or responsively which had resulted in unsafe admissions to the home. People received help and support to plan for the future and care plans clearly documented people end-of-life care needs and choices.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always experience person-centred care. People’s care plans did not fully reflect their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. A relative we spoke to said, “There has been a very high turnover of staff, a lot of very good staff have gone and so now staff don’t know [relative] like they used to, it’s a shame.”

We spoke with the management team about the lack of person-centred care and clear guidance for staff on how to support people in a person-centred way. For example, one person’s care plan did not reflect behaviours that been observed through incident forms and staff had not escalated their concerns. This meant there had been missed opportunities to support the person in a person-centred way and improve their outcomes. The management team stated they were completing immediate care plan reviews and would include people and their families where appropriate.

During the lunchtime meal service, we observed a staff member assisting a person to wear an apron. However, the fastenings to the apron were broken. The staff member tied the apron around the person’s neck. The person involved requested to have the apron removed but staff did not assist with this. The person tried to pull the apron off which caused it to tighten further. This created a choking risk to the person so the assessment team intervened and removed the item.

People received a mixed experience regarding care provision, integration and continuity. For example, some people were supported appropriately with support with their diabetes management and wound care and daily district nurse visits were consistent. However other people did not receive appropriate or consistent support with care needs such as physiotherapy or emotional wellbeing. For example, one person’s care plan showed staff had failed to identify the person was registered with a GP which delayed them receiving support for their emotional wellbeing.

Staff described how they supported people to access services such as dentists and chiropodists. However, as described under the safe section, some staff raised concern about admissions of people with mental health conditions who they felt they were unable to support responsively.

A partner who works with the home told us that the management team’s responsiveness was affected by their ability to locate physical documents and information. The partner said, “While we were on site, we asked to look at some documents and the manager struggled to find them. The manager stated they were responsible for all administration work as well as daily management of the home and they were finding it very overwhelming.”

Systems and processes did not always support safe and responsive care, integration and continuity. We saw evidence, such as emails, raising concerns about the admission of people and whether they were suitable for admission to the home. However, these concerns were not acted upon meaning opportunities to admit people safely were missed.

People and their relatives told us they did not always have a positive experience when they requested access to care plans or updates about people’s conditions. Most people we spoke with told us they did not have access to their care plans and had not been supported to access them despite making requests to do so. One relative said, “I had concerns about how my [relative] was supported with applying their cream and asked to see the care plan but I’m still waiting.” Another relative said, “When I emailed the manager with some information about my [relative], I got an out of office reply from the owner’s email address as well. Makes me wonder who else saw this information.”

Staff were knowledgeable about accessible information standards such as making information available in large print or an alternative language where needed. However, some staff raised concerns about the security of information. For example, some staff raised concerns about the provider having access to all the email addresses of the management team. People told us this affected their ability to freely communicate with the management team.

Care plans we reviewed did not demonstrate that people or relatives were involved in reviews and updates. Communication records we saw supported people’s and staff concerns about security of information. For example, we saw emails showing that staff who had raised concerns about another of the provider’s homes were being copied into emails about a person living at Stoneyford Care Home.

People consistently told us they were fearful to raise concerns and felt by doing so they would be ignored by staff and the management team. Family members we spoke with told us there was a relatives meeting. Some relatives told us the timings of the meeting were inappropriate due to work commitments meaning they were unable to attend. One relative told us they had attending the meeting and raised concerns about the quality of personal care people received. They said, “I have raised this before, but nothing has changed. I have found my [relative] in soiled clothing even after raising the issue.”

Staff told us they were not confident to raise concerns with the provider or management team. One staff member said, “Look at the records, everyone who spoke out to the CQC last time no longer work here.” Another staff member said, “Residents and staff are scared they will be made to leave if they complain.”

There were quality monitoring processes and policies in place to guide staff on how to handle information and follow up complaints. However, these were not completed consistently. For example, one person told us they had made a complaint about a staff member and their care practices. The management team told us they were aware of the complaint but there was no written record of this or the follow up actions.

People we spoke with were not able to fully comment on their experience of equity in access. However, everyone we spoke with told us they had been assisted to access GP support when needed. However, some people told us this support was delayed during out of hours as staff were reluctant to seek advice and support out of hours.

During the assessment the manager told us they had recently admitted someone who required nursing care and were currently awaiting this placement to become available. The manager was not able to tell us how this person’s needs would be met during this time.

Partners who worked with the home told us the service was not always responsive to adjustments for people in line with their recommendations. One professional gave an example of a recommendation for equipment changes to support someone with their mobility. They said, “Even though we explained the benefits of the changes and new equipment the provider was reluctant to support the changes suggested.”

We saw records of weekly walk rounds that included the GP visits and the home received consistent and responsive support from the pharmacy when people required medicines urgently. However as described under Safe, staff were not always responsive in an emergency and did not always use tools appropriately to assess people’s needs which resulted in delays to people’s care. There was also evidence of inappropriate admissions to the home that had resulted in incidents which had not been appropriately escalated to other professionals. The management team took immediate steps to address this during the assessment.

People told us there were multiple occasions where staff spoke in their own language which caused a barrier with effective communication. One person said, “I wish staff would speak in English, it makes me uncomfortable, they could be talking about me. Even if they’re not, if I could understand then maybe I could join in the conversation too.”

Staff told us they were not always supported with appropriate reasonable adjustments to enable them to return to work quickly and safely following periods of sickness.

Processes in place did not always support equity in experience and outcomes. For example, was saw an email addressing concerns and feedback about a staff member’s performance which was sent to other members of the staff. This did not reflect best practice or uphold the provider’s own policies.

People were supported to document their care wishes and plans should they need end of life care. People told us they had been supported to completed ReSPECT forms where appropriate. This form creates a process for personalised recommendations in the event of an emergency or where people are unable to decide or express their wishes.

Staff told us they had received training in end-of-life care and support and training records supported this. Staff were knowledgeable about people’s wishes and were aware of appropriate tools such as ReSPECT forms.

The home was not currently supporting anyone who was in receipt of end-of-life care, however people had been consulted about their wishes for the future and what treatment they wished to receive in an emergency, and these were clearly documented in people’s care plans.