Stoneyford Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

During our assessment of this key question, we found concerns around good governance which resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider and management team were not inclusive at all levels and systems and processes for people to speak up without fear of consequence were not embedded. Systems to monitor and improve quality and to monitor and mitigate risks had not always been implemented effectively. Systems and processes for improving quality were not effective at monitoring and improving the quality of service. Staff felt some positive improvements that had been made previously were retracted in line with reduced budgets set by the provider.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some staff and people living at the home were not aware of the changes to the manager of the home. During the assessment through discussions with the management team, staff and reviewing documentation, we found leaders were not inclusive at all levels and did not always understand the context in which care treatment and support embodied the culture and value of the workforce. Staff used words such as ‘negative’ and ‘toxic’ to describe the culture of the home. One staff member said, “Everything changed after the last assessment, managers stopped working weekends. We never see the provider and if something goes wrong it’s immediately seen as staff’s fault.”

There was not a clear or shared direction and culture communicated to people or staff at Stoneyford Care Home. There were no clear processes in place for upskilling the newly appointed manager or deputy manager. For example, we reviewed the new manager’s induction and training record. All objectives had been marked complete as ‘already aware’ on the same date and the plan did not identify any ongoing training or mentoring. This meant the provider was not aware and did not track the manager’s performance and could not be assured of the culture or direction of the home. We saw evidence that regular team meetings were held and staff feedback was sought; however, there was little oversight of any actions that resulted from these meetings.

Staff we spoke with were unclear about the management structure within the home and some staff said they were unsure who their direct line manager was. One person said, “Usually I only get feedback if something is wrong, but it can be from [a range of people] and sometimes it’s contradictive, so I still don’t know if I’m doing something correctly.” Another staff member said, “I have been encouraged by the manager to lie about why I need annual leave otherwise it would be declined, that’s not fair.”

A lack of management oversight had led to risks for people using the service. Since the last assessment there had been a change to the management structure within the home. There was no longer a clear description of roles within the leadership team to ensure it was always clear who was responsible for overseeing and managing delegated tasks in the service. Administration support had been removed and this decreased the time the manager was able to spend carrying out a hands-on role in the home. We raised the concerns with management team after seeing evidence from staff about annual leave concerns. This was investigated and staff were responded to about the concerns, however there was no outcome or follow up actions documented to investigate the cause. This did not demonstrate capable or inclusive leadership. The new manager stated they would be undertaking supervisions following our assessment to improve communication with staff.

Staff told us they were reluctant to speak up and felt unable to challenge working practices within the home. Staff told us they were fearful of a negative reaction to voicing their concerns.

Where staff had told us they had spoken up or raised concerns about issues such as performance of other colleagues, issues around pay and annual leave there was no record to show these issues had been acknowledged or who was responsible for following up the concerns and actions needed. The provider had a whistleblowing policy in place which detailed who to contact. However, staff we spoke to did not always feel a positive culture had been fostered to allow people to speak up without consequence of losing their employment.

Staff we spoke with stated they felt they were treated equally overall but struggled to get support for things like caring responsibilities and time off personal medical appointments. Staff said they felt the recruitment process was fair and inclusive, however some staff explained they were required to undertake roles they were not employed for such as catering and they were uncomfortable doing this.

The provider and management team did not take active steps to ensure staff and leaders were representative of the population of people using the service. During the assessment we saw staff and people struggling with a language barrier and staff requesting reasonable adjustments for things such as caring responsibilities. However, the management team were not aware of these concerns and had not highlighted them through their performance management systems.

Some staff were concerned that staff performance was not monitored and managed effectively or consistently. Staff we spoke to felt their concerns had not been investigated or addressed and this had impacted on the care people received.

Systems to monitor and improve quality and to monitor and mitigate risks had not always been implemented effectively. This meant complaints, accidents, incidents, and other adverse events had not always been investigated or responded to completely. There were significant shortfalls in many of the records viewed. This placed people at risk of receiving unsafe care or care which did not meet their needs. The provider was not meeting all standards of good quality care including assessment and planning of risks and care needs, providing personalised care and support and deploying staff to meet people's needs. There were risks relating to medicines management, manual handling and restraint techniques and lack of seeking consent to care. Therefore, people did not always receive good quality or safe care. There had been a lack of governance oversight, and this meant some people had experienced poor outcomes and not had the care they needed in a timely way.

While people told us they were supported with things like GP and dental appointments, many people stated they were not supported to access the community for social or wellbeing support. One person said, “I would like to go to my own hairdresser on the high street, but they [manager] said I had to pay staff £10 each way to take me.” People described requesting support for things like accessing banks that had not been acted upon.

The manager described a positive working relationship with the GP practice and pharmacy and other visiting professionals such as district nurses and chiropodists. The management team stated they were looking to develop links with the local community going forward and to offer more support and access to people within the community.

We received mixed feedback from partners that worked with the home. Some found the service to be ‘responsive’ and ‘proactive’ in following advice and recommendations and other stated they found the relationship with the management team and provider ‘challenging.’

Through the assessment process, by speaking with staff and reviewing documentation it showed, at times, the management team were strained when trying to interact with partners openly and transparently. This concern derived from mixed priorities set by the provider and a micro-management style that hindered collaborative and seamless working relationships.

Staff told us they had worked hard to uphold changes and improvements made since the last inspection but felt that the provider had withdrawn many improvements to cut costs. One staff member commented “The service provided is more about money than care again.” When asked to elaborate on what this meant staff referred to reduction of kitchen staff and training, activity equipment and staff to support this and high turnover of staff due to reduced management support and availability.

The systems and processes for improving quality had not been effective and they were not established or operated effectively to ensure compliance with regulations by assessing, monitoring and improving quality of service. Audits had not identified problems, were not robust enough and improvements were needed. People were placed at risk by risks which had not been identified or mitigated as identified within this report through poor care plan records and documentation, risk assessments and guidance.