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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

Improvements had been made since our last assessment and the service was no longer in breach of the regulation relating to safe care and treatment. Everyone we spoke with told us they now felt safe living at the home however some people stated concerns remained in relation to staffing of communal areas. While people told us staff responded to incidents and accidents, record keeping did not reflect whether staff took appropriate action to observe and monitor people in line with the provider’s policy. While staff were knowledgeable about safeguarding and knew how to keep people safe, they had failed to identify the gaps and errors with record keeping. People were supported in a person-centred way when having their medicines administered and IPC was to a high standard throughout the home.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had made significant improvements to the culture of safety within the home, and people told us their concerns were now listened to. However, where concerns around safety were identified or incidents had occurred, records did not accurately reflect when actions taken or opportunities to identify gaps in these records were missed. This meant lessons were not always learnt to continually identify and embed good practice. Incident forms had not been fully reviewed by the management team to identify areas for improvement or mitigate risks for people such as falls and pressure care. For example, where staff had failed to complete records in line with the falls policy this had not been identified by the management review.

The provider had improved how they worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. The management team were actively reviewing pressure care during the time of our inspection as concerns had been raised by other professionals about the level of support people were receiving to mitigate risk of pressure damage from lack of repositioning. The management team had acted immediately to mitigate the risk identified and sought clinical guidance to review care plans and repositioning times to ensure people remained safe.

Furthermore, a person newly admitted to home told us they had been well supported on their arrival and said, “Staff were really good and listened to what I wanted from my care and planned it really well.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Relatives consistently told us the manager shared concerns quickly and appropriately. We saw safeguarding records were consistently submitted and the manager shared concerns quickly and appropriately with the local authority safeguarding team and CQC. People we spoke with told us improvements had been made, and they felt safe. Staff felt confident raising any concerns with the management team. One staff member said, “I always feel listened to, and I am happy with the level of support I get if I raise a concern.” Staff had completed safeguarding training and there was a safeguarding policy in place to provide staff with guidance.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe and proactive in identifying deteriorating conditions. While some improvements had been made to care plans, risk assessments and guidance for staff on how to support people since our last assessment, risks still remained in the observation and recording of actions relating to risk. For example, people had monthly observations, such as blood pressure, pulse and respiration rates checked and giving a score which was recorded onto the electronic care system as part of the National Early Warning Score 2 (NEWS2) which is a system used to track risk into deterioration of people’s health and conditions. Where the score indicated, further observations were needed to monitor people’s conditions and staff had consistently failed to follow this guidance and management reviews had not identified these gaps. While we did not see evidence of anyone suffering harm during the inspection as a result, this meant people had not been supported with managing risks to their health.

The provider did not always detect and control potential risks in the care environment. Following the last inspection concerns were raised about the availability of staff within communal areas and while people told us there had been improvements it was still an ongoing concern. We observed numerous times during the inspection where both the communal lounge and dining room were unattended, and people did not have a robust way to gain staff attention even in an emergency. However, improvements had been made in the monitoring of the home and equipment. For example, the daily manager walk rounds had identified areas of concerns such as malodours and minor maintenance repairs. Records showed clear follow up actions.

The provider could not provide assurances that there were always enough qualified, skilled and experienced staff within the home. The provider used a dependency tool which helped identify the amount staff needed to support people in the home. Due to concerns highlighted surrounding pressure care and falls it could not be established whether the dependency tool accurately reflected the level of support people needed. However, the provider responded immediately to this feedback and took steps to ensure people’s safety whilst risks were reviewed and the dependency tool updated.

The provider and manager had made significant improvements in methods used to assess and manage the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff told us improvements had been made within the kitchen and there was now a dedicated kitchen staff team who were able to ensure cleanliness levels and identify risks. One staff member said, “Things are so much better, we have a review with the manager at the end of every day to check standards and make sure everything is done, everyone is committed to high standards.” Further checks and observations of the home and people’s bedrooms showed further improvements had been made in cleanliness and daily records showed detailed and consistent cleaning records that were audited effectively by management.

Improvements had been made since our last inspection, and we observed people being administered their medicines safely and in line with guidance however issues remained with the quality of record keeping such as staff competency checks regarding the administration of medicines. For example, competency checks consistently failed to recognise any area of improvement or areas of good practice demonstrated by staff and only stated ‘no action needed’. Records did not show what actions or processes had been observed or the person the staff member had been supporting. This meant the management team could not evidence how staff were competent in administering medicines. However, people told us they received good support from staff with medicines. We observed one staff member taking extra time to sit with a person and explain their medicines prior to administering them. Where people required their medicines covertly this was now fully understood by all staff and clearly documented within care plans.