About the service:

Stonebow House is a residential care home providing accommodation and personal care to for a maximum of 30 people. There were 20 people living there at the time of inspection.

People’s experience of using this service:

• Risks associated with the home environment had not been assessed.

• There was not an effective system in place to identify, action and learn from identified risks.

• People were not always treated with dignity and respect.

• People were not always consulted with about aspects of their home and the management of risks.

• Staff had relevant training to perform their roles effectively.

• Staff felt supported by the registered manager.

• There were systems in place to protect people from the risk of abuse and harm.

• People were supported with their nutritional needs and had choices with meals.

• Medicines were managed safely.

• People were able to access external health professionals and were supported with their needs when required.

• More information is in the Detailed Findings below.

• We identified two breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Rating at last inspection:

• At the last inspection on 18 April 2018 the service was rated ‘Requires Improvement’. At this inspection, the rating for the service has remained at ‘Requires Improvement’.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

We carried out an unannounced comprehensive inspection of this service on 18 and 20 April 2018.

Stonebow House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. A maximum of 30 older people can live at the home. There were 30 people living at home on the day of the inspection, a number of whom were living with dementia. Nursing care was not provided.

There was no registered manager in post. The provider was recruiting a new manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in March 2017, the service was rated Good. At this inspection we found the service required improvement overall.

Staff were available to provide advice or guidance that reduced people’s risks. Care records did not reflect guidance needed to support people.

People received their medicines as prescribed and at the correct time. However, we found systems and processes needed to be improved to ensure creams were applied as prescribed. Staff had not always followed safe practices and left medicines unattended during the medicine round.

Staff had been provided with training that reflected the needs of people who lived at the home. The training information showed that staffs knowledge was being updated. People told us and we saw their privacy and dignity were respected and staff were kind to them.

People had not always have accurate records of their care kept. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People had not always been supported to maintain their hobbies and interests or live in an environment that supported their needs. The provider had not reviewed any concerns raised as no records had been kept. Information was available for the provider to improve the service.

Regular checks had been completed to monitor the quality of the care that people received and look at whether improvements may be needed. The current management team were approachable and visible within the home which people and staff liked.

People told us they felt safe and free from the potential risk of abuse. Staff told us about how they supported people’s safety. People told us there were enough staff to support them. Staff told us they had time to meet the needs of people living at the home.

People told us they liked the staff and felt they knew how to look after them and were included in day to day decisions about their care and support. People were supported to eat and drink enough to keep them healthy.

Stonebow House Residential Home is registered to provide accommodation and care for up to 30 older people. There were 24 people living at the home at the time of our inspection.

This inspection took place on 9 February 2017 and was unannounced.

A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us staff cared for them in ways which helped them to feel safe. Staff understood what actions to take to protect people from the risk of potential abuse. Staff knew the risks to individual people’s safety and communicated information with other staff so people’s safety needs would be met. There were enough staff employed to care for people and people told us staff knew their care and safety needs well.

Staff had received training and understood people’s individual care needs so they would be able to care for people and meet their needs. People’s rights and freedoms were respected by staff. Staff encouraged people to have things they enjoyed to eat and drink so they remained well. People’s health was monitored and staff acted on advice they obtained from health and social care professionals. People told us staff acted quickly when they asked for help to maintain their health.

Staff had developed caring relationships with people living at the home and understood what was important to them. People enjoyed spending time with staff and sought out staffs’ company. People were encouraged to make decisions about their daily care and staff respected the choices people made. People needs for independence and their rights to dignity and privacy were understood by staff, who took action to promote these.

People had developed plans for their care with support from relatives, staff and other professionals where needed. Plans were regularly reviewed and care adjusted as people’s needs changed. People had opportunities to do things they enjoyed both within and outside of the home. People were supported to keep in touch with relatives and friends who were important to them. People knew what to do if they needed to make a complaint or raise a concern and staff knew how to support people to do this. There were systems in place so if a complaint was made prompt action would be taken by the registered manager to address the concern and improve the service further.

People found the registered manager and senior team approachable and were encouraged to make suggestions about the care they received through discussion with staff and at residents’ meetings. There was clear and open communication between the registered manager, people, their relatives, and staff so the home would be further developed. Regular checks on the quality of the care people received were undertaken by the registered manager and actions were taken where development or suggestions had been identified.

This inspection took place on 6 October 2014 and was unannounced.

Stonebow House Residential Home provides accommodation for people who require personal care for a maximum of 30 older people some of who have a dementia related illness. There were 25 people living at the home when we visited and there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were positive about the care they received and about the staff who looked after them. Relatives said that they were very happy with the overall care and treatment and felt part of their family ’member's lives. Our observations and the records we looked at supported this view.

People told us that they felt safe and well cared for. Staff were able to tell us about how they kept people safe. During our inspection we observed that staff were available to meet people’s care and social needs. People received their medicines as prescribed and at the correct time.

People told us and we saw that their privacy and dignity were respected. The care provided took into account people’s views and input from their relatives.

The provider acted in accordance with the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. At the time of our inspection no one had an application in place.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People were supported to eat and drink enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with both internal and external training which they felt reflected the needs of people who lived at the home.

Staff told us that they would raise concerns with the nursing staff, the duty manager or the registered manager and were confident that any concerns were dealt with. The provider and registered manager made regular checks to monitor the quality of the care that people received and look at where improvements may be needed.

We inspected Stonebow and saw how care and supported was provided for the people who lived there. We spoke with three people who used the service, three visiting relatives, a visiting medical practitioner and staff on duty.

Consent had been obtained from people before care and treatment had been provided. Alternatively, arrangements had been made to support people who were unable to consent to their treatment or support.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were aware of each person’s needs. Staff demonstrated that they knew how to give care and support to meet those needs to ensure people’s health and welfare was maintained.

People we spoke with said: “The care is wonderful here, the staff are superb.” “Cannot fault the service, they are all so good”.

Staff at Stonebow had established working relationships with other agencies to make sure that people received appropriate health and social care support.

We saw that staff had a kind and caring approach towards people they supported. People appeared happy, comfortable and relaxed in their home. Staff were given the training and support they needed to develop their knowledge and skills. This ensured that staff provided appropriate care and support to people who lived at Stonebow.

We last inspected Stonebow House in May 2012 and issued compliance actions because we found the service had not been compliant with two regulations. We had been told by people who lived at Stonebow House and visiting relatives that there had been a problem with the lack of activities for some time. The registered manager told us they had found recruitment of an activities coordinator difficult. We found that people's privacy, dignity and independence were respected; although people had not been able to choose to take part in meaningful activities in their daily lives. During this inspection we found that improvements had been made and this compliance action had been met.

At the previous inspection we found that the provider had not assessed and monitored the quality of service that people received. This meant the providers could not be sure that people received a quality service due to the lack of a consistent formal review of their service. During this inspection we found improvements had been made and this compliance action had been met.

We visited Stonebow House and spoke with people who used the service and some visiting relatives. We spent time observing their care, talking with staff and the registered manager.

We found that people were able to express their views and had been involved in making decisions about their care and treatment.

We found that care and treatment had been planned and delivered in a way that met people’s needs. We talked with some people about their experience of the home. People were complimentary about the care and support that they received. We were told that “staff are excellent, you cannot fault them”, “this place is the best ever”. “I cannot believe that X has settled in here so quickly and seems so well”.

We found that people who used the service were protected from the risk of abuse. People told us that they felt safe and they were aware of how to complain. All of the people we spoke with knew how to raise concerns.

People and their relatives told us that they received a good standard of care from the staff who worked at the home.

We found that staff received appropriate induction, training and regular supervision. Staff told us they were encouraged and supported to undertake further training to increase their skills and knowledge.

We found that the provider had not assessed and monitored the quality of service that people received. The registered manager told us that people who used the service had been asked for their views about their care and treatment in the home. They had been asked to complete an annual satisfaction survey, although this had not been done since January 2011. People we spoke with told us they had not been asked to contribute to a review recently.

This meant the providers could not be sure that people received a quality service due to the lack of a consistent formal review of their service.

We carried out this responsive review because we had received information that the standard of care provided at Stonebow House had put people at risk of not having their care needs met. We have referred this information to Worcestershire Safeguarding Authority.

We visited the home to check that people had their care needs met and were not being put at risk.

We spoke with people who use the service and asked them if staff respected their privacy and maintained their dignity. One person told us ‘they always knock on the door’. People told us they had a choice of food at mealtimes and where they ate their meals. One person told us they would like more activities to take place in the home.

We saw that staff interacted with people who used the service in a friendly, courteous and respectful manner. We observed that staff knocked on doors and waited for a reply before they entered people’s rooms. Staff gave people time to answer any questions they asked. We saw that staff respected people’s privacy by shutting doors when they carried out any personal care. People told us the staff were ‘very good, friendly and caring’.

We looked at care records to check that people’s needs were being met. We found that although information had been recorded it had not been fully evaluated. This meant that no action been taken to make sure that changes to people’s needs had been recognised and that the appropriate care and support was given.