Stonehaven is registered to provide accommodation for up to 24 older people, including people living with dementia. At our last inspection in January 2016 we rated the home as Requires Improvement.

The registered provider also operates a day care support service in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We inspected the home on 28 March 2017. The inspection was unannounced. There were 21 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted eight DoLS applications to the local authority and was waiting for these to be considered. Staff had received training in the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

The registered manager and her team had worked hard to address the issues of concern identified at our last inspection. Significant improvement had been made in many areas, although further action was required to ensure the system for assessing and managing risks was consistently effective. The registered manager had a positive and forward-looking approach and was committed to the ongoing improvement of the home in the future.

People’s medicines were managed safely and staff worked alongside local healthcare services to ensure people had access to any specialist support they required. Staff knew how to recognise and report any concerns to keep people safe from harm. A range of auditing systems was in place to monitor the quality and safety of service provision.

There was a warm, homely atmosphere and staff supported people in a kind, friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of high quality that met their individual needs and preferences. A varied programme of activities and events was organised to provide people with mental and physical stimulation. People were supported to maintain personal interests and hobbies.

There were sufficient staff to meet people’s care needs and staff worked together in a well-coordinated and mutually supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications. Shift handovers and regular team meetings were used effectively to facilitate good communication.

The registered manager maintained a high profile within the home and provided inspiring leadership to her team. Staff were happy in their work and proud of the service they provided to the people in their care.

Stonehaven is registered to provide accommodation for up to 24 older people requiring nursing or personal care, including people living with dementia.

We inspected the home on 19 January 2016. The inspection was unannounced. There were 24 people living in the home on the day of our inspection.

The service did not have a registered manager. A manager had been appointed by the registered provider and at the time of our inspection this person had submitted an application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’), 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for eight people living in the home and was waiting for these to be assessed by the local authority.

Staff knew how to recognise signs of potential abuse and how to report any concerns. Staff also had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

However, people’s care plans were not maintained consistently and people were not involved in reviews of their plan. Some people’s individual risk assessments were not reviewed and updated on a regular basis to take account of changes in their needs.

Staff worked closely with local healthcare services to ensure people had access to any specialist support required. However, the management of people’s medicines was not consistently in line with good practice and national guidance and presented an increased risk to people’s safety.

Although the provider had employed a specialist activities coordinator, this person only worked part-time and some people did not have sufficient stimulation. The provider did not consistently meet the needs of people living with dementia.

There was a warm and welcoming atmosphere in the home. Staff knew people as individuals and provided kind, person-centred care. There were sufficient staff to meet people’s care needs without rushing and staff worked together in a friendly and supportive way.

People were provided with food and drink of good quality that met their nutritional needs.

The provider supported staff to undertake their core training requirements and encouraged staff to study for advanced qualifications.

The manager demonstrated a very responsive and reflective management style, providing a positive role model for other staff. One of the directors of the registered provider spent time in the home on a very regular basis and had a warm relationship with people and staff. However, the systems used by the provider to monitor service quality were not consistently effective.

The manager encouraged people to come directly to her or other senior staff with any concerns. Formal complaints were managed well.    

Summary

Below is a summary of what we found when we inspected Stonehaven on 23 April 2014. The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

During our inspection on 20 September 2013, we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. The provider had sent us an action plan which set out how they planned to address our concerns.

During our inspection on 20 September 2013, we found care records failed to adequately identify the nature of mental capacity problems experienced by people. We also noted that records did not provide clear evidence that people's best interests were considered when decisions were required to be taken on their behalf. We found that available care staff and managers demonstrated an insufficient understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves

During our inspection on 23 April 2014, we looked at people’s care records and found that individual mental capacity assessments and best interest letters had been completed and were placed in people’s care plans and in their service user records. Documentation had been requested from people’s relatives which had enabled the provider to update people’s records with accurate information.

We found that risk assessments had been reviewed at the time of an incident which would ensure that the risk was minimised in the future. We spoke with staff and looked at training records which confirmed that staff had undergone refresher training in February 2014 which had improved their knowledge of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place.

We found that people were cared for in safe and accessible surroundings that supported their health and welfare. The premises had been maintained and appropriate checks undertaken by qualified professionals. This ensured that people, staff and visitors had been protected against the risks of unsafe or unsuitable premises.

Is the service effective?

People’s health and care needs were assessed and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. People we spoke with told us: “Staff are thoughtful and caring. It couldn’t be better.”

People who used the service, their relatives, friends and other healthcare professionals involved with the home completed an annual satisfaction survey. Where concerns or comments were raised these were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. One person told us: “I have nothing to complain about but if I did I know who to speak with. They {the management team} are always around and popping in."

The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role and were able to tell us how they would escalate any concerns raised. We spoke with the registered manager who informed us there had been no formal complaints since our last inspection.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving

During our inspection we spoke with four people who live at Stonehaven, two relatives, two members of staff, the staff supervisor and the assistant manager. We were told on arrival that the registered manager was on leave.

People told us that they liked living at Stonehaven. One person said that Stonehaven was, “Homely.” Another person said there was, “A certain air or atmosphere about the place I like.” One relative told us, “We love the family atmosphere.” Staff we spoke with told us that they enjoyed working at Stonehaven.

People who used the service told us they felt safe and well supported by staff. One person told us that they felt able to complain to the manager, assistant manager or supervisor if they had problems. Another person told us, “Matron is very thorough and if anything is not right she does her best to put it right.”

During our inspection we observed warm and respectful interaction between staff and people who used the service. We saw people being offered choice regarding the care they received. We observed staff working effectively and responsively to assess and support identified need.

We found care records failed to adequately identify the nature of mental capacity problems experienced by people. We also noted that records did not provide clear evidence that people’s best interests were considered when decisions were required to be taken on their behalf. We found that available care staff and managers demonstrated an insufficient understanding of the Mental Capacity Act (2005) and its associated Deprivation of Liberty Safeguards.

We found that the provider’s accident recording system did not provide the detail or analysis essential for effective risk assessment and management.

We spoke with five people who lived at Stonehaven. People told us they were happy with the care they received. One person told us, “I’m quite happy here and the girls look after me. They couldn’t be kinder.” Another person told us, “I am looked after “I’m looked after well, they are good girls here, very good. The meals are good as well.”

Records showed where people did not have the capacity to make decisions the care plan recorded who was to be involved in making a decision in the person’s best interest.

The home was in the process of replacing the activities person. Records showed there had been no activities with people recorded since the middle of September 2012. People told us there was not enough to do. One person said, “There is nothing to do.”

We saw the home was clean and tidy. Staff we spoke with were able to describe how they reduced the risk of infection by wearing gloves and aprons.

People we spoke with told us they knew how to complain. We saw where a complaint had been made this had been dealt with appropriately.

We carried out this responsive review because we had concerns that this service had not been visited since the last inspection which took place over 2 years ago.

Some of the people that we spoke with were unable to answer direct questions about their care and welfare but in our conversations with people they seemed relaxed and at ease in their surroundings.

One person told us “It’s lovely here, lovely people, they look after you ever so well.”

One relative told us “There is wonderful treatment, all through the day and night, I’m happy with the way they look after her, I have no doubts at all.”

Another Person said “I can do anything I want so long as it’s reasonable, they wait on you hand and foot.”