The inspection took place on 7 August 2017 and was unannounced. This meant staff did not know we were visiting.

We last inspected Stoneleigh on 12 and 16 February 2015 and rated the service as Good overall and the safe domain as Requires Improvement in relation to issues found with staffing levels. At this visit we this continued to rate the service as Good overall and Requires Improvement for the safe domain in relation to issues we found with the environment.

The service provides accommodation and personal care for up to 36 people. Stoneleigh care home is situated within the residential area of Annfield Plain. At the time of this inspection there were 33 people living at the home.

The service had a registered manager in place who was on leave at the time of our visit. 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.

We discussed with the regional manager that the décor on the first floor of the home appeared tired with paint on doorways and corridors being chipped and scuffed. We also discussed an area of carpet in the dining area that had no protective seal. The regional manager told us the carpet would be addressed immediately.

Staff understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults. People we spoke with told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way. People confirmed they received their medicines at the correct time and they were always made available to them.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. When we first arrived at the home, the senior carer was in charge and undertaking the administration of medicines so we had to wait some time to access the office which was perfectly acceptable. There were several staff on holiday but we noted that until one staff member came in following an appointment, the senior carer was kept very busy with medicines, telephone calls and visiting professionals. We have made a recommendation about staffing levels within the service.

We found that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people such as identification checks.

Staff received the support and training they required to meet people’s needs. Records confirmed training, supervisions and appraisals were up to date and pre planned for the future. Staff told us they were supported to develop themselves personally and professionally by the home’s management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People gave positive feedback about the meals they were served at the home. Some people had been referred to external healthcare professionals for additional specialist support, for example those with diabetes.

People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times.

People’s needs were assessed before they came to live at the service and then personalised care plans were developed and regularly reviewed to support staff in caring for people they way they preferred.

An activity coordinator was in place but people told us th

Due to the nature of the compliance action set at the previous inspection we did not speak with people using the service on this occasion. Instead we spoke to the manager and looked around the home.

We found the provider had taken steps to improve the environment. For example, all but one bathroom had been refurbished, carpets had been replaced throughout the home and many people’s bedrooms had been redecorated and refurbished. We also saw the laundry had been significantly improved. The laundress told us “Its wonderful now. It was horrendous before.”

All of these measures showed people were provided with an environment that was well maintained and suitably designed.

One relative told us, “We chose this home because we saw that everyone was treated with dignity. All the ladies were dressed nicely and their hair was brushed. They even paint her nails for her when they’ve got time.”

Another visitor commented, “They are so friendly and warm with the residents, and always greet visitors with a smile.”

People and their visitors were very positive about how the home helped them to continue to be involved with the local community. One person said, “There’s always something going on and they get local groups to come in to entertain. Most people here are from this local community and means that they can still feel involved.”

One person wrote to us, “There is a definite odour in the building, especially upstairs. I opened a bathroom door and didn’t think the bathroom was clean. The floor looked stained and the raised toilet seat didn’t look at all clean.”

A visitor commented, “It’s a shame about the smell upstairs.”

One visitor told us, “The cleaner does very well to keep it clean – it’s a big building for one person to clean.”

One relative told us, “The building’s not great compared to other places – there’s no en-suites and the bedrooms are quite small but I wouldn’t move my relative because of the wonderful care.”

One visitor said, “It could be improved, especially the bathrooms and toilets.”

Another person said, “Some areas are getting scruffy now. The previous owners didn’t do much decoration.”

People told us that staffing levels through the day were “generally ok.”

People made many positive comments about the staff attitude. One person said, “They’re so caring, I wouldn’t want to be anywhere else.”

A visitor told us, “The care and dedication of the staff is wonderful. They are so friendly and warm with the residents.”

However people expressed concern about night time staffing levels. One person said, “There have been instances of low staffing level over night. Quite often call bells are left unanswered for periods of 5 minutes plus. Staff always seem to be rushing around.”

One resident told us, “They dash around trying to see to everyone so they don’t have time to talk with me.”

We inspected this service on 12 and 16 February 2015 and our visit was unannounced. This meant the staff and provider did not know we would be visiting. The inspection was carried out by a single Adult Social Care Inspector.

Stoneleigh care home provides care and accommodation for up to 36 people. The home provides a service to people who do not require nursing care including people living with dementia and end of life care. A respite care service is also available. On the day of our inspection there were a total of twenty two people using the service.

The home had a registered manager in place. 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.

During our inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a very friendly and respectful manner.

We spoke with care staff who told us they felt supported by the registered manager. Throughout the day we saw that people and staff were very comfortable and relaxed with the registered manager and staff on duty.

Care records contained risk assessments, which identified risks and described the measures in place to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health professionals as appropriate. We saw people were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

We found people’s care plans were very person centred and written in a way to describe their care, treatment and support needs. These were regularly evaluated, reviewed and updated.

The staff that we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Our observations during the inspection showed us that people were not supported by sufficient numbers of staff. For example, a visitor came to the registered manager’s office to draw her attention to a person using the service who had pulled the alarm bell and had been waiting for some time for someone to assist them with their pillows. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The staff we spoke with confirmed they attended training and development activities to maintain their skills. They told us they had regular supervisions with a senior member of staff where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were appropriate recruitment processes in place.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

During the inspection we saw staff were attentive and patient when supporting people. We spoke with people who used the service and their relatives. We were told they were happy with the service the home provided.

We observed people were encouraged to participate in activities that were meaningful to them. For example, we saw an entertainer was visiting that day. One person told us how they took the handyman’s dog for a walk and attended church independently. Two other people told us how they loved looking in charity shops and how the staff supported them with this activity.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered choice and if people required assistance to eat their meal, this was done in a dignified manner.

We found the building met the needs of the people using the service. For example, corridors were wide and spacious for people who used a wheelchair and there were signs to help people with dementia find their way around.

We saw a complaints procedure was displayed in the main reception of the home. This provided information on the action to take if someone wished to make a complaint.

We discussed the quality assurance systems in place with the registered manager. We found the way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found. We found people using the service were regularly asked for their views.

You can see what action we told the provider to take at the back of the full version of the report.