About the service: Stoneyford Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection the service was registered as a Nursing Home and rated as requires improvement. The home has since changed the registration to a care home without nursing.

People’s experience of using this service:

The service has made improvements since the last inspection in April 2018. There is a new registered manager in post who has a clear strategy and vision for the service and has already started to make change and improve the quality.

The service did not have enough staff to enable them to offer care and support to people with complex needs. The people living at Stoneyford Lodge required two people to support them with personal care and to use the hoist. Although there was senior on duty they were unable to support the staff during medication rounds.Therefore at these times, there were only two members available. This meant that staff were unable to support people adequately and would have been unable to respond to an emergency.

People received kind and caring support from staff who respected their dignity and privacy. They were encouraged to be as independent as possible and staff understood their needs well. Staff were skilled in understanding the needs of people living with dementia and engaged them in meaningful activities. Staff knew them well and understood how to care for them in a personalised way.

People were supported to maintain good health and nutrition; including partnerships with other organisations when needed. There were plans in place which detailed people’s likes and dislikes. People and relatives knew how to raise a concern or complaint.

People were protected from the risk of harm and staff had received training in safeguarding and how to protect people from abuse and avoidable harm.

More information is in the full report

Rating at last inspection: The service was last inspected on 24 April 2018 and was rated as requires improvement

Why we inspected: This was a scheduled inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per out re-inspection programme. If any concerning information is received, we may inspect sooner.

We inspected this service on 24 and 25 April 2018. The inspection was unannounced.

Stoneyford Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Stoneyford Care Home is a nursing home that accommodates up to 60 older people with varying support needs, including nursing and people living with dementia. Accommodation is provided at the service over two floors. There were 23 people using the service at the time of our

inspection.

At our last inspection on 18 and 19 October 2017, we identified significant failings and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, need for consent, meeting nutritional and hydration needs, person-centred care and good governance. In addition a breach of the Care Quality Commission (Registration) Regulations 18 notifications of other incidents. CQC had not been notified of incidents the provider was required to inform us about.

Following the last inspection the provider sent us an action plan to tell us what action they would take to meet these breaches in regulation.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection, the registered manager had left the service and two registered managers within the organisation, separately managed the service for a period. A new manager was in place and they were in the process of submitting their registered manager application. We will monitor this. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection, the registered provider has announced that they wish to relinquish the regulatory activity that enables them to provide nursing care. The registered provider had taken all reasonable action to recruit and retain nurses to provide clinical care but was unable to achieve sustainability. At the time of writing this report, the management and staff team were working with commissioners (who fund care for people), people who use the service and their relatives and representatives to transfer people with nursing needs to alternative placements. The service will continue to be a care home providing accommodation and personal care.

Risks associated with people’s needs had been assessed and planned for. Improvements had been made to how some risks were managed such as wound care. However, further time was required for improvements in documentation and monitoring to be embedded and sustained. Audits and checks in relation to risks associated with the environment had been monitored and equipment was safe and met people’s needs.

Safeguarding procedures had improved. Staff were aware of their responsibility to protect people from avoidable harm and safeguarding incidents had been acted upon. Some people experienced heightened anxiety that affected their mood and behaviour, but information available to guide staff in relation to how to support people, lacked detail.

There were sufficient staff available to meet people’s needs and safe staff recruitment checks were in place and followed. Overall improvements had been made with the management of m

The service is registered to provide accommodation with personal care for up to 60 older people with varying support needs, including nursing and people living with dementia. Accommodation for up to 60 people is provided at the service over two floors. There were 30 people using the service at the time of our inspection.

At our last inspection of the service on the 10 and 11 August 2016 the service was rated overall as ‘Good’. However, some improvements in safety were required. Risks were not always managed so that people were protected from avoidable harm. Robust systems were not in place to ensure that sufficient staff were on duty to meet people's needs. Medicines management and infection control practices also required improvement.

At this inspection we found ongoing concerns of how risks associated to people’s needs were assessed, planned for and reviewed. There were some continued shortfalls in the prevention and control of infections and medicine management. We also found further concerns which led to six breaches of the Health and Social Care Act 2008 Regulations (2014). You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in post and they were available during the inspection, they were currently being supported by a registered manager of another service within the organisation who was also present during the 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People could not be assured appropriate and timely action was taken when there was an allegation or concerns of abuse or avoidable harm. Where people had a Deprivation of Liberty Safeguard authorisation with conditions that required the provider to action, these were found not to have been completed. The principles of the Mental Capacity Act 2005 were not always followed. Some inconsistencies were identified in how best interest decisions had been made.

Risks associated to people’s healthcare needs had not always been appropriately assessed, planned for, monitored and reviewed. This impacted on people’s safety and welfare.

The deployment of staff required further review to ensure there were sufficient staff available at all times to support people’s safety, including oversight and accountability of clinical needs and risks.

Some issues were identified with the management of medicines in relation to storage and management. Action was being taken to improve audits and systems, oversight and accountability.

The checks and systems in place with regard to cleanliness and the prevention and control of infection control had improved but some shortfalls were identified.

People could not be assured their dietary and nutritional needs were consistently and effectively managed. Actions to follow external healthcare professional recommendations were not always acted upon or in a timely manner.

Improvements were required in how people’s healthcare needs were met. Further action was needed to ensure the service worked with external healthcare professionals in a collaborative way to meet people’s health needs and outcomes.

Staff received an induction, ongoing training and opportunities to review their work and development needs. Nurses employed to work at the service were appropriately registered with the Nursing and Midwifery Council. Staff had been recruited through safe recruitment procedures.

Some inconsistencies were identified in how staff provided a caring, kind and compassionate service. Whilst some positive staff engagement was observed, however people’s dignity and respect were compromised at times.

There was no advocacy service information available for people if they required th

This inspection took place on 10 and 11 August 2016 and was unannounced.

Accommodation for up to 60 people is provided in the service over two floors. The service is designed to meet the needs of older people living with or without dementia. There were 48 people using the service at the time of our inspection.

A registered manager was in post and she was available during the 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.

Risks were not always managed so that people were protected from avoidable harm. Robust systems were not in place to ensure that sufficient staff were on duty to meet people’s needs. Medicines management and infection control practices required improvement.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Staff were recruited through safe recruitment practices.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink.

External professionals were involved in people’s care as appropriate. However, the environment could be further improved to better support people living with dementia.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though care plans could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that appropriate action would be taken.

The provider and registered manager were meeting their regulatory responsibilities and there were effective systems in place to monitor and improve the quality of the service provided.

We spoke with eight people who used the service who told us that they experienced care, treatment and support that met their needs and protected their rights.

One person who used the service told us, ”The staff here are marvellous, they always come quickly when I press my call bell, they show kindness and warmth in their approach to me. I would not want to be anywhere else.”

A second person who used the service told us, “The staff know me here, they care about me.”

A visitor told us, “The staff here have done everything they can to accommodate us, it’s very homely. We have a key worker, any issues are sorted out straight away and some staff really go that extra mile to help you.”

We inspected the service on 14 and 15 January 2015. Stoneyford Christian Nursing Home is registered with the Care Quality Commission to provide accommodation for up to 60 older people with varying support needs including nursing and dementia care needs. On the day of our inspection there were 38 people living at the home.

The home had a registered 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 on 3 April 2014 we asked the provider to take action to make improvements to ensure that staff understood their role and responsibility to keep people safe, and this action has been completed.

People told us that they were well looked after and felt safe. Staff understood their role and responsibility in relation to offering safe and effective support, and recognising and reporting poor practice. However, on occasions people were at risk of harm because staff did not follow the correct procedures or use the correct equipment.

People who used the service, relatives and staff felt that a recent reduction in the number of staff on duty and other staffing issues had a negative impact on the service.

People could not always be assured their medicines would be managed safely and they would be given these as they were intended to be given.

Staff felt supported in their role, however some staff did not feel fully prepared for their work by the training they received. Staff were unclear about their role in protecting people’s rights to make decisions for themselves or how to lawfully restrict someone’s liberty.

People were provided with sufficient food and drink to maintain their health and wellbeing, and they praised the standard of food provided. People were supported to receive any healthcare they needed and any healthcare advice provided was acted upon.

Staff treated people with respect and kindness and listened to their wishes. People felt their need for help and support and any requests they made were well responded to.

People did not have opportunities to follow their individual hobbies and interests and did not engage well with the activities that were provided on the day of the inspection. People’s care needs and individual preferences were assessed and kept under review, although the care plans did not always contain sufficient detail to show how to meet people’s individual care and support needs.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to these. Staff knew the complaints procedure and people who used the service felt comfortable about making a complaint if they needed to. Relatives felt confident they would be listened to and taken seriously.

People living at the home and the staff team had opportunities to be involved in discussions about the running of the home and felt the registered manager provided good leadership. There were systems in place to monitor the quality of the services provided.