Archived: Stone Gables Care Home

Updated 24 April 2019

The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury and died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with Care Quality Commission about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

Inspection team: On the first day of the inspection, two inspectors were present. On the remaining three days of the inspection, one inspector was present.

Service and service type: Stone Gables Care Home 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.

It is a condition of the provider’s registration that they have a manager registered with CQC. There was no registered manager at the time of our inspection. A temporary manager had been appointed at the time of our inspection. Within this report they will be referred to as the manager.

Notice of inspection: The inspection was unannounced.

What we did: Before the inspection, we liaised with the local authority and the safeguarding team. We did not ask the service to complete a Provider Information Return before this inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We reviewed all the information we held about the service including notifications we had received from the provider. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. During our inspection, we notified the fire service. They visited the service and have requested that the provider acts to address the concerns they found. We also reported our concerns to the safeguarding team, the local authority and the infection control team.

During the inspection, we spoke with three people and two relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with staff, which included agency staff, the cook and domestic staff. Throughout the inspection we liaised with the nominated individual, the regional manager, the head of quality, the temporary manager and the deputy manager.

During the inspection we reviewed five staff recruitment files, five people's care records and medication administration records (MARs). We also looked at records relating to the management of the service. We spoke with a visiting professional at the service.

Updated 24 April 2019

About the service: Stone Gables Care Home is a residential care home that was providing personal care to 26 people aged 65 and over at the time of the inspection.

Why we inspected: This inspection was prompted by a serious incident and information of concerns we received.

People’s experience of using this service: During the inspection, we identified many concerns relating to people’s safety. This included the service not having appropriate fire evacuation equipment in place. Also, a lack of training and guidance for staff on how to support people in the event of a fire. There were insufficient staffing levels during the day and at night which all put people at significant risk of harm.

We found the premises and equipment used to support people were not safe or clean. Issues relating to the environment, which we identified at our last inspection, had not been addressed. This included carpeting and flooring being very dirty and smelling of urine. Furniture including beds, armchairs, tables and dining room chairs were dirty and stained. Bedding and towels were very worn, some had holes and were stained. Mattresses were stained, smelled strongly of urine and were wet.

Staffing levels had not been calculated in line with people’s needs. This meant staff struggled to meet people’s needs. Poor standards of care were observed; people had dirty fingernails and some people had food stains on their clothing.

Medicines were not managed safely. Staff did not always have guidance to ensure they administered ‘as required’ medicines to people. Medicines were not stored safely and stock levels of medication were not recorded. Topical cream administration records were not always completed by staff.

Risks to people were not always properly assessed. This included moving and handling, nutritional needs, use of equipment and falls risks. The management team had failed to address this which meant people were at risk of harm.

Assessments of people’s needs were not up to date which resulted in people’s needs not being met.

Systems were not in place to monitor accidents and incidents.

Staff demonstrated a limited understanding of safeguarding and records showed they had not received appropriate training in this area. During our inspection, we reported our concerns to the local safeguarding team. This means external professionals will look into our concerns.

The provider did not always maintain appropriate records relating to the requirements of the Mental Capacity Act 2005 (MCA). There was a failure to properly oversee and make applications for authorisations under the Deprivation of Liberty Safeguards (DoLS). People had not been included in decisions about their care.

People living with dementia did not have their care provided in line with best practice. This impacted on their quality of life and wellbeing. We have made a recommendation about this. People spent lengthy periods of time in the communal area; in the same chairs, only moving to attend for their meals in the adjoining room or to use the toilet.

An activity staff member was in post, but they had not received any training on how to plan and facilitate meaningful activities for people. Activities were often attended by the same people leaving others unstimulated.

People’s nutritional needs were not always met and advice from health care professionals was not always followed. This put people at risk of receiving inappropriate and unsafe care.

Staff did not always receive an induction, or complete mandatory training to ensure they had the skills they required for their roles. Staff did not always receive supervision and appraisal of their performance.

In August 2018, the registered provider went into administration. The administrators had employed a care company to run the home while a buyer was sought and had oversight of their management.

The governance of the service was poor. The provider had an awareness of the issues we identified, but had not mitigated risks within the provision associated with issues we found.

After the first day of the inspection, we requested an urgent action plan from the provider to tell us how they would address the concerns we found. They responded with a plan which gave timescales for the completion of works. We visited the service again to follow this up and found that not all of the actions had been completed. We found there were no plans in place as to how these would be met. We continued to monitor the service regarding the improvements they were making.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 4 April 2018). This service has been rated Requires Improvement at the last three inspections.

Enforcement: The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.