St Stephen's Care Home

St Stephen's Care Home is a residential care home providing accommodation and personal care

to up to 51 people. The service provides support to younger adults and older people, including people with dementia. At the time of our inspection there were 25 people using the service.

St Stephen's Care Home accommodates people in one adapted building.

People’s experience of using this service and what we found

Risks to people were not consistently reduced because of the way their medicines and risks were managed. Where the provider’s checks had identified areas which required improvements, such as premises improvements, these had not always been promptly addressed. There were inconsistencies in the guidance provided to staff on how to safely assist people. However, people and relatives told us there had been recent improvements made in the way safety was managed.

Staff understood what actions to take to prevent people from experiencing abuse. There were enough staff to care for people and the provider checked staff were suitable to work with people. Systems were in place to reduce the likelihood of the spread of infections. Where learning from safety concerns had been identified leaders communicated this to staff teams.

A new manager was in post and was applying to become registered with The Care Quality Commission. People, relatives and staff were positive about the support now provided but told us they wanted continuity of leadership.

People’s care plans were not always updated promptly when their needs changed. In addition, people’s care plans did not consistently give staff the guidance they need to support people’s individual underlying health needs effectively. People and relatives told us there had been improvements in the personal care provided. People were positive about the support they received to keep in touch with others who were important to them.

Some people enjoyed the range of interesting things they were supported to do, but other people told us there was limited activities available in the evenings and at weekends. Systems were in place to respond to complaints and to support people with their communication needs, and meet people’s end of life preferences.

People were cared for by staff who had received training and developed the skills and knowledge to look after them. Relatives and health and social care professionals advised us people were supported to have enough to eat and gave us examples of how this had led to improved health outcomes for people. Where people wanted support to see other health and social care professionals staff assisted them.

People were supported to have drinks of their choice and enough to eat to remain well.

Some areas of the home had recently been refurbished but these areas were not yet fully used. This meant areas of the home were crowded at times, which may affect people’s well-being.

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

People told us they were treated kindly by staff. Staff supported people with compassion, encouraged and assisted people to make their own choices and promoted people’s independence.

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

Rating at last inspection

The last rating for this service was good, (published 25 December 2021).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about how people were supported to have their medicines as prescribed, assistance with skin health and falls management. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from the way their medicines were managed. Please see the safe section of this full report. The provider’s representative and manager began to address these concerns during the inspection.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Stephen's Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to how people's medicines and risks are managed at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Stephen’s Care Home is a residential care home that provides personal care for up to 51 people aged 65 and over, some people may be living with dementia or mental health needs. At the time of the inspection 33 people were living at the home.

People’s experience of using this service and what we found

There had been many changes at the home including in the roles of home manager and care staff. People and relatives were positive about the improvements made to provide care which reflected people’s individual needs and people did not have to wait long if they wanted support from staff.

Staff had a good understanding about how to keep people safe from harm and the safeguarding procedures that should be followed to report any incidents of concern or abuse they identified. Risk assessments were in place to manage potential risks within people's day to day lives, whilst also promoting their independence. The manager was taking action to further mitigate any risks to people during the refurbishment of the home environment.

People were supported by staff to have the medicines they needed to remain well. Staff used their skills and the equipment required to reduce the risk of people experiencing infections. Information on people’s safety and care needs was regularly communicated between staff, and learning taken from any incidents.

Staff recruitment procedures were in place and appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction and on-going training was provided to support staff in gaining the skills, knowledge and support they needed to undertake their roles.

Wherever possible, people's consent was gained before any care was provided. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People enjoyed good health outcomes which were achieved by staff following the advice of health and social care professionals. People were seen to enjoy their mealtime experiences and were encouraged to choose what they wanted to eat and drink.

The views of people, relatives, staff and health and social care professionals were considered when people’s needs were assessed, and their care plans developed and reviewed.

Relatives told us staff were approachable and they were encouraged to make suggestions which were listened to. Staff morale was improving, and staff were supported to provide good care. The manager and provider checked the quality and safety of the care provided and were committed to making ongoing improvements and developing the home further.

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

Rating at last inspection

The last rating for this service was good. Last report published (22 January 2021).

Why we inspected

The inspection was prompted in part due to concerns received about management, staffing, management of risks and a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of falls.

A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Stephen’s Care Home on our website at www.cqc.org.uk

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Senior managers were working in the home alongside the regular staff to support them through the outbreak at a time of anxiety.

• Prior to the outbreak people had been able to see visitors either using garden visits or making use of the adjoining day centre.Appointments had to be made and limited to certain members within a household.

• At the time of the inspection visitors were not permitted due to the COVID-19 outbreak.

• On arrival at the home visitors such as healthcare professionals had their temperature taken and were asked to supply information. This included contact visitors may have had with people who had COVID-19. Hand gel was made available.

• The environment was well maintained and clean. Additional cleaning had been put into place to lower the risk of cross infection. One member of staff was seen cleaning a light switch. Doors handles were seen to be cleaned once anyone left the building.

• People were isolating within their own bedrooms. Signage was in place regarding people’s individual COVID-19 status. Information and guidance were displayed within the home environment.

• Changes had taken place within the environment such as the removal of some furniture within the lounge areas and dining room to enable social distancing.

• Staff had received additional training in the use of Personal Protective Equipment (PPE). Systems were in place for staff to safely put PPE on and remove it safely and in line with guidance. Staff were seen to change their PPE when moving from one area of the home to another.

• Clinical waste was disposed of in line with government guidance.

• Agency staff were used to provide cover for staff who were having to self isolate. Staff from these agencies were not working at any other facility to reduce the risk of cross infection.

• The provider was engaging in regular testing for COVID-19 involving people living at the home and staff members.

• There were detailed risk assessments and policy documents which had been implemented.

St Stephen’s Care Home is a residential care home that accommodates up to 51 older adults, some who may be living with dementia or mental health needs. At the time of the visit there were 49 people who lived there. There is no nursing care provided at this service.

People’s experiences of using this service

People were receiving a reliable and person-centred care service from a caring staff team which was well-led.

The manager and the registered provider had ensured the premises were maintained and any faults rectified. They had also completed audits to monitor the safety and quality of care provided.

People and their relatives told us they received care in a safe way. Individual risks to people and the environment had been identified and assessed and measures put in place to manage them and minimise the risk of avoidable harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm.

Improvements were required to the safe management of medicines, this was because thickening powders used to manage risks of dysphagia had not been adequately monitored and medicines records for ‘as required’ medicines protocols had not been accurately reviewed. The manager took immediate action to address the shortfalls. We made a recommendation about this.

Some people raised concerns regarding the security of their property and clothing. We shared their concerns with the manager who informed us they will review the laundry system in the home and remind people to use lockers for their valuables.

Risks associated with falls and malnutrition had been managed and there were processes to ensure staff learned from accident and incidents. In the majority of the cases, themes had been identified and action had been taken to reduce the risk of accidents and incidents.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s individual needs. Staff had received a range of training and support to enable them to carry out their role safely. However, staff records we checked and the training matrix showed staff had not completed induction. The manager took action to address this.

Staff showed a genuine motivation to deliver care in a person-centred way based on people’s preferences and likes. They treated people with kindness, compassion and respect and ensured that people’s dignity was maintained. People and their relatives spoke positively about the care and support provided.

People’s needs, and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

Records related to consent for care were completed and people told us they were always offered choice and control over the care they received. Restrictions on people’s liberties had been considered and authorisations applied for where required.

Care was delivered in a personalised way which was in line with information recorded in people's care plans. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted person-centred care and a positive culture within the staff team. People, family members and staff all described the manager as supportive and approachable. The manager showed they were committed to improving the service and displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

Rating at last inspection: This was the first inspection since the home was re-registered under a new company in 2017.

Why we inspected: This was a routine planned comprehensive inspection.

Follow up: We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates. We will follow up on the recommendations we have made at our next inspection.

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