Archived: Steephill

At our last inspection on 20 and 23 July 2015, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was non-compliant with medicines, assessing and managing risks to people’s health and wellbeing and ensuring the MCA 2005 code of practice was implemented. In this inspection we found improvements had been made and the provider had met the requirements relating to management of risks to people and MCA 2005, but still required improvement to ensure medicines were managed safely.

There was a registered manager at the home. 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. Providers are required to notify CQC about significant events that happened in the care home. The provider failed to notify us about incidents involving serious injuries and allegations of abuse.

Medicines were not always managed safely. Auditing processes had not picked up discrepancies in medicines administration. The safe storage of medicines which required refrigeration was not always monitored or recorded. Details around topical creams did not always give sufficient information to ensure these were applied as prescribed. Measures were not always in place to ensure there were adequate gaps between the administrations of some medicines.

Risks relating to the home were not always managed safely. Auditing and quality assurances processes were in place, but did not always pick up key areas of risk or drive improvement. Fire detection and emergency equipment was in place; however, records showed these had not always been checked regularly in accordance with the provider’s policy to ensure they would work in an emergency.

Improvements had been made to the assessing and managing of risks to people’s health and wellbeing. Staff were knowledgeable about assessing and reducing risks to people and an effective system was in place to ensure individual risks to people were managed safely. People had access to healthcare services and were supported to maintain a healthy and balanced diet.

The provider had made improvements in ensuring the MCA 2005 code of practice was implemented. Staff followed legislation designed to protect people’s rights and freedoms. People were encouraged to make choices about every aspect of their lives and where people lacked capacity to make a decision, staff acted in their best their best interests.

Staff understood how to keep people safe. People were protected from the risk of abuse; staff knew how to identify, prevent and report abuse to their manager or local safeguarding authority. There was an open and transparent culture within the service and the provider listened and made changes in response to feedback and complaints.

People and their families felt the home was well organised and the staff cared for people with kindness and compassion. People received personalised care and support. Staff demonstrated a good awareness of people’s individual needs and responded effectively when they changed. People had access to a range of activities tailored to their individual interests.

The provider had adapted the environment to make it more suitable for people living with dementia or visual impairment, however on going improvements were needed.

Recruitment practices had ensured that all pre-employment checks were completed before new staff commenced working in the home. There were enough suitably trained and supported staff deployed to meet people’s needs. Staff received a programme of training with regular supervision and observation of their work.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have taken in the full version of this report.

On this occasion we found procedures in place to ensure people had access to call bells. Consent had been sought, or "best interest" decisions made for people who required specific equipment. If, because of mental frailty, people were not able to make decisions their relatives had been involved. These decisions had been clearly documented.

We looked at five care plans. These included clear information about how people should be cared for. We spoke with four people living at Steephill. They all said they were happy living there and were cared for appropriately. One person said 'the care is very good'.

We spoke with four care staff, the manager, assistant manager and cook. They told us they had completed training in safeguarding vulnerable adults and were familiar with local procedures for reporting suspected abuse. The home was clean and procedures were in place to ensure cleanliness was maintained and the risk of infection was reduced.

We observed a friendly atmosphere in the home. People who needed assistance were given this. However, procedures were not in place to ensure people could always request assistance from staff when in their rooms. People received their medications appropriately.

On the day of our inspection sufficient staff were available to care for people and some had time to sit with people and engage in activities with them. Staff had completed a range of training appropriate to their role in the home. A number of quality assurance measures were in place which meant the service received feedback from people living in the home, their relatives and relevant health professionals who visited the home.