Stable Steps Care Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The registered manager told us about the initial assessment process they would complete prior to people moving into the home. People’s needs had been assessed prior to admission; however, the registered manager commented on the challenges they experienced with people’s needs as often they presented with higher levels of need upon admission, than expected. It was not always evident the registered manager, when assessing people prior to admission, had considered the impact on other people living at the home and their differing dependencies as we found a large disparity between people’s specific needs.

Whilst a variety of risk assessments were completed it was not always clear these were updated in response to changes or reviewed sufficiently frequently to ensure they remained accurate and up to date.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We found risk based assessments were in place for people, such as Waterlow and MUST. Waterlow is used to assess people’s risk of developing pressure sores and MUST are used to assess people’s risk of malnutrition or obesity. However, we found these were not consistently reviewed to ensure they were current and accurately reflected people’s needs. We found limited evidence people and their relatives had been involved in the assessments.

We noted people in their rooms did not always have access to drinks as they were not available or they had been placed out of the person’s reach. We observed people were given a choice of orange or blackcurrant cordial at mealtimes and hot drinks were served to people in the lounge areas.

The main meal provision at the home was by a ready meal provider; however, people and their relatives gave mostly positive feedback about the food at the home. One person told us, “The food varies, I eat what they give me. I get plenty, no short measures.” One relative told us, “A couple of things I have said to the nurse is that [relative] is losing their eyesight a bit and needs prompting to eat their food and they [staff] have got that in hand.” Another person gave mixed feedback and told us, “The food is okay, but I find it is heavy with lots of meat, I prefer pasta and rice. If I don’t like something, they will give me other things.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We observed staff generally worked well together but were not always proactive at engaging with people and promoting independence and choice. The home received input from a variety of healthcare providers due to people living at the home having a variety of conditions; some people had complex needs including mental health, dementia and other cognitive impairments. During our inspection we received feedback from one visiting professional expressing concerns about the care and support delivered to people at the home. During one of our site visits, we observed concerns verbally raised by a visiting professional in relation to the delay in seeking assistance with a person in crisis. After we had fed back our concerns about the care and support of people with complex needs to the registered manager, they then asked other visiting professionals to provide feedback which was passed on to us and this feedback was positive.

Relatives told us they were kept updated about their loved ones changing health needs and had access to other services. One relative told us, “They look after all her personal care. [Relative] has an eye appointment coming up and my daughter does her hair and they have a chiropodist that comes in.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Opportunities for physical activity were limited due to the lack of outside accessible space. We found a relatively small number of people could access the local church café each week, but opportunities for fresh air for everyone beyond this regular outing were not demonstrated. Further opportunities needed exploring taking into consideration people’s hobbies, interests and abilities.

People and relatives told us they had access to support for healthier lives and they told us they saw a GP when necessary. One person told us, “I came here and the doctor said he would get me sorted. He got me some electrical stuff and cream, and my knees are much better.” Another person told us, “We get plenty to eat and drink and they [staff] monitor our weight and what we drink.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care plans did not include their goals or aspirations, or any information about positive outcomes to achieve. Although the provider had systems for oversight, these were not being effectively used to review and improve people’s care, including risks associated with people’s specific needs, and to ensure appropriate action and learning was taken in response to incidents and falls.After the draft report was sent to the provider, they told us they had made several improvements to their practice around assessing people’s needs in relation to goals and aspirations. We will review these on our next inspection.

Although we received mostly positive feedback from people about the care they received at the home, we were not assured people were experiencing positive outcomes in their daily lives. Some people told us they did not go out of the home or they did not leave their bedroom often due to other people living at the home. One person told us, “I don’t like going in the lounge because most of them [other people living at the home] have dementia and I don’t want to feel as though I am one of them and I can’t have a conversation with any of them anyway.” Another person told us, “I have a gate for stopping people coming in. I stay in my room, there’s no one to talk to in the lounge.” One relative told us, “I think she is safe here but there is a problem with people walking up and down the corridor and walking in people’s rooms. She has a gate on which I am happy with but sometimes they just push it open and come in.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

There was an inconsistent approach to consent to care and treatment at the home. Records did not always reflect where there was a legally authorised responsible person in place to make lawful decisions about care and treatment where people lacked capacity to make those decisions for themselves. Where people lacked capacity there was some evidence that mental capacity assessments were completed and best interest decisions made. However, these did not always cover each area where a decision needed to be made, they did not always include the relevant people in decision making or demonstrate least restrictive options had been considered, such as decisions relating to covert medicines.After the draft report was sent to the provider, they told us they had made several improvements to their practice around mental capacity and consent. We will review these on our next inspection.

We reviewed the consent records for people who had safety gates on their bedroom doors and found these were inconsistent. The gates were a restriction on people’s freedom and needed formal consent or an appropriate best interest decision. We were not provided with evidence or assurances for all the gates where consent had been given by people who had the legal right to do so. We also found best interest decisions had been made to consent to care and support by just one member of staff at the home and did not include any other interested parties, such as family or a health or social care professional. Further and comprehensive consideration should be given to ensuring that all consents are given by people themselves, those who have the legal power to do so or as a best interest decision that involves all the relevant people and not just one member of the provider’s staff.

We observed staff were kind when providing support but did not always ensure they obtained consent before delivering care. For example, throughout the inspection we saw people had actions done to them before staff asked their opinion or consent, such as having a clothes protector placed on them; we observed this to be a blanket approach by staff where everyone wore a clothes protector without first being asked if they wanted to wear one.