Stable Steps Care Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained Requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to how people were supported with care that was individual, personalised and met their needs.

This service scored 46 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We served a warning notice on the registered manager after the last inspection in 2023 as we found repeated concerns about the poor provision of person-centred care at the home. People did not receive personalised care that was individualised and met their needs. Staff interactions did not always demonstrate they knew service users well or were skilled and knowledgeable about how to effectively manage a person’s distress. Our observations demonstrated staff did not always ensure care was appropriate and reflected individual need. Inspectors did not always observe personalised or meaningful interactions with people, particularly those with enhanced supervision, such as 1:1 and 2:1 care and support. We found the provision of person centred care had not improved and we found continued concerns at this inspection.

People did not have a choice around their options for bathing. There were two showers at the home for up to 50 people. There was no option to have a bath for people who did not like showers, due to their dementia or through choice, as there was no bath at the home. We noted many people were served their food on a plastic plate and were served their drinks in a plastic spouted beaker. We spoke with the registered manager about the approach of providing this type of equipment to everyone and they told us some people had been assessed as needing this type of crockery and cups; however, there were only a small number of people where this was necessary. One relative commented on the first day of our inspection, “I noticed they were giving [relative] a drink in one of those feeders. I mentioned that [relative] likes to drink out of a proper china cup, so they have changed it.” However, during our observations on the subsequent 2 site visits, we observed this person being served their drinks in a plastic spouted beaker.

We found the environment experienced by people was not always appropriate to promote good experiences for people, in particular those people with dementia. We found the environment was often noisy and busy and this may cause overstimulation and distress in those people with dementia. We were aware from care documentation that some people preferred a quieter area and could become overwhelmed by noisy and busy environments. However, the home did not benefit from smaller rooms where people could access quieter and more personal areas to relax in.

There were 2 activity co-ordinators employed at the home and we saw activities taking place throughout our inspection. We saw an activities programme was displayed. On the first two site visits, the activities listed were 1:1 activities and charades on day 1 and Wednesday wellness and hairdresser visit on day 2. We also observed some simple activities that were happening during our inspection that were not part of the displayed programme, these included colouring, games and crafts in the lounge. One person told us, “They do have activities and they bring us games and quizzes to do. They have entertainers every couple of months. Not many trips but [Name] goes to a local church cafe for a coffee.”

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

We found continued concerns around the delivery of person-centred and individualised care. Interactions with people were not always effective and we found a lack of meaningful support strategies in place for people on 1:1 support and people with distressed behaviours. Despite the home being registered with a service specialism of dementia care, we were not assured the staff team fully understood the diverse health and care needs of people with dementia and how to effectively support people and provide meaningful care interactions to ensure a good quality of life.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was limited evidence to demonstrate how the service took a person centred approach to meeting people’s specific communication needs or alternative approaches to communication such as use of visual aids. The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The registered manager told us they were aware of the Accessible Information Standard, which requires staff to ensure information is in formats that people can understand. However, the registered manager advised us people at the home were not able to use alternative communication approaches due to their cognitive impairment. We spoke with the registered manager about enabling people, through communication, to be involved in their care plans and they told us there were only 2 people at the home who had capacity to have input in their care plan.After the draft report was sent to the provider, they told us they had made several improvements to introduce communication aids. We will review these on our next inspection.

Families commented they were updated with information when people became unwell but it was not evident people had been fully involved in developing their care plan. Where families were making decisions about risk, it was not clear staff had provided all the information needed to make an informed decision. For example, there was a lack of evidence that when families had requested a safety gate on their relative’s bedroom door, information about the identified fire safety risks had not been provided and discussed as part of the decision. Similarly, where decisions were taken to not follow a professional’s guidance around modified diets, people had the most up to date information provided to them and there was a full understanding of the risks associated with this practice, such as choking and aspiration.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

There was a comments box in the reception area of the home and there was a complaints policy and procedure in place. We reviewed recent complaints at the home and saw they had been responded to by the registered manager.

The provider had some systems to involve people and seek feedback but we saw no evidence these were being used effectively. For example, there was a resident of the day system in place where people’s care needs were reviewed but these records did not demonstrate feedback was sought from people or their families, although this was part of the to do list for this process. We found no evidence in the care plans we reviewed people or their families had been consulted about their assessments of need or care plans.

The registered manager told us in order to involve families in their loved one’s care plan, they had printed off the entire care plan and asked them to read and sign it. However, they told us this had not been effective in getting families involved. We were not assured the registered manager had considered the implications of this practice in relation to data protection laws and sharing personal and sensitive information.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We were not assured staff and leaders always actively listened to information about people who are most likely to experience inequality in experience or outcomes. There was no evidence of seeking feedback from people or reviewing lessons learnt about access in order to improve how people accessed health services.

The registered manager told us they were not aware of anyone in the home who had faced discrimination either within the service or when trying to access other services or the community.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People’s human rights were not always upheld as they had been living in an environment not conducive to their individual needs and were not always supported to make decisions for themselves. Although staff had received training in equality and diversity, we found staff were not always treating people as individuals. We did not see evidence people had been provided with the opportunity and supported to give their views and achieve their goals.

People’s freedom was not always promoted and people who displayed distressed behaviours did not always have the same opportunities or access to activities as other people using the service. Staff did not always recognise how people’s capacity could fluctuate to support decision making and choice where this was appropriate.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People did not always have detailed or personalised care plans in relation to their wishes for end of life care. When peoples’ health had deteriorated, it was not always apparent action had been taken to implement these care plans and ensure information about people approaching the end of their life was clearly communicated to the staff team. For example, on our first site visit we found one person had been placed on the end of life care pathway and had been prescribed anticipatory medicines. At the end of our second site visit 2 days later, we found this person had still not had their care plans updated to reflect this significant change in their care needs and no end of life care plan was in place. There was limited evidence that staff had completed training in relation to providing this type of support.