Stable Steps Care Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Shortfalls in the provision of safe and effective care had not been identified and actioned. Improvements within the service had been minimal since the last inspection. It was evident good, effective and safe provision of dementia care and person-centred care for whom the service was specifically provided, was not understood and implemented by the staff team. Although staff were kind and gentle, care delivery was often generic and task led without any reference to good therapeutic strategies to provide meaningful interventions to people with dementia and manage people’s distressed behaviours. The provision of enhanced supervision, funded by commissioners of the service, was of particular concern during this inspection.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

It was not always evident people were involved with the management team at the service. Whilst the registered manager appeared to know people and their needs, people were not always clear of their involvement with the registered manager and several people told us they were not aware of who the manager was. One person told us, “There are loads of managers. I don’t see them much and don’t have much to do with them.” One relative told us, “I don’t know the names of the managers, is it two men? They say hello if they pass but that’s all.” However, one person we spoke with knew who the manager was and gave positive feedback and stated, “[Name] has helped me with things to do with my social worker and she keeps my family well informed of what is going on with me.”

The provider’s compliance manager had recently left the service and the provider had made changes to the arrangements for oversight which had led the registered manager to delegate several governance checks to other staff including senior carers. It was not clear staff taking these additional roles had sufficient managerial training to understand the purpose of these checks to ensure they effectively identified areas for concerns, as many areas of concern we noted had not been identified through the providers own systems of checks.

People did not always feel they could speak up and that their voice would be heard.

The registered manager told us staff could go to her at any time about anything and that staff are not scared to approach her. Staff did not raise any concerns about the manager with us.

The provider did not operate an open and accessible system for providing feedback on their care, as people were not enabled to do so through the lack of accessible information individual to each person. The provider did not make efforts to ensure everything possible was done to facilitate a person’s communication needs to be able to speak up through different ways and means and ensure their voice was heard.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they felt supported in their role. Staff completed equality and diversity training and they employed and supported a diverse workforce.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

We found repeated concerns at this inspection which demonstrated a failure to ensure improvements were embedded and sustained. We found concerns relating to the environment, the management of people’s individual risks, the provision of person centred care, the management of people’s medicines management and the effective support for people with dementia. Although audits and reviews were taking place, they had not identified the concerns the inspection team found and where concerns had already been identified, these had not always been addressed and actioned. Despite the provider already working to an action plan, concerns raised at the last inspection and set out in the inspection report and the warning notice served on the registered manager, had not been addressed fully.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

There was some evidence staff worked effectively with partner agencies such as health care services, but there was limited evidence of full engagement with other aspects of the community. We noted some people were supported to access a local café but there was limited evidence of other ways people were supported to access the local community. We noted some people were keen to be able to go out of the home and engage in activities; however, we found very little evidence of this for people. The activity worker told us they tried to get people out to the local shops and other services whenever they could, but we saw no evidence of efforts made to fully engage the home and the people living there with meaningful and specific community engagement.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

There was limited evidence of how the service learnt from incidents and feedback from people and relatives and made subsequent improvements. We found several areas of shortfall which had been noted at previous inspections and not yet been addressed or embedded. For example, issues with personalised care, governance and oversight, the management of medicines and risk management. We did note some areas for improvement in relation to staffing and recruitment since the last inspection. However, other assurances or action plans provided following previous inspections had not been followed through, for example, in relation to improving access to outside space.

Stable Steps Care Centre has been rated requires improvement for the last three inspections, and at each inspection since the home registered with CQC. We have identified multiple and repeat breaches of regulations. This is evidence of a history of failing to respond adequately to serious concerns and shortfalls set out in inspection reports and enforcement action.