St Stephens Care Home

St Stephens Care Home is a care home providing personal and nursing care for up to 40 people across two units, one specialising in providing care to people living with dementia. At the time of the inspection there were 23 people living at the service.

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

Since our last inspection, the provider had made some improvements to the service, however other improvements had not been sustained and further improvements were required.

Whilst the provider had made changes to aspects of their governance systems, they did not have effective oversight to safely mitigate environmental risks, ensure the premises were maintained, ensure staff were always suitably deployed or had received appropriate induction training and supervision.

The provider had not ensured risks in relation to the environment were fully monitored and managed. This included the safe storage of items, security of the premises and aspects of fire safety. Not all the required health and safety checks had been undertaken. Feedback from people, staff and our observations indicated staff were not always suitably deployed.

Some improvements had been made, and systems were in place to protect people from abuse. Overall medicines were managed safely and systems were in place to help prevent the risk of infection.

The provider had not addressed all the issues we found at the last inspection. Aspects of the premises needed to be improved, including ensuring the service was dementia friendly and areas needed refurbishment. Some actions had been commenced, such as the installation of new flooring.

Managers had taken some action to provide supervision to staff and support them to undertake the required training and eLearning. However, we were not assured staff had always received appropriate induction training and supervision.

Staff had made improvements in relation to working with other agencies to support people to receive effective care. Overall, people and their relatives were positive about staff and told us they were knowledgeable and communicated well. However, further improvements were needed to ensure people’s individual needs were fully supported.

Overall, the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. 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.

The provider had implemented an electronic recording system, however, whilst some improvements had been made to people’s care records, records relating to the care provided were not always complete and accurate.

The provider took several immediate actions during the inspection to address the issues raised and planned to make further changes to accelerate the required improvements.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 December 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider set out a programme of environmental improvements and shared the progression with people using the service. At this inspection we found insufficient action had been taken to progress improvements. This service has been rated requires improvement or inadequate for the last 3 consecutive inspections.

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. 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 Stephens Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to staffing, the premises, safe management of risks and governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 Stephens Care Home is a care home providing personal and nursing care for up to 40 people across two units, one specialising in providing care to people living with dementia. At the time of the inspection there were 22 people living at the service.

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

Following our previous inspection, a new registered manager and deputy manager were in place. They had focused on the recruitment of staff, however the provider continued to need to recruit staff. The service remained reliant on the use of agency staff and although this had reduced since the last inspection, staffing issues impacted on the cleanliness of the building and the activities provided to people. Staff were recruited safely, and systems were now in place to ensure agency staff had been trained.

We identified ongoing issues in relation to person-centred care. Whilst managers were promoting a more person-centred approach, we found some practices could be improved. Care plans and assessments were being rewritten onto a new electronic system, however these needed to be more person-centred. People told us activities were limited.

The safety of the premises had improved, maintenance checks around the building were now carried out. Improvements were also found in relation to the management of nutritional risks. However, we identified other aspects of risk which had not been effectively identified or managed.

Some redecoration and refurbishment had commenced, but progress had been slow. We have made a recommendation about this.

Aspects of medicines management and infection prevention and control had improved, but there remained issues which required further improvement. Systems had been implemented to help safeguard people from abuse and people told us they felt safe.

The provider had better oversight of staff training and supervisions, which were now in progress. Overall staff told us systems and communication had improved.

Since the last inspection some improvements had been made regarding the oversight and management of people’s health needs. However, daily records were not always complete to demonstrate people’s needs had been met. A new chef had been recruited, people were satisfied with the food provided and menus were under review.

People spoken with were generally positive about the staff and support they received. Regular staff understood people’s preferences and were keen to promote good care. Improvements had been made to respecting people’s dignity and privacy and this needed to be embedded.

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. Records relating to deprivation of liberty (DoLS) authorisations had improved.

The provider and registered managers were undertaking audits, however these needed to be more robust as they had not identified all the issues we found at this inspection. We received some concerns during the inspection which we raised as a safeguarding issue for further investigation. The provider had not ensured sufficient oversight of the service at night. They took action to address this following the inspection.

The provider had a large action plan in place and the registered manager acknowledged there were further improvements to be made and had plans for the development of the service. The provider told us they continued to invest in the service and were bringing in extra support to progress the action plan. Further work was needed to ensure people and their relatives were able to provide feedback and be involved in decisions about the development of the service.

The provider had worked in partnership with health and care agencies.

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

Rating at last inspection and update.

The last rating for this service was inadequate (published 23 May 2022).

At this inspection we found improvements had been made in some areas, however, the provider remained in breach of some regulations.

This service has been in Special Measures since 20 May 2022. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection.

The provider was in the process of addressing the outstanding breaches and had plans in place to mitigate our concerns. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider still needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Stephens Care Home on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, safe management of risk, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan and meet with the provider following this report being published 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 Stephens Care Home is a care home providing personal and nursing care for up to 40 people across two units, one specialising in providing care to people living with dementia. At the time of the inspection there were 33 people living at the service.

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

Risks were not safely managed. Where risks had been assessed and plans put in place to reduce hazards, staff had not always followed them. The registered provider was unable to demonstrate staff had undertaken appropriate training to support people safely with moving and handling. Robust systems were not in place to ensure learning occurred when things went wrong.

Risks relating to fire safety were not well managed. An external fire risk assessment had identified actions were required, but these had not been completed in a timely way. Safety testing and checks on various services/equipment had not been undertaken as required.

Medicines were not always managed safely. Accurate medication records were not consistently maintained. We identified discrepancies in the stocks of people’s medicines as well as other issues. We were not assured that the provider was promoting safety regarding the layout of the premises and hygiene practices.

There were not enough suitably experienced staff to safely meet people’s care and wellbeing needs. There had been a high turnover of staff and the provider was recruiting new staff. They were heavily reliant on agency staff and had not always deployed staff appropriately. Skill mix and experience had not always been considered. We found staff were often unavailable to support people in the communal area in one of the households and staff found it difficult to respond to all call bells. The registered provider was unable to demonstrate staff had received appropriate induction; training and supervision to carry out their roles effectively.

Staff had not always followed procedures designed to protect people from abuse. However, people spoken with told us they felt safe living at the home. Staff told us they understood the need to protect people from abuse and felt able to report any concerns should they need to.

Records relating to nutritional and fluid intake were inconsistent. We received mixed feedback about the standard of the food provided.

Aspects of people’s health and care needs required monitoring and oversight, such as with catheter care, hydration and skin integrity. Daily care records showed people did not always receive consistent or adequate support to meet their needs.

The provider did not have a robust system in place to monitor applications for Deprivation of Liberty Safeguards (DoLS) authorisations or when any authorisations needed to be reassessed. DoLS authorisations were in place for some people but not all applications had been submitted as required. The nominated individual confirmed these applications were in progress following the inspection. We heard staff seeking consent from people to provide care during the inspection.

Staff had not always ensured people’s dignity and privacy was maintained. During the inspection we observed some caring and positive interactions between people and staff. Overall people told us they felt well treated, and staff were kind in their approach. We observed staff being supportive and considerate in their approach to end -of-life care.

People were not always supported in a person-centred way. They were supported to make some choices for example, where they ate their meal or when they went to bed. However, this was inconsistent. People were not provided with opportunities to engage in meaningful activities. There had previously been an activities coordinator at the home, however they were now undertaking a different role and the service was in the process of recruiting a new coordinator.

There were systematic and widespread failings in the way the service was led and managed. The systems and processes for monitoring the quality and safety of the service failed to identify and mitigate risk. There was a lack of auditing and oversight of routine safety checks. Where issues had been identified, the provider had not acted in a timely way to address these.

Prior to the inspection members of the management team had left. Following the inspection, a new manager was recruited. There had been poor communication throughout the staff team and organisation. Staff meetings were not routinely held but this was now being addressed. The provider was working with other agencies such as the local authority to make the necessary improvements.

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

Rating at last inspection

This service was registered with us on 13 October 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the management of the service. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report. Following our inspection, the provider had started to work with the local authority and other agencies to begin making the necessary improvements and to mitigate the most serious risks.

Enforcement and Recommendations

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 breaches in relation to safe care and treatment, medicines, infection control, staffing, person centred care and good governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. 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.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures.This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The provider was facilitating visits for people who used the service safely. Visitors were familiar with following the required procedures. As a result, people who used the service had their human rights upheld.

Many people preferred to stay in their rooms but where people congregated into lounges and dining rooms, social distancing was maintained. People were encouraged to be socially distant from each other when in communal areas. Staff worked on designated living areas in the home to help stop the transmission of infection between people.

An infection prevention specialist had recently visited the service and provided guidance to maintain hygiene standards.