The Steppes Residential Care Home

The Steppes accommodates 29 people in two adapted houses. There were 28 people

accommodated when we visited. Nine people were living in the annex and 19 people in the main house.

We found the following examples of good practice.

The provider had sufficient stock of Personal Protective Equipment (PPE) which was well organised in designated areas for donning and doffing (put on and take off). Staff participated in training sessions around infection control and using PPE.

The service had systems in place for safe visiting to allow people to see and speak to their friends and relatives. Visitation adjustments had been introduced including a visiting pod which had been created to safely facilitate relatives' visits on a pre-booked basis.

The provider participated in the Covid-19 regular testing programme for both people and staff.

The provider had robust systems to ensure safe admissions, including only allowing new admissions after a confirmed negative Covid-19 test result.

A cleaning schedule was in place to ensure effective cleaning took place, which included enhanced cleaning of frequently touched surfaces.

The service had ensured people’s health needs had been assessed and plans were in place to minimise the risk of Covid 19 to their health and wellbeing.

We found two breaches of legal requirement at the last inspection in October 2016 relating to incomplete care records and medicine management. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Responsive to at least good. The provider had followed their action plan which they said would be completed on 9 February 2017. We found there were improvements to the care plans and the medicine management. People had received their medicines as prescribed. However, further improvements were needed to ensure people’s medicines would always be managed in accordance with current best practice. We have made a recommendation that the service consider current guidance on medicine management

The Steppes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Steppes accommodates 29 people in two adapted adjacent houses. There were 28 people accommodated when we visited. Ten people were accommodated in The Lodge and 18 people in The Steppes main house.

At our last inspection we rated the service Requires Improvement. At this inspection we found the service was rated Good.

There was a registered manager. 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.

We found improvements had been made to people’s care plans. There was a new detailed care planning system and people’s individual care was recorded and reviewed monthly to ensure they were safe and well. Staff knew what people valued and how they liked to be supported. Healthcare professionals supported people when required.

We found improvements to infection control in the laundry. There was a new sluice room and staff ensured infection control procedures were followed.

People lived in a safe and well maintained home and staff knew how to keep people safe. People told us they felt the home was safe. Staff were trained to identify and report any safety concerns. People were supported by staff that were well trained and had regular supervision to support their personal development.

People were treated with kindness and compassion and we observed staff engaged with people positively to support their wellbeing. People were treated with respect and they were supported to be independent. They were able to make choices and decisions and staff supported them.

People had a range of activities to choose from which included exercise classes, arts and crafts, musical entertainments, bingo and walks into town. There were links with the local community with trips out regularly organised.

The services quality assurance systems had improved. Regular audits had been completed and action plans ensured improvements were made. People and their relatives completed surveys about the home and action was taken to improve the service.

People’s medicines were not always managed safely to ensure people were receiving medicines correctly. Medicine management was regularly audited but improvements were not always sustained.

People’s care plans did not provide sufficient detail. There was insufficient guidance to support one person living with mental health needs. Care plans for people were not always person centred and complete to ensure staff knew how to meet people’s individual needs. Care plan reviews were incomplete.

There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The services quality assurance system had not identified some shortfalls we found for improvement for example improvements to infection control procedures. The environment could be improved to ensure there was enough space for people to dine and use the communal areas.

People and their relatives told us they felt the home was safe. Staff knew how to keep people safe and were trained to report any concerns. People were supported by staff that were well trained and had access to training to develop their knowledge.

People were treated with kindness and compassion and we observed staff engaged with people in a positive way most of the time. Relatives felt welcomed in the home and told us the staff were kind but sometimes people had to wait for assistance.

People were able to make some choices and decisions and staff supported them to do this. Staff knew what people valued and how they liked to be supported. Healthcare professionals supported people when required.

People had a choice of meals and we observed most people ate their food and could more if they wanted. When people required assistance with their food staff supported them and gave them time to enjoy their meal. People had a range of activities to choose from which included exercise classes, arts and crafts, musical entertainments, bingo and walks into town. There were links with the local community with trips out regularly organised.

The provider and the registered manager monitored the quality of the service with regular checks and when necessary action was taken. Staff felt well supported by the registered manager and deputy manager. Staff meetings and resident meetings were held and people were encouraged to make comments and contribute to the running of the home during meeting and using the annual surveys provided.

We also spoke with five members of staff who felt the home was "a great place to work" and "homely". We also spoke with three visitors who told us the staff were 'excellent' and 'caring, supportive and kindness itself'.

We looked at the care records of four people who used the service.These were comprehensive and detailed the health and social care needs of the person and recorded how any possible risks were minimised. Records were kept under review and were updated when required.

The home had a warm and welcoming atmosphere during our inspection visit. We saw that the furnishings and decor were domestic in style and provided a homely and comfortable environment.The premises were clean and well maintained and recent improvements had included the redecoration of bedrooms and new carpets.

The staff we spoke with told us about the range of training they had received and the support that management gave them. This meant they had the necessary skills to provide the care and support needed by the people who used the service.

We spoke with seven staff during our inspection. This included the registered provider, the registered manager, three care staff and ancillary staff. All staff were very motivated, committed and positive about working at the home. Staff praised the training, teamwork and supportive atmosphere.

People were cared for, or supported by, suitably qualified and sufficient numbers of staff.

Comments made by people living at the home included 'The staff are exceptional, the service provided is amazing'. Another person told us 'I am very well supported the staff here are lovely, so caring'. Many favourable comments about the care and support provided were given to us by people living at the home.

The staff we spoke with were extremely knowledgeable about the practical and emotional support needs of the people in their care. Staff were friendly and professional.

Complaints were not commonplace. Opportunities were made available for people to raise any concerns that they may have. People knew how to make a complaint if they had any concerns. People living at the home were keen to point out to us that they had no complaints and had never had to raise any concerns about the service.