The Steppes Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection this key question was rated requires improvement. At this assessment this key question has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We identified some areas of medicines management required improvement. We also found some people did not always have risk assessments in place for specific health conditions. This meant staff may not have always had relevant information about signs of deteriorating health, or guidance on how to escalate concerns. This was a breach of regulation in relation to safe care and treatment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and family members told us they felt listened to. If they had any concerns, they felt comfortable raising them. Family members told us they felt involved and if changes were required to their family member’s care, they were assured they would be done. One family member told us, “When [person] came in, they were more mobile and moved into the Lodge but when getting to and from their room became too much, they were confined to their room but as soon as a room became available, they were given a downstairs room.” Another relative told us, “When it came to end of life, we were kept updated with everything.”

Staff felt confident to raise concerns and felt able to make suggestions for improving the service. Staff told us there was a supportive learning culture at the service, and they learned from incidents together. One staff member told us, “There are some incidents and accidents. If things happen staff will do role playing and we talk through the problem and try and solve it together to help us learn.”

The provider had a proactive and positive culture of safety, based on openness and honesty. The registered manager and senior staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. For example, the registered manager showed us how falls were analysed and what improvements had been implemented. One family member told us, “If I make a request staff react. I’ve never heard [person] being told to do something.”

People told us they felt safe in the service and knew they could raise any concerns they may have. Family members confirmed they felt their loved ones were safe and could raise concerns with management and staff. One person told us, “If I have an appointment at the hospital, they will always take me, stay and bring me back.”

The registered manager told us systems were in place to ensure people received continuity of care at the service. This included staff developing their skills. One senior staff member who was up skilled to be the Falls Champion told us “I complete all the care plans on moving and handling for residents. I've also done risk assessments on equipment and hazards too.”

We received positive feedback from health professionals. A health professional shared how staff were receptive to advice and followed treatment plans people required.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. We saw the service worked with partner agencies and sought appropriate support from the local GP practice, for example, after someone had a fall. The registered manager made sure there was continuity of care, including when people moved between different services. For example, the registered manager showed us a completed pre-admission assessment to ensure a person’s needs could be safely met at the service.

People living at the service and their relatives told us they felt their loved ones were safe at the service. One person told us, “I feel very safe, safe because it’s a combination of everyone here. Whatever your problem, always somebody to sort it out. People[staff] take every opportunity to help you. Everybody helps each other.” Another person told us, “I feel very safe here because all of the staff treat me like one of their friends.”

Staff were aware of the safeguarding procedures and knew how and when to raise a safeguarding concern. A staff member told us, “I'd report any concerns about people to my senior, write in the notes, in the incident forms and in the communication book.”

People were able to express their views and choices without fear. We observed people felt comfortable around staff.

Safeguarding adults’ policies and procedures were in place, and we saw evidence of a recent safeguarding audit. Staff followed processes to ensure any safeguarding concerns were reported and recorded. There were systems in place for the management team to review safeguarding adults concerns to ensure they were learnt from. However, we found the registered manager did not have systems in place to monitor and ensure CQC notifications were always sent about people who had a Deprivation of Liberty Safeguard (DoLS). We found one person who was living under a DoLS which CQC had not been notified of.

People and relatives told us they were very happy with the service. People told us staff would always support them and never restricted them.

Staff told us they knew people well and understood their care needs and associated risks, for example staff told us how they informed people about any risks and how to keep themselves safe. The manager told us about one person who was living in a room upstairs, but their health was deteriorating, and they were unable to navigate the stairs safely and were becoming isolated, so the manager supported them to move to a downstairs room which meant they could come out of their room and engage with others more. Some staff however did not always demonstrate an awareness of people's risks but knew where to find personalised guidance on how to support people safely. For example, staff told us they removed a person’s call bell as they were no longer able to use it, however they did not consider how the person would then be able to call for staff assistance. They also had not considered putting additional monitoring in place or equipment such as a sensor mat. Staff we spoke to were working safely with people who had complicated needs and were at higher risk, for example, of falls. However, we found staff did not have knowledge of the discrepancies we found in the care documentation. For example, one person’s care documentation stated they used a specific type of walking aid, however their risk assessment stated they used a different type of walking aid and staff we spoke to were unaware of this.

We found although people and relatives gave us positive feedback, people at the service did not always have appropriate risk assessments in place. Although staff knew people well, we did not observe people were always safe. People living in a separate building to the main service known as the ‘Lodge’ were sometimes left alone for periods of time which increased their risk of experiencing distress and there were not always systems, such as call bells, in place for people who were confused. We observed one person living in the ‘Lodge’ pressing a call bell on behalf of another person who needed support but could not use their call bell. We observed staff left people in the dining room in the main building, which also increased the risk people would be without support if someone were to choke on their food.

The provider did not always work well with people to understand and manage risks. Processes to ensure people’s needs and risks were always identified and accurately recorded were not effective. For example, we found some people’s needs were not always assessed regarding their ability to summon assistance if they needed it. We found one person living with advanced dementia was not able to use a call bell and had no other way to seek help if needed. We were not assured systems or processes were in place to ensure staff were deployed at regular times to the ‘Lodge’. While the registered manager and staff told us staff knew to go in to the ‘Lodge’, we observed instances where there were no staff available, and the inspection team could not leave the building. This meant there was a risk people could be exposed to the risk of harm. We found some people did not have care documentation for all their specific health conditions. This meant staff may not always have had information to identify symptoms of deterioration, nor did they always have guidance on when to escalate concerns to relevant partner agencies. We also found there were some discrepancies in information recorded within care documentation about what support people required. Additionally, some staff were not always aware of all people’s risks and told us they relied upon care plans and risk assessments to ensure they knew how to safely deliver care. This meant people may have been placed at an increased risk of harm. We identified some concerns with documentation. For example, the provider had a falls audit, however the audit had failed to record a fall which had recently occurred. We also found care documentation did not include specific plans for people's medical conditions. For example, we found one person with 8 medical conditions who did not have any specific care plans for staff to enable them to recognise signs and symptoms of those conditions and what support the person needed.

People and family members told us they felt the environment was safe, and the equipment, facilities and technology supported the delivery of safe care. One person said, “Must be safe, never had any problems or anything happen to me.” Another person said, “Never had a problem getting help when I need some.”

Feedback from staff and the registered manager confirmed effective systems were in place to ensure the safety of the premises and equipment. Staff confirmed they completed appropriate training and maintained high standards of cleanliness. Comments included, “If we support people to get up in the morning, we do a basic clean of the room and change any sheets that may need doing.” One staff member told us, “I feel supported and feel that managers will know the answers to my questions if I have them.”

The service was spacious, had plenty of natural light and was clean. Equipment people required to be safe had been appropriately maintained. We observed the communal areas being homely and there were no trip hazards.

The provider detected and controlled potential risks in the care environment. We saw evidence in the maintenance records that environmental checks had taken place, and any issues had been reported and fixed. We saw evidence equipment and the lift had recently been serviced.

People told us “There are enough people [staff] to help me when I need it.” And “Always enough people. Never had a problem getting help when I need some, so kind when they do.” Family members told us “Staff don’t rush [person] and take their time.”

Staff told us the ‘Lodge’ was staffed. Staff told us “Staff are always in and out, there’s always someone [in the ‘Lodge’] whether it’s a cleaner, activity co-ordinator or staff. We just know to go over.” Staff we spoke to did not understand the risk to people living in the ‘Lodge’ and being left alone, or with staff who were not trained to support with personal care needs or manage emergency situations. Staff told us “In the evening sometimes it is harder … sometimes it is difficult.” Staff told us they received training to enable them to undertake their roles. Staff felt confident if they required additional training and support it would be provided. All staff had received training on dementia and were aware of how dementia impacted people. One staff member told us, “I engage them and want them to feel safe and secure. Particularly the people living with dementia. Their condition can often make them confused and gives them the feeling of being unsafe and abandoned. I reassure people and talk about their families and explain where they are. It is about remaining calm, and not adding fuel to the situation to make their distress and anger worse.”

We observed the ‘Lodge’ which is a separate key coded building was left without any staff for up to 15 minutes at points during our assessment. On one day of the inspection, we were left alone in the ‘Lodge’ and a person living in the ‘Lodge’ had to open the door for us to leave. We did not see sufficient staff were utilised in supporting people living in the ‘Lodge’, which was left un-staffed for periods of time. Although staff told us there were enough staff to support people safely, we did not observe this. However, we found staff in the main building were more visible and although busy, they were able to attend to people quickly. During the assessment the emergency bell was activated and 3 staff came swiftly to support someone who had just had a fall.

We looked at 3 people’s recruitment records and found recruitment processes were in place to ensure suitable staff were employed at the service. Processes were in place to ensure all staff attended training; however we found a high number of staff had not completed falls training.

Relatives told us the service was clean. One relative told us, “I think it is so clean and that’s nice.” Another relative told us, "I cannot fault the cleaning, everything is spotless.”

Housekeeping staff told us about the cleaning schedules they completed on a daily, weekly and monthly basis around the service. Cleaning books were completed by housekeeping staff to help manage tasks which were required. Housekeeping staff told us communication was good, and they felt supported by the registered manager. Comments included, " There are plenty of cleaning products and I tell them if I need anything. There is plenty of Personal Protective Equipment (PPE)."

We observed the service was clean and well maintained. We observed housekeeping staff working hard to keep the service clean and protected people from the risk of infection. We observed staff using recommended infection prevention and control best practices when removing soiled bedding and clothes from people’s rooms to reduce cross-contamination.

The provider assessed and managed the risk of infection. Processes to detect and control the risk of infections spreading were in place and concerns were shared with staff promptly. Staff had PPE situated throughout the service giving them easy access to wear it when needed. We saw the provider maintained areas to dispose of clinical waste to support staff to minimise the spread of potentially infectious waste.

People did not always receive their medicines in a safe way. People's feedback was positive, however we found shortfalls in how people's medicines were managed which did not align with the feedback we received. People told us “I do take tablets. Very lovely carer brings them along and helps me take them, tells me what they are for.” And “‘I take quite a bit of medication. They are very particular about medicines. Always on time, wait whilst you take them and write it all down.”

Staff told us they received training, and competency checks to enable them to administer medicines. Staff felt training offered was adequate for their needs.

Processes were not always effectively in place to ensure medicines were safely administered or managed. We reviewed PRN protocols which are medicines prescribed for people as and when required. On a few occasions we found PRN protocols were missing and the stated formulation for one medicine did not align with how it was prescribed. Some risk assessments and relevant documentation were not in place for some people. For example, we found an over-the-counter medicine was being used for 1 person, but there was no documentation to support this. We also found there was not a risk assessment for 1 person who required a cream containing paraffin which can be flammable. Oversight of medicine errors required improvement as there was no clear documentation process in place, and instead this was recorded on the back of a person’s medicine administration record (MAR) sheets. These concerns had not been identified by the provider and there was a risk people could be exposed to harm. Fridge temperatures were monitored routinely, with no observable gaps in the previous 3 months. There was a clear process around management of controlled drugs (CDs), with access to keys described both in the policy and described to us by staff. Stock levels of CDs were correct and well maintained, however index pages sometimes did not correspond to the correct page. Transfer to and discharge from hospital had a clear process to ensure people were receiving the correct medicine, as prescribed. Medication reviews were carried out by a practice pharmacist every 6 months or sooner to ensure medicines remained effective and safe for the resident. There was a comprehensive training package available, and evidence was seen of records of completion of medicines training.