Steeton Court Nursing Home

Steeton Court is a care home providing personal and nursing care to older people and people living with dementia or physical disabilities. At the time of the inspection there were 19 people using the service which can accommodate up to 65 people in this purpose built two storey home.

Rating at last inspection and update: The last rating for this service was inadequate (published 6 December 2019) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that 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 action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Steeton Court Nursing Home on our website at www.cqc.org.uk.

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

People received safe care and support because systems for assessing and managing risk were robust and staff knew how to safeguard people. Care plans included up to date and comprehensive individual risk assessments which gave staff the information they needed to maintain people’s safety.

New and emerging risks including the effects of COVID-19 had been assessed. Improvements had been made to the systems for managing medicines and regular auditing meant these systems remained safe.

Clear processes were in place to prevent and control infection within the home. The provider had been proactive in following government and local guidance in relation to managing the COVID-19 pandemic.

Systems for recruitment of new staff were safe. Staffing was well organised and was appropriate to the needs of people using the service. Staff received the training and support they needed to care for and support people safely and effectively.

People’s nutritional needs and preferences were assessed, and plans put in place to make sure they were met.

People were supported to have maximum choice and control of their lives and the provider had made improvements in systems for assessing people’s capacity to make decisions. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider assessed peoples’ needs before they began to use the service and regular reviews took place to make sure care plans reflected people’s current needs. People were supported by a range of health and social care professionals to maintain their overall health and wellbeing.

People were supported to make decisions about their care and care plans reflected a person- centred approach.

People were treated with kindness and consideration and care was delivered in way which met people’s dignity and independence needs.

People were supported to maintain relationships to avoid social isolation during the pandemic. Complaints about the service were managed effectively.

Changes in management systems had been effective in improving quality assurance systems. Analysis of accidents and incidents enabled the provider to learn lessons from previous events and implement positive change.

People were unanimous in their feedback in relation to the improvements made at the service. One relative said “I can’t praise enough the improvements. There has been a very noticeable change in the home.”

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Steeton Court is a care home providing personal and nursing care to older people and people living with dementia or physical disabilities. At the time of the inspection there were 38 people using the service which can accommodate up to 68 people in this purpose built two storey home.

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

Accidents and incidents were not analysed and not enough was being done to make sure action was taken to minimise risks to people’s safety. Medicines management was poor. The security of the home was poor and not enough checks were being completed to make sure the premises were safe. Although staff told us they would report any safeguarding issues we found safeguarding issues had not always been reported to the local authority. The home was clean and odour free.

Staff were not always recruited safely and there were not always enough staff on duty to make sure people received the care and support they needed. Staff training was not up to date and staff did not feel supported in their roles.

Meals at the home were good, however, people’s hydration needs were not always being met. The advice from healthcare professionals was not always being followed, which placed people at risk. People said they could see a GP if they needed to.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always supported to look their best and were not always treated with respect. Care plans lacked detail about people’s cultural and spiritual needs and there was little evidence people had been involved in designing their care plans.

Care plans were not person-centred and did not meet people’s needs or preferences. End of life care plans only contained very basic information. Complaints had not always been investigated or responded to. Activities and outings were taking place.

Systems in place to monitor, assess and improve the safety and quality of the service being provided were not effective. The safety and oversight of the service was inadequate.

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

Rating

The last rating for this service was good (published 8 June 2017) and there were no breaches of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about medicines management, risk management, safeguarding, staffing, staff training, lack of person-centred care, lack of leadership and direction. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

The provider has sent us an action plan detailing how they intend to mitigate risks to people using the service.

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 Steeton Court Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, consent, person-centred care, nutrition and hydration, dignity and respect, staff training and support, receiving and acting on complaints, good governance and staff recruitment 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Steeton Court Nursing Home is located in the residential area of Steeton. The home is registered to provide care to a total of 71 people and on the day of our inspection there were 54 people living at the service. The home is built on two floors with access to the first floor by means of two passenger lifts and a stair lift. The majority of bedrooms are single rooms with en-suite facilities. The communal areas of the home include lounges, dining rooms and conservatories. There is an enclosed sensory garden to the outside of the property.

A registered manager was in post and had employed in this capacity since 2010. 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.

At our last inspection in 2015 we rated the service 'good' overall and 'requires improvement' in the well led domain, as we needed assurance that previous concerns were sustained. At this inspection we concluded improvements had been sustained.

People told us they felt safe living at the service and in the company of staff. Staff had received safeguarding training and understood their responsibilities regarding keeping people safe. Appropriate assessments were in place in people's care records to identify and mitigate risk and incidents/accidents documented. However, a more robust audit record of the number of incidents individual people had experienced would assist the service monitor individual trends.

Sufficient staff were deployed to keep people safe and we saw training was up to date or booked. Staff told us the training provided was of a good standard and enabled them to carry out effective care and support. We saw staff were kind and compassionate in their approach and there was a stable staff team which meant staff knew people well. Morale was good amongst staff who felt able to voice any concerns to the management team.

The service was acting in accordance with the Mental Capacity Act (2005) and the requirements of the Deprivation of Liberty Safeguards. People's consent was sought wherever possible and evidence of best interest decisions were in place. People's choice and preferences were respected.

People mostly told us they enjoyed the food provided although some people would like to see a greater variety and choice. Nutritional risk assessments were in place and people found to be at risk referred to the GP or dietician. We saw where people's intake was recorded and nutritionally supplements prescribed and correctly administered.

People were given the choice to participate in a variety of activities on a group or one to one basis.

Complaints were taken seriously and addressed although a low level of complaints had been received.

People's care was planned following needs assessments and kept up to date. We saw and people told us the care provided was in line with people's care plans. People's healthcare needs were effectively supported.

A range of quality audit processes were in place to identify and drive improvements in the service. Meetings and surveys were in place to gauge satisfaction among people who lived at the service and actions taken as a result. Staff attended regular meetings to discuss relevant topics and any issues or service developments.

We found that people were involved in making decisions about their care and staff treated people with respect and dignity. We found that people's nutritional needs were being met but the choice of food wasn't particularly varied. The environment of the home was clean and also well maintained. There were sufficient numbers of staff to meet the needs of people but on occasion, during meal times in particular, staff could be very busy which meant care duties could be rushed. We found that the provider had appropriate systems and processes for monitoring the quality of care and maintained people's care records in a format that could be easily understood.