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Stepping Stones Requires improvement

We are carrying out a review of quality at Stepping Stones. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 November 2019

About the service

Stepping Stones is a residential care home that provides accommodation and personal care for up to fifteen people with a physical disability. Some people may also have some learning difficulties.The care home is located on one site but split across two bungalows and three self-contained flats.

The service was registered for the support of up to fifteen people. Fourteen people were using the service at the time of the inspection. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. The thematic review looks in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers for improvement.

As part of the thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion, and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

The management of incidents was not always consistent. The provider had taken action to safeguard people when incidents/allegations had occurred, but had not in all cases informed other agencies in line with safeguarding procedures. This could mean that people would not be fully protected from the risk of harm/abuse. We found no evidence that people had been harmed and the provider responded promptly by liaising with the local authority in relation to gaps we found and by also reviewing their incident and reporting procedures.

We found improvements had been made in the overall running of the service and audits were more robust. However, they failed to pick up the issues we identified on inspection in relation to incidents. Improvements and processes to ensure people continued to receive a safe and good quality service needed further embedding. Improvements were still needed in relation to personalised care planning and the environment to ensure people’s dignity and independence was maintained. The provider had an action plan in place to address these areas and had shared this with us.

We found the overall culture of the service had improved. People, relatives and other agencies said people were more involved in decisions about their care, had more opportunities and their rights and independence were being promoted. The provider and registered manager understood their roles and responsibilities, and talked about improvement in staff training, recruitment, supervision and oversight to ensure improvements in culture and practice were embedded and sustained.

Healthcare professionals told us communication had improved and the culture of the service was more open and positive. People’s health and dietary needs were understood and met.

People told us staff were caring and respected their privacy and independence. People said the overall care and support they received had improved since the last inspection and since the new registered manager had been appointed.

Improvements had been made to the environment and an a

Inspection areas

Safe

Requires improvement

Updated 7 November 2019

The service was not always safe.

Details are in our safe findings below.

Effective

Requires improvement

Updated 7 November 2019

The service was not always effective.

Details are in our effective findings below.

Caring

Requires improvement

Updated 7 November 2019

The service was not always caring.

Details are in our caring findings below.

Responsive

Requires improvement

Updated 7 November 2019

The service was not always responsive.

Details are in our responsive findings below.

Well-led

Requires improvement

Updated 7 November 2019

The service was not always well-led.

Details are in our well-Led findings below.