Archived: Winterbourne Steepleton - Steepleton Manor Care Home

Winterbourne Steepleton- Steepleton Manor is a residential care home providing nursing and personal care to up to 32 people. The service provides support to predominately older people. At the time of our inspection there were 19 people using the service.

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

Some people could not be consistently confident that the risks they faced would be assessed, mitigated and monitored.

Overall, people’s medicine management was safe. However, improvements were needed to the safety of unwanted medicines waiting for collection.

Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Overall, staff followed recommended IPC practices with some minor areas for improvement. Safe visiting was supported.

There was a poor understanding of The Mental capacity Act 2005 and this meant people were not consistently 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. Actions were taken following the inspection visit to make sure any restrictive practices were reviewed with people and or their representatives.

People’s needs were assessed. However, their emotional and social wellbeing needs were not consistently planned for or were consistently delivered in a person-centred way.

The governance systems were not entirely effective and had not identified the shortfalls found at this inspection.

The registered provider and manager took actions in response to our feedback and findings. However, we were not able to assess the impact of these actions on people’s experiences at this inspection.

People felt safe and were comfortable and relaxed with staff who supported them. Relatives told us they felt their family members were safe and overall were well cared for. Throughout the inspection we saw relaxed, kind and caring interactions between staff and people. People received good quality nursing care.

Overall, there were enough staff to meet people's needs but some people experienced some delays in support at mealtimes. There was a staff team who knew people well and they were recruited safely.

There was an open, improving and positive culture within the home and people, staff and a relative told us the manager and staff team were approachable and helpful.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (10 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to requires improvement following this 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 COVID-19 and other infection outbreaks effectively.

Enforcement

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 found breaches in relation to risk management, understanding of the MCA and governance at this inspection.

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

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.

Steepleton Manor is a 'care home'. It provides long term and respite accommodation for up to 32 older people with personal care and nursing care needs. At the time of the inspection 24 people lived at the home with nursing, mental health needs, some of whom were living with dementia. Steepleton Manor Care Home is a large detached period property in Winterbourne Steepleton. The accommodation is arranged over three floors.

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

Following a previous visit to the service on 24 November 2020, we found evidence the provider needed to make improvements. In particular, we highlighted concerns about lack of robust cleaning schedules and housekeeping records. Also, confusion about arrangements for cleaning the rooms of people affected by the virus and a lack of proper systems for managing and monitoring infection prevention and control arrangements.

In response, the Care Quality Commission took enforcement action by serving a warning notice on the provider and registered manager which required them to make urgent improvements by 14 December 2020. The provider sent us an action plan which outlined the improvements being made to improve infection prevention and control standards with a timescale for each action. This inspection was to check required improvements had been made, which we confirmed at our visit.

Risks for people were reduced because infection prevention and control had improved. All areas of the home were clean and well maintained and cleanliness had improved. Staff followed cleaning schedules. Dedicated staff handwash basins had been installed and improvements been made in the laundry to prevent cross infection risks.

Quality monitoring systems had improved to reflect steps the service was taking to assess, monitor and mitigate the risks relating to the health, safety and welfare of people and staff. A nurse had a designated role to lead on infection prevention and control. Frequent comprehensive infection prevention and control audits were carried out to monitor practice and address any areas for improvement. Infection control policies and contingency plans for managing COVID 19 outbreaks had been updated to reflect the latest government guidance and were followed. Staff individual risk assessments related to COVID 19 had been completed.

Staff were committed to keeping people safe. They had received further infection control training and used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise risks to people. Staff and people were regularly tested in line with the government’s current testing programme.

Staff understood the impact the isolation could have on people and sought to support people’s emotional wellbeing. People were supported to keep in touch with family and friends by telephone and video calls. In the dining room, people enjoyed lunch and were well supported by staff. Chairs and tables were positioned to encourage social distancing.

Although visitors were not currently permitted, except in exceptional circumstances, as advised by local Director for Public Health. There were plans to resume visiting in the near future with measures in place to prevent the spread of infection by visitors. This included visitors having temperature checks, completing a health questionnaire and being supplied with PPE. The size of the home meant there were light and airy, well ventilated spaces and large gardens, which helped promote social distancing.

Why we inspected

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns highlighted at our previous inspection on 24 November 2020 about infection prevention and control measures at the service. A decision was made for us to visit to look at these risks.

We were assured improvements had been made and that this service has met good infection prevention and control guidelines. Please see the Safe and Well led sections of this full report.

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.

Steepleton Manor is a 'care home'. It provides long term and respite accommodation for up to 32 older people with personal care and nursing care needs. At the time of the inspection 20 people lived at the home with nursing, mental health needs and some people were living with dementia. Steepleton Manor Care Home is a large detached period property in Winterbourne Steepleton. The accommodation is arranged over three floors.

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

Following a COVID 19 outbreak at the service, we received concerning information about poor infection prevention and control and hygiene practices at Steepleton Manor. This was following an infection control visit on 19 November 2020 by staff from the Dorset NHS Clinical Commissioning Group (CCG) Quality Improvement Team.

At the inspection, several improvements had been made following the CCG visit, such as improvements in staff handwashing facilities and in correct use of personal protective equipment. However, concerns were highlighted, particularly about lack of robust cleaning schedules/housekeeping records and confusion about arrangements for cleaning rooms of people affected by the virus. Also, about lack of proper systems for managing and monitoring infection prevention and control arrangements.

Staff reported people were in good spirits despite the current restrictions of being cared for in their rooms. An activity co-ordinator visited people regularly to support them with one to one activities. People were supported to keep in touch with loved ones via telephone, mobile phone and via internet.

Staff had received update training on how to keep people safe during the COVID-19 pandemic and had plentiful supplies of personal protective equipment. Staff morale was good, they said they felt well supported by registered manager and nursing staff.

Staff and people were regularly tested in line with the government’s current testing programme. The size of the home and variety of spaces meant there were light and airy, well ventilated spaces and large gardens, which helped promote social distancing.

Why we inspected

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns we had received about infection prevention and control measures at the service. A decision was made for us to visit to look at these risks.

We have found evidence that the provider needs to make improvements. Please see the Safe 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.

Follow up

We requested an action plan from the provider by 14 December 2020 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.

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

Steepleton Manor Care Home is a large detached period property in Winterbourne Steepleton. The home provides long term and respite accommodation for up to 30 older people with personal care and nursing care needs. At the time of our inspection 22 people were living at the home.

Our last inspection on 19 September 2016 we found that systems and processes in place to assess, monitor and improve the service were ineffective. 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 question well led. We found that during this inspection the action plan had been followed and improvements had been made.

The service had a registered manager in post. 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.

People, relatives, a health professionals and staff told us that Steepleton Manor was a safe home. Safeguarding alerts were being managed and lessons learnt by the home. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines.

People were supported by staff who understood the risks they faced and valued their right to live full lives. Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date.

There were sufficient numbers of safely recruited staff at the home. A dependency tool was used to calculate the number of staff hours required to meet people’s needs.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred. Staff were able to access care plans and guidance on the go by using hand held devices.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were diabetic and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Improvements had been made in relation to the completion and assessment of capacity assessments and best interest decisions.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, district nurses and a chiropodist.

People, professionals and relatives told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and support provided reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People were encouraged to feedback. We reviewed survey results which contained mainly positive feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. The registered manager told us that lessons were learnt and shared with staff in meetings. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them. Staff felt recognised and that team moral was good. An employee of the month programme was in place.

People, relatives, professionals and staff felt that the service was well led. The registered and area manager both encouraged an open working environment.

The service understood its reporting responsibilities to CQC and other regulatory bodies they provided information in a timely way.

Improvements had been made to quality monitoring systems within the home. Audits and additional checks were completed by the registered and area manager. The management team analysed the detail and identified trends, actions and learning which was then shared as appropriate.

The service worked in partnership with other agencies. Professionals told us that communication with the home was good.

Steepleton Manor Care Home was last inspected on17 and 22 July 2015. At that inspection we found that the provider needed to make improvements in the risks people faced and ensuing improvements were made in the way the service developed.

Steepleton Manor Care Home provides accommodation and nursing and personal care for up to 30 older people. There were 18 people living there when we visited.

There was a registered manager in place. 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.’

The provider was meeting the requirements of the Mental Capacity Act 2005. Staff understood some of the concepts of the Act, such as allowing people to make decisions for themselves.

The provider had systems in place to ensure the quality of the service was regularly reviewed but this was not consistently applied which meant that some peoples care records required updating.

Staff lacked guidance with relation to some of the tasks they were required to do. The management did not give staff clear guidance on how to complete some tasks such as close observation of people.

People were not consistently offered choices at mealtimes such as where to sit and what to eat, the system for obtaining peoples choices was ineffective as it failed to take into account some people’s memory problems.

Staff told us they felt supported by the management and they felt their opinions were valued.

Staff knew people’s needs and the care records generally supported their comments. One person told us "staff help me with washing and dressing, they know my needs and my daily routines. I am well looked after, sometimes they (staff) sit and chat when I go to the lounge”. Another person told us “ the staff a good to me and never rush, a great place to stay”. A relative told us that they felt involved in arrangements made for their loved one.

Staff demonstrated a caring and compassionate approach to people living at the home. People told us there were enough staff to meet their needs, our observations confirmed this.

Staff told us they worked well as a team and enjoyed working at the home.

We found a breache of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

We found that people's needs were assessed and care was planned and delivered to meet people's needs. A person told us, "I'm aware that I have a care plan. I have been invited to look at the write up and give my opinion." Another person told us, 'The care here is second to none.'

We saw that the home was clean and well presented, and that people were protected from the risk of healthcare associated infections. A person who lives in the home told us, "They clean my room every day."

We found that staff were knowledgable about people's needs. We also found that staff were supported to provide care and treatment to people. A person told us, 'The head of care is very good. She explains things not only to me, but also explains things to the staff."

We viewed six people's care records and found that the home had not maintained each person's personal care record appropriately. We also found that people's personal care records and personal information were not stored securely at all times.

We reviewed the care records for three people currently living at the home and saw that they were offered care that ensured their specific individual needs were met.

The service provided a wide range of activities for people and the home had access to a mini bus twice a week. People told us they enjoyed a variety of trips out to local events and establishments such as garden centres and public houses.

People who used the service told us that the staff managed their medications and they were happy with the systems. We saw robust policies in place for the administration of medication, but did note that sometimes the staff did not document the correct code when they omitted a medication because a person stated they did not want to take it.

People told us and the duty rotas confirmed that there was always sufficient staff on duty. One person said, "If you need someone there is always a member of staff to help." A relative of a person using the service said, "The staff are very supportive. I am very pleased with the care here."