Stepping Stones Red Marley

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Assessments were up-to-date and staff understood people’s current needs well. Most people using the service were assessed for nursing support around their medicines and complex mental health conditions. The service had a positive record for supporting people where other placements had broken down. The registered manager said, “..We adapt accordingly and keep everyone safe and offer opportunity to move towards independence. Some people won’t be able to step down but can become more independent and learn skills. We look at what we can offer and enhance their life.”

Although the service provided nursing care it would not be able to cater for people who needed lots of equipment or were not mobile. This is because all bedrooms were above ground level and there were no lifts. One health care professional said, “It is an old building. If the person I visited became physically frail, she may have to move as there are stairs throughout the property.” The registered manager told us that people were informed of this during the assessment process, that if their needs deteriorated, the service may be unable to continue to provide care that met these needs. The registered manager commented, “We have to be really clear about the types of nursing needs, it’s a listed building, we looked at a stairlift but that would cause issues. People have this made clear at the offset about deterioration and support.”

The registered manager was mindful that any potential new assessment needed to consider the people already living in the service and the impact on staff resources. The registered manager said, “We have to consider if it’s safe for people already here. Depending on where the vacancy is as will have an impact. We haven’t always got it right, occasionally had to serve notice but we try and give people an opportunity.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People received care, treatment and support that was evidence-based and in line with good practice standards. We saw good recording in people’s physical wellbeing care plans and health action plans about their conditions and how they could best be supported.

People were supported with their nutritional and hydrational needs by staff. Where required and when people consented, staff would record their weight and observations to monitor and provide any further input if needed. We raised with the registered manager that some people did not have a lot of food and drink preferences recorded in their care plans, in case they transferred into a setting with staff that did not know them as well or they were unable to say. We were told this would be addressed.

One person needed a specific daily amount of fluid due to their health condition, and we saw that staff followed this guidance and clearly recorded this person’s intake to keep them safe. We saw that where appropriate external professionals had been involved and advice sought.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was good evidence of multidisciplinary team working between staff and external health and social care professionals. We saw clear recordings in people’s care plans of who was involved in their care, meetings that had taken place and outcomes to implement. Professionals we gathered feedback from praised the service for the shared communication they received. One professional recorded in a recent review that, ‘they would try and visit more regularly to build a rapport as [person’s name] had not wanted to engage on this occasion.’ It was noted [person] has been more settled at this service and that there had been less incidents. One professional told us, “I have observed them contacting GP’s and my team when required and in a timely manner.”

People living in the service had care needs including neurodevelopmental and mental health conditions. The registered manager told us they were able to seek specialist support when needed to ensure people received the right care appropriate to their individual needs commenting, “We have good partnerships with professionals, I can reach out and they are quick to respond. Because of the complex nature of people, we get a lot of support and social workers work well together, they know me now and I don’t ask for support unless we need it.”

The staff team had systems in place to share information between day and night shifts. This included a verbal and written handover. We saw information was recorded about people’s medicines, how they had presented that day and any concerns that needed to be monitored.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to external health and social care professionals when they needed them. Staff and leaders worked with people to ensure their needs were met and utilised best practice resources. We found that staff were aware of people’s health needs and were able to speak confidently about how they supported them around these.

People were involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. People had a health folder which contained information to share with other care partners if they needed to transfer into a different setting for treatment. This had details about the person’s medicines, preferences, communication, capacity and previous and ongoing health needs.

Staff had access to information on people’s specific health conditions to aid their understanding of potential risks, support needs and the impact this can have on the person. This enabled them to encourage and support people to make healthier choices to help promote and maintain their health and wellbeing.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We saw good recording and awareness from staff when people had attended appointments for specific health conditions including recognising that the person may be tired, need extra support and to be aware their blood pressure may drop following this time. For another person they were on a specific dietary intake and there was good information about which foods would benefit them, and which should be avoided.

Staff were mindful that the people they supported did not always wish to engage with practices that would improve their health. For example, some people would decline any routine observations or appointments with healthcare professionals. At these times staff continued to encourage, support and raise any concerns. Staff told us it helped building relationships based on mutual trust with people, commenting, “We spend so much time with people that we pick up on certain things and if they are not behaving as they normally would, and this is why it is good to work in one main area.”

The staff team were encouraging in improving outcomes and supporting people to gain skills of independent living. One staff said, “We do try, and this is the aim of service, but I have noticed that people who have been in the system a long time it’s hard to change their habits. They have potential and you see this but it’s breaking down the routine.” Another staff told us, “That is the overall goal for everyone here, with a lot of people they are very comfortable with their lives here, they are very capable, one person and could live independently and he doesn’t want to.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were able to make their own decisions about their care and their life. Records included information about people’s capacity and how they were able to refuse or give consent for specific decisions. We saw that where able, people were encouraged to sign their care plans to show they had read them and were involved and in agreement with what had been recorded.

We saw that where some people were deprived of their liberty a Deprivation of Liberty Safeguards (DoLS) was in place to legally authorise this. The registered manager kept track of these on a matrix which showed when they were due to expire, if there were any conditions to meet and the reason it was in place.

The registered manager and staff ensured that people were heard and felt valued regardless of their capacity. They shared an example of supporting a person in 2024 to challenge their DoLS saying, “We have supported a person to challenge their DoLS. This went to the Court of Protection. The legal process did not focus on the person’s wishes but focused on area’s that enhanced delusions and gave false hope. We have tried to make complaints but currently no-one has listened.”

Staff had received appropriate training in mental capacity awareness and demonstrated understanding in applying this commenting, “It depends on decision and person’s capacity levels, some people have zero capacity for one thing but full capacity with other things. We offer choice every time” and “Most people are very good with capacity so it’s supporting them. I’m a key worker for one person and he has capacity with money but overspends so I sat with him last week and went through his finances and we looked at a budget for him. It’s completely his choice but he wanted this support.”