St Stephens Nursing Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to dignity and respect.

This service scored 45 (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 did not always treat people with kindness, empathy and compassion

We observed that staff engagement with people was not always consistent. Although we saw some positive interactions where people were treated with kindness, we also observed large proportions of time where staff did not interact with people in a compassionate or respectful way. We observed that staff would regularly sit with people without making an attempt to communicate with them or engage them in meaningful conversation. We saw example where a staff member was supporting a person to eat without speaking to them, and another example of a person being given a liquid medication similarly without communication. This was disrespectful and didn’t reflect people as individuals who should be engaged in their own care, or benefiting from regular social interaction. However, this was not always the case and we also saw staff interacting with people with kindness, patience and good humour. One member of staff was ending their shift during our visit and personally said goodbye to each person before leaving. Another staff member was supporting a person with stomach tube and did so with great patience, gently explaining each step they were taking and seeking the person’s consent. The provider needed to ensure that moments such as these were consistently the case.

Feedback from relatives was that they observed staff treated their loved ones with kindness. One relative told us “They are absolutely lovely, they really are”. We also heard examples of the impact individual staff members had made on the people they supported, such as arranging for one person to have regular manicures or for another person to attend a local wrestling event. These gestures were appreciated and brought people meaning and joy.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The model of care did not fully reflect people’s individual strengths, wishes and ambitions. People’s ability to participate in daily life was sometimes limited because of staffing levels, activity provision and elements of institutionalised practice. The service had not fully explored what people wished to achieve from their own care or sought ongoing on their experience of living at St Stephens. Where people may become distressed or anxious, proactive action had not always been taken to plan for this to support people’s wellbeing.

However some elements of people’s care were individualised and each person had a room which reflected their own personalities and interests. One person had a keyboard in their room at wheelchair height which we saw them playing, another person enjoyed completing jigsaws and had been supported by staff to frame and take pride in these. They smiled and expressed joy in completing these when they showed them to the inspection team. We saw people were able to spend time in their own rooms doing things that were meaningful to them, but daytime activities and engagement did not have the same level of personalisation.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Although there were some positive steps being taken to promote people’s independence, further steps needed to ensure this happened consistently. The majority of people had limited mobility and used wheelchairs, however the kitchen was not adapted to take this into account. This meant people did not consistently have the ability to be involved in preparing their own food. Although there were choices of food available, these were often similar for example the choice being between two pies or two types of roast dinner. It was not clear how people had been involved in designing the menu. However, people did speak positively about the quality of food with one relative stating “(Person name) is raving about the food at the moment because apparently they have got a new chef”. Mealtimes were organised so that people on modified diets due to choking risks ate separately from those who did not require dietary modifications. This arrangement did not promote independence or choice, nor did it support people’s ability to dine with their peers and friends if they wished.

However, there was guidance in place on how staff should encourage people to have independence with their personal care, which was personalised to the ability of each person. This helped them have control over their own personal hygiene and promote their dignity and respect. One person told us “Yes I dress myself”.

The provider did not listen to and understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We were not assured people’s needs would always be responded to in a timely or safe way, due to inconsistent levels of sufficiently trained or competent staff. Monitoring systems were not always effective, for example in monitoring the risks of constipation for people who could not do so themselves which left them at a greater risk of discomfort and risk of harm. In some cases, people had not received the timely support they required to alleviate that risk.

We observed communal areas of the service were sometimes extremely noisy which did not present an environment which consistently met people’s sensory needs. For most of the inspection 2 people were seated together who became extremely distressed by each other’s presence. There was no clear guidance of how staff should respond to this situation or what the causes of this distress were, for example whether they represented an unmet support need. Staff then placed another person in same vicinity despite their care plan stating they disliked noise and multiple people speaking at the same time or arguing and this would cause them distress. They become audibly extremely frustrated about being placed in this situation, which staff had not pre-empted, and did not take prompt action to try and resolve or reduce the distress to people.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Although staff told us they enjoyed working at the service and felt supported by the manager, they also raised concerns that the levels of staffing at certain times was not safe. This exposed staff to a greater risk of emotional or physical harm as they would not be able to perform some tasks safely or have access to an appropriate level of support from other staff.

However, staff spoke passionately about the team they worked with and how the manager supported their wellbeing. One staff member told us “Management are really good with support. If I have childcare commitments, they are very supportive and we can be flexible”. Another member of staff added “I’m really happy with the provider. They are good to us. The manager’s door is always open. I can tell her anything”.