St Stephens Nursing Home

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 changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to person centred care.

This service scored 54 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

There was no clear process to discuss or review people’s care with them to ensure that their physical and social needs were understood and clearly documented. Although some relatives told us that they had been involved in care reviews, there was no clear evidence that people themselves had consistently been involved and what their wishes were. Although there was robust and up to date guidance of how to support people’s health needs, people’s emotional needs and mental wellbeing had not always been fully assessed. We saw some people had a positive behaviour support plan (PBS) which were used to help staff understand the potential causes of a person’s distress or anxiety, to allow them to respond and prevent this. Some care plans had been written by staff who had not received appropriate training to do so and did not represent a thorough assessment of people’s emotional needs. Once identified, the registered manager involved local learning disability services to review those plans in partnership to ensure they were used to maximise people’s wellbeing.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

There was clear information about how the service should support people safely, however the service was not consistently meeting best practice guidance for people with a learning disability and autistic people in line with RSRCRC. People’s care did not always promote independence, choice or meaningful engagement which are all vital to support people’s emotional wellbeing and ability to participate in their own lives as equals.

Despite this, we found staff were knowledgeable about people’s needs and how to support people safely. One person had diabetes and a staff member confidently talked through about what their usual blood sugar levels would be and what action they would take if they were at an unsafe level. The person themselves was knowledgeable about their own diabetes and explained how they were supported by staff, telling us “I’ve got to be careful with my diabetes- I’ve been drinking black coffee and shouldn’t have milk. I must listen to the nurses”.

The provider did not always work well across teams and services to support people. Although staff spoke highly of the team they worked with, they also told us there were not always enough staff to support people safely in line with guidance. Staff had raised at a recent meeting that they felt the level of staffing was too low to safely respond to an incident. Despite this the situation had not improved at the time of the inspection. However, feedback from partner agencies was that the team at St Stephens were responsive and worked well with them. They told us that staff shared concerns appropriately and made referrals when people’s health and wellbeing changed.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The service were good at supporting people’s physical wellbeing and supporting them in managing their complex health and care conditions. However, they did not always implement appropriate support for people’s mental wellbeing. Where people were documented as becoming anxious or distressed, there was not always clear guidance for staff or when guidance was in place, it was not being followed. We were told that one person liked to “create attention and play up to an audience”, but the provider had not fully explored what the causes of this might be such as an unmet support need. The provider had not considered the importance of regular meaningful engagement and activities for promoting people’s mental wellbeing.

People were supported to manage their physical health needs, including staying hydrated and accessing a healthy diet that was modified to meet their needs. Staff were knowledgeable about people’s health needs and how to support them in staying healthy. There was provision for physical activity and staff had worked with local learning disability services to plan exercises for one person to strengthen their limbs. This meant they could do more for themselves and their health had significantly improved. Another person also had specific guidance for how staff would support them with daily exercise.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

It was not always clear what outcomes people wished to achieve from their care. Leaders could not clearly evidence ongoing engagement with people to understand the life they wished to lead at St Stephens Nursing Home, or regular reviews with them to ensure it continued to meet their expectations. Some monitoring systems in place were effective to support people’s health and wellbeing, but this was not consistently the case. For example, the risks to people around constipation had not been consistently managed and leaders had not recognised or responded to this. Systems to learn lessons when things go wrong were not as robust as they needed to be, for example a lack of analysis over longer term trends or themes.

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

Staff demonstrated a good understanding of the principles of consent, and we observed that these were consistently respected at all times. Staff received guidance on how to understand and communicate with people who were not able to do so verbally including through body language and other physical signals to obtain consent. This include around intimate tasks such as personal care, where there was clear guidance about how to support people as independently as possible and respecting their autonomy over their bodies. One person told us ““Yes, (staff) knock before coming into my room.”

Where people were assessed not to have mental capacity to make a particular decision, this was clearly recorded in line with the Mental Capacity Act 2005. In these instances, a best interest decision was made in partnership with people’s relatives and professionals involved in their care. These were regularly reviewed to ensure they remained appropriate and in each person’s best interest.