St Stephens Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met.

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

This service scored 46 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People did not consistently have access to high quality, meaningful or person-centred activities. During April we identified that there were 2 days each week where no activities were planned, and another 2 days where the activities were only accessible to a small minority of people. Instead, people spent the majority of time seated watching television with limited engagement. People did not have bespoke activity planners and instead the same activity planner was in use for the whole service which did not reflect people’s different wishes and preferences for how they spent their time. Having regular meaning stimulation is important to support people’s wellbeing, development and sense of purpose. The management were looking to increase the number and quality of activities, however recognised they had improvements to make in this area.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People were supported by a knowledgeable care team who knew them well, however there were not always sufficient staff to support people safely or ensure continuity or experience. We saw 8 night shifts over the previous 6 weeks where only 2 staff were on shift. The majority of people required 2 staff to support them with personal care. Some people had epilepsy and required continuous observation to monitor them and provide support in the event of a seizure. As a result, we could not be assured that the remaining staff member would be able to support people safely or in a timely manner. The provider acknowledged that this was not a safe staffing level and had introduced a protocol to prevent this from occurring again.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Some information was available in accessible formats to support people making choices, but this was not consistently the case. Pictorial menus were in place which were used to help people choose what they would like to eat, and each person had an easy read guide in their room on how to make a complaint. However, people did not have an accessible version of their own care plan and there were further opportunities to provide additional information in more accessible formats. Although there was guidance in place for staff on how to communicate with people and share information with them, we observed there was limited engagement with people or attempt to do so.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

It was not always clear how all people had been involved in their own care, to ensure it continued to meet their wishes and expectations. Care plans and risk assessments did not consistently contain any detail about how they had been reviewed, and how people had been involved in care planning if they wished to do so. There were service user meetings where people could give feedback, which documented matters like activities people would like to see and food choices. Some action had been taken following suggestions at these groups, including the introduction of regular baking sessions as an activity which people had stated they would enjoy. However, these meetings were infrequent, with only 2 taking place in the last year. In their absence it was not always clear how some people were being regularly consulted on their own care or what they would like to achieve from living at St Stephens.

Relatives told us they were able to be involved in their loved one’s care should they wish, and information was shared proactively with them as needed. One relative told us “Yes once a year they have a review. I always go, my relative is always involved as well, they can say what they would like to do or if there’s anything upsetting them or generally”. Another relative added “. Communication is very good and they let us know if anything changes”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People were generally able to access health and care support when required; however, staff levels and competency had not been fully monitored or assessed to ensure this could always be delivered safely and in a timely way.

However, people were supported to access regular appointments with health services in response to their changing needs. One relative told us “They have been to the dentist and have up to date glasses. All that I’m very happy with.” Another relative explained “The only thing I can say is that (person name) has 100% improved since they have moved there his health. Their health and wellbeing is much better and they look happier”

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

The provider had not ensured people had the same ability to participate in their own community, in the way others in society would take for granted. Although some people were supported to take part in local voluntary clubs, this access was restricted because of the size of vehicle and staffing levels. This meant the provider had to alternate people’s involvement, meaning some people went significant periods of time going out into the community. Certain people could also not go out in the same way as their peers because of limited staff available who could support their needs. Some staff raised concerns that decisions about who was able to go out appeared to favour people with less complex needs. One staff member told us “Often people don’t go out for 1-2 months. I am sad because it’s summer and people should be able to get out. I worry that only people with lower needs get to go out. Most people spend time just watching television”.

Where people were prescribed rescue medications for seizures, there were insufficient staff trained to administer these, which meant people with epilepsy were restricted in their ability to access the community. Although nurses were trained to provide this support, only 1 nurse was on shift at a time and was unable to leave the service. Only 1 care worker was trained to administer a specific type of rescue medication and only worked on certain days, while no care workers were trained to administer another, meaning the individual in receipt of this medication was unable to leave the home. Staff also reported that other people were unable to take part in certain community activities, despite there being no clear rationale for this restriction or evidence that alternative ways to support participation had been explored, particularly as people returned to the care home for mealtimes in any case. During the inspection, the provider advised they were aware of these issues and were working to improve access to activities and increase the number of staff trained to carry out these tasks.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider had not fully considered what people wished to achieve in the future, as people did not have any recorded aspirations such as if people wished to learn a new skill or go on holiday. However, the provider had worked with people and relatives to discuss end of life in a proactive and sensitive way and plans were in place for how people would like to be cared for if their health needs deteriorated. For example, one person was a fan of the Beatles and had expressed a desire for one of their songs to be played at their funeral. The provider had recently also built a memorial garden which allowed people to approach bereavement in a way that was accessible and personalised.