St Stephens Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe and care treatment and staffing.

This service scored 56 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

There was no clear process in place to ensure all opportunities for learning from incidents were sought and taken. It was not always clear that potential contributory factors and triggers for incidents had been explored and reviewed to improve people’s experience of care. For example, one person would regularly become distressed during personal care and could strike the staff supporting them. There were no routine debriefs to check up on the wellbeing of these staff and the action recorded from these incidents was merely to ensure staff had read the relevant care plan. There was no detailed exploration of what might have caused the person to become distressed in that instance and whether this reflected a need to try something different or amend the care plan. There was also no clear system to review themes from incidents and accidents to understand what be causing these and take proactive action to ensure care was continuing to meet people’s needs safely.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Before people moved to the service there were appropriate assessments of their needs to ensure they could be supported safely. The provider worked in partnership with people and their families to ensure the transition was safe and seamless. This included supporting people to visit St Stephens where possible and involving people who lived at the service in this process to ensure they were comfortable with those who they would be sharing their home with. One relative told us “The transition was seamless. Staff are learning their needs fast and are open to any suggestions or concerns we raise”.

In the majority of cases, the service worked proactively with partner agencies proactively when people’s needs to ensure they had up to date and evidence placed guidance on how to support them. On the day of the inspection, the registered manager was supporting a person to attend an appointment with mental health services. They worked in partnership with them to implement strategies to improve their wellbeing, which were effective in reducing instances of distress.

There was clear guidance on when staff should be concerned about people’s wellbeing and make a referral to another organisation to ensure they received the support they needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff were trained and knowledgeable about how to safeguard people from the risk of harm and could describe signs of abuse and neglect that they should look out for. Leaders acted with candour and openness in raising safeguarding referrals to the local authority and CQC in line with their responsibilities.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty and whether any conditions relating to those authorisations were being met. Where the risks to people were deemed sufficient that restrictions such as living in locked accommodation were needed, to ensure their safety, appropriate authorisations were sought and recorded.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The majority of risks to people were managed well, with clear plans and assessments in place on how staff should protect people from the risk of harm. However, the risk of constipation was not always managed safely which exposed people to a greater risk of harm, or being in significant discomfort. People with a learning disability are at a greater risk of constipation or being unable to communicate their symptoms effectively, increasing the risk of serious consequences and long-term health complications. A number of people had not had a bowel movement for 5 or 6 days, yet the usage of prescribed medication or seeking of medical advice had not always been sought proactively. There had not been robust monitoring of this risk to ensure people’s discomfort and exposure to harm was minimised.

However other risks were well managed. When people were at risk of their skin breaking down, there was a regular schedule of repositioning which was taking place in line with clinical guidance. A number of people were diagnosed with epilepsy and staff could confidently describe signs they would look for and how they would respond if a person had a seizure. Risk assessments were regularly reviewed to ensure they reflected current best practice to support people safely, and how staff should manage people’s complex health and care needs.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

People lived in a property that was a vibrant space and reflected people’s own personalities and interests. There was a large accessible garden and people had spacious rooms which they were able to personalise as they wished. Although the property was largely in a well maintained and safe condition, risks to people were not always managed safely. This was because there were not always enough staff during the night to allow the service to be evacuated during a fire in line with their evacuation plan. After the inspection the provider put in place a protocol to ensure the service had sufficient staff during night shifts.

We identified a small number of areas concerns with the environment which required action, however these were already known to the provider and an improvement plan was in place to address them. There were regular checks to ensure the safety of the premises and equipment, including checks on utilities such as gas, electricity and water as well as the equipment used to support people.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

We identified regular occasions when the levels of staff were not sufficient to manage people’s health and care needs safely. This was particularly the case at night, where staff raised concerns that sickness absence was regularly not backfilled by staff which left only 2 staff on duty. This was despite the majority of people requiring 2 staff for support with personal care, moving and handling or evacuation which meant there was a high risk of unsafe or delayed care. One staff member told us “Sometimes staff have to put all service users to bed early if there are not enough night staff and at times there is only one carer at night. That is risky and if something happens like a fire I don’t know how we would manage this. We have a nurse on duty but they have a job to do and for one carer changing continence pads is hard”.

There were no effective systems in place to regularly monitor staff were competent to perform high risk tasks such as administering medication, including that to be given after an epileptic seizure. There was no clear process to ensure checks on staff ability in these areas were consistent, or in some cases no checks had been undertaken at all. There were insufficient staff trained in specialised tasks such administering epileptic medications, which prevented some people being able to access the community in the same ways as their peers. Once we raised this as a concern the provider implemented an updated process to ensure a robust assessment of staff competency and to ensure additional members of staff were trained.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. There was a high level of cleanliness at the service, which was closely monitored and supported by staff who were trained to protect people from the spread of infection. Where possible, people were encouraged to be active participants in keeping the space they lived in clean. This included with tasks such as changing bedding in their bedrooms. They were supported to manage their own personal care with as much independence as possible and to maintain their personal hygiene and dignity.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

The provider had not ensured they had competency assessed staff to support people with medications, including high risk medicines such as those for epilepsy. These processes were either not in place or lacked a consistent framework meaning the provider could not be assured that staff were able to perform these tasks safely. There were also an insufficient number of staff trained to administer certain medications which acted as a restriction on people in their daily lives. Management of laxatives to relieve constipation was not consistent, with protocols not clear on when people should be given these to ensure people’s discomfort was minimised.

There were systems in place to monitor the safety of medication including regular audits. These identified some issues which had been raised with staff and improvements made, however hadn’t identified all the issues found during the inspection. Medications were stored safely and people’s medication was regularly reviewed to ensure it remained effective. There was guidance in place for how antipsychotic medications should be managed in the least restrictive manner. The service followed the principles of STOMP (Stopping over medication of people with a learning disability and autistic people). STOMP is a national programme focused on reducing inappropriate prescribing of antipsychotic medications to control behaviour and focuses holistically on people’s support needs and how they can be met through less restrictive means.