Steep House 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.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff told us they completed online forms following incidents, which were then reviewed and any required actions for people’s safety completed. A relative confirmed staff were good at keeping them informed of any issues. A staff member told us about the learning which had taken place following the review of a recent safety incident and how the key learning points had then been shared with staff through both the clinical risk meetings and staff meetings. The provider also shared learning outcomes across their other homes.

The provider had processes to monitor, identify and act upon any trends in incidents, such as an increase in the number of falls or wounds people experienced. Staff were also updated regarding any national safety alerts to enable them to take any required actions to support people 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.

Staff told us, “Handovers provide all the information for a newly admitted person.” People’s care records also informed staff about their care needs and any associated risks when they were first admitted, which ensured people were admitted safely. A relative said, “When [name of person] first came here, they were a bit overwhelmed, but they [staff] gave us confidence from the beginning."

The provider had processes to ensure relevant information was shared with other services and professionals when people were transferred to external services, such as hospitals. The electronic care planning system enabled staff to produce a ‘hospital pack’ for the person, which contained relevant information to support the person’s safe transfer.

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 completed safeguarding training both as part of their induction and through regular refreshers. Staff spoken with understood what abuse was, what to report and to whom. The provider ensured relevant authorities were notified of any concerns which were investigated. People’s records confirmed both they and their families participated in safeguarding decisions. Records showed staff had spoken with a person’s family about how to keep them and others safe in a way which did not restrict their human rights.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found where people were subject to restrictions for their safety, their consent was sought. If they lacked capacity to consent, an MCA assessment was completed and a best interest decision made which involved relevant parties. The provider submitted DoLS applications where required for people and the status of their application and any associated conditions was recorded to inform staff.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s care plans demonstrated risks to them had been assessed and strategies were in place to enable staff to provide them with safe care. A person’s care plan described the signs they were becoming distressed and the actions to take, which reflected what their relative had told us.

Records showed people were consulted where possible about how they wanted risks to them managed. A relative said, "[Person] is encouraged to be as independent as possible, but [person] has a strong risk of falling, but they [staff] do try to strike a balance."

People’s risks were reviewed regularly and staff updated through meetings, handovers and the person’s records, about any changes made and their ongoing management. People’s clinical risks were kept under review at the provider’s weekly clinical risk meeting.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider ensured required safety checks were completed and safety certificates were in place for electrical, gas, water and fire safety. There was evidence equipment had been maintained and regularly serviced. Staff said, “Recently we got new hoists in. Our maintenance man comes in and checks their safety and we are always sure they are safe to use.” The building was secure and safe, hazardous substances were stored securely.

The provider ensured health and safety audits were completed in order to identify and address any safety issues. Processes were in place to enable staff to report any concerns with the environment which were then addressed.

We observed aspects of the service required re-decoration; this was noted on the provider’s service improvement plan and work to address this was underway.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had processes to assess people’s needs and to calculate staffing requirements. We saw there were sufficient numbers of staff deployed to meet people’s needs and to maintain their safety. People, relatives and staff confirmed there were enough staff to support people. Their feedback included, “If I need anyone in the night, I just buzz and they do come quite quickly.”

Staff had an induction to their role, training and regular supervision. Nurses also completed clinical trainings to update their knowledge and meet their professional registration requirements. Staff supported people in a way which showed they were well trained. We saw staff responded positively and competently when people showed signs of emotional distress.

Overall, there were safe recruitment practices. Pre-employment checks were carried out to ensure the appropriate vetting of staff. We found 1 example of where 1 required pre-employment check had not been completed. This was discussed with the registered manager who described the new processes now in place which mitigated the risk of repetition.

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.

People and their relatives told us the home was clean, which we observed. The providers cleaning schedules for the home were completed consistently by staff.

Staff completed infection control training and followed best practice guidance; they were seen to be bare below their elbows. Staff were observed to be using appropriate personal protective equipment whilst carrying out their duties.

If people living with dementia were resistant to accepting personal care, relatives told us staff encouraged their loved one to accept this care. Records demonstrated how and when people were supported with showers and bathing.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People’s medicines records showed that they received their medicines safely and as prescribed. Staff were knowledgeable about people and their medicines, and people's preferences were taken into account.

There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security. Suitable temperature monitoring was carried out to make sure medicines were safe and effective.

People’s records contained detailed, person‑centred information to support the safe administration of medicines. The provider was reviewing people’s constipation medicine plans to provide clear guidance on the effective use of prescribed medicines where dosing was variable or on an ‘as required’ basis.

Records were in place to show that risks were considered for people taking higher-risk medicines such as anticoagulants and flammable emollients. The provider was reviewing care plans for a long acting, high risk medicine to specify whether routine blood tests were required and how monitoring should be managed. Staff had suitable, up to date training, and the provider carried out medicines audits routinely to support safe medicines management.