St Stephen's Care Home

Updated 17 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors, a specialist advisor in nursing and an Expert by Experience, on the first day of the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The inspection team consisted of 2 inspectors on the second day of the inspection.

Service and service type

St Stephen's Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Stephen's Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been appointed and was in the process of applying to become registered with The Care Quality Commission.

Notice of inspection

The first day of the inspection was unannounced. The second day of the inspection was announced.

Inspection activity started on 14 September 2022 and ended on 10 October 2022. We visited the service on 20 and 21 September 2022.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spent time seeing how people were cared for and spoke with 11 people living at the home. We also spoke with 6 relatives and a health and social care professional for feedback on their experiences of care and working with the service.

We spoke with 12 staff who worked at the home. This included the manager, 2 senior care workers, 5 care staff, an activities co-ordinator, 2 catering staff and a member of maintenance staff. We also spoke with 3 provider’s representatives.

We reviewed a range of records. This included 8 people’s care records, multiple medication records and people’s fluid records. We looked at records relating to the management of the service and people’s safety, such as checks on the premises and people’s personal emergency evacuation plans.

We also looked at audits and checks undertaken by the manager and provider’s representatives about the quality of the care provided. This included surveys completed by people and relatives. We reviewed records showing how staff were recruited and trained and how staff competen

Updated 17 December 2022

About the service

St Stephen's Care Home is a residential care home providing accommodation and personal care

to up to 51 people. The service provides support to younger adults and older people, including people with dementia. At the time of our inspection there were 25 people using the service.

St Stephen's Care Home accommodates people in one adapted building.

People’s experience of using this service and what we found

Risks to people were not consistently reduced because of the way their medicines and risks were managed. Where the provider’s checks had identified areas which required improvements, such as premises improvements, these had not always been promptly addressed. There were inconsistencies in the guidance provided to staff on how to safely assist people. However, people and relatives told us there had been recent improvements made in the way safety was managed.

Staff understood what actions to take to prevent people from experiencing abuse. There were enough staff to care for people and the provider checked staff were suitable to work with people. Systems were in place to reduce the likelihood of the spread of infections. Where learning from safety concerns had been identified leaders communicated this to staff teams.

A new manager was in post and was applying to become registered with The Care Quality Commission. People, relatives and staff were positive about the support now provided but told us they wanted continuity of leadership.

People’s care plans were not always updated promptly when their needs changed. In addition, people’s care plans did not consistently give staff the guidance they need to support people’s individual underlying health needs effectively. People and relatives told us there had been improvements in the personal care provided. People were positive about the support they received to keep in touch with others who were important to them.

Some people enjoyed the range of interesting things they were supported to do, but other people told us there was limited activities available in the evenings and at weekends. Systems were in place to respond to complaints and to support people with their communication needs, and meet people’s end of life preferences.

People were cared for by staff who had received training and developed the skills and knowledge to look after them. Relatives and health and social care professionals advised us people were supported to have enough to eat and gave us examples of how this had led to improved health outcomes for people. Where people wanted support to see other health and social care professionals staff assisted them.

People were supported to have drinks of their choice and enough to eat to remain well.

Some areas of the home had recently been refurbished but these areas were not yet fully used. This meant areas of the home were crowded at times, which may affect people’s well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they were treated kindly by staff. Staff supported people with compassion, encouraged and assisted people to make their own choices and promoted people’s independence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good, (published 25 December 2021).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about how people were supported to have their medicines as prescribed, assistance with skin health and falls management. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from the way their medicines were managed. Please see the safe section of this full report. The provider’s representative and manager began to address these concerns during the inspection.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Stephen's Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to how people's medicines and risks are managed at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.