Archived: Stepping Stones

Stepping Stones is a residential care home providing personal care to three adults with a learning disability, mental health condition or autistic people at the time of the inspection. The home can support up to four people and was provided in a newly built house. One person had moved out of the home since our last inspection on 7 May 2021. The provider was not able to move anyone new into the home as we had imposed a condition on their registration to restrict any new admissions to the home.

The home was established for short- or medium-term accommodation to assess and provide specialist support for people living with a learning disability or autism. The aim is for people to develop their skills and independence to move onto other appropriate long-term accommodation.

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

People had been harmed and remained at risk of further harm. Incidents of psychological and physical abuse between people were not always reported to the local safeguarding authority and the Care Quality Commission.

Incidents were not reviewed by the registered manager or provider to ensure action was taken to learn from these and prevent them reoccurring. Care plans and risk assessments were not updated following incidents. Action was not taken to ensure people’s safety.

Staff did not have the skills, knowledge and guidance to support people during incidents of behaviour that challenged. This resulted in people’s anxieties and behaviour escalating and put people and staff at risk of harm.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection that considered risk management and safeguarding under our key question of Safe. Based on our inspection of these areas the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting had not maximised people’s choice, control and

Independence.

Right care:

• Care was not person-centred and did not promote people’s dignity, privacy and human

Rights. Staff lacked understanding of how to support behaviour that challenged in a positive way.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people led confident, inclusive and empowered lives. The lack of understanding by the provider, registered manager and the resulting attitude and values displayed by staff had led to a negative culture in the home. This had a negative impact on people’s self-esteem, confidence, human rights and quality of life.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 17 June 2021) and there were multiple breaches of regulations. We imposed conditions on the location which meant the provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about risk management following incidents. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and safeguarding people from abuse and improper treatment at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

Following this inspection, we worked closely with commissioning authorities to ensure people were safeguarded from on-going harm. Three people were supported to move out of Stepping Stones. There is currently no one living at Stepping Stones.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Stepping Stones is a residential care home providing personal care to four younger adults with a learning disability and/or autism at the time of the inspection. The service can support up to four people and was provided in a newly built house. The service was established for short- or medium-term accommodation to assess and provide specialist support for people living with a learning disability or autism. The aim is for people to develop their skills and independence to move onto other appropriate long-term accommodation.

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

People we spoke with did not describe being happy living in the service or living meaningful and fulfilling lives. One person told us, “I put up with a lot of rubbish here. I don’t do anything. I just come down and make a coffee and go back to my room. I don’t talk to anyone here…I want to be in hospital as they look after you there.” Another person told us, “I want to go out, but they won’t take me out, so I go to bed all day and just get up to smoke and eat and drink.”

Incidents of potential abuse were not always reported to the local safeguarding authority and CQC. Incidents were not consistently recorded and there was no management and oversight of incidents by the provider. Care plans and risk assessments were not updated following incidents and there was no action taken to avoid reoccurrence. This put people at risk of harm.

Staff were not always recruited safely as employment gaps were not explored on interview. Staff with offences on their Disclosure and Barring Service check (DBS) did not have adequate risk assessments in place to manage this risk.

People were unlawfully physically restrained by staff who had not received up to date training in restrictive physical interventions and positive behaviour support. Staff lacked the skills, knowledge and guidance to support people safely and to meet their needs. Inappropriate punitive practices were used to manage people’s behaviour such as sending people to their bedrooms and not letting people do the things they wanted to do. This often resulted in people’s behaviour escalating and staff lacked the knowledge to identify this. The provider had failed to recognise this was a form of secluding people.

There was a complete lack of infection prevention and control management which put people at significant risk of harm from Covid-19. Staff were not wearing face masks; people had not been tested regularly and had not been encouraged to social distance in their home. The service had a Covid-19 outbreak in December 2020 and every person had tested positive for Covid-19. Despite this the provider had continued to not follow government guidelines for Covid-19.

There was no governance in place by the provider to ensure people received safe, quality care. The registered manager and provider failed to complete any quality assurance of the service and failed to identify the concerns we found during our inspection. The registered manager and provider had failed to meet all their regulatory requirements. For example, the failure to notify CQC of safeguarding incidents.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not maximise people’s choice, control and independence. People were not empowered to make day to day choices, enabled to take control of their care and enabled to be as independent as possible. This meant people were disempowered in all areas of their lives and not enabled to live their life to the full.

Right care:

• Care was not person-centred and did not promote people’s dignity, privacy and human rights. Staff lacked the knowledge and skills to support people in a person-centred way. Staff lacked understanding of learning disabilities and autism and how to support behaviour that challenged in a positive way. People were not supported in a person-centred way and interactions lacked respect. For example, when one person became distressed due to waiting to go out, they were told to, “Leave staff alone and they will be ready when they are ready.”

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people

using services led confident, inclusive and empowered lives. The lack of understanding by the registered manager and the resulting attitude and values displayed by staff had led to a negative culture in the service. The registered manager and staff spoke about and to people in a derogatory way. For example, staff said “If you read about (person) on paper, you wouldn’t touch them with a barge pole” and, “(Name) was trying to get out of the door and have a go so we did them in a seated restraint until they calmed.” This had a negative impact on people’s self-esteem, confidence, human rights and quality of life.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 4 March 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the safeguarding management of an incident. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stepping Stones 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, fit and proper persons employed and notification of other events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Stepping Stones is a residential care home providing personal to two younger adults with a learning disability or autism at the time of the inspection. The service can support up to four people. The service was provided in a new built house.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. There were deliberately no identifying signs, intercom, or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People told us they enjoyed living at Stepping Stones and staff supported them to achieve their goals.

The provider and registered manager had oversight of the service and completed some checks of the service. However, these were not robust and had not identified that staff were not always recruited safely.

People were involved in everything that happened at the service. Staff knew people well and were caring. They treated people with dignity and respect. People told us they felt safe at Stepping Stones and got on well with staff.

Assessments of people’s needs and any risks had been completed. People had planned their support with staff and took managed risks. Staff knew the signs of abuse and were confident to raise any concerns with the registered manager. People were not discriminated against and received care tailored to them.

People were supported to be independent and took part in household chores and activities they enjoyed at the service and in their community.

People were supported to be as healthy as possible. Staff supported them to health care appointments and for check-ups. People’s medicines were managed safely. People were supported to plan and prepare balanced meals, of food they liked and met their needs and preferences.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff felt supported by the registered manager and were motivated. Staff worked as a team and supported people in a consistent way. Records in respect of each person were accurate and held securely.

There were enough staff to support people. Staff had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and shared the provider’s vision for the service.

The service was clean and well maintained. People used all areas of the building and grounds.

A process was in place to investigate and resolve any complaints or concerns received.

The registered manager had informed CQC of significant events that had happened at the service, so we could check that appropriate action had been taken.

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

Rating at last inspection

This service was registered with us on 07/02/2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on our inspection programme.

Enforcement

We have identified a breach in relation to staff recruitment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.