Stable Steps Care Centre

Stable Steps Care Centre is a residential care home providing personal and nursing care to up to 50 people. The service provides support to older and younger adults and people living with dementia. At the time of our inspection there were 46 people using the service. Stable Steps Care Centre is situated in Cale Green, close to the centre of Stockport. The home provides care across two floors, with nursing care being provided primarily on the ground floor and dementia care on the first floor. Most bedrooms are single occupancy but facilities for shared occupancy were available. There were a variety of communal areas including lounge and dining areas, and shared adapted bathrooms.

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

People were not always supported by staff who were suitably deployed and robustly recruited. People did not always feel safe and evidence to show how lessons were learnt was not always robust. We have made a recommendation about the systems for the management of accidents and incidents. Medicines were safely stored and managed, although we have made a recommendation around the systems of clinical management. The environment was clean, and checks of equipment and health and safety were completed. We have made a recommendation about the availability of specialist equipment.

The management team had introduced a number of systems for audits and oversight. These were newly in place, and we were unable to assess the impact of these in improving people’s quality of life and experience at the service during this inspection. An action plan was in place and new systems for care planning and recording keeping were being explored. People, families, staff, and healthcare professional’s views on the culture of the home varied. We have made a recommendation about the use of CCTV in the service.

People’s needs were not always accurately assessed. People and families did not always feel that staff had the necessary training and understanding and not all staff felt supported in their roles. Referrals to healthcare services were made, although we received mixed feedback about how advice from other professionals was incorporated and followed. We were not always assured about staff’s understanding of people’s needs. The provider had plans to improve the environment but not all work had been completed and people were not always able to access areas of the service, such as outside space. People had mixed views about the food and records in relation to how people’s needs were met in this area were not always robust.

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

People had mixed views about how they were cared for. Staff supported people with a variety of complex needs, but records did not evidence that people were involved in decision making and that dignity and independence was always considered.

People were not always cared for in line with their individual needs and preferences, and people and families did not feel communication needs were being effectively met. The service responded to formal complaints, but verbal concerns were not always captured in records, and people did not always feel able to raise concerns or feel confident that these would be addressed.

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 04 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection the service remained in breach of some regulations. The provider had made some improvements and was no longer in breach of regulation 12.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up from our findings at the last inspection.

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.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, staffing levels and training, recruitment and systems for oversight and quality of the service 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.

We have made a recommendation about the use of CCTV, availability of specialist equipment, management of medicines, and the systems for managing accidents and incidents.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stable Steps Care Centre is situated in Cale Green, close to the centre of Stockport. The home provides care across two floors, with nursing care being provided primarily on the ground floor and dementia care on the first floor. Most bedrooms are single occupancy but facilities for shared occupancy were available. There were a variety of communal areas including lounge and dining areas, shared adapted bathrooms and the provider was in the process of landscaping a secure outside area.

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

Systems of governance were not always robust enough to ensure risks were quickly identified and addressed. The registered manager had identified some areas for improvement prior to the inspection but work in these areas, such as developing care plans, was ongoing and needed to be embedded. The registered manager and team were very responsive to feedback and keen to improve the service and took immediate action to address any shortfalls identified.

Risk to people, such as furniture being unsecured, was not always identified and mitigated. However, any shortfalls identified were addressed immediately. Medicines were suitably stored and records of administration maintained. However, we found that medicines which were being crushed or given covertly did not always have the relevant assessments and care plans in place, to ensure they were being safely given. The registered manager took steps to immediately address this with the relevant local healthcare services. Staff were not always suitably deployed and recruitment records did not always demonstrate that robust recruitment processes had been completed. The systems in place to ensure lessons were effectively learnt needed to be more robust.

Staff completed a variety of training. Training was ongoing and staff felt well supported in their roles. Work to improve the premises was ongoing. There were mixed views about the food. The registered manager was in the process of making improvements to the mealtime experience. Staff worked with healthcare professionals to meet the needs of people. However, some work was needed to improve how information and care plans were developed to reflect advice and guidance given by health care professionals.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service had not been embedded to support good practice. People were not always encouraged to make choices around daily lives and records did not always demonstrate how best interest decisions and least restrictive approaches were being taken.

Work to improve the quality and care plans to ensure they were detailed and person-centred was ongoing. At the time of the inspection further work was required. People were supported to maintain relationships with friends and family and activities were available for people both in groups and on an individual basis. People felt able to raise concerns. We noted some improvements to how people were supported as they reached the end of life was required. The registered manager had arranged for additional training for staff in this area prior to the inspection.

People generally spoke positively about staff and we observed some kind and caring interactions between people. However, we also noted some shortfalls in how people were supported on the first day of inspection. This had improved on subsequent visits.

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 15 March 2021 and this is the first inspection.

Why we inspected

This was a planned inspection of this newly registered service under the current provider registration.

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.

Enforcement and Recommendations

We have identified breaches in relation to how people are provided with person-centred care; how risk to people are mitigated; how medicines are safely managed; how staff are safely recruited; and the oversight of the service at this inspection.

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

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.