Archived: Steephill

Updated 28 October 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 August 2016 and was unannounced. The inspection team comprised of two inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed previous inspection reports and notifications we had been sent by the provider. A notification is information about important events which the service is required to send us by law.

We spoke with 10 people living at the home, two relatives and a health care professional (district nurse). We also spoke with the registered manager, six care staff, the administrator and the chef.

We looked at care plans and associated records for four people and records relating to the management of the service. These included staff duty records, staff recruitment files, records of complaints, accidents and incidents, and quality assurance records. We observed care and support being delivered in communal areas including the use of moving and handling equipment. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 28 October 2016

This inspection took place on 17 August 2016 and was unannounced. The home provides accommodation for up to 35 older people with personal care needs. There were 14 people living at the home when we visited. All areas of the home were accessible via a passenger lift and there were two lounges and a dining room on the ground floor of the home. There was accessible outdoor space from the ground floor. All bedrooms were for used for single occupancy.

At our last inspection on 20 and 23 July 2015, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was non-compliant with medicines, assessing and managing risks to people’s health and wellbeing and ensuring the MCA 2005 code of practice was implemented. In this inspection we found improvements had been made and the provider had met the requirements relating to management of risks to people and MCA 2005, but still required improvement to ensure medicines were managed safely.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. Providers are required to notify CQC about significant events that happened in the care home. The provider failed to notify us about incidents involving serious injuries and allegations of abuse.

Medicines were not always managed safely. Auditing processes had not picked up discrepancies in medicines administration. The safe storage of medicines which required refrigeration was not always monitored or recorded. Details around topical creams did not always give sufficient information to ensure these were applied as prescribed. Measures were not always in place to ensure there were adequate gaps between the administrations of some medicines.

Risks relating to the home were not always managed safely. Auditing and quality assurances processes were in place, but did not always pick up key areas of risk or drive improvement. Fire detection and emergency equipment was in place; however, records showed these had not always been checked regularly in accordance with the provider’s policy to ensure they would work in an emergency.

Improvements had been made to the assessing and managing of risks to people’s health and wellbeing. Staff were knowledgeable about assessing and reducing risks to people and an effective system was in place to ensure individual risks to people were managed safely. People had access to healthcare services and were supported to maintain a healthy and balanced diet.

The provider had made improvements in ensuring the MCA 2005 code of practice was implemented. Staff followed legislation designed to protect people’s rights and freedoms. People were encouraged to make choices about every aspect of their lives and where people lacked capacity to make a decision, staff acted in their best their best interests.

Staff understood how to keep people safe. People were protected from the risk of abuse; staff knew how to identify, prevent and report abuse to their manager or local safeguarding authority. There was an open and transparent culture within the service and the provider listened and made changes in response to feedback and complaints.

People and their families felt the home was well organised and the staff cared for people with kindness and compassion. People received personalised care and support. Staff demonstrated a good awareness of people’s individual needs and responded effectively when they changed. People had access to a range of activities tailored to their individual interests.

The provider had adapted the environment to make it more suitable for people living with dementia or visual impairment, however on going improvements were needed.

Recruitment practices had ensured that all pre-employment checks were completed before new staff commenced working in the home. There were enough suitably trained and supported staff deployed to meet people’s needs. Staff received a programme of training with regular supervision and observation of their work.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have taken in the full version of this report.