St Stephen's Care Home

Safe – this means we looked for evidence that people were protected from avoidable harm. At our last inspection this key question was rated requires improvement. At this assessment this key question remains at requires improvement. We identified continued shortfalls with medicines, clinical care, infection prevention and control and the environment. We found significant shortfalls in the environment which was not always safe, and risks were identified around infection prevention and control (IPC), medicines, clinical documentation and oral care. The providers internal audits did not always identify the risks we found during our inspection, however, the provider was responsive and started to take immediate action during our visit. Systems were not robust to monitor and mitigate risks to the health, safety and welfare of people using the service and lessons had not always been learnt. This placed people at increased risk of harm. This was a continued breach of regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question good. At this assessment we did not assess all quality statements within this key question. The overall rating for this key question remains good based on the findings at the last inspection. Staff demonstrated good knowledge of people and their support needs, however this was not always reflected in people's care plans. For example, oral care and bowel monitoring guidance lacked detail and required further development to ensure staff were able to provide consistent support to people.

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last inspection we rated this key question good. At this assessment we did not assess all quality statements within this key question. The overall rating for this key question remains good based on the findings at the last inspection. People and relatives told us they were supported by staff who were caring and compassionate. However, we observed staff did not always promote people’s dignity or gain consent before carrying out care tasks.

Responsive – this means we looked for evidence that the service met people’s needs. At our last inspection we rated this key question requires improvement. At this assessment this key question has improved to good. Not all people and their relatives knew how to make a formal complaint if they needed to, and information was not always available in an accessible way. Most people told us they would share any concerns with their relatives. Care plans did not always consistently demonstrate people and relative involvement. The service gathered feedback from people, relatives and staff through regular service surveys and meetings. People had end of life plans in place, which detailed their wishes and preferences.

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection this key question was rated requires improvement. At this assessment this key question remains at requires improvement. We identified improvements were needed in management oversight and governance in relation to medicines, staffing, Infection Prevention and Control (IPC), clinical care documentation and oral care . Managers were responsive to our feedback and told us they were committed to improve the safety and quality of care being delivered and had put an action plan in place. However, these were not yet embedded and some documentation which had been provided to inspectors required further details. The systems for governance and oversight had not always been effective in identifying the service’s shortfalls. People and families spoke positively about managers. The provider’s oversight and governance failed to ensure systems and processes identified the improvements needed in the quality and safety of care being provided. This was a breach of Regulation 17, (Good Governance), of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.