Stable Steps Care Centre

Updated 19 August 2023

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 was undertaken by 3 inspectors and a medicines inspector over the course of 2 site visits.

Service and service type

Stable Steps Care Centre 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. Stable Steps Care Centre is a care home with 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 a registered manager in post.

Notice of inspection

This inspection was unannounced on both days of inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included information of concern and notifications the service is required to submit regarding any significant events happening at the service. We sought feedback from the local authority, professionals who work with the service 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. All this information was used to plan the inspection.

During the inspection

We reviewed staffing levels and walked around the building to ensure it was clean and a safe place for people to live. We observed how staff supported people and provided care.

We spoke with 6 people who use the service, 5 relatives and 11 members of staff including the registered manager, compliance manager, care workers, and auxiliary staff including kitchen staff.

During the inspection we visited both units, reviewed multiple medicine administration records and looked at medicines related documentation.

We reviewed a range of records including 6 people's care records. We looked at 8 staff files in relation to recruitment, training and support. A variety of records relating to the management of the service, including policies and procedures were examined during and following the site visits.

Updated 19 August 2023

About the service

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.