St Stephen's Court

Updated 1 April 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

This inspection was undertaken by 3 inspectors, 1 medicines team support officer 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.

Service and service type

St Stephen’s Court 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. St Stephen’s Court 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.

What we did before the inspection

We reviewed the information we held about the service, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. We contacted the local authority commissioning and safeguarding teams, the local NHS IPC team, fire service, integrated care board and Healthwatch to request feedback. 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. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 7 relatives about their experience of the care provided. We spoke with 12 members of staff including the registered manager, head of care delivery manager, head of care outcomes manager, the deputy manager, a clinical manager, a nurse and 6 care staff. We reviewed a range of records. This included care records for 11 people and multiple medicines records. We looked at a variety of records relating to the management of the service, including policies and procedures. We also received feedback from 1 health professional who was employed by the provider and visited the service as part of the provider’s therapy team and from 2 health and social care professionals who visited the service.

On the third day of inspection we reviewed documentation the provider has sent to us electronically.

Following the inspection site visits we spoke with the provider’s nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We requested additional information by email and continued to seek clarification from the provider to validate the evidence we found.

Updated 1 April 2023

About the service

St Stephen’s Court is a residential care home providing accommodation and personal care to people who have acquired brain injuries, neurological conditions, mental health needs and learning and physical disabilities. The service was registered to provide support to up to 30 people. At the time of our inspection 31 people were using the service. One person did move out of the service during our inspection.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

The service was registered with CQC prior to the publication of the Right support, right care, right culture guidance. The service was larger than recommended by current best practice guidance. However, the building had been separated into 4 units to provide smaller living accommodation for people. Each unit had a communal area people could access to decide who they wanted to socialise with.

Systems were in place to ensure medicines were managed safely. However, there was excess stock of topical medicines (creams and lotions applied to the skin) for some people. We have made a recommendation about this. Risk assessments were completed to assess known risks people were exposed to and people were encouraged to be as independent as possible. In addition, a range of risk assessments had been completed to assess the safety of the environment.

People were supported to personalise their bedrooms to reflect their taste and preferences and their opinions were sought to ensure people were included in decisions about their care.

Right Care

There were sufficient numbers of staff to meet people's needs. Agency staff were used to ensure safe staffing levels were always maintained. Staff knew people well and care records contained person-centred information to guide staff in how support should be delivered. Information was available to people in alternative formats to support people's communication needs if this was necessary.

Assessments of people's needs had been completed and people were involved in the process. Care plans were in place which detailed how to meet people’s needs.

Staff understood their safeguarding responsibilities. They told us they would be confident in raising any concerns they had and felt confident any issue would be dealt with appropriately.

Right Culture

The management team promoted a positive culture at the service. Managers led by example and advocated staff provided support to people which was person-centred to their individual needs. 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 this practice.

Systems were in place to ensure staff were recruited safely. Most people spoke positively about their relationships with staff. The registered manager was proactive in responding to feedback from people in relation to staffing.

The registered manager worked in an open and transparent way. However, records were not available to demonstrate staff were meeting the requirements of the duty of candour regulation. We have made a recommendation about this.

Systems were in place to review quality and there was a culture of learning from previous incidents to improve performance and staff practices. However, medicines audits did not review all of the medicines which were in use. We have made a recommendation about this.

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

Rating at last inspection

The last rating for this service was good (published 31 March 2020).

Why we inspected

We received concerns in relation to the management of the service and support provided to people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Stephen’s Court on our website at www.cqc.org.uk.

Recommendations

We have made recommendations in relation to medicines and duty of candour at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.