CQC report explained · a residential care home
What the CQC found at Stepping Stones
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- People's risks were assessed and staff had guidance on how to manage them. Medicines, safeguarding, recruitment and infection control were also found to be safe.
- Effective?
- Good
- This key question was not inspected in this focused inspection, so its previous rating carries over.
- Caring?
- Good
- This key question was not inspected in this focused inspection, so its previous rating carries over.
- Responsive?
- Requires improvement
- Some support plans did not explain people's social, leisure or work-related goals, or how staff would help them achieve these. Records did not always show that activities and individual support hours had been provided.
- Well-led?
- Requires improvement
- New monitoring systems had been introduced, but they did not yet reliably identify gaps in personalised care, medicine records and individual support hours.
What inspectors found, February 2023
Stepping Stones was rated Requires Improvement; inspectors found people were safe, but personalised care and quality monitoring were not yet consistent.
This was an unannounced focused inspection. Inspectors visited on 8, 9 and 19 December 2022. They spoke with people, relatives and staff, observed care, and checked care, medicine, recruitment and management records.
The home was rated Good for Safe. Risks were assessed, medicines were generally given safely, safeguarding systems were in place, and infection control was effective. Staffing shortages had been a challenge, but the provider had a contingency plan and was recruiting.
Responsive and Well-led were both rated Requires Improvement. Some people did not have detailed plans for their interests, activities, goals or longer-term independence. Records did not always show that planned activities or individual support hours had been provided.
The overall rating remained Requires Improvement. The provider had improved risk management and governance since the previous inspection, but the home still breached Regulation 9 because care was not always personalised. The other key question ratings were carried over from the previous inspection because they were not inspected this time.
Risk management
People's personal and health risks were identified and staff had clear guidance. Clinical meetings were used to review changes and escalate concerns.
“Risks to people had been identified and assessed which gave staff clear guidance on how they should support and monitor people to keep them safe.” from the report
Safe medicines
Medicines were stored safely and people received them as prescribed. Staff had protocols for medicines given only when needed.
“People's medicines were stored safely. Staff ensured people received their medicines as prescribed.” from the report
Positive relationships
Inspectors saw staff engaging positively with people. Relatives described people as safe, happy and well cared for.
“We observed staff positively engaging with people throughout the inspection.” from the report
Activities and skills
Some people took part in activities such as sailing, horse riding, college and holidays. Others were supported to develop practical and personal skills.
“Some people were being supported to engage in old and new activities such as sailing, horse riding, attending college and going on holiday.” from the report
Communication support
People's communication needs were assessed and recorded. Staff had guidance about preferred ways to communicate with each person.
“People's individual communication needs had been assessed and recorded.” from the report
Care was not always personalised
seriousSome support plans did not give enough detail about people's interests, aspirations, future plans or the support needed to achieve them. This was an ongoing breach of Regulation 9.
“People's care had not always been planned and delivered in a way that was personalised to their needs and promoted their wellbeing” from the report
Activities were not consistently recorded
needs fixingSome people went days without a documented meaningful activity other than watching television, listening to music or relaxing. Records did not always show that planned activities had been offered.
“some people went some days without a documented meaningful activity other than watching televisions, listening to music or relaxing.” from the report
Individual support hours were not monitored
needs fixingThe home did not yet have an effective system to show that allocated individual support hours had been provided or used for people's desired activities.
“An effective monitoring system was not yet in place to monitor that people had received their allocated individual support hours” from the report
Medicine records had gaps
needs fixingInspectors found gaps in some medicine administration records. The provider's medicine audit had not identified these gaps, so the audit was being strengthened.
“We found some gaps in people's medicine administration records.” from the report
- 01How will you make sure every person's support plan includes their interests, aspirations, future plans and the help needed to achieve them?
- 02How do you record and check that planned activities have been offered and that people are supported to take part?
- 03How are each person's allocated individual support hours used, and where can we see a record of what happened?
- 04What changes have been made to medicine audits since inspectors found gaps in medicine administration records?
- 05How will you keep relatives informed about important changes or incidents affecting their family member?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used in the overall rating. This explanation was written from the published report of 24 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Stepping Stones is rated Requires Improvement; inspectors found safety risks, weak monitoring and care that did not always support people's choices and goals.
This was an unannounced focused inspection on 6 May 2022. Inspectors reviewed Safe and Well-led only because concerns had been raised about staffing and medicines. They spoke with people, relatives, staff and professionals, and checked care, medicines, recruitment and management records.
The home had systems to identify people's risks, but these were not always followed well. Specialist advice had not been obtained for people at risk of choking. Fire evacuation drills and water safety checks were missing, some medicines records were incomplete, and infection control checks did not fully reflect COVID-19 measures.
People were often supported by staff who knew them and had positive relationships with them. However, records did not always explain people's social and leisure goals or how staff should help them achieve these. The overall rating fell from Good to Requires Improvement. Safe was rated Requires Improvement, while Well-led remained Requires Improvement.
Positive staff relationships
Inspectors saw staff engaging positively with people. Relatives also described positive relationships and said staff involved them in care decisions.
“We found staff positively engaging with people throughout the inspection.” from the report
Support with medicines
The home reviewed medicines and followed principles aimed at reducing unnecessary over-medication. Medicines were stored safely and reviewed regularly.
“The service ensured people's behaviour was not controlled by excessive and inappropriate use of medicines.” from the report
Health care partnerships
Records showed support with health appointments and screening. Health care professionals praised the home's work during the pandemic.
“Health care professionals praised the professionalism of the managers throughout the COVID -19 pandemic and said staff had worked flexibly during the restrictions to meet people needs.” from the report
Risk information was incomplete
seriousThe home had not obtained specialist advice for people at risk of choking. Some diabetes and epilepsy plans did not explain clearly what staff should do if someone became unwell.
“However, the service had not sought specialist advice when people had been identified as risk of choking to ensure the arrangements in place were sufficient to keep people safe when eating and drinking.” from the report
Environmental safety checks
seriousPlanned fire evacuation drills had not been completed and water checks were not maintained. Inspectors said this left people at risk of harm.
“Systems were either not in place or robust enough to demonstrate people's safety was effectively managed. This placed people at risk of harm.” from the report
Care did not always reflect people's goals
seriousCare records did not properly describe people's social, leisure or work-related aspirations. Support to regain activities and develop independence was not consistent.
“People's care records did not reflect their social and leisure/occupational aspirations and how they wanted to be supported to achieve this.” from the report
Weak quality monitoring
seriousThe provider's audits had not identified several problems found by inspectors. Infection control audits also did not check all the additional measures needed during the pandemic.
“The provider had a system of audits to monitor the quality of the service. However, these had not identified the issues we found during the inspection such as fire drills, water checks, recruitment records, people's risk management plans and notifications.” from the report
Staffing and communication
needs fixingSome staff reported shortages and said this sometimes limited the support people received to live as they wished. Staff and relatives also said communication was variable or needed to improve.
“They explained that on occasions staffing had not been at the required level which meant they were unable to provide care which enabled people to live a life of their choice.” from the report
- 01What specialist assessments have now been completed for people at risk of choking, and how are staff following the advice?
- 02How often are fire evacuation drills and water safety checks now completed, and can we see the records?
- 03How are you checking that medicines competency assessments and medicines administration records are complete?
- 04How do current care plans record each person's interests, goals and preferred support to build independence?
- 05How are one-to-one hours and staffing levels monitored to make sure people can attend activities, visit family and use the community?
This was a focused inspection of Safe and Well-led only; the other key question ratings were not inspected and were carried forward from earlier comprehensive inspections. This explanation was written from the published report of 16 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Stepping Stones
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2019Goodstayed GoodSafe: GoodResponsive: GoodWell-led: Requires improvement
- November 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £1,030 to £1,360 a week. 31 can care for a couple. 12 years' experience on average.
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