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?
- Requires improvement
- Medicines were not always stored securely, recruitment checks were incomplete and staffing arrangements at night had not been fully reviewed. Inspectors also found risks involving people's money and some external doors, although people and relatives said they felt safe.
- Effective?
- Requires improvement
- Some mental capacity assessments and best-interest decisions were missing. Staff had not always recognised restrictive practices or ensured that restrictions had the correct legal authority.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff supported people to make choices, be independent and maintain relationships.
- Responsive?
- Good
- Care plans were personalised and regularly reviewed. People were supported with activities, interests, healthcare and visits, although more accessible information was needed.
- Well-led?
- Requires improvement
- The management team created an open and positive culture, but quality systems were not reliable enough to identify and fix the problems found. The provider had also stopped sending reports required by a registration condition.
What inspectors found, August 2023
Rated Requires Improvement; inspectors found kind and individual care, but breaches involving medicines, consent, restrictions, recruitment and management systems.
Inspectors visited on 30 May and 1 June 2023. The first day was unannounced. They spoke with people living there, relatives, staff, visitors and partner agencies. They reviewed care records, medicines, recruitment files and management records.
People were generally treated with kindness and supported to make choices, stay active and maintain relationships. The home was clean and homely. People and relatives said they felt safe, had enough staff and could raise concerns.
However, medicines were not always stored securely. Recruitment checks were incomplete. Inspectors also found problems with mental capacity assessments, best-interest decisions and legal authorisation for restrictions on people's freedom. The home's quality checks had not found these issues.
The overall rating remains Requires Improvement, as do Safe, Effective and Well-led. Caring and Responsive improved from Requires Improvement to Good. This was the third consecutive inspection with an overall Requires Improvement rating.
Kind and respectful care
People were treated with kindness and staff understood their individual needs. Inspectors saw staff respecting privacy, dignity and personal choices.
“People were treated with kindness and supported by staff who had a good understanding of their individual needs.” from the report
Independence and daily life
People were encouraged to use their strengths and develop independence. Staff supported people to have fulfilling days.
“People had fulfilling days and staff supported people by focussing on their strengths and encouraging people to be independent.” from the report
Personalised support
Support plans included people's preferences, health needs, likes and dislikes. Staff knew people well and updated plans when needs changed.
“Support plans were informative and provided staff with detailed information on people's likes, dislikes, personal preferences, care needs and medical history.” from the report
Activities and relationships
People were supported to take part in activities, go out and maintain contact with family and friends.
“People were encouraged and supported to lead active lifestyles, follow their interests and take part in social activities.” from the report
Openness about complaints
People and relatives knew how to complain and felt they would be listened to. A formal complaints process was available.
“People and their relatives were aware of how to make a complaint and felt comfortable raising concerns if something was not right or if they were unhappy.” from the report
Medicines storage
seriousSome medicines were kept where all staff could access the keys. The manager took immediate action when inspectors raised this.
“The failure to store people's medicines securely was a breach of regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.” from the report
Consent and restrictive practices
seriousThere were missing capacity assessments and best-interest decisions for managing money and using restrictions such as lap belts or constant supervision.
“The failure to properly assess and record people's capacity and best interest decisions risked compromising people's rights.” from the report
Unlawful restrictions
seriousSome people were continuously supervised and controlled and were not free to leave, but there was no legal framework in place for these restrictions. Existing DoLS authorisations were not being systematically reviewed.
“There was no legal framework in place to support these restrictions.” from the report
Management checks
seriousQuality systems had not identified several of the problems found during the inspection. The provider had also stopped sending monthly reports required by a registration condition.
“Systems were either not embedded into practice or undertaken robustly enough to identify and monitor the quality of the service and effectively drive improvements.” from the report
Accessible information
needs fixingSupport plans identified communication needs, but more work was needed to provide information in accessible formats such as easy read or pictures.
“However, we found more work was needed to develop information in an accessible format, such as easy read or pictorial to help ensure people's support plans are fully accessible.” from the report
- 01What has been changed to ensure all medicines are stored securely, and how is this checked now?
- 02Which people are subject to restrictions, and can you show us the current capacity assessments, best-interest decisions and DoLS authorisations?
- 03How have recruitment checks been completed for all current staff, including DBS checks and full employment histories?
- 04How have night staffing levels been reviewed against people's assessed needs and the layout of the home?
- 05What quality checks are now in place to find problems with medicines, consent, finances, staffing and DoLS before they affect people?
This was a follow-up inspection covering all five key questions, carried out to check action from the previous inspection; the report also included infection prevention and control checks. This explanation was written from the published report of 19 August 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, November 2019
Stepping Stones is rated Requires Improvement; care had improved, but safeguarding reports, care records and quality checks were not yet reliable.
Inspectors visited unannounced on 30 September and 2 October 2019. They spoke with 11 people, staff, relatives and health professionals. They observed care and checked care records, medicines, incidents, staff files and management records.
The home had improved since its previous inspection, when it was rated Inadequate and placed in special measures. People said they had more choice, freedom and independence. Staff knew people well, and inspectors found kind interactions, safer medicines management, better cleanliness and more activities.
However, some incidents involving possible harm or abuse had not been reported to outside agencies as required. The checks used by managers had not found this problem. Some care records were still not personalised or up to date, and parts of the building still made independent movement and privacy harder.
The overall rating and all five question ratings were Requires Improvement. The home was no longer Inadequate or in special measures, but CQC found two breaches and said further improvement needed to be embedded and sustained.
Kind and respectful support
Inspectors saw staff using kindness, humour and understanding. People said staff respected their privacy and treated them better than at the previous inspection.
“Staff interactions we observed were kind, and staff were gentle and used humour and understanding of individuals to engage people” from the report
Safer medicines and staffing
There were enough staff for people's assessed needs. Medicines were stored, recorded and given safely, with staff training and competency checks.
“Medicines were stored, recorded and administered safely. Medicines Administration Records (MARS) were completed in line with best practice.” from the report
More activities and community access
People had more opportunities to go out, follow interests and maintain relationships. Staff organisation allowed some people to spend longer doing activities.
“An activities coordinator had been appointed and had been supporting people to access the community more frequently and to pursue particular interests and hobbies.” from the report
Cleaner environment
The home was clean and infection control procedures were followed. Some repairs and decoration had also been completed since the previous inspection.
“At this inspection we found the home was clean throughout and infection control procedures were understood and followed by staff.” from the report
Safeguarding reports were inconsistent
seriousSome incidents where people may have been at risk of harm or abuse were not reported to outside agencies as required. CQC said this could leave people less fully protected, although it found no evidence that anyone had been harmed.
“Incidents in the home where people had been placed at potential risk of harm and/or abuse had not in all cases been reported in line with safeguarding procedures.” from the report
Quality checks missed problems
seriousManagement audits had improved but did not identify the incident-reporting failures. CQC found that systems were not robust enough to ensure the correct procedures were followed.
“We found no evidence that people had been harmed. However, systems were either not in place or robust enough to ensure correct procedures were followed when incidents of potential harm occurred.” from the report
Care records were unfinished
needs fixingOnly five of 14 people's care plans had been moved to the new electronic format. The other nine records did not always explain people's choices and preferred support clearly.
“The care records for the other nine people were still in an old format and did not in all cases include information about how people chose and preferred to be supported.” from the report
Access and privacy needed work
needs fixingHeavy doors made it difficult for some wheelchair users to move around independently. A communal bathroom did not provide a place to change, which could affect privacy, and some damp remained.
“Doors to bedrooms, bathrooms and communal areas were heavy and people who required wheelchairs to mobilise struggled to open doors without support.” from the report
- 01How are incidents involving possible harm or abuse reported to the local authority and CQC now?
- 02Have all care records been updated to include each person's choices, preferences and risks?
- 03Have the heavy doors been replaced, and have the remaining damp and bathroom privacy issues been resolved?
- 04How do your audits now check that safeguarding reports and care records are complete?
- 05What evidence can you show that the improvements have been sustained since this inspection?
This was an unannounced follow-up inspection covering the home, care and all five key questions, after the previous Inadequate rating and enforcement action. This explanation was written from the published report of 7 November 2019 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
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2019Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- March 2014
Registered with the Care Quality Commission on 31 March 2014.
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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