This inspection took place on the 4th and 5th July 2016 and was unannounced. Steep House Nursing Home is registered to provide accommodation for up to 56 older people who require nursing or personal care. The accommodation is arranged over three floors and has a garden area. At the time of our inspection there were 52 people living at the home. A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People were protected from the risk of abuse. The staff we spoke with demonstrated their understanding of how to safeguard people and report any safeguarding concerns. The provider ensured that safeguarding policies and procedures were in place and accessible to staff.
Risks affecting individuals had been identified, appropriately assessed and measures put in place to protect them from harm. People’s risks assessments were regularly evaluated to ensure they remained current. Environmental risks were regularly reviewed and documented and personal evacuation plans were in place to ensure that people were kept safe in the event of an adverse incident such as a fire. Equipment and utilities were serviced regularly, and internal checks protected people and others from potential risks in the home.
The home was adequately staffed to meet people’s care needs on the days of our inspection. Where shortfalls were identified, the registered manager sourced additional off duty staff to cover any shortages and ensure staffing levels were maintained. However some staff and relatives expressed concern that there were not always enough staff to manage if staff were away or off sick.
The provider had not in every case ensured that all the relevant recruitment checks were carried out for newly employed staff. This meant that people might not always be protected from the risk of the provider employing staff who were not suitable for their role.
The provider had appropriate arrangements in place for managing people's medicines safely. There were accurate records of medicines administration by nurses and topical creams administered by care staff and information to support the administration of medicines was available to staff. However, some improvements were required to ensure that medicines were always stored safely to ensure that risks to people were minimised.
New staff followed a period of induction which included the provider’s mandatory training, followed by a period of working alongside more experienced staff, to ensure that they were competent to carry out their role. The registered manager held regular supervisions with staff and staff told us that they felt supported by the registered manager and the head of care. Staff completed a range of training to develop the skills and knowledge they required to meet people’s needs.
The provider followed appropriate procedures to ensure people’s rights were upheld in line with the Mental Capacity Act (2005). Mental capacity assessments had been completed for people and people’s consent to care and treatment had been sought accordingly. Best interest decisions were completed when people lacked the capacity to make their own decisions.
People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available to people throughout the day. For lunch a choice of freshly cooked meals was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.
People were supported to maintain good health through access to ongoing health support. Records showed that other healthcare professionals had been involved in people’s care such as the dietician, diabetic nurse, occupational therapist, and referrals were made where appropriate.
People received care and support from staff that knew them well and were caring in their approach. Relatives described staff as kind and caring, friendly and welcoming. People were offered choices in their day to day decisions. The relationships between staff and people receiving support demonstrated dignity and respect.
The head of care knew each person and their needs well and acted in accordance with those needs to ensure that people received safe and effective care. Care plans contained some detailed and individual information around aspects of people’s care, such as their nutrition needs and wound care. However information about some people’s health conditions was not always complete and did not consistently provide staff with the information they might need to support the person effectively, for example around managing behaviour which challenges.
Activities were available for people to take part in and the activities programme was run by a committed activities leader. However activities were not always individualised and designed to stimulate people living with dementia. We have made a recommendation to support the provider to ensure that people’s social needs are met.
A system was in place for people to raise their complaints and concerns and they were acted on.
Quality assurance systems had been put in place and were effectively operated to monitor aspects of the quality of service delivered for people. Audits identified shortfalls and actions plans were put in place to secure improvements. Relatives' and residents' views had been sought on the quality of the service.
The registered manager promoted an open and positive culture within the home. They were proactive in encouraging input from and engagement with staff, people and their relatives. Staff were supported to be clear about their roles and responsibilities through effective supervision, training and team meetings.
During this inspection we found two breaches of regulation. You can see what action we asked the provider to take at the back of the full version of this report.