Stepping Stones

Updated 24 February 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 carried out by 3 inspectors and 2 Experts by Experiences. 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

Stepping Stones 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. Stepping Stones is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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. Inspection activity started on 8 December 2022 and ended on 19 December 2022. We visited the service on 8, 9 and 19 December 2022.

What we did before the inspection

We reviewed the intelligence that we held about the service. We used this information to plan our inspection.

The provider was asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. The provider returned the PIR the day before the inspection therefore we did not include this information in our planning but gathered the relevant information during our inspection.

During the inspection

We spoke with 11 people who used the service and we observed interactions with staff for people who were unable to talk, had limited communication or did not wish to speak to us.

We spoke over the telephone with 7 relatives about their experience of the care provided to their loved ones.

We spoke with 23 members of staff including the nominated individual, registered manager, deputy manager, clinical lead, recruitment manager, behaviour lead, 2 activity leads, 1 team leader, 1 senior carer and 13 care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 4 people's care records and a number of medicine records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including training data and quality assurance records and policies and procedures were reviewed.

During the inspection

We received feedback from one professional who regularly visits the service.

Updated 24 February 2023

About the service

Stepping Stones is a residential care home providing care to 32 people at the time of the inspection. There are 8 different households set in 4.5 acres that can support up to 33 people living with a learning disability or autistic spectrum disorder.

People living at Stepping Stones have access on site to an art room, a music room, a gym and a sensory room as well as an outdoor swimming pool.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Based on our review of key questions of safe, responsive and well-led, the service was not always able to fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The manager and provider had implemented new monitoring systems to continue to improve the quality of the service people received. However, more time was needed to allow these systems to bring about and sustain individualised outcomes for all people. In addition, some of the systems were not always effective or audited to ensure they picked up the concerns we identified during the inspection.

Right support

People were supported by staff who understood their care and support needs, and what was important to them.

Since our last inspection progress has been made in ensuring people were being supported to start accessing the community again post COVID-19 to enjoy activities and outings. Staff knew people well, however people were not always supported to identify and achieve their aspirations and goals.

People were supported to access specialist health care services and maintain contact with their families.

Right care

People's risks were identified and managed by staff. People's care records reflected their emotional and health needs and progress has been made in identifying shortfalls in people’s care records and updating these. However, some support plans still lacked comprehensive individualised details about people’s social and leisure/occupational aspirations and how they wanted to be supported to achieve this. Further time and development were needed to demonstrate that people's lives were enriched by a service that focused on their wishes, needs and rights.

Right culture

Staff had positive relationships with people and their relatives. There was visible leadership and management of the service and the registered manager’s vision was “to give people who live here a voice.”

The model of care being provided at Stepping Stones did not always maximise people's choice, control and independence. The provider had identified areas that required improvement and was working on their service improvement plan. However further time was needed to enable the provider and management team to demonstrate how the improvements being made would enhance people's quality of life and well-being for all people living at Stepping Stones such as empowering people to live a life of their choice.

The provider recognised that their values and the principles of Right support, right care, right culture guidance still needed to be fully understood and embedded into staff practices to ensure people were explicitly supported to live a fulfilled life.

People’s relatives told us that their loved ones felt safe living at Stepping Stones.

People’s personal risks had been identified and assessed which gave staff guidance on how they should support and monitor people to reduce their individual risks. Risks relating to the environment were now assessed.

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 16 June 2022).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also received information of concern in relation to people's care since our last inspection.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings of this 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Stepping Stones on our website at www.cqc.org.uk

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to person centred care at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.