Background to this inspection
Updated
13 October 2022
Inspection team
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 three inspectors.
Service and service type
Winterbourne Steepleton- Steepleton Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, this included notifications made by the service and concerns raised with the Care Quality Commission. We sought feedback from the local authority and Clinical Commissioning Group (CCG) who work with the service. We used all of this information to plan our inspection.
The provider was not 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.
We used information gathered as part of monitoring activity that took place on 27 May 2022 to help plan the inspection and inform our judgements. In addition, we also used feedback from the manager’s CQC registered manager’s interview.
We used all of this information to plan our inspection.
During the inspection
Inspection activity started on 20 June 2002 and ended on 6 July 2022. We visited the service location on 20 June 2022.
We spoke with 11 people who used the service about their experience of the care provided and with one visiting relative. We spoke with nine members of staff including the operations manager, manager, head of care, nursing and care staff, maintenance staff and housekeeping staff.
We reviewed a range of records. This included elements of five people's care plans and care records. We looked at MCA assessments, best interest decisions and Deprivation of Liberty Safeguards applications. We looked at a variety of records relating to the management of the service.
We also held a remote video call with the manager to discuss the governance arrangements at the service and to give inspection feedback to the provider, operations manager and manager.
After the inspection visit
We continued to seek clarification from the manager and provider to validate evidence found. We looked at further records related to two people. We also reviewed records related to governance and oversight. The provider gave us a summary of the governance arrangements in place following the departure of the previous registered manager.
We asked the manager to share a poster asking people, staff and family and friends to contribute to our inspection. We did not receive any feedback from this.
Updated
13 October 2022
About the service
Winterbourne Steepleton- Steepleton Manor is a residential care home providing nursing and personal care to up to 32 people. The service provides support to predominately older people. At the time of our inspection there were 19 people using the service.
People’s experience of using this service and what we found
Some people could not be consistently confident that the risks they faced would be assessed, mitigated and monitored.
Overall, people’s medicine management was safe. However, improvements were needed to the safety of unwanted medicines waiting for collection.
Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Overall, staff followed recommended IPC practices with some minor areas for improvement. Safe visiting was supported.
There was a poor understanding of The Mental capacity Act 2005 and this meant people were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Actions were taken following the inspection visit to make sure any restrictive practices were reviewed with people and or their representatives.
People’s needs were assessed. However, their emotional and social wellbeing needs were not consistently planned for or were consistently delivered in a person-centred way.
The governance systems were not entirely effective and had not identified the shortfalls found at this inspection.
The registered provider and manager took actions in response to our feedback and findings. However, we were not able to assess the impact of these actions on people’s experiences at this inspection.
People felt safe and were comfortable and relaxed with staff who supported them. Relatives told us they felt their family members were safe and overall were well cared for. Throughout the inspection we saw relaxed, kind and caring interactions between staff and people. People received good quality nursing care.
Overall, there were enough staff to meet people's needs but some people experienced some delays in support at mealtimes. There was a staff team who knew people well and they were recruited safely.
There was an open, improving and positive culture within the home and people, staff and a relative told us the manager and staff team were approachable and helpful.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was good (10 March 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed to requires improvement following 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.
Enforcement
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 found breaches in relation to risk management, understanding of the MCA and governance at this inspection.
Please see the action we have told the provider to take at the end of the full version 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.