Archived: Stepping Out

Updated 13 February 2020

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 Care Act 2014.

Inspection team

The inspection was carried out by two inspectors and was announced.

Service and service type

Stepping Out is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at the service to speak with us.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service about their experience of the care provided. We spoke with seven members of staff including a representative of the provider, the registered manager, deputy manager, and support workers. We also spoke with one health professional.

We reviewed a range of records. This included three people’s care records and four medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one health professional, and one social care professional.

Updated 13 February 2020

About the service

Stepping Out provides short to medium term residential accommodation for up to seven adults with enduring mental health conditions, who would benefit from a short to medium stay in a residential setting. At the time of this inspection there were five people living in the service.

Stepping Out is a two storey house with five bedrooms on the first floor and two bedrooms on the ground floor. There are communal areas such as a kitchen and two lounge areas, together with outside space and a garden.

Stepping Out is a service that aims to support people to make changes in their lives to become more able to cope with day to day living. The aim is to empower people to reach their goals and develop coping strategies in preparation for independent living.

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

People and staff were at risk of avoidable harm; plans to manage known risks to people were unclear and did not provide staff with enough information to keep people safe. There was little evidence of learning from events or action taken to improve safety.

Staffing levels in the service were not adequate to ensure people and staff were safe at all times. Staff told us they did not always feel safe with the number of staff on shift.

People’s medicines were managed safely, and staff kept accurate records

Staff received relevant training, but this needed to be extended to include more in-depth training due to the increasing complexity of people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Support plans failed to take into account a full assessment of people's needs. One support plan was blank, despite the person having lived in the service for over three months. Old information was also contained within some support plans. Therefore, staff were not always able to support people in the most effective way as some information was not made available to them.

The provision of meaningful activity did not always meet people's individual needs. Some people told us that they would enjoy group activity, but due to staffing levels this had not always been possible. We have made a recommendation about this.

Governance systems in place were not sufficiently robust to enable the service to identify where safety and quality was being compromised, and to drive continual improvement. Accidents and incidents were not analysed in order to identify trends or patterns and therefore mitigate future risk.

Despite significant shortfalls in the safety and governance of the service, people praised the kind and caring nature of staff. We observed positive interactions between staff and people throughout the inspection. People repeatedly gave us positive examples of how staff had changed their lives for the better and helped them reach their goals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published 31 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive, and well-led sections of this full report.

The provider took some immediate actions during and following the inspection, such as increasing staffing levels and arranged for a health and safety review of the premises.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, person-centred care, governance, and reporting procedures.

Following the inspection we formally requested additional information from the provider in relation to governance systems and processes that will support people’s immediate safety.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.