This inspection took place on 26 March and 12 April 2018. The first day of the inspection was unannounced. This meant the provider did not know we would be visiting.

St Stephen's Court is a residential care home providing accommodation and nursing care for up to 30 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 29 people living at the service.

The service was last inspected in December 2016 when we found one breach of the Health and Social Care Act 2008. This related to Good Governance. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation although further improvements were ongoing.

A registered manager was in post. 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.

At the last inspection we found not all aspects of the service were safe. Our concerns related to safety of the premises, risk assessments and infection control. We also found that not all aspects of the service were well led.

The provider submitted an action plan after the last inspection explaining how they would become compliant. At this inspection we found improvements had been made and the service was now rated good. Individual risks to people were assessed and plans were in place to mitigate these. Visiting professionals were complimentary about the way the registered manager and staff managed risks. They told us security had also improved. Systems for auditing the quality and safety of the service had improved and the registered manager and deputy had a good overview of the service.

Medicines were managed safely and there were suitable procedures in place for the ordering receipt storage and administration of medicines. We found one treatment room was dusty on the first day of the inspection and this was clean and well ordered by the second day. The registered manager told us she would add this to their list of routine checks. The rest of the home was clean and tidy. A small number of rooms had some malodour but this was addressed during the inspection.

Routine safety checks were carried out on the safety of the premises and equipment. This included fire safety checks. The premises were generally clean and tidy and were safe at the time of the inspection although staff reported some delays with repairs. We have made a recommendation about this.

We observed and visiting professionals told us there were suitable numbers of staff on duty. We observed people being cared for at their own pace.

Suitable procedures were in place for the recruitment of staff. Appropriate checks on the suitability of staff to work with vulnerable people were carried out.

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

The service demonstrated a good understanding of the Mental Capacity Act (2005) and documentation related to this was well maintained. Where people lacked capacity, decisions made in the best interests were appropriately recorded and kept under review.

People’s nutritional needs were met and their nutritional status was monitored and appropriate action taken when necessary. Some people said the menu could be repetitive which we fed back to the provider.

People had access to a variety of health professionals. They told us staff cared well for people, they were contacted for advice in a timely manner and their advice was followed by staff

This was an unannounced inspection which took place on the 28 and 30 November and 14 December 2016. The service was last inspected in December 2015 and breaches in regulations were found relating to person centred care, dignity and privacy, safe care and treatment, food and hydration, premises and equipment, complaints, governance and staffing. The provider submitted an action plan after the last inspection explaining how they would become compliant.

St Stephen's Court is a residential care home providing accommodation and nursing care for up to 30 people. Care is provided for people with learning, neurological and physical disabilities. At the time of the inspection there were 29 people living at the service.

The service had a registered manager in post. 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.

The service had not identified a number of issues in checks and audits which we found at inspection. These related to hygiene and maintenance of key areas of the home.

The service was not operating in line with its statement of purpose and public website. They were not running as five specialist units, but as two larger units with a varied mixture of staffing and people’s needs. The registered manager agreed to review how the service and staff was managed to support differing needs and capacity support requirements of people using the service. Staffing levels were appropriate, but the levels of staff turnover and absence meant that staffing deployment required daily management support. Staff were recruited safely and nursing staff were supported in helping people with complex support needs, including medicines.

Staff morale had been identified for an area of improvement by the provider. An action plan had been drafted for completion in mid-2016, but to date no effective action had been taken. Staff told us they felt this was the major issue holding back the service. The provider told us about their plans to improve staff morale and reduce staff turnover in future.

Some staff training to use the hydrotherapy pool was not kept up to date as staff left, resulting in people being unable to use this part of the service. We have made a recommendation in respect of this.

People care plans had been updated and the service has implemented a person centred approach when planning the delivery of care. Care plans were detailed and described what people's complex support needs were. People told us they felt involved in their care and its review. Where people lacked capacity we saw that best interest’s decisions had been made in line with the requirements of the Mental Capacity Act.

People felt the service offered to them was caring and supported them to achieve their personal goals and ambitions. We saw that staff supported people to maintain their dignity and privacy, as well as to develop skills and personal interests.

The provider’s response to some on going and low level complaints and issues was not consistent. Some issues were not being effectively managed or feedback given to people who raised issues.

The service had offered an innovative and popular activity making a summerhouse, and they planned to build on this in the future. People were supported to access activities or develop their self-care skills. The service had facilities to support this.

Improvements had been made to the service delivery since our last inspection, but identified improvements around hygiene practice, had not been embedded by the provider. Action had not been taken promptly to resolve these issues.

The registered manager and deputy manager were visible to people, staff and external professionals and we were told they were thought of as caring and skilled in supp

This was an unannounced inspection which took place on the 10 December 2015. The service was last inspected in June 2015 and was meeting the regulations in force at the time.

St Stephen's Court is a residential care home providing accommodation and nursing care for up to 30 people. Care is provided for people with learning, neurological and physical disabilities. At the time of the inspection there were 27 people living at the service, including one person receiving respite care. One person was in hospital.

The service did not have a registered manager, but had an acting manager who was in the process of applying to register. 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 told us they felt safe living at the service and that staff knew how to act to keep them safe from harm. Safeguarding alerts were raised with external agencies however there was limited review and learning by the service after incidents had occurred. The provider reviewed long term trends and supported services to improve. The building and equipment were not always well maintained. We found that some repairs were required and areas needed improved cleaning to control the risk of infection. Staff worked with people to improve their environment and self care skills.

We observed that people had to wait for staff to respond to their needs at times. People told us staffing levels, staff absence and use of agency staff were an issue. Staff were not always properly trained and supported to meet people’s behaviour support needs. We observed that some staff lacked the skills to support people’s behaviour. Not all staff had received appropriate checks by an appropriately skilled person to provide PEG feeding assistance.

Medicines were managed well by the staff and people received the help they needed to take them safely. Where people’s needs changed the staff sought medical advice and encouraged people to maintain their well-being. External healthcare professionals’ advice was sought quickly and acted upon. There were regular meetings with external healthcare professionals.

People were supported by staff who did not always know how best to support them. Staff were generally aware of people’s choices and how they preferred to be cared for, but some care plans lacked personal details. Where decisions had to be made about people’s care, families and external professionals were involved and consulted as part of the process. The service did not always respond quickly to people’s needs as they changed over time. Some reviews of care plans we saw lacked detail about how best to support the individual as their needs changed. The service looked to ensure that records were kept to demonstrate that reviews were occurring. The service supported people to access appropriate external healthcare support so the staff could keep them safe and well.

People were not always supported to maintain a suitable diet. Not all staff were aware of people’s dietary requirements and people told us the choices of food were sometimes limited. People told us there was times when portions were limited. Feedback from the service showed that people could have additional portions or access a skills kitchen themselves. However, not all people seemed to be aware of this or staff did not suggest this to them.

Staff were caring and valued the people they worked with. Some staff showed kindness and empathy in responding to people’s needs. However others did not interact well with people and we observed some negative interactions between staff and people.

Privacy and dignity were not always respected by the staff team. Care notes were not always stored in a confidential manner.

The service did not respond cons

People or their representatives were provided with the information they needed to make an informed decision about the care provided. They were asked to consent to that care. We saw the benefits and risks of care were explained.

People’s needs were assessed effectively. We saw people experienced care, treatment and support that met their needs.

Procedures were in place to manage medicines correctly. There were enough qualified and experienced staff to provide care.

The provider had an effective complaints system in place. Complaints were taken seriously and responded to appropriately.

People who used the service were positive about the care and support provided. Comments included “The care received is very good” and “The carers are very caring.”

We used a number of different methods to help us understand the experiences of people using the service, because most people using the service had complex needs which meant they were not all able to tell us their experiences.

We saw that people were cared for effectively and that care was planned for the individual. We saw that the home had effective systems in place to monitor its performance and manage emergency procedures. We saw that people were safe.

However we found that there was not always sufficient suitably qualified and experienced staff on duty.

The people staying in the service and the visitors we met during the visit were very positive about the way that the home was managed. Comments included: “I like it here” and “I like helping to do the house work with staff”.

Many of the people living in the home had difficulty in communicating verbally, but one person told us that they were well looked after, and that the staff treated people with respect. This person said that they were happy living in the home, were comfortable, and couldn't think of any ways to improve the home. Another person living in the home told us, "I like it here".

We spoke with a number of visiting relatives. One told us they were "ecstatic about the care!". A second told us that, "I'm really pleased. The carers are so loving. [My relative] is well looked after and is happy here".

Another relative said that "[My relative] has settled down well and is being well cared for." A fourth relative commented, "[My relative] is really happy here, it's brilliant, so much going on and so many activities.

We inspected St Stephen’s Court on 10 and 11 June 2015. The first day of our visit was unannounced. We last inspected the service in July 2014. At that inspection, we found breaches of legal requirements in two areas; supporting staff and assessing and monitoring the quality of service provided. We asked the provider to take action to make improvements and they told us they would be fully compliant with the regulations by 31 October 2014. On this visit we found improvements had been made in both of the regulations that had been previously breached and the registered provider was now meeting current regulations.

St Stephen's Court is a residential care home providing accommodation and nursing care for up to 30 people. Care is provided for people with learning, neurological and physical disabilities. At the time of the inspection there were 28 people living at the service.

The service did not have a registered manager and was being managed by an acting manager. We were informed a new manager had been recruited and was due to commence their employment on 1 September 2015. 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 using the service told us they were well cared for and felt safe at the home and with the staff who provided their care and support. Financial checks and procedures were in place to protect people’s personal possessions and valuables.

Staff members had a good understanding of safeguarding adult’s procedures and knew how to report concerns. A whistleblowing policy and information was available for staff to report any risks or concerns about practice in confidence within the organisation.

Staffing levels were sufficient to meet people’s needs. Employment procedures ensured that appropriate recruitment checks were undertaken to determine the suitability of individuals to work with vulnerable adults.

Medicines management and arrangements were appropriate, effective and safe. Medicines records were accurate, complete and stored securely.

People had up to date and appropriate risk assessments in place to ensure risks were identified and reduced. Accidents and incidents were reviewed and analysed regularly to identify possible trends and to prevent reoccurrences. Duty managers were available out of hours for advice and in the event of an emergency.

People received care from staff who were now provided with effective training to ensure they had the necessary skills and knowledge to effectively meet their needs.

Staff now received regular supervisions and annual appraisals were carried out. All new staff received appropriate induction training and were supported in their professional development and there were regular opportunities for promotion.

The requirements of Mental Capacity Act 2005 (MCA) were followed and Deprivation of Liberty Safeguards (DoLS) were appropriately applied to make sure people were not restricted unnecessarily, unless it was in their best interest. Detailed information was readily available for staff.

People were supported to make sure they had enough to eat and drink and their nutritional needs were met to ensure they stayed healthy. They told us they enjoyed the food prepared at the home and had a choice about what they ate.

People were supported to have access to healthcare services and referrals had been made to health professionals for advice and guidance where required. The home was well appointed, furnished and decorated throughout. The home was clean, tidy and well maintained.

People spoke positively about living at the home and told us staff treated them well. Relatives we spoke with told us they felt people were well looked after and cared for.

Staff interacted well with people and they were patient, unhurried and took time to explain things to people clearly. We saw staff were approachable, attentive and well organised. There was a calm, friendly and relaxed atmosphere throughout the home.

Staff acted in a professional and friendly manner and treated people with dignity and respect. We observed staff supporting people and promoting their dignity. Staff regularly checked on people to see if they needed support or assistance.

People were encouraged by staff to be independent, and maintain hobbies and interests that were important to them. People’s relatives were involved in the care and support of their family member. Care records confirmed the involvement of people in care planning and reviews.

Advocacy information was accessible to people and their relatives. Relatives told us communication with the home was good. Meetings for people using the home and their relatives were held every month. Surveys were undertaken and people’s feedback was acted upon.

People’s care records were up to date and accurate. Where applicable health and social care professionals were involved in reviews. Staff were knowledgeable about the people they cared for and understood their needs.

People and their relatives felt able to raise any issues or concerns and complaints received by the service were dealt with effectively.

People and relatives we spoke with were positive and complimentary about the range of activities available and how people were engaged and motivated.

We received positive feedback from people, their relatives and staff about the management team and how the home was run and managed. A new manager had been recruited and was due to commence their employment at the home.

Management now regularly checked and audited the quality of service provided and made sure people were happy with the service, support and care they received. Up to date and accurate records were kept of equipment and systems servicing and maintenance.

The home had an inclusive, warm and enabling atmosphere. People integrated well with each other. The provider had links with another organisation to develop their knowledge and ensure they were up to date with best practice.

Staff meetings were regularly held. Staff told us they felt management at the home were approachable, they were supported to do their job and felt they were part of a close staff team.