St Mary's House

St Mary’s House is a residential care home providing accommodation and personal care for up to 24 people. The service provides care and support to older people, some of whom are living with dementia. At the time of our inspection there were 19 people using the service.

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

People using the service and their family members said they were happy with the support provided and would recommend the service to others. They told us they or their relatives were supported by staff who understood how to keep them safe and were kind, caring and respectful towards them.

People were supported by staff who were recruited safely, had appropriate training and were well supported by the registered manager. Staff understood how to safeguard people using the service and were confident any concerns they raised would be listened to.

Improved procedures were in place and followed for the safe management and administration of medicines.

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.

People’s care was planned around their wishes, preferences and needs. People and their relatives understood how to complain but had not needed to because they were happy with the care provided. They were confident that, if they contacted the home, the management team would respond to them promptly.

Systems were in place to monitor the quality of care people received as well as their satisfaction with it. People, relatives and staff were encouraged to share their feedback.

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 and update

The last rating for this service was requires improvement (published 24 April 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in March 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their management and administration of medicines.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 from requires improvement to good. This is based on the findings at this inspection.

We also 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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Mary's House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St. Mary's House is a privately-run home for up to 24 people over the age of 65, including people living with dementia. The home provides accommodation and personal care with any nursing services being provided by external health services.

People’s experience of using this service:

• At this inspection the service did not meet the characteristics of Good in all areas. In the areas of Safe and Well-Led the service met the characteristics of Requires Improvement. More information can be found in the full report.

• People did not always receive safe care and support. We found one medicine which was prescribed for an individual being administered generally to others.

• We found some staff records which did not contain sufficient evidence that staff had been thoroughly checked and vetted via the recruitment process.

• We found that there was a risk to people who lived on the top floor of the home of falling down stairs.

• There was no policy for the management of controlled drugs and controlled drugs were not covered in the "Administration of medication Procedure".

• There was no separate lockable fridge for medicines and records of daily temperatures were not taken.

• The service was not consistently well led. The registered provider carried out quality assurance checks however they were not effective in identifying areas for improvement.

• The registered provider had not reviewed or developed the service regarding management and quality assurance despite this being an area for action at the previous inspection in 2016.

• Elsewhere, people received effective care from staff who knew them and understood their needs.

• People and their relatives told us that they felt safe and well cared for in the home. People were complimentary about the quality of meals and how staff respected their dignity and privacy.

• We found where people lacked capacity that the appropriate authorisations were in place and being reviewed by the local authority.

• People accessed health care when needed and there were records in relation to hydration, nutrition, pressure area care monitoring and healthcare.

• People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff.

• The provider had a complaint process which people and relatives were aware of, although the home had an open-door policy which welcomed informal discussions and conversations whenever needed.

Rating at last inspection

At our last inspection of 5 and 6 September 2016 the service was rated “Good”.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

St. Mary’s House is a care home providing personal care for up to 24 older people, including people with dementia. At the time of our inspection there were 22 people living in the home.

There was an established registered manager who had worked in the service for many years. 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 and their relatives told us they felt safe and well cared for. Staff respected and understood people's need for privacy and promoted their independence. People were supported to maintain their hobbies and interests at home and in their local community.

At the time of our inspection most people living at St. Mary’s House had capacity to make decisions about their care. Their rights were protected because the registered manager and staff understood the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This is legislation that protects people who are not able to consent to their care and support, and ensures people are not unlawfully restricted of their freedom or liberty.

People's needs were assessed and reviewed to ensure they received all the support they needed. The care plan records included important information on how each person liked to live their life. People were fully involved in reviewing and providing feedback on the care and support they received, and relatives and family members were encouraged to contribute to the care planning of people.

Staff knew people well and knew when people were unhappy and how to respond to them. People and their relatives were encouraged to share their views about the care provided in the home. People knew how to complain and make suggestions, and were confident their views would be acted upon by staff and the registered manager.

People were supported to keep healthy and their nutritional needs and preferences were met. Any changes to their health or wellbeing or accidents and incidents were responded to quickly. Referrals were made to other professionals as necessary to help keep them safe and well.

St. Mary’s House was safely maintained and people lived in a home that met their assessed needs. Individual bedrooms were furnished to comfortable standards, were personalised and were homely. The standards of hygiene and cleanliness were good.

Staff understood how to protect people from harm and provide safe care. Staff knew how to recognise and respond to abuse correctly and had received safeguarding training. The service encouraged people to take positive risks whilst promoting their independence. Where risks were identified, there was guidance on the ways to keep people safe in their home and in the local community. Medicines were managed safely and people had their medicines at the times they needed them.

Staffing levels met the present care needs of the people that lived at the service. Staff received a structured induction and essential training to support them in their role. This was followed by on-going refresher training to update and develop their knowledge and skills. Staff also undertook training specific to the needs of people they supported. The provider recruited staff safely which helped ensure that people were protected from unsuitable workers.

The registered manager was also the registered provider and had been in charge at the service for a long time. She knew people and staff well and had good oversight of everything that happened at the service. The registered manager had values for the service, which were known and shared by the staff team. There was an open and inclusive atmosphere in the service and the manager showed effective leadership. Staff felt supported in their roles by the registered manager. Regular opportunities were available for staff to share any concerns or ideas they had to continuously improve their service.

The provider carried out regular audits and quality assurance measures to ensure people received a high quality level of care. There were on-going checks to monitor the health and safety of the service. Where improvements were needed or lessons learnt, action was taken.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at three care records and found that they contained details of people's personal wishes, assessments of health and social care needs, care plans, records of medicines and daily care notes.

We saw evidence that the home had clear procedures for reporting any concerns about possible abuse and that they followed the local authority's safeguarding policy. We saw that staff had police checks carried out as part of the recruitment process, as well as having to provide other basic details and references. All staff received mandatory training in safeguarding vulnerable adults and reporting allegations of abuse..

Medicines were being managed appropriately in the home. The latest audit by the local pharmacist carried out in June 2013 found that the home's procedures and recording were in "excellent order".

Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place.

Monitoring of the care provided at the home was done daily as the owner worked at the home and took time to speak with people and their visitors throughout the day. Staff were clear about their roles and duties due to well-laid out policies and procedures in the home.

We found that plans had been put in place to regularly monitor the views of people and that steps had been taken to ensure that all staff received regular supervision and appraisal.