St Teresa's - Care Home with Nursing Physical Disabilities

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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’s experience of using this service and what we found

People said they felt safe and well cared for. Relatives agreed with this view and commented “They have really kept all the residents very safe and they have thought about the residents as opposed to themselves – that is clear.”

There had been several changes in the management of the service since the last inspection. The recently appointed registered manager and regional manager had implemented the Leonard Cheshire organisation policies and procedures at the service. Staff found some of these changes challenging. For example, a review of staffing levels and deployment of staff around the service. Meetings with senior managers, human resources and staff were held to reach a compromise in how staff would be deployed around the service. Staff felt listened to and were satisfied with the allocation of core staff to particular units so that people could be supported by staff that knew them well.

People told us, as did relatives (with one exception) that there were sufficient staff on duty to meet people’s needs. Staff felt if the staff rota was adhered to there would be sufficient staff on duty to meet peoples care needs. The difficulties arose when staff went sick at short notice or did not turn up for shift. When this occurred staff completed additional shifts or agency staffing was arranged. The provider has reviewed and continues to monitor staffing levels across all departments.

Appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people.

People told us ‘residents’ meetings were held so that they had the opportunity to share their ideas on how the service was run. They also felt able to speak with the staff at the service.

People said the quality of meals had ‘improved’ and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition.

Care plans contained information about people and their care needs. People were supported to make choices and had their support provided according to their wishes.

People were supported by staff who had received training to ensure their needs could be met. Staff received regular supervision to support their role.

People had good health care support from professionals. When people were unwell, staff had raised any concerns with health professionals to address their health care needs. Staff worked in partnership with health and care professionals.

Staff were patient and friendly, and people's privacy and dignity were respected. Staff knew how people preferred their care and support to be provided.

People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had followed national and local Infection, protection and control guidance in line with the Covid-19 pandemic. The providers policy covered the use of PPE, handwashing, cleaning protocols, testing and the visiting policy: which had been recently reviewed to help visitors to see their families safely.

Systems were implemented to ensure the effective management of medicines. Staff who were administering medication were trained.

There were effective quality assurance processes in place to monitor the quality and safety of the service. There was clear provider oversight and they had ensured effective and competent management was in place.

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 24 January 2018).

Why we inspected

We received concerns in relation to staffing levels and the impact this had on the quality of care and support that was being provided. We also received some concerns about the management of the service. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Teresa’s- Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

St Teresa's - Care Home with Nursing Physical Disabilities is a 'care home'. 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.

St Teresa's - Care Home with Nursing Physical Disabilities provides single room accommodation for up to 27 people with nursing physical disabilities. At the time of the inspection there were 26 people using the service including two people who were staying at St Teresa’s on periods of respite. The service is based in a purpose built single storey detached property which was suitably adapted for the purpose of providing nursing care and support to people. St Teresa’s is close to the local amenities in Marazion and Penzance.

There was 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.

Some people who lived at St Teresa’s had limited communication skills meaning we were unable to gain some people’s verbal views on the service. We observed staff interactions and spoke with seven people who lived there. We observed that people were relaxed, engaged in their own choice of activities and appeared to be happy and well supported by the service. We also spoke with people’s relatives and staff to understand their experiences.

The atmosphere at the service was welcoming, calm and friendly. The service was divided into three units but people moved freely between each one. Each unit area provided large lounges and dining areas suitable for people to use with mobility aids. People were able to spend their time in various areas of the service as they chose. There were a range of mobility aids and equipment to support people. People's bedrooms were personalised as were the furnishings in lounge areas.

Some people had complex needs and were not able to tell us about their experiences. Comments from those people we spoke with about the quality of their care and support were positive. People told us, “They [the staff] have given me a life back, I can do things I thought I would never do” and “This is our home, not just a care home.”.

We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect. People told us, “Staff are lovely, they will do anything for you.”. Staff demonstrated a good depth of knowledge about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals.

St Teresa’s used a staffing assessment tool to work out the required numbers required to staff the service. Staffing levels were perceived to be low by both service users and staff. People commented, “They could do with more staff. I know other people need help too but sometimes I have to wait for a really long time before it’s my turn to get up” and “It’s an excellent place, they do an excellent job but the staff are really stretched.” Staff commented, “Our units are pretty well staffed. Recently we have had a large amount of sickness which is unusual. It is rare for us to have agency but we have had to use agency recently”. We spoke with the registered manager about this and were shown the staffing assessment that demonstrated that the core staffing hours was currently being met. The registered manager said she was aware that due to recent staff illness and increasing complexity of people’s care needs there had been additional pressure on staff. The registered manager was in the process of undertaking a new assessment for people whose needs were increasing to ensure there were adequate funds in place to increase staff numbers when required.

One nurse was available to provide nursing support to people. Staff told us this put pressure on the nurse on duty due to the complexity of people’s needs. A relative of a person who lived at St Teresa’s shared their concerns about staffing levels generally and in particular about the availability of appropriately trained staff to support their relative with their feeding regime. The deputy manager told us specialist training to support individual feeding regimes had been provided to staff on one of the three units but had not yet been provided to staff on other units.

We have made a recommendation about staffing levels in the Safe domain of this report.

People's care and support needs had been assessed before they moved into the service. This included risk assessments to ensure peoples safety. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence. For example, we saw risk assessments regarding appropriately supporting people to access their local community as well as keeping safe in their home environment. People told us, “I feel safe, I don’t have to worry about what will happen to me all the time, knowing someone is always around, it’s a good feeling.”

People had a care plan that provided staff with direction and guidance about how to meet people’s individual needs and wishes. Care records included details of people's choices, personal preferences and dislikes. These were regularly reviewed and any changes in people’s needs were communicated to staff.

Staff had been recruited safely and received training relevant to their role. Staff said they were supported by the registered manager. They had the skills, knowledge and experience required to support people in their care.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

The service was suitably maintained. It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedure in place to manage infection control risks.

Medicines management systems were robust. Staff were confident about the action to take if they had any safeguarding concerns and were confident the registered manager would follow up any worries they might have.

The service worked successfully with healthcare services to ensure people's health care needs were met. People were supported to access services from a variety of healthcare professionals including GPs, dentists, psychological services, occupational therapists as well as other specialist medical services to provide additional support when required. Health and social care professionals were positive about the service, comments included, “I feel that St Theresa’s Nursing Home is generally a well run home with caring staff who are always are happy and willing to accommodate any visits from [multi-professionals].”

People's nutrition and hydration needs were being met. The cook had information about people's dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Staff were positive about their work and confirmed they were supported by the management team. Staff received regular training to make sure they had the skills and knowledge to meet people's needs. The service had signed up and achieved the Gold Standard Framework. This aimed to provide optimal care for people approaching the end of life.

We found the building generally met the needs of people who lived there. For example, corridors were wide and spacious for people who used a wheelchair. There was overhead tracking available in two of the wings of the building which accommodated 18 people and had en-suite facilities to their bedrooms which meant people's movement was less restrictive. There was insufficient signage available to help people orientate around the service. For example, each unit had a small naming plate at the entrance but this was difficult to read. There was a lack of signage for communal toilets. This would negatively impact users with visual or learning impairments. We brought this to the attention of the registered manager who told us she would ensure clearer signage was made available to help orientate people around the service.

There was a complaints procedure which was made available to people on their admission to the home and their relatives. People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Complaints received were investigated and issues raised were dealt with in a timely way with the complainant being informed of the outcome.

There were regular feedback opportunities for people to give their thoughts on how the service was working. This included a compliments, complaints and suggestions book on main reception for people to leave their comments. The organisation also employed a regional customer support advisor. They visited the service and spent time with people regularly to gather people’s views. There was also an annual ‘Have Your Say’ survey. This was provided to all people who used the survey. The last results of the survey in 2017 demonstrated people were happy with the care and sup

The service received a comprehensive inspection in March 2014 at which time it was found to be meeting the requirements of regulations.

The service is required to have a registered manager and at the time of our inspection 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.

People who used the service were looked after by staff who understood they had a duty to protect people from harm and abuse. Staff had been suitably trained to recognise potential signs of abuse and knew how to report abuse. Staff said they would raise issues with the registered manager or local authority.

The atmosphere at the service was welcoming, calm and friendly. The service was divided into three units but people moved freely between each one. Each unit area provided large lounges and dining areas suitable for people to use with mobility aids. People were able to spend their time in various areas of the service as they chose. There were a range of mobility aids and equipment to support people. People’s bedrooms were personalised as were the furnishings in lounge areas.

Some people had complex needs and were not able to tell us about their experiences. However comments from those people we spoke with told us they felt safe because there were sufficient staff on duty to meet their needs. Comments included, “The staff are always around I don’t have to wait long before they [staff] answer my call” and “You never have to wait long. I don’t need as much help as some people but you never see the staff having to rush around”. People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure peoples safety. Care records included details of people’s choices, personal preferences and dislikes.

Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

The medicines system was well organised, and people received their medicines on time and there were safe systems for storage. People had access to a general practitioner (GP), and other medical professionals including a dentist, chiropodist and an optician. Where referrals for further investigation were made by a GP, staff had made sure records were regularly updated so there was a clear audit trail for any prescribed treatment.

People’s nutrition and hydration needs were being met. The cook had information about people’s dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Staff were positive about their work and confirmed they were supported by the management team. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs. The service had signed up and achieved the Gold Standard Framework. This aims to provide optimal care for people approaching the end of life.

We found the building met the needs of people who lived there. For example, corridors were wide and spacious for people who used a wheelchair. There was overhead tracking from everyone’s en-suite facility to their bed which meant people’s movement was less restrictive.

People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Complaints received were investigated and issues raised were dealt with in a timely way with the complainant being informed of the outcome.

The management team used a variety of methods to assess and monitor the quality of the service. People and their relatives were asked for their opinions about the service. Regular audits of the service were undertaken which helped to monitor, maintain or improve the quality of service provided to people. Response from this monitoring showed that overall satisfaction with the service was very positive.

This inspection was completed as at our previous inspection in July 2013, we had concerns about staffing levels at the Trelowan unit. Subsequently we issued a compliance action requiring the registered persons to improve staffing levels. At this inspection we judged the improvements made as satisfactory but have suggested they still need to be kept under close review.

Prior to this inspection we also received concerns from a member of the public regarding standards of cleanliness, storage arrangements for medication, that people who lived at the home did not get their incontinence pads changed as frequently as they should, and staff were not trained appropriately.

As a consequence of the concerns which were raised to us, we inspected the relevant outcome areas as part of this inspection. This inspection concluded there were no concerns about standards in these areas.

We were able to speak with several of the staff on duty, and people who lived in the home. The people we spoke with were all positive about their experiences.

In summary people who lived in the home were cared for to a high standard. Systems regarding the storage, administration and recording of medication were appropriate. The home was clean and staff received appropriate training about infection control standards. Staff were trained appropriately, appeared knowledgeable about their roles, and appeared caring in their attitudes. There were appropriate levels of staff available to people.

This inspection focused on the Trelowan unit. This was because at the previous inspection, when we inspected all the units, we had particular concerns about staffing levels at the Trelowan unit.

The inspection was carried out over two days. We spoke with five of the people who lived at Trelowan. People were positive about the care they received, the food provided and staff attitudes.

When we inspected the home it was clean and odour free. The home was well maintained, well-furnished and decorated to a good standard. Leonard Cheshire planned to redevelop the Trelowan unit in the next year which will provide a more purpose built facility for people with physical disabilities.

We had concerns about staffing levels at the home and improvement was required in this area. Staff recruitment processes and training were to a good standard.

On the day of the inspection, we spoke with 12 of the 25 people who lived at St Teresa's. People were positive about the care and support they received. Comments regarding the care included 'it's great,' 'everything is tickety boo' and the home was 'my home,' 'a very nice place,' 'is appropriately adapted for our needs and is always kept clean.' People said the food was to a good standard, there was a relaxed atmosphere, there were no fixed routines and choice was encouraged regarding what people wanted to do and eat.

When we inspected the home was clean and odour free. The home was well maintained, well furnished and decorated to a good standard.

We had some concerns raised regarding staffing levels, although staff were observed working professionally and doing their best to meet the needs of the people that lived in the home. Quality assurance systems were satisfactory.