Archived: St Anthony's Court

At the previous inspection, we asked the provider to take action to ensure their quality assurance processes identified concerns early enough to prevent them turning into issues. In February 2014 the provider performed their own audit, using new systems. At this inspection, we found the provider's new audit had outlined a wide range of areas, which showed they remained non-compliant. They had put new management systems in during April 2014 to address the deficits they identified.

We considered our inspection findings to answer questions we always ask;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

People generally made positive comments about the care provided. One person reported 'they look after me all right,' and another 'they're very good.' Some people felt improvements could be made. One person told us 'the care depends on who looks after you' and another 'a couple of nurses are quite nice, others' the person then looked down and shook their head.

We observed staff patiently and kindly supporting a person who was living with dementia. The person swore at the staff more than once. Staff remained consistently polite and professional while they appropriately supported the person with their mobility. We observed staff caring for people who were frail and remained in bed most of the time. They consistently treated them in a friendly, kindly manner, addressing them by their own preferred name.

The acting manager told us they had successfully recruited more staff, reduced agency staff usage and were reinstating a key worker system, to ensure people were cared for as they wished and needed.

Is the service responsive?

People reported staff did not always respond promptly when they used their bell. One person told us 'bell response varies.' We observed a person who waited over four minutes when they rang their bell to receive assistance to go to the toilet. The acting manager told us they were in the process of performing an analysis of staff response time to call bells to ensure improvements took place.

Many of the people and staff we spoke with felt they needed to know more about how the management were responding to the need for change in the home. The acting manager told us they were in the process of setting up meetings to receive comments from people living in the home, their supporters and staff. One staff meeting had been held already.

Several of the people raised concerns with us about hairdressing. One person told us 'we used to have a hairdresser but not anymore.' The acting manager reported they had also received comments about the hairdressing service. They were in the process of responding by setting up a meeting to review the service and how improvements would be made.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to responding to people when assessing and monitoring the quality of service provision.

Is the service safe?

We saw cleanliness varied across the home. This included chairs, wheeled equipment and sluice rooms. The laundry area was dusty. Appropriate equipment was not consistently provided to prevent risks of cross infection across the home or in the laundry. The acting manager had recently increased hours for cleaning. They also had plans in place to improve systems for infection control, including staff training.

The home had not been maintained regularly, with a wide range of areas needing attention. A maintenance worker had recently been recruited. They were working their way through the areas needing maintenance. Parts of the home did not provide a suitable environment for some of the people living here. The provider told us they would be performing a review of the home environment. They would then develop an action plan for improvements.

Staff told us they had not always received an induction onto their role. Relevant training had not always taken place and some of them had not received regular supervision. This was reflected in staff training and supervision records. The acting manager had identified staff support as an issue. They had put in an action plan to address deficits.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had been submitted from this home. The acting manager reported they had identified deficits in staff training. They were working through a programme to ensure all staff were trained as relevant to be aware of their responsibilities in this area.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control, safety of the building and staff support, to enable them to meet people's needs.

Is the service effective?

The provider's audit of February 2014 had identified deficits in care provision. Since then people had all been reassessed for risk of pressure ulcers and relevant plans were being developed.

We saw the provider's new systems were not yet fully operational. Staff we spoke with knew about meeting people's needs but what they told us showed they did not always respond in a consistent manner. For example staff told us about differing approaches to supporting a person who was at risk of dehydration and a different person who had catheter care needs.

Some people's care plans had not been revised when needed. For example we saw a person had risks relating to when they used their wheelchair. They did not have a risk assessment and their care plan had not been revised for over a year. Some people did not have monitoring systems put in place when needed. For example one person experienced anxiety which staff knew about, but as they did not have monitoring records, any trigger factors and the frequency of their anxious behaviours could not be assessed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care and welfare of people.

Is the service well led?

The home had a registered manager. This person was not always available in the home as they managed another home close by. At the time of this inspection the home was being managed by an experienced acting manager who had worked in a range of homes for the provider.

The provider had introduced a new, more detailed system for audit. This audit had been performed in February 2014. It had identified a wide range of areas which needed to be addressed. The acting manager told us they had identified further issues relating to quality of service provision since they had started working in the home in April 2014. They were working through a process of identifying all of the deficits in service provision and making sure relevant actions took place. For example they had ordered new beds with integral bed rails to replace the old deteriorated beds in the home. Once they had ensured immediate necessary actions had taken place, they would go on to develop a detailed long-term plan for improvements in the home. The acting manager reported they would be continuing to work in the home to ensure improvements in service provision were identified and acted upon.

The records we saw showed us that people's care was comprehensively planned and reviewed. Two of the relatives we spoke to told us "I have no concerns about the quality of care my mother receives" and "I feel confident that Mum is safe and well looked after". One member of staff told us "I like working here, it feels like home".

We saw records that showed us that staff had received training in safeguarding people from abuse and when we spoke to staff they spoke confidently about how to report any concerns.

During our inspection the manager told us about some concerns that had been raised relating to infection control and the measures they had put in place to address these.

We found that people's views and experiences were taken into account in the way the service was delivered in relation to their care. One person commented "I see the manager or deputy almost every day and I could talk to them if I had any concerns."

The provider had effective systems to monitor the quality of service that people received. There were also effective systems to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.