St Anne's Home - London

St Anne’s Home – London is a care home which provides nursing and personal care for up to 34 older people who may be living with dementia. At the time of this inspection there were 32 people being supported in the purpose-built care home.

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

People were kept safe from the risk of harm or abuse. People using the service felt safe with staff at the service. Staff knew how report concerns of abuse. People had risk assessments in place. There were enough staff at the service to meet people’s needs and nobody had to wait long for support.

Staff were recruited safely. Improvements had been made in the management of medicines. People were protected from the risks associated with the spread of infection. Accidents and incidents were recorded and lessons learnt from these shared with staff.

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.

Managers and staff understood their role and responsibilities. The provider had reviewed their quality assurance systems which led to improvements in the delivery of safe care and treatment. People spoke positively about staff and managers. Staff and relatives spoke positively about the leadership in the service.

The provider involved people, relatives, staff and professionals in developing the service. People and staff had regular meetings so they could be updated on changes within the service. The provider carried out quality surveys to identify areas for improvement. The provider worked jointly with other agencies to improve outcomes for people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 December 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection, we recommended the provider seek guidance in relation to quality monitoring and auditing systems. At this inspection we found the provider had followed the recommendation and improvements had been made.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 November 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 safe care and treatment.

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.

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

We 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.

Follow up

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

We found the following examples of good practice.

Infection control was monitored as soon as you entered the service. Staff at reception ensured visitors signed in and wore appropriate personal protective equipment. This included wearing a mask, gloves and using hand sanitiser. Where people preferred to wash their hands there were facilities to do this throughout the home. Hand washing was encouraged as the best way to reduce the spread of the virus.

The service had a strict visiting policy to reduce the spread of the virus. Only one visitor was allowed in the service at any time and they had to book a time slot.

The provider was part of the NHS Test and Trace initiative to reduce the spread of Covid-19. There were consent forms for visitors to complete on their arrival at the service. Visitors details were stored for 21 days after the visit and destroyed unless they needed to contact Test and Trace. Consent Forms were also kept by the home for 21 days after the visit and then destroyed.

Further information is in the detailed findings below.

St Anne’s Home – London is a residential care home providing personal and nursing care to 32 older people at the time of the inspection. The service can support up to 34 people in a purpose-built care home.

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

People’s medicines needs were not always managed safely. There were inconsistencies in people’s medicine care plans and ‘as required’ medicine guidance. The service did not always follow their provider’s policy in relation to proper medicines management.

People trusted staff. Risks to people’s needs were identified, assessed and mitigated. People’s needs were met by enough and suitable staff who safeguarded them from the risk of harm and abuse. People were protected from the risk of infection. Incidents were investigated, and lessons learnt to minimise their recurrence.

People’s needs were identified before they moved to the home. People told us their needs were met by staff who were well trained and knew their needs. Staff received regular supervision and told us they felt well supported. People’s dietary needs were met. They had access to ongoing healthcare service.

The home was accessible. However, it was not dementia friendly. We have made a recommendation in relation to dementia friendly environment.

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 told us staff were kind and treated them with dignity and respected their privacy. People’s needs in relation to their protected characteristics were identified and met. People’s freedom was respected, and independence encouraged.

People’s personal needs were met by staff who knew how to provide person-centred care. People’s care plans were individualised. People were satisfied with the complaint’s process. There were systems in place to support people to have a pain-free and comfortable death.

People and staff told us the home was well-led and the registered manager was approachable. Staff told us they liked working at the home and they worked well as a team. The registered manager worked in partnership with other agencies to improve people's experiences.

The provider had quality assurance systems in place to assess, monitor and evaluate the service. However, these were not always effective. We have made a recommendation in relation to quality monitoring systems.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 16 November 2018) and there were three breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but were not enough and the provider was still in breach of a regulation.

The last rating for this service was requires improvement (published 16 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection.

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.

St Anne’s Home 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 Anne's Home provides accommodation for 34 people who require nursing or personal care. At the time of our inspection there were 32 people living at the home. Accommodation was provided over three floors and offered comfortable and spacious facilities. There were a number of independent flats attached to the home including separate living quarters for the Sisters. The aim of the provider is to offer the highest quality of care and security for older people, taking into account the particular conditions associated with the ageing process.

The service had a registered manager. 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 did not always receive time specific medicines at the correct time, which may have affected their health and well-being. The arrangements for storing medicines for people were not always robust. Medicines records were not always completed fully and accurately. We were not assured that appropriate arrangements were in place for the recording, using and safe administration of some medicines.

Staff told us they felt supported and received supervision and training. However, the home did not record formal supervision for all staff that worked at the service. Staff received appraisals twice yearly. The home had recruitment procedures in place however the provider did not have a system in place to update criminal record checks for staff.

The home did not follow their complaints policy whilst addressing people’s complaints. The home did not have an effective system in place to record and investigate complaints.

The home had monitoring and auditing systems in place to check the safety and quality of the service. However, they were not always effective in identifying gaps and errors. People, relatives staff, and health and social care professionals told us the senior management was approachable. People’s, relatives’ and health and social care professionals feedback was sought and considered to improve the service.

The service had appropriate systems in place for safeguarding people. Risk assessments were in place which provided guidance on how to support people safely. There were enough staff to meet people’s needs.

People were able to make choices about most aspects of their daily lives. People were provided with a choice of food and drink and supported to eat healthily. People had access to health care professionals and were supported to lead healthy lifestyles.

People and their relatives told us they liked the staff. We saw staff interacting with people in a caring way and staff had a good understanding of how to promote people’s dignity.

Care plans were in place and people were involved in planning the care and support they received. People had access to a wide variety of activities at the home.

We have made two recommendations about formal supervision for staff and continued suitability for staff to work with vulnerable people or people at risk.

We found the registered provider was not meeting legal requirements and was in breach of three Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe care and treatment, receiving and acting on complaints and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

This report only covers our findings in relation to this recommendation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Anne’s Home London’ on our website at www.cqc.org.uk’.

St Anne's Home provides accommodation for 32 people who require nursing or personal care. The home is situated in the town of Stoke Newington and close to community facilities. At the time of our inspection there were 32 people living at the home.

Accommodation was provided over three floors and offered comfortable and spacious facilities. There were a number of independent flats attached to the home including separate living quarters for the Sisters. The aim of the provider is to offer the highest quality of care and security for older people, taking into account the particular conditions associated with the ageing process.

The service had a registered manager. 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 in the home told us they felt safe. Staff followed environmental risk management plans and further training had taken place. Improvements had been made to the environment to mitigate identified risks and people had been informed of these changes.

St Anne’s Home provides accommodation for 32 people who require nursing or personal care. The home is situated in the town of Stoke Newington and close to community facilities. At the time of our inspection there were 30 people living at the home.

Accommodation was provided over three floors and offered comfortable and spacious facilities. There was a number of independent flats attached to the home including separate living quarters for the Sisters. The aim of the provider is to offer the highest quality of care and security for older people, taking into account the particular conditions associated with the ageing process.

The service had a registered manager. 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.

Staff had a clear understanding of safeguarding and whistleblowing procedures and had received training on how to protect people from harm.

Risk assessments had not always been followed in relation to the environment to ensure that they were always protected from avoidable harm. People’s healthcare needs were assessed to show how risks should be minimised and staff adhered to the guidelines.

The provider had the appropriate systems in place to ensure medicines were managed safely. Staff had received the required mandatory medicines training.

People’s nutritional needs were met and any dietary needs were managed appropriately. Special requests by people were included in the menus.

Good systems were in place to assess the suitability of the staff employed. Sufficient numbers of staff were available to meet people's needs in a timely way. Staff shared their knowledge and information on specific areas of training.

People were involved in decisions about the care they received and told us staff were kind and caring. People’s needs were assessed before they moved to the home.

Staff worked within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to a wide range of activities that were both individualised as well as meaningful for people. People’s religious, cultural and social needs were met and their wishes were respected and valued.

Reasonable adjustments were in place to support people with their healthcare needs. People were supported to maintain good health and to obtain treatment when required. Healthcare professionals spoke positively about the service.

Spacious well-equipped facilities were available to people and their privacy and dignity was respected. There was an effective transitional process in place for people when they were referred into the home.

Staff were well supported by the registered manager and enjoyed their work together as a team.

People’s views were sought on how the home was managed. Complaints had been responded to appropriately when they were raised.

The registered manager and provider had quality monitoring systems in place, which helped ensure that all areas of the service were working well. However, these were not always effective as they had failed to identify that staff were not always following an environmental risk management plan.

We have made one recommendation relating to safe care and treatment.

The service had developed links with local NHS professionals to support people with their health needs. We saw evidence of timely communication with community health services. People who used the service and their relatives spoke positively about staff. One said, "they always come if you need them." Another said, "they are very caring."

Staff received appropriate professional development. They said they were well supported in their roles with access to support when they needed, training and individual supervision.

People who used the service were asked for their views about their care and treatment and we saw evidence this had influenced the delivery of care. Senior staff monitored the quality of the service in a range of ways.