St. Catherines Residential Care Home

People’s experience of using this service:

At our last inspection we found two breaches of the regulation in relation to providing safe care and the quality monitoring of the service. At this inspection we found that many improvements had been made and the breaches of the regulations had been met. However, some improvements were still required in some areas to ensure that people received consistently safe care.

Some staff needed to complete their training on how to support people to move and transfer safely. Staff needed to ensure they followed people’s risk assessment consistently to ensure they received safe care. Care records were not always completed to show that care and support had been provided in line with people’s assessed needs.

People and relatives told us about how things had really improved at the home. People told us that

more activities were taking place and the environment had been improved. The quality monitoring systems had been improved this meant that checks on the day to day running of the service were being made so areas requiring improvement where being picked up on and improvements made.

Staff were kind and had built good relationships with the people receiving care and support. Staff protected people’s privacy and treated them with dignity. Activities were varied and person-centred. People received their medicines as required. People and Relatives knew who to contact if they had any complaints.

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

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

Rating at last inspection and update: The home was rated requires improvement at our last inspection (May 2018). 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.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor information we receive about the service until we return as per our inspection programme. If we receive any concerning information, we may inspect sooner.

At the time of our last inspection in January 2018 which was a focused inspection, the service was rated as requires improvement. We undertook that inspection to check that the provider had made the required improvements that were identified in our previous comprehensive inspection in July 2017.We found at our inspection of January 2018 that although some improvements had been made we felt sufficient progress had not yet been made, or sustained to satisfy the requirements of regulations 12 or 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ( HSCA). Regulation 12 was not met because the provider had not always ensured that there were sufficient numbers of staff available to meet people’s needs in a safe and timely way. The environment did not always promote safety and comfort and safe recruitment practices had not always been followed to protect people from the risk of receiving care from unsuitable staff. Regulation 17 was not met because the provider’s quality monitoring systems and processes had been ineffective. At this inspection we found that although some progress had been made we again found that sufficient progress had not been made or sustained to satisfy the requirements of regulation 12 or 17 HSCA.

We found that some improvements had been made to promote the safety and governance of the service, improve the environment and recruitment practices. However, the shortfalls that we identified within this inspection showed that further improvements were still required. The provider had failed to make sufficient improvements and the quality assurance system had not always been effective. This meant that this inspection was the fourth consecutive inspection whereby the provider had failed to achieve a ‘good rating’ in the well led area of our inspection.

St Catherine's Residential Care Home is a ‘care home’. People in a care home receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Catherine’s provides accommodation and personal care for up to 22 people. At the time of our inspection, there were 21 people living at the home.

The service was required to have a registered manager in place as part of the conditions of their registration. At the time of our last inspection a registered manager was in post and they had registered with us in January 2018. However, shortly after our inspection the registered manager was dismissed. A new manager had been appointed although they had started the registration process they were not yet registered with us. 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.

It is a legal requirement for providers to display their rating. This is to show whether a service was rated as ‘outstanding’, ‘good', 'requires improvment’or ‘inadequate’ following an inspection. The ratings are designed to improve transparency by providing people who use services, and the public, with a clear statement about the quality and safety of the care provided. At our inspection in July 2017 we found the provider had not displayed the rating of their previous inspection ‘requires improvement’ on their website. At the inspection of January 2018 we again found that the provider had not displayed their most recent rating from July 2017 of ‘inadequate’. This was a repeated offence under regulation 20 A of the HSCA. The provider was given a fixed penalty notice for both offences. The first fixed penalty notice has been paid for both offences.

People were not always supported to manage risks to keep them safe. Where actions had been identified to mitigate risks, these actions were not always consistently applied which placed people at risk of harm. Although staff were safely recruited and staffing levels had been increased staff were not always deployed in a way so that they were available in communal areas of the home to respond to request from people and to check on people’s safety.

Some staff did not fully understand the needs of people living with dementia. Plans were in place to improve the training and supervision staff received to carry out their role effectively.

Staff knew how to report concerns where people may be at risk of harm and medications were given in a safe way.

People were treated with dignity and people who were able were supported to maintain their independence. People were given the opportunity to express their preferences with regard to their care and people knew how to make a complaint if they needed too.

Improvements had been made to the environment and were continuing to be made to make the home a more comfortable and safer place for people to live in.

We imposed conditions on to the provider’s registration for this registered location which required the provider to submit monthly reports to us, telling us what quality assurance activities that had undertaken each month to monitor and promote the safety and quality of care provided to people.

We undertook this focused inspection on 25 and 26 January 2018 to check the provider had followed their plans and to monitor their compliance with the legal requirements of the regulations. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St. Catherine’s Residential Care Home on our website at www.cqc.org.uk.

At our last inspection in July 2017, we found the provider to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had not always ensured that there were sufficient numbers of staff available to meet peoples’ needs in a safe and timely way. The environment did not always promote peace, comfort or safety; safe recruitment practices had not always been followed to protect people from the risk of receiving care from unsuitable staff.

We also found the provider to be in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014 because the provider’s quality monitoring systems and processes had been ineffective in sustaining improvements as well as identifying other shortfalls found during the inspection. Where quality assurance processes had identified areas in need of improvement, the provider had not always responded efficiently to ensure the safety and quality of the service was maintained in a timely manner.

At this inspection, we found improvements had been made to both the safety and the quality of the service, but further improvements were still required. This has been reflected in the revision of the overall rating of the service at this inspection. Therefore the rating has been changed from ‘Inadequate’ to ‘Requires improvement’ in both, Safe and Well-led. However, we felt sufficient improvements had not yet been made, or sustained to satisfy the requirements of regulations 12 or 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This meant there were continued breaches of these regulations. You can see what further action we have taken at the end of this report.

We will continue to monitor the safety, effectiveness and sustainability of the service at our next inspection. If further improvements have not been made by this time or if the improvements noted at this inspection are not sustained, we will take further enforcement action to further protect the safety of people living at the home.

St. Catherine’s Residential Care 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. Catherine’s provides accommodation and personal care for up to 22 people. At the time of our inspection, there were 21 people living at the home.

The service was required to have a registered manager in place as part of the conditions of their registration. At the time of our last inspection, the manager of the service had not successfully registered with us which meant the provider was not compliant with the legal requirements of their registration. This is an offence under section 33 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection, there was a registered manager in post at the time of our visit because the manager in post had registered with us in January 2018. 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. However, since our inspection we have been told that the registered manager was no longer in this post and a new manager has been appointed.

We found that some improvements had been made to promote the safety and governance of the service. However, the shortfalls that we identified within this inspection showed that further improvements were still required. The provider had failed to make sufficient improvements to the efficacy of their quality assurance systems within the stipulated time frame. This meant that this inspection was the third consecutive inspection whereby the provider had failed to achieve a ‘good’ rating in the well-led area of our inspection. It was also the second inspection whereby they have failed to meet the requirements of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what further action we have taken at the end of this report.

It is a legal requirement for providers to display their rating. This is to show whether a service was rated as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’ following an inspection. The ratings are designed to improve transparency by providing people who use services, and the public, with a clear statement about the quality and safety of the care provided. At the time of our last inspection in July 2017 we found that the provider had not displayed the rating of their previous inspection (‘requires improvement’) on their website. This was a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the provider was given a fixed penalty notice for the offence. At this inspection, we found that the provider had not displayed the rating of their most recent inspection from July 2017, ‘Inadequate’. This was a repeated offence under regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take in respect of this offence.

Despite an increase in staffing levels within the home, staff continued to be ‘busy and ‘disorganised’ which meant people did not always receive the care they required when they required it. Fire safety systems and practices within the home were not always implemented or monitored effectively, which meant people’s safety and well-being were not always in the event of a fire.

The provider had not always ensured safe recruitment practices had been followed to ensure people were only supported by staff who were suitability skilled and safe to do so. Furthermore, staffs training compliance had not always been effectively monitored to ensure they had the knowledge and the skills they required to fulfil their responsibilities.

Most people received their medicines as prescribed and improvements had been made to the storage of medicines.

People were supported to live in an environment that promoted their safety and comfort because improvements had been made to the maintenance and cleanliness of the property.

People were protected against the risk of abuse and avoidable harm because staff knew the signs and symptoms to look out for and were aware of the reporting procedures.

The provider had made some improvements to their quality monitoring processes within the service but these improvements had not always been implemented effectively or sustained. This meant compliance was fragile and further improvements were still required. Quality assurance practices had failed to proactively identify the shortfalls we found during our inspection.

St Catherine’s Residential Care Home provides accommodation and personal care for up to 22 people. At the time of our inspection, there were 19 people living at the home. At the last inspection the service was rated as requires improvement without breaches and sufficient improvements had not been made.

There had not been a registered manager in post since May 2016. The provider had appointed a new manager who had been managing the day to day running of the service since May 2016 but they had failed to successfully complete their registration with us. 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 provider was in breach of the conditions of their registration as they are required to have a registered manager. This is an offence under section 33 of the Health and Social Care Act 2008.

The service was not always safe because the provider had not always ensured that there were sufficient numbers of staff available to meet peoples’ needs in a safe and timely way. The environment did not always promote peace, comfort or safety; it was not always clean or free from clutter which put people at risk. The provider’s quality monitoring systems and processes had been ineffective in sustaining improvements as well as identifying other shortfalls found during the inspection. Where quality assurance processes had identified areas in need of improvement, the provider had not always responded efficiently to ensure the safety and quality of the service was maintained in a timely manner. Staff did not always feel listened to or supported by the provider. Staff morale was low due to time pressures; staff did not always feel like they had enough time to do everything that was required of them including domestic chores and were unable to support people to engage in activities of interest.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Care was provided to people with consent, where possible. Key processes had been followed to ensure that people were not unlawfully restricted. Staff had the knowledge and skills they required to care for people and to protect people from the risk of abuse and avoidable harm. They also knew what the reporting procedures were and were familiar with the whilst-blowing policy.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary. People’s nutritional needs were assessed and monitored to identify any risks associated with their dietary requirements.

People were supported by staff that were kind, caring and who took the time to get to know them, including their personal histories, likes and dislikes. People were also cared for by staff that protected their privacy and dignity, respected them as individuals and promoted their independence as far as reasonably possible.

People were encouraged to express their views in all aspects of their lives including the care and support that was provided to them and people felt involved in the planning and review of their care. This was because the staff communicated with people in ways they could understand. People were aware of the complaints procedure and were confident that any issues that they had would be dealt with efficiently.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement has been made within this timeframe and we continue to find a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months of our return visit if they do not improve. After which, this service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will then be conducted within a further six months, and if there is still not enough improvement and an on-going rating of inadequate is awarded for any key question or overall, we will take further action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Catherine’s Residential Care Home provides accommodation and personal care for up to 22 people. At the time of our inspection, there were 19 people living at the home.

There was not a registered manager in post at the time of our visit because the person who was registered to manage the home had recently left. However, the provider had appointed a new manager who was in the process of applying for their registration with us. 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 was not always safe because the provider had not always followed safe recruitment practices and ensured that people were receiving their care from staff that had been recruited safely. People were also at risk of not receiving their medicines when they required them because the provider’s quality monitoring systems and processes had been ineffective in monitoring safe medication management. The quality monitoring systems had also failed to ensure that staff had access to the correct information about people’s individual care needs and related risks in order to promote people’s safety.

The service was effective because care was given with consent, where possible. Whilst key processes had not always been fully followed to ensure that people were not unlawfully restricted, immediate action was taken by the new manager to rectify this. We also found that staff had the knowledge and skills they required to care for people and to protect people from the risk of abuse and avoidable harm. They also knew what the reporting procedures were.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary. People’s nutritional needs were assessed and monitored to identify any risks associated with nutrition and hydration.

The service was caring because people were supported by staff that were kind, caring and who took the time to get to know them, including their personal histories, likes and dislikes. People were also cared for by staff that protected their privacy and dignity, respected them as individuals and promoted their independence as far as reasonably possible.

People were encouraged to express their views in all aspects of their lives including the care and support that was provided to them and people felt involved in the planning and review of their care. This was because the staff communicated with people in ways they could understand.

People were actively encouraged and supported to engage in activities that they enjoyed. People were also supported to maintain positive relationships with their friends and relatives.

Staff felt supported and appreciated in their work and reported St Catherine’s Residential Home to have an open and honest leadership culture. The management team endeavoured to improve and develop the service and had plans in place to improve the quality monitoring processes. People were encouraged to offer feedback on the quality of the service and knew how to complain if they needed to. They felt that the new manager was responsive to feedback.

At the time of our inspection we were told that 19 people lived at St Catherine's. During our inspection we spoke with or spent some time with six of the people who lived there, four care staff on duty, one kitchen member of staff and the manager. We also spoke with three people's relatives that were visiting the home on the day of our inspection.

All of the people spoken with told us that they were happy living at the home. One person said, 'I am happy here, the food is good. I've never had anything I did not like.'

We found that people's needs had been assessed and care was planned. One staff member told us, 'I think people's care plans have the information we need so that we can meet their needs.'

We saw that systems were in place to monitor the quality of the services provided so that actions, when needed, could be made to make improvements.

We saw that people's privacy and dignity was maintained. People were encouraged with their independence. One person told us, "I go to my room whenever I wish to and can use the lift on my own."

People had an initial assessment to identify their needs but these was not always reflected in people's care plans. Activities were planned for and took place. One person told us, "I can read my books or the newspapers that are delivered here and most days activities take place. We have visiting people as well to lead exercise classes."

Steps had been taken by the provider to safeguard people against the risk of harm or abuse.

Appropriate checks had taken place to ensure that staff were suitable for their job roles. One staff member told us, "I had an induction when I started my job."

We saw that some processes were in place to monitor the quality of service and identify improvements where needed. However, we found that audits were not always completed in a timely way and were not always effective.

We saw the home was clean and tidy and had a relaxed homely atmosphere.

People were involved in their care and were encouraged to maintain their independence. We saw people were supported with mobility and were not rushed.

We saw visits by healthcare professionals who supported people to meet their health needs.

People were given opportunities to take part in different activities, so that they had a meaningful and interesting lifestyle. One person said "we enjoy our armchair exercise session".

We saw the organisations safeguarding policy. This showed that staff had the information they need so that they knew what action to take if there was an allegation of abuse.

There were sufficient staff available to support people to meet their needs and one person told us, "I am happy here".

Audits were completed to assess and monitor the quality of the service provided. An analysis of the findings of the audits, which would demonstrate the continuous improvement of the service, was not available.