Archived: St Anne's Residential Care Home

St Anne's Residential Care Home hereafter referred to as ‘St Anne's’, is registered to provide accommodation and personal care for up to 23 older people. At the time of the inspection, 15 people were living at the service.

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

When we inspected the service on 14 January 2021, we found people, staff and visitors were not fully protected from the risks of infection and best practice guidance was not always followed in

relation to infection prevention and control. At this inspection we found improvements had been made.

The provider had reflected on the concerns raised at the previous inspection and made changes to infection control practices with support and guidance from their local specialist infection control team.

The provider had reviewed and changed the arrangements for donning and doffing personal protective equipment (PPE) for staff entering and leaving the service and introduced a new procedure. We found the services new designated area for donning and doffing PPE contained sufficient supplies of PPE, the availability of hand washing facilities along with appropriate arrangements for the disposal of used PPE to reduce the spread of infection and/or cross contamination.

Individual risk assessments had been completed for all people and staff to identify who might be at higher risk from COVID-19 or in a clinically vulnerable group because of their individual health needs and/or their ethnicity.

Staff had been provided with clear guidance relating to infection control practices and the use of PPE. Staff wore appropriate PPE when they supported people and were able to tell us which PPE was needed for different tasks, such as administering medicines, handling food and delivering other personal care tasks.

Hand washing facilities and hand sanitizer were located around the home and we observed staff washing and cleansing their hands between tasks.

The provider had made changes to the environment by spacing out tables and chairs in communal areas to support people to socially distance during meal times. Staff encouraged and supported people to socially distance whilst in communal areas of the home.

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 01 August 2018).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met in relation to specific concerns we had about infection control practices. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

We were not fully assured that Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures.

The arrangements in place for the donning and doffing of personal protective equipment (PPE) for staff entering and leaving the service, were not sufficiently robust to reduce the risk of transmission and or control/prevent the spread of infection.

Personal protective equipment (PPE) was readily available, however, staff were not always wearing PPE safely and in line with current guidance. We observed, staff were not changing their gloves between tasks or interactions with people living at the service.

Whilst individual risk assessments had been completed for most staff working at the service, risk assessments had not been completed for all newly recruited staff.

It was not evident from our observations that staff were supporting or encouraging people to socially distance or that seating arrangements in the lounge or dining room enabled people to socially distance, in line with Public Health England's current Covid 19 guidelines. We have made a recommendation in relation to this.

We found the following examples of good practice.

Systems were in place to help manage the risks and prevent the spread of COVID-19.

Visitors to the service had been restricted. There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing.

Staff provided instructions on arrival at the service to ensure visitors understood the infection prevention and control protocols they needed to follow to keep people safe.

There were sufficient stocks of PPE available.

People and staff took part in regular COVID-19 "whole home" testing.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches.

We were not fully assured this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to Infection Prevention Control. Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

At the last inspection in April 2017 we rated the key questions of Effective and Well Led as Requires Improvement. Following that inspection, we asked the provider to complete an action plan to improve the environment. We also asked them to tell us what they would do and by when to improve the key questions, Effective and Well-Led to at least Good.

During this inspection in July 2018, we found the provider had invested in the environment. Changes to the flooring, bathrooms, bedrooms and communal areas had made the environment more hygienic and dementia friendly. Governance processes had also significantly improved. These included robust audits to check the service was providing quality care in all areas and there was greater involvement with the local community, for example with schools and local forums.

St Anne’s Residential Care Home (known as St Anne’s), 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 provides care and accommodation for up to 23 people. On the day of the inspection 17 people were using the service. St Anne’s provides care for people who are elderly and frail, some people may have mental health and / or physical needs.

A registered manager was employed to manage the service locally. 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 registered manager was supported by the provider and a manager to run St Anne’s.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The recruitment process of new staff was robust. People and staff were matched carefully and people could meet staff before they started receiving care from them.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “The staff make the place safe in my opinion because they are always on hand” and, “No concerns, my husband will be safe and happy. I was asked lots of questions about how he likes to be cared for.”

Staff used their knowledge of people to help ensure their diverse needs were met. Staff were aware of people’s communication needs and styles and their likes and dislikes.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Staff understood consent and when to follow the necessary legal processes to ensure people’s human rights were respected.

There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff were clear they were working in people’s home. Staff told us care was personalised and based around people’s own routines and wishes. Social engagement opportunities and activities kept people stimulated.

Alternative methods of communication were used, family and advocates were utilised to help staff understand people’s needs when verbal communication was not easy for them. There were pictorial formats of menus and activities, for example, to help people make decisions. Easy read information was visible and there were pictorial instructions to help remind people how to use the bathroom, get dressed and retain their independence in other areas of their life.

There was a management structure in the service which provided clear lines of responsibility and accountability. A registered manager was in post who had overall responsibility for the service. They were supported by the provider, a manager and other senior staff who had designated responsibilities. People told us they knew who to speak to in the office and any changes or concerns were dealt with swiftly and efficiently, “I feel that I could talk to any member of staff and that my concern would be sorted out.”

Feedback received by the service and outcomes from audits were used to aid learning and drive improvement across the service. The manager and staff monitored the quality of the service by regularly by undertaking a range of regular audits and speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were approachable and included them in discussions about their care and the running of the service. Comments included, “[Provider’s names] are in charge and they are very approachable as is [manager’s name].”

St Anne’s Residential Care Home (known as St Anne’s), provides care and accommodation for up to 23 people. On the day of the inspection 17 people were using the service. St Anne’s provides care for people who are elderly and frail and may have mild mental health and / or physical care needs. Five beds were “discharge to assess” (DTA) beds. These were for people transitioning from hospital to home and who required a short stay (up to 6 weeks) to support their recovery.

The service had 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.

The environment was mostly free from obstacles to enable people to move freely around the home and equipment was well maintained. However, we found the home was not well maintained in all areas. Some carpets looked extremely worn and were very stained and threadbare, some people’s rooms were in a poor state of repair with wall paper falling off and broken flooring. Staff told us this had been raised with the provider and registered manager repeatedly. The provider and registered manager shared with us the maintenance which had been undertaken in the past year but the service remained in need of updating to meet the needs of people with dementia.

There were effective quality assurance systems in place but staff feedback was not always acted upon especially in relation to the environment. Incidents were appropriately recorded and analysed from trends. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service. Inspection feedback was listened too to further enhance quality of care.

On the day of the inspection staff within the service were relaxed, there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People were comfortable with staff and we observed positive interactions between people and staff. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People, or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.

Staff exhibited a kind and compassionate attitude towards people. Good relationships had been developed and practice was focused on the person and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People’s independence was encouraged and people were free to make choices regarding their care and positive risks. People were promoted to live full and active lives and enjoyed friendships within the service.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, district nurses and social workers.

People we observed were safe and they told us they felt safe and well-cared for by staff.

All staff had undertaken training on safeguarding vulnerable adults from abuse. They displayed good knowledge of how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005). This ensured people were involved in decisions about their care and their human and legal rights were respected. Families were involved in decision making where necessary. The service followed the processes in place which protected people’s human rights and liberty.

People were supported by staff teams that had received a comprehensive induction programme, tailored training and ongoing support that reflected people’s needs.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

The service had a policy and procedure in place for dealing with any concerns or complaints. People told us they had no complaints and felt confident approaching staff to discuss any minor concerns they might have.

Staff and relatives all described the management to be supportive and approachable. The registered manager had recently appointed a manager to take over the day to day running of the service. They were supported by the provider in their responsibilities to manage the service. The manager was supported by the deputy manager. Staff talked positively about their jobs.

There were effective quality assurance systems in place but staff feedback was not always acted upon especially in relation to the environment. Incidents were appropriately recorded and analysed from trends. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service. Inspection feedback was listened too to further enhance quality of care.

We found one breach related to the environment. You can see what action we told the provider to take at the back of the full version of the report.

One person said 'When I first came here I was scared stiff. People helped me to settle by encouraging me to help; they checked if I liked my room. I was treated like part of the family and then felt settled. If I had any concerns I would tell my daughter who would speak to staff and they would make changes. They are very helpful'.

We asked people about the food they received. One person told us 'We have wonderful food, it really is good. We definitely get a choice; if something is on the menu we don't like we can have something different. We are asked everyday what we would like and we pick out what we want'.

We observed medication being given during our visit. Time was taken to explain to people that were confused why it was necessary to take the tablets offered. We saw that the identified procedures were followed.