St Thomas Complex

St Thomas Complex is a care home providing accommodation and personal care to up to 52 people. The service provides support to older people including people who live with a dementia. At the time of our inspection there were 29 people using the service.

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

There were sufficient staff to support people safely. We have made a recommendation about ensuring staffing levels and staff deployment are kept under review on the lower ground floor of the home to ensure people are kept engaged and stimulated if they wish.

Staff had received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe. Staff contacted health professionals when people’s health needs changed.

Staff followed effective processes to assess and provide the support people needed to take their medicines safely. We have made a recommendation about protocols for the use of ‘when required’ medicines, where prescribed.

People and relatives were very complimentary about the care provided by staff. They trusted the staff who supported them. They said staff were kind, caring and supportive of people and their families. Their comments included, “I can’t recommend the place enough, I was rock bottom before [Name] came in, it is a God send”, and “Staff are lovely, they are so lovely and friendly. They have time to talk with me.”

Staff followed good infection control practices. A programme of refurbishment was taking place around the home.

Records provided guidance to ensure people received safe, person-centred care and support from all staff members. Staff spoke very positively about working at the home and the people they cared for. They said communication was effective to ensure they were kept up-to-date about any changes in people’s care and support needs.

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.

A quality assurance system was in place, to assess the standards of care in the service. We have made a recommendation regarding the external governance of the service.

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 9 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 remained good based on the findings of this inspection.

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

Recommendations

We have made a recommendation to keep staffing levels and staff deployment under review on the lower ground floor.

We have made a recommendation about the management of some medicines.

We have made a recommendation that regular visits to the service by the provider, or their representative should resume, to provide external checks of the service.

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.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. The policies and procedures were updated regularly following any changes in national guidance.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and visitors to use. Hand sanitiser was available throughout the service. Staff had received training on the use of PPE and we observed staff wearing it correctly during the inspection.

Increased daily cleaning schedules were implemented including regular touchpoint cleaning.

People living in the home and their relatives were supported to maintain contact.

We found the following examples of good practice:

• Appropriate measures were in place at the entrance and inside the home to prevent visitors from spreading infection. All visitors were required to wear appropriate personal protective equipment (PPE) and follow good hand hygiene practices.

• Staff had undertaken additional training in infection prevention and control. There was clear guidance and signage in place throughout the home on the correct use of PPE and handwashing techniques. Regular infection control audits were carried out.

• Additional cleaning was taking place including frequently touched surfaces. Some changes had been made to the layout of furniture to ensure social distancing.

• Family members had been able to visit their relatives safely. However, local visiting restrictions were in place at the time of the inspection. People were supported to keep in touch with their family members via video or telephone calls. Communication records were kept for all contact people had with their family members.

• The registered manager ensured staff were fully supported to maintain their wellbeing.

Further information is in the detailed findings below.

St Thomas Complex is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This home does not provide nursing care. At the time of our inspection there were 30 people living at the home.

There was a registered manager in post at the time of our inspection. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Staff had completed safeguarding training to ensure they were able to recognise the types of abuse and take appropriate action. Safeguarding concerns had been investigated. Where risks were identified they were assessed and managed to minimise the risk to people who used the service and others.

A robust recruitment process was in place with the service carrying out relevant checks to ensure staff were suitable to work with vulnerable people. Staff received relevant training to ensure they had the appropriate knowledge to carry out their role. Supervisions and appraisals were regularly held.

Medicines continued to be managed safely. Medicines records we viewed were accurate and up to date including records for the receipt, return and administration of medicines.

The service carried out monthly health and safety checks including fire safety to ensure people lived in a safe environment. Systems were in place to ensure people would remain safe in the event of an emergency including a continuity plan to ensure people would continue to receive care.

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

The service had developed good working relationships with external health care professionals visiting the service. We saw evidence in care plans of cooperation between care staff and healthcare professionals including, GPs and nurses.

People were supported to have a balanced diet. Kitchen staff had a sound understanding of people’s dietary needs. People’s cultural and religious needs were supported.

Staff were respectful and patient when supporting people. People and relatives told us staff were kind and caring. People were supported to make their own choices and to be as independent as possible. Staff we spoke with were able to describe people’s personal preferences.

The service offered a range of activities. People were supported to maintain links to their local community. Care plans were person centred and gave clear information on how to support people in line with their preferences. People and relatives knew how to make a complaint. Relatives told us both the registered manager and deputy manager were approachable.

The service regularly sought feedback from people, relatives and staff in order to monitor and improve standards. The provider had effective quality assurance processes to monitor the quality and safety of the service provided. The registered manager ensured statutory notifications had been completed and sent to the CQC in accordance with legal requirements.

Further information is in the detailed findings below.

St Thomas Complex is a three storey home that provides personal care and support for up to 52 people, some of who are living with dementia. At the time of our inspection there were 40 people using the service.

At the time of our inspection the service did not have a registered manager. However, the person managing the service had applied for registration. 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 good understanding of safeguarding and were confident in their role in safeguarding people.

Risk assessments were in place for people when required and there was a clear link to care plans in place. There were also general risk assessments regarding the premises and environment.

Medicines where managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly.

Staff were recruited in a safe and consistent manner with all appropriate checks carried out. Staffing levels had recently been increased, and plans were in place to introduce a more robust system to analyse staffing requirements in line with people’s needs. From staffing rotas we saw that staffing levels were consistent and alternative arrangements were available to cover shortages of staff.

Staff had some up to date training but at the time of the inspection this did not include safeguarding, Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS). However, the manager had identified this as was planning to book staff on the next available training courses.

The registered manager and staff we spoke to had a good understanding of the MCA and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place for every person who used the service.

Staff received regular supervision and told us they felt supported in their roles and they could approach the manager if they had any issues or concerns. Annual appraisals were out of date for all staff members. The manager had a plan in place to bring appraisals up to date in early 2016.

We observed people and staff during mealtimes. People were enjoying their meals, some independently and others with support from staff. There were choices available for people and support provided by staff was caring, compassionate and at an appropriate pace to each individual.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs.

The manager and staff carried out regular audits. These related to people’s specific needs and the environment.

There was a range of activities available for people in the service. Activities ranged from a church service every month, chair exercises, singers, pantomimes, animal therapy, cookery, cards, arts and crafts, dolls and soft toy therapy. Staff had a good understanding of activities each individual enjoyed doing. People who used the service discussed activities at residents’ meetings and with the activities co-ordinator individually.