We carried out a review of the data available to us about St Mary's Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Mary's Residential Care Home, you can give feedback on this service.
St Mary’s Residential Care Home is a residential care home providing personal care to 27 older people some whom are living with dementia at the time of the inspection. The service can support up to 29 people.
The service provides accommodation over two floors with a lift and stairs available to access the upper floor. There are two lounges and a dining room as well as a number of communal bathrooms and toilets.
People’s experience of using this service and what we found
The registered manager had made improvements to the overall running of the service.
People living at St Marys Residential Home received care from a staff team who were caring and ensured people needs were met in a timely manner. One relative said, “St Mary's is a very nice place, comfortable, clean, I think it very nice, I wouldn't mind being there myself.”
Staff delivered care and support that was personalised. Staff were kind, caring and motivated and people and their relatives were complimentary about the care provided. Staff respected people’s privacy, dignity and independence and encouraged people to be as independent as possible.
Systems ensured that people's risks were well managed, and lessons were learnt when things went wrong. People and staff could approach the registered manager who acted on concerns raised to make improvements to people's care. A relative told us, “I am certain [family member] is safe, the staff are looking after her, make sure that everything is locked and sealed, and they cannot get out of the place (for their safety).”
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 27 April 2020).
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
The inspection was prompted in part due to concerns received about people’s privacy, dignity and choice. We also checked they had followed their action plan from the previous inspection and to confirm they now met legal requirements. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe section of this full report
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.
St Mary’s residential care home is a residential care home providing personal care for up to 29 people. At the time of the inspection there were 24 people living in the home.
The home provides accommodation over two floors with a lift and stairs available to access the upper floor. There are two lounges and a dining room as well as a number of communal bathrooms and toilets.
People’s experience of using this service and what we found
There were not enough staff to meet people’s needs, specifically at night. Due to the numbers of staff at night and how they needed to be allocated to meet people’s needs, a large part of the building was usually left unmonitored. The daily allocation of staff meant some people’s mealtime experience was not as good as it should be. Staff were mostly safely recruited but we had ongoing concerns in relation to the information collated at recruitment to assure the provider recruited staff were of good character. We have issued a recommendation in this area. Environmental risk assessments had now been completed and were effective at addressing risks. Individual risks were mitigated but records to show this were not always up to date. The provider had not implemented the latest guidance on managing and administering medicines and some concerns in practice were noted. We have issued a recommendation about this.
People’s autonomy and independence was not always respected and we saw walking aids often taken out of people’s reach due to the layout of the lounge area. We also saw an inappropriate response when concerns were raised and undignified support provided to someone whilst they were having their lunch. Interactions we saw were mostly positive and we were told staff were predominantly caring and that this area had recently improved. People were supported to provide feedback through suggestion boxes, surveys and resident meetings, action plans were developed and concerns addressed.
The new registered manager had taken positive steps to improve the service and had been proactive at addressing concerns from the previous inspection in the short time they had been in post. However, they were aware there was more to do. A suite of quality audits had been introduced and areas of concern were known but a live action and improvement plan had not been developed from which the provider and registered manager could systematically work through. This meant improvement remained reactive. There were two action plans, one from the last inspection which was complete and one following a quality visit from the local authority which the registered manager was working through. They told us they were going to add all the action plans together following feedback from the inspection.
The provider was working to improve the environment and had taken some steps to ensure it met people’s needs better. Work was completed with other professionals to support people’s needs and the provider delivered food which met people’s dietary requirements. 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.
Care plans were comprehensive and information was available in different formats. Records of people’s additional monitoring requirements were accurate and in line with the care plans we looked at. There were limited activities but people told us they had enough to keep them entertained. When complaints were received we saw the provider acknowledged when they needed to make improvements and apologies were made. We shared our concerns in the response to the information received above and were assured it would be managed correctly.
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 (14 January 2019) and there were three breaches to the 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 two of the previous breaches had been met and we found additional breaches. This meant enough improvement had not been sustained and the provider was still in breach of regulations.
The provider has been rated as requires improvement for the last two inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to the promotion of independence and autonomy, a lack of staff to meet people’s needs and ineffective analysis of risk at this inspection. We have also noted a continuous breach in relation to overall governance and oversight.
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 Marys is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
St Marys is registered to accommodate up to 29 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit, 26 people were living in the home. Ten of the people living in the home were living with a diagnosis of dementia.
A registered manager worked in the home. 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 of St Marys, we rated the home overall as Requires Improvement. This was because people had not always received care that was safe, effective or responsive to their needs. Systems in place to monitor the quality of care had not been robust. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.
At this inspection we found that improvements had been made in some areas but that there were shortfalls in others. This resulted in three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2018. The overall rating for the home therefore remains as requires improvement.
Risks associated with hot surfaces, hot water and fire had not all been identified or managed well. This placed people at risk of avoidable harm. Robust recruitment processes were not in place to ensure that staff working in the home were of good character. Furthermore, the systems in place had not been effective at assessing, monitoring and mitigating risks to people’s safety. In response to our findings, the provider told us they would immediately act to rectify these shortfalls. You can see what action we told the provider to take at the back of the full version of the report.
Other risks to people’s safety such as not eating or drinking enough, falling and developing pressure ulcers had been managed well. The home was clean and tidy and the equipment that people used had been serviced when required to make sure it was safe to use.
People received care from staff who were kind, caring, polite and compassionate. People were treated with dignity and respect and their care needs and preferences were being met. They had a say in how their care was to be delivered and were listened to and their opinions respected. They were supported to have maximum choice and control of their lives.
There were some activities available to people to improve their wellbeing. These were limited but the provider was working to improve and tailor these to people’s own interests and hobbies.
The food that people received was of good quality and home cooked. There was a choice of food and drink available and people received enough to meet their needs.
Staff had received sufficient training and supervision to provide them with the skills to keep people safe and to meet their needs. People received support to maintain their health although people were not routinely reminded when they were due a dental appointment.
There were enough staff working in the home to support people when they required this. Some improvements had been made to the environment since our last inspection and these were ongoing. Further improvements are needed to ensure the home has been fully adapted to meet people’s needs.
The provider and registered manager were open and approachable and welcomed feedback from people, relatives, staff and external organisations on how to improve the quality of care people received. The staff enjoyed working in the home and felt valued and appreciated.
We have made two recommendations to the provider to assist them with making improvements. The first is regarding using best practice guidance in dementia care during the on-going refurbishment of the premises. The second is to consult the National Institute of Health and Care Excellence guidance on ‘oral health for adults in care homes’ to implement any changes necessary to their practice.
People in care homes receive accommodation and 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 Mary’s Residential Care Home accommodates people across two floors. People are accommodated in single rooms, and there are communal toilet and bathroom facilities for people to use. This was the first comprehensive inspection carried out for this organisation.
There was 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.
At this inspection we found one breach 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 this report.
Care plans did not always contain enough guidance for staff to mitigate risks to people. There were some risks associated with people’s environment which had not previously been identified by the provider.
People’s food and fluids intake was not always monitored and recorded appropriately. People were not always referred for a review for their swallowing, and care plans did not always have enough detail about people’s diets.
Mental capacity assessments had not been carried out for people with variable or limited mental capacity in order to ensure that decisions were made in people’s best interests. Staff sought consent from people wherever possible, before delivering care.
Care records were not always written in a person-centred manner, and did not always contain full information about people’s health and care needs, their preferences and their histories.
Improvements were needed in the overall governance systems in the home, to ensure they assessed, monitored and improved the quality of the service provided. There were plans in place for improvements to be made.
Staff had received some training relevant to their role, such as manual handling, but further training was needed in areas such as mental capacity and dementia.
There were plans in place to address the above concerns, as the provider was working with the registered manager and a consultant on a service improvement plan.
There were enough staff to keep people safe and meet their needs. They knew how to report any concerns they had, and there were safe recruitment systems in place. People received their medicines as they were prescribed, and people felt safe living in the home.
People told us they enjoyed the meals in the home and people were supported to engage in activities in the home.
People had access to healthcare and staff supported them to see the doctor or occupational therapist if they needed. Staff provided compassionate care to people and respected their privacy, dignity and independence. People had choices of where to spend their time and were supported to eat a healthy balanced diet.
The registered manager was available to people, and people felt listened to. The registered manager demonstrated team work and staff were positive about their roles.