Archived: St Peters Court

Updated 29 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place over two days on 25th September 2018 and 2nd October 2018. The inspection team consisted of an inspector and an expert by experience who was present on the first day of inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

This inspection was prompted in part by a notification of an incident, following which a person using the service died. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, as part of this inspection we looked to see if the risk to other people because of this incident had been mitigated as the incident indicated potential concerns about the management of falls.

Prior to our inspection we reviewed the information we held about the service. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We reviewed the Provider Information Return (PIR). This is a form in which we ask the provider to give some key information about the service, what the service does well and improvements they plan to make.

Whilst some people were able to talk to us, others could not. During our inspection we observed how the staff interacted with people and we spent time observing the support and care provided to help us understand their experiences of living in the service. We observed care and support in the communal areas, the midday meal, and we looked around the service. The inspection team also spent time sitting and observing people in other areas throughout the service and were able to see the interaction between people and staff. Some people were able to talk with us about the service they received but others could not. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During the inspection we reviewed the records at the service. These included staff files which contained staff recruitment, training and supervision records. Also, medicine records, complaints, accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises.

We looked at five people's care documentation along with other relevant records to support our findings. We also 'pathway tracked' people living at the service. This is when we looked at their care documentation in depth and obtained information about their care and treatment at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection we spoke with three people, five relatives/visitors, five care staff, two qualified nurses, a visiting volunteer, two members of a quality audit company engaged in the service by the registered provider, the office manager (who was acting manager on day one of our inspection), one administrator, the new manager (whose first day in post was the second day of our inspection), one director and the registered provider. Additionally following the inspection we spoke with external professionals and healthcare authorities.

Updated 29 November 2018

St Peters Court is a 'care home'. People in care homes receive accommodation and nursing and personal care as a single package under a contractual agreement with the local authority, health authority or the individual, if privately funded. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Peters Court is registered to accommodate up to 24 people, including people who live with dementia or a dementia related condition, in one purpose built building in the grounds of St Peters Hospital, Maldon. St Peters Court is a large detached property and the premises is set out on one main floor. Each person using the service having their own individual bedroom with communal facilities available for people to make use of within the service. The building is split into two zones with named corridors depicting street names for residential and nursing service users. At the time of our inspection there were 19 people using the service with one person in hospital,

This was the services first inspection under a new provider. At the time of inspection we found the service to be requires improvement. We found four breaches of regulation relating to regulation 12 - safe care and treatment, regulation 9 – person centred care, regulation 18 – staffing and regulation 17 - good governance. Additionally, we have made recommendations with regard to, meaningful activity provision, visiting rights in care homes, DoLs applications and environmental building works.

A registered manager was not in post at the time of this inspection. At the time of this inspection the office manager had been covering the service as acting manager for one month. We were advised a new manager was being recruited and they were due to start on 1st October 2018 which was the day before our second day of inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Additionally at the time of this inspection the registered provider had enlisted the help of an external quality audit company to help ensure the service was compliant in the five key areas of safe, effective, caring, responsive and well led. Whilst this mitigated some risk our inspection still identified areas which required action which we have outlined in the main report

Staff were not always effectively deployed. There was not always enough staff to care for people safely and effectively. In some instances where people had received funding for one to one care this had not happened.

Staff did not always follow safe practice in regard to the administration, storage and recording of people's prescribed medicines. People did not always have their medicines administered and reviewed in a timely safe manner.

Systems for monitoring accidents and incidents were not effective. The provider could not evidence that incidents were always investigated appropriately, or that lessons were learnt and shared and actions taken to mitigate future risks.

Some improvements were required to ensure infection control legislation was followed at all times. This required the registered provider to address some improvements in the service.

Risk assessments did not always provide clear guidance to staff as to how to manage identified risks associated with people's needs.

improvements were required to ensure DoLs authorisations were submitted in a timely manner and people should be fully supported to have maximum choice and control of their lives

People received enough specific food and drink to meet their dietary needs.

Care plans contained some information about what was important to people and about how their needs should be met. However, this often lacked sufficient detail to implement responsive person-centred care.

People were supported by caring staff and we saw warm responsive actions from them.

People were not always supported appropriately with maintaining relationships with people that were important to them.

The registered provider was currently in the process of having a lot of improvements made to the environment which meant there were quite a few redundant communal areas in the service. Whilst we acknowledge this it had been a prolonged process, there was no assessment in place or evidence to show appropriate consultation had taken place with people. The registered provider should ensure the completion of building works in a timely manner to avoid disruption and a lack of facilities for people using the service.

Improvements were required to ensure people were consistently provided with regular access to meaningful activities and stimulation, appropriate to their needs, to protect them from social isolation, and promote their wellbeing. Care and support plans needed improvement to reflect how staff should support people, to lead fulfilled and meaningful lives, through activity, therapy and social inclusion.

People told us they would feel confident in raising concerns and complaints, and we saw there were processes in place to ensure these were responded to appropriately.

Feedback about leadership in the service was variable. The inconsistency of regular management in the service had not lent itself well to the sustainability of processes.

There was not a robust and responsive approach to measuring, monitoring and improving quality in the service which took the views, opinions and diverse needs of people and staff into account. Systems to monitor and improve the service were not effective and the registered provider did not have a clear overview of the service and the quality of care being provided to people. Systems for gaining and acting on feedback from people were not always effective.

It is a legal requirement that a provider's latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We advised the provider of the requirement to do this following this first rated inspection for the service.

Further information is in the detailed findings below. You can see what action we told the provider to take at the back of the full version of the report.