St Catherines Nursing Home

St Catherine's is a 'care home'. People in care homes receive accommodation and nursing or personal care. The service has two separate buildings. The service can support up to 67 older people, some of whom may be living with dementia. There were 48 people living at the service at the time of the inspection.

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

There was a strong, visible person-centred culture. All the people, relatives and staff spoken with gave us positive feedback about the caring nature of the service, quality of the staff and thoughtful support they received.

People spoken with told us they felt safe. People had individual risk assessments in place so staff could identify and manage any risks appropriately.

Safeguarding procedures were robust and staff understood how to safeguard people. Systems were in place to make sure managers and staff learned from events such as incidents, concerns and investigations.

There were enough staff to ensure people’s care and support needs were met. Staff told us they had training to enable them to perform their roles and were able to improve and develop new skills. Staff felt supported and told us they received regular supervision. The provider completed appropriate pre-employment checks for new staff, to check they were suitable to work at the service.

Medicines were managed safely at the service. We saw infection control audits were undertaken which showed any issues were identified and acted upon.

People and relatives made positive comments about the quality of care provided at the service. 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.

People made positive comments about the quality of food provided and told us their preferences and dietary needs were accommodated. Some people required their fluid intake to be monitored to minimise their risk of dehydration. Some people’s record had been completed appropriately and monitored. However, we found few people’s records had not been fully completed or sufficiently monitored. We have recommended the provider considers current guidance for the prevention of dehydration in older people.

Respect for privacy and dignity was at the heart of the service’s culture and values. People and staff felt respected and listened to. The service promoted people’s wellbeing by taking account of their needs including activities within the service and community.

Complaints were recorded and dealt with in line with organisational policy. There were planned and regular checks completed at the service to check the quality and safety of the service provided.

Staff spoken with made very positive comments about the staff team and registered manager.

Rating at last inspection

The last rating for this service was good (published 4 November 2017). There was also an inspection on 7 November 2018 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

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

There was a manager at the service who was 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.

Our last inspection at St Catherine’s took place on 2 and 5 September 2016. We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regard to regulations 17: Good Governance, 18: Staffing and 19: Fit and proper persons employed. The registered provider sent an action plan detailing how they were going to make improvements.

At this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of Regulation 18: Staffing, as staff had been provided with regular supervision and annual appraisal in line with the registered provider’s policy. We also found sufficient improvements had been made to Regulation 19: Fit and proper persons employed as recruitment procedures were now operated effectively to ensure all of the required information was obtained for each person employed.

However, we found sufficient improvements had not been made to achieve full compliance with Regulation 17: Good governance. Although there were a number of processes in place to monitor the quality and safety of the service, more improvements were required to fully meet the regulation. Therefore, this was a continued breach. We found people’s care plans and risk assessments were reviewed regularly and in response to any change in needs. However, daily records relating to the care and treatment of each person were not complete, accurate and up to date. In addition the systems in place to monitor the regular completion of daily care records were not fully effective to ensure care provided was monitored, and that risks were managed safely.

This inspection took place on 2 October 2017 and was unannounced. This meant the people who lived at St Catherine’s and the staff who worked there did not know we were coming. On the day of our inspection there were 36 people living at St Catherine’s. The home has two separate buildings and at the time of this inspection the lower building was unoccupied as it was being refurbished and renovated.

People living at the home and their relatives spoken with were very positive about their experience of living at St Catherine’s. They told us they, or their family member, felt safe and were generally happy.

Staff were aware of safeguarding procedures and knew what to do if an allegation was made or if they suspected abuse.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Sufficient numbers of staff were provided to meet people’s needs, although some people and their relatives felt at times there was a shortage of staff.

We found the home was clean and well maintained in the areas we checked.

Staff had regular updates to their training and were provided with relevant supervision and appraisal so they had the skills and support they needed to undertake their role.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) code of practice and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health.

A varied diet was provided to people which took into account dietary needs and preferences so their health was promoted and choices could be respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care.

People were treated with dignity and respect and their privacy was protected. All the people, relatives and visiting health professionals we spoke with made positive comments about the care provided by staff.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with the registered manager or staff if they had any worries or concerns and they would be listened to.

Staff told us they felt they had a very good team. Staff, people, relatives and professionals said the registered manager was approachable and very supportive, and communication was good within the service.

We found one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at St. Catherine’s took place on 12 May 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 2 and 5 September 2016 and was unannounced. This meant the people who lived at St. Catherine’s and the staff who worked there did not know we were coming. On the day of our inspection there were 35 people living at St. Catherine’s. The home comprised of two separate buildings and at the time of this inspection the lower building was unoccupied as it was being refurbished and renovated.

People spoken with were very positive about their experience of living at St. Catherine’s. They told us they felt safe and they liked the staff.

Relatives spoke highly of the staff and the care provided to their family member. They had no concerns or complaints about the home.

We found systems were in place to make sure people received their medicines safely.

Some gaps in staff recruitment records showed procedures had not always been adhered to so people’s safety was promoted and risks minimised.

Staff were provided with relevant induction and some training to make sure they had the right skills for their role. Records showed some staff required refresher training to update their knowledge. Some staff had not been provided with supervision or appraisal at appropriate frequencies for support and development. Staff understood their role and what was expected of them. They told us they liked their jobs, worked well as a team and were well supported by the registered manager.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided to people which took into account dietary needs and preferences so their health was promoted and choices could be respected.

A range of activities were available to provide leisure opportunities.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were some effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via questionnaires. The results of these had been audited to identify any areas for improvement. Some gaps in records meant relevant information had not been kept and made some audits ineffective as full information was not available.

We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulations 17: Good Governance, 18: Staffing and 19: Fit and proper persons employed.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with 8 people living at the home, 5 relatives and 1 visiting professional to obtain their views of the support provided. In addition, we spoke with the registered manager, the administrator, 2 qualified nurses, 2 care staff, the activities worker and a domestic staff about their roles and responsibilities.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service, or their representatives told us they felt safe.

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff had been provided with training in these subjects so that they were aware of important information to ensure people were safeguarded as required.

Policies and procedures were in place in relation to the safe management of medication. Staff that administered medication had been provided with training in the safe handling of medication. This meant that people's health and safety was promoted.

Is the service effective?

People's health and care needs were assessed with them and their representatives, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Staff were provided with training to ensure they had the skills to meet people's needs. Managers' were accessible to staff for advice and support. Staff were provided with formal individual supervision and appraisals at an appropriate frequency to ensure they were adequately supported and their performance was appraised.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

We asked people using the service and relatives for their opinions about the support provided. Feedback from people was positive, for example; 'they are very kind people', 'they are all right, I can't grumble at all', 'the staff are marvellous. I am a regular visitor and they (staff) always take time to chat to me. They really care here' and 'they (staff) are very good. I can't fault them'.

When speaking with staff it was clear that they genuinely cared for the people they supported and had a detailed knowledge of the person's interests, personality and support needs.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. A system was in place to ensure where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in and outside the service, which helped to keep people involved with their local community.

People spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found that appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Whilst the home comprised of two separate buildings, at the time of this inspection only the purpose built building that accommodated up to 33 people was in use.

People living at the home told us that they were happy and that they were satisfied with the care they received. They told us, "I think it is wonderful here. I am very grateful to be here" and "the staff are lovely."

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff were positive. We found that care and support was offered appropriately to people.

We found that suitable arrangements were in place to ensure people were safeguarded against the risk of abuse and their rights were upheld.

We found that sufficient numbers of staff were provided to meet people's needs. Staff were provided with relevant training to maintain and update their skills and knowledge.

We found that procedures were in place to audit and monitor systems within the home.