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Reports


Inspection carried out on 14 August 2017

During a routine inspection

Saint Mary’s Nursing Home provides accommodation, nursing and personal care for up to 40 older people, some people are living with dementia.

There were 28 people living in the service when we inspected on 14 August 2017. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 28 September 2015, we found breaches of regulation that affected the well-being of people using the service, this included safety, staffing and how the provider monitored the service that people received. The overall rating for the service was ‘Inadequate’. At a further comprehensive inspection of 27 June 2016 we found that there had been improvements made and the service was rated ‘Requires improvement’ overall. These improvements needed to be embedded in practice and sustained. The registered manager sent us reports on a monthly basis which kept us informed of the improvements they were making.

You can read the report from our last inspection, by selecting the 'all reports' link for Saint Mary’s Nursing Home on our website at www.cqc.org.uk.

At this comprehensive inspection of 14 August 2017 we found that the improvements previously made had been sustained and further improvements had been implemented.

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.

There were robust systems in place which supported the registered manager to monitor and assess the service provided to people. These systems allowed the provider and registered manager to effectively address shortfalls, take action to address them and put measures in place to minimise the risks of similar issues arising in the future.

Staff were provided with the training and support that they needed to meet people’s needs. There was a training plan in place to ensure that the staff’s knowledge was kept up to date. People had good relationships with the people using the service. People were treated with care and their independence, privacy and dignity was promoted and respected.

Systems were in place to minimise the risks to people and to keep them safe. This included risk assessments to identify how assessed risks were minimised and processes designed to keep people safe from abuse.

There was a system in place to assess how many staff were needed to meet people’s assessed and changing needs. This was kept under review to ensure that staffing numbers were increased if people required more care and support or if more people used the service. There were safe staff recruitment processes in place.

People’s care records had been reviewed and updated, they were more person centred and included the input from people and their representatives. Improvements had been made in the social activities provided for people to participate in to reduce the risks of isolation. There were plans in place to develop these further.

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.

Improvements had been made in the infection control and environment. Systems were in place to monitor the cleanliness of the service. There was an ongoing refurbishment plan in place.

People were provided with their prescribed medicines safely and when they needed them.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration. People were supported to see, when needed, health and social care professionals.

There was a complaints procedure in place and systems to respond and address to people’s comments, concerns and complaints.

Inspection carried out on 27 June 2016

During a routine inspection

Saint Mary’s Nursing Home provides accommodation, nursing and personal care for up to 40 older people, some people are living with dementia.

There were 22 people living in the service when we inspected on 27 June 2016. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 19 January 2015. The service was rated inadequate. Breaches of legal requirements were found. These related to infection control, staffing levels, staff training and support, how people’s consent was obtained, how the service met the care and welfare needs of people and governance. We undertook a focused inspection on 27 April 2015 to check that they had followed their improvement plan and to confirm that they now met legal requirements. We found that the provider had made improvements which were ongoing and needed to be sustained and embedded into practice to provide people with good quality care. Another comprehensive inspection was carried out on 28 September 2015, although some improvements had been made we found breaches of regulation that affected the well-being of people using the service, this included safety, staffing and how the provider monitored the service that people received. The overall rating for the service was ‘Inadequate’. This means that it was placed into ‘Special measures’ by CQC. The provider had sent us reports on a monthly basis which kept us informed of the improvements they were making. This inspection of 27 June 2016 was to check that improvements had been made to provide a safe good quality service for the people living there. We found that there had been improvements made in the governance systems in place for monitoring that people receive a good quality service. However, these were not yet embedded into practice.

There was not 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. There was an acting manager in post who had started working in the service following our last inspection, they had made a registered manager application with CQC.

We found that there had been improvements made in the governance systems in place for monitoring that people receive a good quality service. However, these were not yet embedded into practice. Once embedded, these new systems would allow the provider to effectively address the identified shortfalls to prevent issues reoccurring. Feedback received regarding the new manager was positive. The manager had recognised the areas that still needed improvements, this told us that the service had independently identified shortfalls and were in the process of addressing them. The provider had employed an external consultant who was working with the manager to make the necessary improvements.

There had been some improvement made in staff training. However, further improvements were needed. This was acknowledged by the manager who was in the process of negotiating a new training provider to ensure that all staff received up to date training. Improvements had been made in how staff were supported.

Systems were in place to ensure the safety of people who used the service, however, bed rails assessments were not completed appropriately. Following our inspection the manager told us that these had been put into place.

Improvements had been made in how the staffing numbers were calculated to meet people’s needs. These would be revisited when plans to accommodate more people in the service, from one of the other provider’s locations. This would also include increased staffing. We will continue to monitor how this is managed when the provider is aware of the numbers of people moving in.

People’s care records were being reviewed and updated, they were more person centred and included the input from people and their representatives. This was ongoing and the manager and staff were working on ensuring all care plans were up to date, included appropriate terminology and reflected people’s needs and preferences. The manager acknowledged that improvements made regarding social activities for people were ongoing and they were not yet where they wanted to be.

Improvements had been made in the infection control and environment. New systems were in place to monitor the cleanliness of the service. There was an ongoing refurbishment plan in place.

Improvements had been made in the safe management of medicines. People were provided with their prescribed medicines safely and when they needed them.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration. People were supported to see, when needed, health and social care professionals.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. There were systems in place to obtain and act in accordance with people’s consent to respect people’s rights and choices.

Inspection carried out on 28 September 2015

During a routine inspection

Saint Mary’s Nursing Home provides accommodation, nursing and personal care for up to 40 older people, some people are living with dementia.

There were 21 people living in the service when we inspected on 28 September 2015. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 19 January 2015. The service was rated inadequate. Breaches of legal requirements were found. These related to infection control, staffing levels, staff training and support, and how people’s consent was obtained. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also found that the service required improvements in how they ensured the care and welfare of people who used the service and how the service ensured that they were providing a good quality service. We issued warning notices and told the provider they should make improvements by 23 March 2015. We undertook a focused inspection on 27 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We found that the provider had made improvements which were ongoing and needed to be sustained and embedded into practice to provide people with good quality care.

Although some improvements had been made we found multiple breaches of regulation that affected the well-being of people using the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve.
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

There was not 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. There was an acting manager in post who had started working in the service following our last inspection.

The quality assurance systems were not robust enough to independently identify and address shortfalls. There had been some improvements which were ongoing but these were not made in a timely manner to ensure people were provided with a good quality service at all times.

There had been some improvement made in staff training. However, further improvements were needed. Improvements were needed in how new staff were supported to identify training needs and identify how their competence was assessed during their probationary period.

Improvements were needed to ensure that people were supported by staff who had the qualifications, competence and skills to meet their needs safely.

People’s care records had been reviewed and updated, however further improvements were required in the ways that people’s care was planned for, care records needed to be more person centred which identified the care and support people required and preferred to meet their needs. People’s privacy was not always respected.

Improvements were needed to maintain good infection control to safeguard people from cross infection. Environmental improvements were needed to ensure that people were safe.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. The systems in place to obtain and act in accordance with people’s consent had been improved to respect people’s rights and choices.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Inspection carried out on 27 April 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 19 January 2015. Breaches of legal requirements were found. These related to infection control, staffing levels, staff training and support, and how people’s consent was obtained. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also found that the service required improvements in how they ensured the care and welfare of people who used the service and how the service ensured that they were providing a good quality service. We issued warning notices and told the provider when they should make improvements by 23 March 2015.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Saint Mary’s Nursing Home on our website at www.cqc.org.uk.

Saint Mary’s Nursing Home provides accommodation, nursing and personal care for up to 40 older people, some people are living with dementia.

There were 22 people living in the service when we inspected on 27 April 2015. This was an unannounced inspection.

There was not 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. There was an acting manager in post who had started working in the service following our last inspection.

There were improved systems in place to meet people’s needs safely. People’s care records had been reviewed and updated to reflect the care and support they required. Staff respected people’s privacy and dignity.

There were now appropriate arrangements in place to protect people from risks associated with infection control.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration.

There were sufficient numbers of staff to meet people’s needs. Improvements had been made in how the staff were provided with the training and support they needed to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. The systems in place to obtain and act in accordance with people’s consent had been improved to respect people’s rights and choices.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

There were improvements made in how the service sought people’s views and experiences. Improvements were made in the service’s quality assurance processes. However, these needed to be embedded further to show that the service can sustain the progress made.

Inspection carried out on 19 January 2015

During a routine inspection

We inspected this service on 19 January 2015 and this was an unannounced inspection. Saint Mary’s Nursing Home provides accommodation and personal and nursing care for up to 40 older people. Some people are living with dementia. There were 27 people living in the service when we inspected.

At our last inspection on 3 September 2014, we asked the provider to take action to make improvements in care and welfare of people who use the service, cleanliness and infection control, staff recruitment, training and supervision and assessing and monitoring the quality of the service provision. The provider wrote to us to tell us how they had implemented these improvements. During this inspection we checked on their improvement plan and found that some actions had been completed, but there was need for further improvement and we had identified further issues which needed action.

There was not 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 service was being managed by a registered manager from another of the provider’s services. We refer to this manager in this report as the acting manager.

We found multiple breaches of regulation that affected the wellbeing of people using the service. People were not protected against the risks of receiving care or treatment that is inappropriate or unsafe. Risks to their welfare were recognised but assessments for people were not up to date or in some cases completed. People’s nutritional needs were not being consistently assessed and met.

There were not sufficient numbers of staff to meet people’s needs. Staff were not always available when people needed assistance, care and support.

The service was not clean and hygienic enough to protect people from the risks of poor hygiene.

People who used the service were supported by staff who were not trained and had the necessary skills to meet their needs effectively.

The acting manager told us that the service was up to date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS), however, appropriate referrals had not been made to ensure that people were not unlawfully deprived of their freedom to make their own decisions. Despite staff having training in MCA and DoLS not all understood them and how they impacted on the care provided to people.

People’s privacy and dignity was respected and staff interacted with people in a caring manner.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Where concerns were identified about a person’s food intake referrals had been made for specialist advice and support. However, improvements were needed in how the service monitored people’s dietary and fluid intake.

People were provided with their medicines when they needed them.

A complaints procedure was in place. People’s concerns and complaints were listened to and addressed in a timely manner. Improvements were needed in the ways that the service obtained people’s views and used these to improve the service.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

Inspection carried out on 3 September 2014

During an inspection in response to concerns

Prior to our inspection we had received concerns from an anonymous source about the care provided in the service and the staffing levels. We undertook this inspection to check that people were being provided with safe and effective care.

We spoke with nine of the 32 people who used the service and one person's relative. We also spoke with five staff members and the registered manager from another of the provider's services. We observed the care and support provided to people to check that staff interactions were effective and caring. We looked at three people's care records. Other records viewed included staff training and supervision records, staff recruitment records, the staff rota, meeting minutes and records associated with the quality assurance in the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We looked at the training records of eight staff members and found that only one of these held information to show that they had been provided with training in DoLS and Mental Capacity Act (MCA) 2005. The registered manager from another of the provider's service told us that they were aware of the changes relating to DoLS following a supreme court judgement in March 2014. However, we were not able to check the understanding with the current management of the service as they were on leave during our inspection.

Staff records showed that the staff, particularly the newer staff, had not been provided with the training and support that they needed to meet people's needs in a safe and effective manner. This included five of the staff member's that we tracked had not been provided with training in safeguarding vulnerable adults from abuse. A compliance action has been set and the provider must tell us how they plan to improve.

Staff recruitment records showed that the provider's recruitment procedures and processes were not robust enough. Robust checks had not been undertaken to ensure that people were supported by staff who were of good character and able to work with vulnerable people. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We had not planned to inspect the infection control in the service during this inspection. However, we noted that the service was not clean and hygienic; therefore we included this in our inspection. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy living in the service and that the ways that the staff supported them were effective. One person said, "We are very happy." Another person said, "I am quite comfortable and the staff help me when I need anything."

Discussions with staff, our observations and the staff rota showed that there were sufficient staff members to meet people's needs. People told us that they felt that the staff were available when they needed assistance.

Is the service caring?

People told us that the staff treated them with respect. One person said, "They (staff) are good, some better than others, but no one is unkind." Another person said, "The staff are very kind."

We saw that staff interacted with people in a caring, respectful and professional manner.

Is the service responsive?

We were concerned that the ways that people's care records were maintained did not reflect people's needs accurately, how these needs were met and any changes in people's needs and preferences. Therefore we could not be assured that staff were provided with the information to meet people's needs and that people were provided with the care and support that they required. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw that the staff responded to people's requests for assistance, including call bells, in a timely manner.

Is the service well-led?

The shortfalls which we identified in the care provided to people, infection control, staff training and the recruitment of staff identified concerns about how the service was led to ensure that people were provided with safe and effective care.

There was no evidence in the service to show that the provider had effective quality assurance systems in place to ensure that they continued to identify shortfalls, addressed them and continued to improve.

The registered manager of the service had recently left and their application to cancel their registration was being processed by CQC. When this is complete the registered manager will be removed from our records relating to this service. The registered manager from another of the provider's services and a staff member told us that there was a new manager working in the service. However, they were on leave at the time of our inspection.

Inspection carried out on 14 January 2014

During an inspection in response to concerns

Prior to our inspection we received information from an anonymous source. This information raised concerns about the staffing arrangements in the service. This included insufficient staffing levels during the night shift to meet people’s needs and senior staff in charge of the night shifts that were not qualified. The purpose of this inspection was to check that the staffing levels were appropriate to meet the needs of the people who used the service.

During our inspection we spoke with five people who used the service. They were complimentary about the approach of the staff. They told us that they were happy living in the service and staff treated them well. One person said, “I am happy here. It is not home but I feel safe and secure and they (staff) are kind to me and help me to manage. I couldn’t do that on my own anymore.”

We saw that staffing levels were sufficient to meet people's care needs and staff interacted with people in a caring, respectful and professional manner.

Inspection carried out on 4 July 2013

During a routine inspection

We spoke with 11 of the 27 people who used the service. People told us that they were happy living in the service. One person said, “I am very happy here, they look after me well." Another person said "I love it here." Another said, “It is very good.” Another person said, "I am very happy, no worries at all, I am well looked after and get everything I need."

People told us that the staff treated them with respect and kindness. One person said, “They (staff) are very good. I know their name and they know me.” Another person said, “The staff are smashing.” Another person said, "They (staff) are all wonderful." This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We also spoke with three people's visitors who told us that they were happy with the service provided. One visitor said, "It never smells, it is cleaner than clean. My (relative) is always clean, I am very impressed." Another said, "The staff are all so kind, they are all smiling."

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

We found that the service was clean throughout and equipment was fit for purpose and safe for use.