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Archived: St.Theresa's Nursing Home Inadequate

Reports


Inspection carried out on 1 November 2016

During a routine inspection

We carried out this unannounced comprehensive inspection of St Theresa’s nursing home on 1November 2016. We undertook this visit as we had received concerns in respect of the care and welfare of people using the service. We looked at the concerns raised, plus we checked what action the provider had taken in relation to concerns brought to the commission’s attention during our last inspection in January 2106. At that time we found a breach of legal requirements, in that new staff were starting work at the service without a satisfactory Disclosure and Barring Service (DBS)check in place. We received information of concern prior to this inspection that a person had been allowed to work alone with vulnerable people before required checks had been completed. We discussed this with the manager who confirmed this to have occurred. A record showed a DBS check for a staff member appointed in August 2015 had not been requested until June 2016. The failure to complete necessary checks before allowing staff to provide care exposed people to unnecessary risk. This was a repeated breach of regulation requiring action to be taken from the comprehensive inspection in January 2016.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Theresa’s Nursing Home on our website at www.cqc.org.uk The provider for this location is registered under the legal entity of Morleigh Limited which is part of a group of nursing and residential care homes.

St Theresa’s is a care home which provides accommodation for up to 45 people who require nursing care. At the time of the inspection 22 people were living at the service. Most people who lived at St Theresa’s required general nursing care due to illness. Some people were living with dementia. St Theresa’s is a purpose built single storey building with a range of aids and adaptation in place.

The service is required to have a registered manager. 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. St Theresa’s has been without a registered manager since March 2014. Since that time five managers have been appointed. Two of those managers left after a short employment period at St Theresa’s. One was moved to manage another service in the group and then left. One was moved from another service in the group to manage St Theresa’s on a part time basis and the current manager commenced in October 2016.This has meant there has been no management stability at the service. The current manager told us they had submitted an application to the commission for registration. However, this could not be verified at the time of the inspection visit and was not found to be the case following the inspection.

Medicines were not being managed safely. Handwritten entries were not always double signed. There were gaps in records of when creams had been applied and not consistently signed as given. There were inaccurate records of the amounts of medicines being stored. Medicines were not being returned to the pharmacist as required. Medicines requiring cold storage were being stored at above the recommended temperature range. This had been identified by the manager but not acted upon.

The premises and equipment were not being maintained in a safe and secure way. The collection of soiled laundry from bedrooms and cleaning procedures did not ensure suitable standards of cleanliness. There was no designated facility to wash commode bowls effectively. A broken shower door was propped against a wall in the bathroom. Water temperatures were inconsistent with one hot bath tap supplying water at a temperature above the safe range. A door to a store room which contained cleaning products was left open and

Inspection carried out on 25 January 2016

During a routine inspection

St Theresa’s Nursing Home is a care home that provides nursing care for up to 45 older people, some of whom had a diagnosis of dementia. On the day of the inspection there were 20 people living in the service.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. The manager in charge of the day to day running of the service had submitted an application to CQC for the registered manager position. A registered manager is a person who has registered with the 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.

We carried out this unannounced inspection of St Theresa’s Nursing Home on 25 January 2016. At this comprehensive inspection we checked to see if the service had made the required improvements identified at inspections on 15 September and 3 August 2015. In September 2015 we had serious concerns about the lack of consistent management of the service, which had resulted in poor outcomes for people. The management and monitoring of the nurses and the nursing care provided to people was inadequate. There were serious risks to people’s safety because insufficient and inconsistent action was taken to provide safe and appropriate treatment in relation to pressure area care, wound care, weight loss and falls. There was not a safe or proper system in place to manage medicines.

At our inspection in August 2015 we found recruitment systems were not robust. This was because a new member of staff was working in the service before the relevant checks had been completed to confirm that they were suitable to work in a care environment. The service was not acting in accordance with the Mental Capacity Act because there were no assessments of whether people had capacity to consent to their care and treatment.

At this inspection we found improvements had been made in all the areas where we had concerns except for recruitment. Recruitment systems were still not robust. Pre-employment checks were not consistently obtained to ensure new staff were suitable to work with the people who lived in the service.

A new manager had been managing the day to day running of the service since the middle of November 2015. The manager had built a solid team of nurses and care staff since being in post. They were clearly committed and dedicated to the role and had inspired staff to work together to substantially improve the outcomes for people living at St Theresa’s.

The nursing care provided to people was now safe and planned in a way that consistently met each person’s individual needs. Where people were assessed as being at risk of skin damage due to pressure, weight loss and falls or in need of wound care appropriate treatment plans and monitoring systems were in place. We found equipment, such as hospital beds, pressure relieving mattresses and cushions were in working order and appropriate to meet each individual person’s needs.

People’s individual health needs were well managed and staff had the skills to recognise when people may be a risk of their health deteriorating. The service worked closely with GPs and specialised nurses such as tissue viability nurses. Tissue viability nurses regularly visited the service to advise staff how to manage people who were at risk of skin damage. Since our last inspection the manager had arranged for a GP from the local practice to visit the service every two weeks. This meant people had regular access to a GP to help them maintain good health and manage on-going conditions.

Assessments of people’s capacity to consent to care and treatment had been completed. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Lib

Inspection carried out on 15 September 2015

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

St Theresa’s Nursing Home is a care home that provides nursing care for up to 45 older people. On the day of the inspection there were 24 people living in the home. Some of the people at the time of our inspection had mental frailty due to a diagnosis of dementia.

We carried out an unannounced comprehensive inspection of this service on 6 August 2015. After that inspection we received concerns in relation to the safety of the nursing care provided to people living at St Theresa’s Nursing Home. These concerns were about how risks to people in relation to pressure area care, wound care, nutrition and hydration and medicines were identified and managed. Concerns were raised about staffing levels and competency, particularly in relation to nursing staff, and a general lack of confidence in the management of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Theresa’s Nursing Home on our website at www.cqc.org.uk.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. A registered manager is a person who has registered with the 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.

We found there were serious risks to people’s safety because the service had not adequately assessed the risk to people in relation to pressure area care, wound care, weight loss and falls. Where people were assessed as being at risk of skin damage due to pressure, weight loss and falls or in need of wound care, insufficient and inconsistent action was taken to provide safe and appropriate treatment. Systems to ensure consistent treatment was given to people were either not in place, or if put in place, were not followed. Risk assessments were not being updated when specific risks to people changed.

The service significantly disregarded the needs of people in relation to their care and treatment. The service had failed to recognise, in a timely manner, when one person was in need of treatment. When this was realised, action was not taken to give appropriate treatment to relieve the person’s pain and distress. When the noise from a pump on a mattress for another person was causing the person to become distressed, the service failed to take appropriate action to alleviate their anxiety and provide equipment that was safe.

There was not a safe or proper system in place to manage medicines. Inappropriate medicine was being given to one person because the medicine was not suitable to be chewed when given disguised in food. The correct procedure for handwritten Medicine Administration Records (MAR) was not being followed. Records showed people did not always receive their prescribed medicines in a timely manner. Records of medicines, that required stricter controls by law, held by the service did not match the stock held.

There were adequate numbers of suitably qualified care staff on duty. However, there were insufficient numbers of permanently employed nurses who knew people’s needs.

People did not receive care and treatment that was responsive to their individual needs. Care records were inconsistent and where the need for treatment had been identified, care plans for that treatment had not been written to give staff clear instructions to follow. The lack of specific care plans related to where it had been identified that people should be re-positioned at regular intervals, had been assessed as being at risk of losing weight and in need of wound care.

The management of the service was inconsistent which had resulted in poor outcomes for people. The management and monitoring of the nurses and the nursing care provided to people was inadequate. There was a lack of communication between nurses and management regarding the day-to-day provision of nursing care.

The service had failed to actively seek the views of people and their families. The culture of the service and the changes in management meant people and their families had lost confidence in the service and, as a result no longer shared their views and concerns. The three relatives all told us they had lost all confidence in the service because of the change of managers and the shortage of permanent nursing staff. They said there was no point in telling a manager or nurse anything because they would then leave the service and nothing would be done.

Audit processes were not effective and had failed to identify shortfalls in relation to medicines, care plans, tissue viability and maintenance of equipment.

The provider has overall responsibility for the quality of management in the service and the delivery of care to people using the service. The provider has repeatedly not achieved this at St Theresa’s Nursing Home in the two years the Morleigh group has owned the service. The Care Quality Commission has carried out seven inspections (including this one) of the service since November 2013. At each inspection there have been breaches of the regulations. At five of the seven inspections the service was not meeting the required regulations in relation to the management and organisational governance of the service.

We identified three breaches of the Health and Social Care Act regulations. We are taking further action in relation to this provider and will report on this when it is completed.

Inspection carried out on 6 August 2015

During a routine inspection

The inspection took place on 06 August 2015 and was an unannounced comprehensive inspection. St Theresa’s Nursing Home is a care home that provides nursing care for up to 45 older people. On the day of the inspection there were 26 people living at the service. Some of the people at the time of our visit were living with dementia.

At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection in April 2015. At that time we found risk assessments did not give clear guidance to staff as to how to minimise identified risks. Incidences of people falling were not consistently recorded or action taken to protect people from the risk of falls. Parts of the building were in need of decoration and one toilet was being used to store equipment. Although there were maintenance logs in place to record any problems with the building or equipment these were not acted on in a timely manner. People’s personal preferences were not consistently taken into account. Activities were limited and were not planned in line with people’s interests. Medicine Administration Records (MAR) were difficult to decipher and there were gaps in the records. No documentation could be located. Records associated with the running of the service could not always be located. After the inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. At this inspection we found the breaches had been met.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. The manager in charge of the day to day running of the service was awaiting Disclosure and Barring Service (DBS) checks before putting in an application for the registered manager position. 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. People and staff told us the manager was available and had worked to develop the staff team. We saw systems had been put in place to carry out and record regular staff supervision and training. Records were easily located.

Risk assessments were in place for a range of areas including falls. Where people had been identified as being at risk of falling there was clear guidance for staff as to how to minimise the risk. When falls occurred these were recorded in incident logs which were audited monthly. This meant any trends could be highlighted and action taken to protect people from the risk of falling.

A problem with the roof of the building had resulted in leaks in the ceiling in various areas of the service. These had been addressed as they occurred. On the day of the inspection the manager told us the maintenance team had identified the root of the problem and would be carrying out the repairs within the next few days. There had been some redecorating and toilets and bathrooms were in good working order.

The manager told us they had recently had problems with reoccurring faults in air mattresses. As a result the provider had changed the system for supplying air mattresses to the service. This was now being done through the organisations own stock. The maintenance team were carrying out any repairs internally. There had recently been an audit of wheelchairs and hoists which had identified some were in need of repair. Arrangements had been made to bring additional equipment into the service to ensure people’s needs were met safely. Staff told us there was sometimes a shortage of readily available equipment and we have made a recommendation to put systems in place to ensure people have access to well-maintained equipment at all times.

Medicine Administration Records (MAR) were well organised. People received their medicines as prescribed and at a time that suited them.

There were sufficient numbers of staff to support people. However staff were not always effectively organised in order to give people additional support during the lunch time period. Recruitment systems were not robust. Pre-employment checks were not consistently obtained to ensure new staff were suitable to work with the people who lived in the home.

Some people living at the service were subject to constant supervision and/or restrictive practices such as the use of bed rails and alarm mats. Legislation laid out in the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) requires that in these circumstances certain legal processes must be adhered to. This includes mental capacity assessments to identify if people are able to consent to the care provided and, where they are not, formal applications to obtain authorisation in order to restrict people’s liberty should be made. We did not see any mental capacity assessments in people’s care documentation. No DoLS applications had been made for the people living in the service since the last inspection.

Care plans were in the process of being updated. Where this had occurred the information was detailed and relevant to the individual. Life histories had been developed to help staff understand and know people.

An advocacy group had been started to give people an opportunity to voice their opinions about the service. Feedback from the first meeting had resulted in a barbeque and trip out being arranged. Information about how to complain was readily available to people and visitors to the service. A relative told us the manager listened to any concerns they raised.

Whilst some monitoring of records was taking place and improvements made, this had not identified the lack of mental capacity assessments and recruitment procedures not being followed.

We identified breaches of the Health and Social Care Act regulations. You can see what action we have told the provider to take at the back of the full version of the report.

Inspection carried out on 25, 27 &28 April 2015

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

The inspection took place on 25, 27 and 28 April 2015 and was unannounced. At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection in February 2015. At that time we found the provider had not fully implemented an effective system to regularly assess and monitor the quality of service across the organisation. At this inspection we found a new Head of Operations had been put in post to address this and put new standardised systems in place to develop the organisations individual nursing and residential homes including St Theresa’s. In February 2015 we found staff were not supported by a robust system of training, supervision and appraisal. At this inspection we found training had been brought up to date and staff had received appraisals although not supervisions.

St Theresa’s Nursing Home is a care home that provides nursing care for up to 45 older people. On the day of the inspection there were 27 people living at the service. Some of the people at the time of our visit were living with dementia.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. There had been a manager in post until a few days before the inspection when they had left suddenly without giving notice due to personal reasons. 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 provider told us a new manager had been recruited and was due to start in post on 11 May 2015, when they would submit an application to become the registered manager of the service.

Risk assessments were in place and identified when people were at risk of falls. However there was no guidance for staff to help them minimise identified risks. We could not locate any evidence that falls were consistently recorded and action taken to protect people from the risk of falls.

Maintenance logs and audits were kept to identify any problems with equipment or the premises. However it was not evident that these were acted upon in a timely manner. Parts of the building were in need of decoration. The service was free from odour and clean throughout.

There were enough care staff on duty to help ensure people’s health needs were met. There was only one nurse on duty at any one time. They were often rushed with several demands on their time. A care worker said; “the nurses are rushed off their feet.” Someone using the service said; “If anything happens….one nurse, what does she do?”

Systems for administering and recording medicines were not robust. Medicines Administration Records (MAR) contained handwritten entries and deletions making some entries difficult to decipher. There were gaps in the records meaning it was unclear if people had received their medicines as prescribed.

No documentation could be located to evidence that applications had been made to deprive people of their liberty when necessary to keep them safe. We saw when one person left the building a member of care staff went with them. The correct legal procedures had not been adhered to.

Food and fluid charts were kept when people had been identified as being at risk from poor diet and/or dehydration. However amounts were not tallied at the end of each day meaning any low intakes might not be noticed. New forms were put into circulation to address this on the day of the inspection.

People told us they enjoyed the food and were given a choice. People’s preferences and cultural needs were taken into account. People were supported to eat when necessary. This was done with dignity and kindness.

There was an activity co-ordinator in post who worked two hours a day during the week. People had access to a range of activities such as books, jigsaws and games. There was an activity timetable on the noticeboard but activities scheduled did not take place during the inspection.

During the inspection staff and senior management often found it difficult or were unable to locate information. It is important robust systems are in place to ensure people’s care documentation and other related records are easily accessible in all circumstances.

We identified several breaches of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.

Inspection carried out on 3 February 2015

During a routine inspection

St Theresa’s Nursing Home is a care home that provides nursing care for up to 45 older people. On the day of the inspection there were 28 people living in the home. Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. The provider advised us that a new manager had been recently recruited and was due to start in post on 16 February 2015. A registered manager is a person who has registered with the 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.

We carried out this unannounced inspection of St Theresa’s Nursing Home on 3 February 2015. At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection on 9 September 2014. At that time we found the provider had not fully implemented an effective system to regularly assess and monitor the quality of service that people received. At this inspection we found the manager had implemented a quality assurance system to identify areas of the service that required improvement. However, there was no system in place to monitor the quality of the service provided at the provider level by using an auditing process external to the home. You can see what action we told the provider to take at the back of the full version of the report.

Staff were not consistently supervised, supported and trained to carry out their roles. Records showed that 57% of staff had not had a one-to-one supervision or appraisal since 2013. All staff told us it had been several months since they last had a supervision meeting. One staff member told us, “supervision is not happening”. Training records showed that not all staff had received relevant training for their role and refresher training was not up-to-date. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the home. Comments included; “nice here, you can’t fault it”, “very good here, just right”, “home is very good indeed” and “the quality of the care is perfect…the carers are good, not one bad one” . A relative told us, “I am happy to leave my Mother here”.

Staff interacted with people in a friendly and respectful way and people were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff. Where people did not have the capacity to make certain decisions the home acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards

Staff had received training in safeguarding adults and were aware of the home’s safeguarding and whistleblowing policies. They were knowledgeable in recognising signs of potential abuse and the relevant reporting procedures.

We observed the support people received during the lunchtime period. People had a choice of eating their meals in the dining room, their bedroom or one of the lounges. People told us they enjoyed their meals and they were able to choose what they wanted each day. Comments included, “food is very good, too much but not worried about waste because I ask for less”, they know I like sausages”, “food is OK, warm and nicely presented”, “the cook is very good, I have a choice and I talk to the cook”, “food is all home cooked, perfect and good choice”, “the food is alright, I am given a choice so I have mash not chips”.

People told us staff treated them with care and compassion. Comments included, very good, if you want anything they [staff] will try to get it”, “if you are in pain they [staff] will ease you...the highest praise” , “no matter who they are they get good care”, “the staff are fine – no trouble” and “very good I like the staff”.

People received care and support that was responsive to their needs and their privacy was respected. Visitors told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

People told us they knew how to complain and would be happy to speak with the acting manager or nurse in charge if they had any concerns.

Inspection carried out on 9 September 2014

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

This inspection was carried out by two inspectors in one day. We carried out this inspection to check if compliance actions set at our inspection of 3 June 2014 had been met.

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

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

We found the service was safe.

We saw that people were treated with dignity and respect by the staff. During our inspection we spoke with five people living in the home and they told us they were happy living at St Theresa’s. People told us “best place there is” and “very happy living here”.

At our inspection of 3 June 2014 we found there were not always enough staff on duty to meet people’s needs. At this inspection we spent time in the communal areas and observed people to check if there were enough staff to safely meet people’s needs. We found there were adequate numbers of qualified, skilled and experienced staff to meet people’s needs.

Is the service effective?

We found the service was effective.

People’s health and care needs were assessed and specialist dietary, mobility and equipment needs had been identified in care plans where required. There were good systems in place to update staff each day about people’s changing needs. Staff we spoke with and observed showed they had good knowledge of the people they supported.

Is the service caring?

We found the service was caring.

We spent time in the communal lounge and dining room to observe how staff responded to people’s needs. We observed staff responded to people in a kind and sensitive manner. For example we observed staff assisting some people to eat their lunch. We saw staff assisted each individual in a relaxed and unrushed way, talking with the person throughout to reassure them and explain what was happening.

Is the service responsive?

We found the service was responsive.

Care plans were personalised and reflected people’s individual needs. This meant staff knew how people wanted to be supported.

The home employed an activity co-ordinator for 10 hours each week who provided activities within the home, such as arts and crafts and arranged external entertainers such as musicians.

Is the service well-led?

We found the service was not well-led in all areas.

The registration of the provider of this regulated activity is subject to a registered manager condition and this location did not have a registered manager. However, a new manager was appointed in May 2014 and at the time of this inspection they were in the process of submitting their application to become the registered manager for this service.

At our inspection of 3 June 2014 we found the provider did not have an effective and comprehensive quality assurance system in place. At this inspection we found the compliance action set for the provider to improve the quality monitoring of the service had been partially met.

The manager of the service monitored daily the quality of the care delivered. This was achieved by completing daily checks of care records, observation of staff practice and speaking to people living in the home. Staff and people told us the manager was approachable and responded to any concerns or suggestions.

However, we found the provider had not implemented an effective and comprehensive quality assurance system to take an overview of the service and learn from the findings. The views of people who used the service and their representatives had not been sought and meetings for people and their families had not taken place.

We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to quality assurance.

Inspection carried out on 3 June 2014

During a routine inspection

During our inspection of this service we considered our findings to answer our five 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 our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

People were treated with dignity and respect. We spoke with six people living in the home and two relatives. Everyone told us they were happy living at St Theresa’s and felt safe. One person told us “it’s very good here”.

Care plans were personalised to the individual and gave comprehensive information about how the person wanted their care and support to be provided.

People were cared for by staff who were properly trained, supervised and appraised. There were not always enough qualified, skilled and experienced staff to meet people’s needs.

The home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards. The legislation regarding DOLS is part of the Mental Capacity Act 2005 (MCA) and requires providers to seek authorisation from the local authority if they feel there may be restrictions or restraints placed upon a person who lacks capacity to make decisions for themselves. At the time of our inspection the home had not made any applications to restrict people’s liberty under DOLS.

Is the service effective?

People’s health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

We spoke with two visitors and they confirmed they were able to visit the home whenever they wished and the home kept them informed of any changes to their relative.

Is the service caring?

People’s individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people’s wishes.

People we spoke with told us they were very happy living in the home and staff were caring and attentive to their needs. One person told us “they [staff] are caring and good”. We observed staff responding to people in a kind and sensitive manner.

Is the service responsive?

People took part in a range of activities inside and outside of the home. The home employed an activity co-ordinator for 10 hours each week who provided activities within the home, such as arts and crafts and arranged external entertainers such as musicians.

St Theresa’s gave clear information to people about how to complain. People living in the home and their visitors told us they knew how to complain and would speak with the new manager if they had any concerns.

Is the service well-led?

The registration of the provider of this regulated activity is subject to a registered manager condition and this location did not have a registered manager. However, a new manager was appointed in May 2014 and we were advised they intended to submit an application to become the registered manager for this location.

The home worked with other services to ensure people’s health needs were met. This included appropriately involving people’s GPs when people were unwell or for regular health checks.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. The provider asked people who used the service for their views about their care and treatment, but their views were not always acted on.

As a result we were not assured that the quality of the service provided to people was continuingly improving. We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to quality assurance.

Inspection carried out on 28 November 2013

During an inspection in response to concerns

New providers took over the running of St Theresa’s Nursing Home on 28 October 2013. Since then we have had a number of concerns raised to us including poor staffing levels and the care and welfare of the people using the service. We carried out an unannounced responsive inspection to look at the areas of concern raised. We found some of the issues bought to our attention had been resolved and some concerns were substantiated.

St Theresa’s Nursing Home provided care and support to a maximum of 45 people. There were 36 people using the service at the time of our inspection. During the course of the inspection we spoke with 12 people who used the service and two visitors.

We saw people’s privacy and dignity were not always being maintained. People we spoke with told us they were encouraged them to do things for themselves and a visitor gave an example of their parent being encouraged to take the decision to sit in the lounge rather than spend all day, every day, lying on the bed isolated in their bedroom. Nobody we spoke with knew about the content of their care plans. One person, who needed two staff to help them, told us they preferred female staff but one was usually a man. We saw staff knocked on people’s doors before entering and drew curtains when providing personal care.

We saw care plans were detailed and gave some direction as to the care and support people needed. They had been regularly reviewed but new problems such as treatment following a fall had not been incorporated into the care plan meaning staff did not always have the most up to date information from which to work.

We saw the home was clean and tidy. There was an odour in one area of the home which may have been coming from a carpet.

We had been told the heating was not working and the home was cold. The parts for the heating system had been ordered and arrived on the day of the inspection. The plumber arrived at the home during the inspection and we were told the heating was fully operational the day after the inspection. We were told of strategies in place whilst the heating was not working to ensure people who sued the service were not cold.

We had been told staff had been reduced since the new providers took over. On the day of the inspection there were enough qualified, skilled and experienced staff to meet people’s needs.

Formal support systems to enable staff to deliver care and treatment safely and to an appropriate standard were not in place. Informal support was ongoing.