19 June 2023
During an inspection looking at part of the service
St Martins is ‘care home’ a providing personal care to up to 30 older people who may be living with dementia, in one large, adapted building. At the time of our inspection there were 25 people using the service.
People’s experience of using this service and what we found
Relatives told us they felt their loved ones were safe living at the service, however, the quality of the service had deteriorated since our last inspection.
People had not been protected from abuse and discrimination. The registered manager had not reported incidents to the local safeguarding authority for investigation. There was a closed culture within the service, the registered manager and senior staff within the service were related. Staff told us they did not feel confident to raise concerns with the registered manager. The provider had not developed a strategy to manage the conflict of interest.
The culture within the service was not open and transparent, relatives told us they had not been informed when incidents involving their loved ones had happened. Staff told us, there was a toxic unprofessional culture and they had been reprimanded by management for acting to keep people safe.
Potential risks to people’s health and welfare had been assessed but there was not always guidance in place to keep them safe, some guidance had placed people at risk. Fire risks had not always been assessed, fire drills had not been completed and people’s evacuation plans were not up to date. Medicines were not always managed safely.
Staff had not been recruited safely, people had been placed at risk, by staff not having all the required checks before they started work. There was not always enough staff to meet people’s needs, there had been a high turnover of permanent staff and agency staff were used to cover any gaps. Staff had not received inductions when they started at the service and their competency to undertake basic tasks had not been assessed.
People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not supported to make day to day decisions, the registered manager had placed restrictions on aspects of people’s daily lives such as where they could eat their meals.
Records were not always accurate or did not exist, there were no records of pre-admission assessments being completed or referrals to health professionals made when people’s needs changed. The service did not always follow government guidance, though visitors were welcomed into the service, they had not been able to visit people in communal areas until 3 weeks before the inspection.
People were supported to eat and drink enough, but they were not offered a choice of meal at lunch time, there was limited choice of jacket potato or salad if they did not want the main meal. People were not always supported to eat their meal when it was served.
People, staff, and relatives had not been asked their opinion on the quality of the service or encouraged to make suggestions to improve the service. Checks and audits completed by the registered manager had not identified the shortfalls found at this inspection.
The providers oversight of the service had been poor until recently when the provider changed their representative to oversee the service. They had identified the majority of the shortfalls found at this inspection and had started to develop an action plan to improve the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 21 November 2019).
Why we inspected
We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, recruitment, training, safeguarding people and governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.