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Inspection carried out on 23 October 2019

During a routine inspection

About the service

St Martins is a residential care home providing personal care and support to up to 30 people in one large extended detached building. At the time of the inspection, there were 24 older people living at St Martins, some of whom were living with dementia.

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

People told us, and our observations confirmed, that they felt happy and safe living at the service. Potential risks to people’s health, safety and welfare had been assessed and there was guidance in place to mitigate risks.

Accidents and incidents had been recorded, analysed and action taken to reduce the risk of them happening again. When incidents had happened, the provider had been open and transparent, they had worked with external agencies to reduce the risk of them happening again.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received training, supervision and appraisal to develop their skills and meet people’s needs. Staff monitored people’s health and referred them to healthcare professionals when required. Staff followed the guidance given to keep people as healthy as possible. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to eat a balanced diet. People had access to activities they enjoyed and kept them as active as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Each person had a care plan that contained details of their choices and preferences. People had been involved as much as possible in developing the plan.

People met with staff before moving into the service to check staff would be able to meet their needs. People were treated with dignity and respect. People were supported to express their opinion on the service. People’s end of life wishes were recorded. Staff worked with GP’s and district nurses to support people at the end of their lives.

Complaints had been recorded and investigated following the provider’s policy. The environment had been developed to support people living with dementia following good practice guidance. People were given information in a way they can understand.

Checks and audits had been completed on the quality of the service and action had been taken when shortfalls were found. The registered manager attended local forums to keep up to date with developments in adult social care to continuously 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 and update

The last rating for this service was Requires Improvement (published 15 November 2018) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what

they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 15 August 2018

During a routine inspection

This inspection took place on 15 and 16 August 2018 and was unannounced.

St Martins is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and care provided, and both were looked at during the inspection. St Martins accommodates up to 30 people in one adapted building. The building is an older building providing large communal areas. At this inspection, 23 people were living at the service. People who used the service were older people with a range of care needs including diabetes, dementia and reduced mobility.

The registered manager worked at the service each day and was supported by a deputy manager. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run.

We last inspected St Martins in March 2017. This was a focussed inspection, looking only at the key area of ‘Effective’, which was rated as ‘Requires Improvement’. This was because the registered manager and staff had limited knowledge of their responsibilities about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). At that inspection, the required improvement was made and the service received a rating of ‘Good’. The last comprehensive inspection was completed in October 2016. At that inspection, except for ‘Effective’, the service received a rating of ‘Good’ for each key area as well as an overall rating of ‘Good’.

People and their visitors told us were happy with the care and quality of service provided. However, at this inspection there were three breaches of regulation and two other areas identified that required improvement. This is the first time the service has been rated Requires Improvement.

Medicines were not always managed safely, PRN protocols for medicines to be taken as and when needed required updating, there was no guidance to distinguish medicines that needed to be taken at times outside of the usual medication rounds, medicines to be returned to the pharmacy were not handled in line with the service’s policy and skin creams were kept insecurely in people’s bedrooms. Storage of creams in people’s rooms had not been risk assessed and the temperature at which the creams were kept was not monitored as required.

The building was adapted to meet people’s needs. Staff completed checks on the environment and equipment, these helped to ensure people were safe. However, the safety certificate for the fixed electrical wiring at the service had expired and there was no record whether electrical work noted as requiring urgent remedial attention had been addressed.

A complaints procedure was in place and was under review to include pictorial prompts to make it easier for some people to use. However, we found a complaint received had not been recorded in line with the service’s policy.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This is so we can check that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner, however, they had not always done so.

Staff were recruited safely, however, some decisions about the employment of staff, although considered, were not always recorded. This is an area identified for improvement.

Pre-assessments for people moving to the service were comprehensive. Potential risks to people’s health and welfare were identified, however although staff were knowledgeable about people’s conditions, there was not always guidance for them to refer to. This is an area identified for improvement.

Staff knew how to recognise the signs of abuse and knew how to report any concerns they may have.

Inspection carried out on 28 March 2017

During an inspection looking at part of the service

The inspection took place on 28 March 2017 and was unannounced.

St Martins is a residential service which provides care to older people, most of whom were living with dementia. St Martins is registered to provide care for up to 30 people. At the time of our inspection there were 29 people living there.

This service was last inspected on 18 October 2016, one regulation was not met and improvement was required.

The home 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager.

People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Mental capacity assessments were completed and correct procedures were followed under Deprivation of Liberty Safeguards.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve the best outcomes for people. The care and support needs of each person were different, and each person’s care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff to support people in an individual way.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. Staff continued to receive training, competence checks and support to meet the needs of people. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs very well. Feedback we received from people and their relatives was positive. We were told about high standards of care; which improved the quality of people’s lives and gave their families peace of mind. We observed warm, caring attitudes from staff and commitment to provide the best service for people.

People were complimentary about the food and were offered choices around their meals and hydration needs. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy and nutritious diet.

Inspection carried out on 18 October 2016

During a routine inspection

The inspection took place on 18 October 2016 and was unannounced.

St Martins is a residential home which provides care to older people including some people who are living with dementia. St Martins is registered to provide care for up to 30 people. At the time of our inspection there were 27 people living at the home.

This service was last inspected on 12 October 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The home 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager.

People enjoyed living at St Martins and they considered it their home. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were supported to make their own decisions and care was given in line with their expressed wishes.

Care plans contained accurate and relevant information for staff to help them provide the individual care people needed. People’s care and support was provided by a consistent staff team who were knowledgeable, trained and knew people well.

People were encouraged and supported by a caring staff team. People told us they felt safe living at St Martins and staff knew how to keep people safe from the risk of abuse. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. The registered manager knew what action to take if concerns regarding people’s safety were brought to their attention. Potential risks were considered positively so that people did things they enjoyed. People were encouraged to maintain relationships and kept in touch with those people who were important to them.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

The registered manager and staff had limited knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records did not always ensure people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided personal care and supported people to retain as much independence as possible.

People were supported to pursue various hobbies and leisure activities.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided.

People told us they could raise concerns or complaints if they needed to because the provider, registered manager and staff were available and approachable.

The registered manager had quality monitoring processes which included audits and checks on medicines management, care records and accidents and incidents. Following their appointment, the registered manager was improving the system of audits and checks to make sure people received a quality service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 12 October 2013

During a routine inspection

We looked at paperwork and found that people had the right support to give consent. People had a full assessment and a care plan, which were reviewed regularly. We saw that the service responded quickly when people�s needs changed.

Medicines were managed in a safe way, and the environment was safe, helping people to retain as much independence as possible.

People have fresh, home cooked food. We found meals to be well thought out and people�s preferences and allergies were known by the cook. People got ready for lunch at their own pace, with staff encouraging people to lay the table if they could. Visitors were coming and going. The house was busy; there was a happy but calm atmosphere.

A staff member introduced us to eight people, two of whom we spoke to in detail. One person told us that �It�s a big something to get used to, but its good here�. Another said �We don�t argue, we get on very well, and dinner is good�. We observed and saw staff were skilled in the way they responded to people. They spoke gently to people and interpreted what support was needed. We saw that staff were busy, but they didn�t rush. They responded in a paced way that seemed to help people remain calm and confident.

We spoke to two relatives. They told us that their relative was happy, and looked well since moving to the home. Another said they felt relieved that their relative was in safe hands.

Inspection carried out on 16 October 2012

During a routine inspection

We made an unannounced visit to the service and spoke to people who use the service, relatives, the Registered Manager and to staff members.

Not all the people at St. Martins were able to talk to us directly to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Other people were able to talk with us and tell about their experiences at the home.

The three people we spoke with gave us positive feedback about the service.

They told us, "I get everything I need here, I have no complaints. I couldn't ask for more. The food is excellent and varied� and �You are speaking to a contented person, it�s like home here. The food is just like I would cook at home�, "They let me do as much as possible for myself and then step in when I need help. The staff are very patient�.

People told us that they were treated with respect by the staff that supported them and that their privacy was maintained. They felt listened to and supported to make decisions about their care. They said that they received the health and personal care they needed and that they were comfortable. They said that their likes and dislikes were taken into consideration.

People said that they felt safe at the home and any concerns they had would be listened to and acted on.

Reports under our old system of regulation (including those from before CQC was created)