St Marys Nursing Home

St Mary’s Nursing Home is a residential care home providing nursing and personal care to up to 48 people aged 65 and over, younger adults and people with a physical disability. The service was supporting 32 people at the time of the inspection.

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

The provider had failed to ensure the ongoing maintenance of the environment which put people at increased risk of infection.

The provider had systems in place for oversight and monitoring the safety and quality of the service which under the new management had mostly resulted in improvements. The new manager and new deputy manager were aware of further improvements that were required to be made. They were open and honest and committed to making positive changes.

People’ care plans required review to ensure they were up to date and reflected people’s risk accurately. Not all care plans were up to date, followed by staff or reviewed regularly. The manager had identified this as an area for improvement and along with the deputy manager, had started reviewing these.

Staffing levels had started to improve in the service. Recruitment of new staff had been a priority for the new manager which would provide better consistency in care for people. People and relatives felt more activities were needed, and a new activities worker had started employment on the day of the inspection.

People and their relatives told us they felt safe. People were supported to remain safe. Staff knew how to report allegations and concerns of abuse and understood their roles clearly and what was expected of them. People’s medicines were managed safely. Safe recruitment and selection processes were in place.

People and relatives were getting to know the new manager. They felt they were approachable and would address any concerns they may have.

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

For more details, please see the full report which is on Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and standards of care. A decision was made for us to inspect and examine those risks. 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 requires improvement based on the findings of this inspection.

Enforcement

We have identified a breach in relation to the environment not keeping people safe from the risk of infection, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Staff were wearing personal protective equipment (PPE) in line with government guidance. Designated areas were set up within the service for staff to remove and apply PPE.

• Staff had received training in infection prevention and control (IPC).

• People and staff were part of a regular testing programme.

Further information is in the detailed findings below.

We found the following examples of good practice.

• Staff were wearing personal protective equipment (PPE) in line with government guidance. Designated areas were set up within the service for staff to remove and apply PPE.

• People received daily one to one care from staff whilst self-isolating to reduce the risk of social isolation.

• Visits were arranged in line with government guidance and facilities were already available to support with visits when able with the use of a visiting pod.

Further information is in the detailed findings below.

St Marys Nursing Home is a residential care home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 48 people. All bedrooms and communal rooms are on one level.

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

Since the last inspection, there had been improvements in record keeping, risk management and ensuring people received individualised care. People had risk assessments and care plans which gave staff the information they needed to support people and keep them safe. Those people considered to have more risks, for example, with food and fluid intake, had additional monitoring charts in place.

People were happy with the care they received and told us their privacy and dignity were respected and their independence promoted. 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.

Staff received training, supervision and support to enable them to feel confident when supporting people’s needs. They knew how to safeguard people from the risk of abuse and poor care.

People’s nutritional needs were met, and they told us they liked the meals provided to them. People received their medicines safely and had access to health care professionals when required.

Staff were recruited safely and, although busy, staff said there were enough of them on duty to support people. There was a comment from staff that some days a week there was no kitchen assistant to deliver hot drinks to people, so care staff completed the task, which could take them away from caring duties. A relative commented they would like to see more staff presence in the lounge. These points were discussed with the registered manager who told us they would address them.

There was a new registered manager in post, who had provided stability and consistency to the staff team. The provider had systems in place to monitor the quality of the service and to respond to complaints. These helped to identify shortfalls, learn lessons and 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 17 October 2018) and there were three 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 regulations.

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.

Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not fully effective. As this is the second time in a row the service has been rated Requires Improvement, we will meet with the provider to discuss their action plan for improvements.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been employed and they were to start the registration process with CQC.

St Marys Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Marys Nursing Home is a single storey, purpose-built home, situated in its own grounds in a residential area of west Hull. The service can support up to 48 people who may have a range of physical health needs; some people may be living with dementia. There are 40 bedrooms, four of which are for shared occupancy. There is a large communal room which incorporates a dining area and seating areas for watching television or quiet time. There are plenty of bathrooms, shower rooms and toilets within easy reach of bedrooms. At the time of the inspection, there were 48 people using the service.

There were inconsistencies with people’s care plans. Some people had care plans, which contained good information and guidance for staff in how to meet their needs; these had improved since the last inspection. However, other people’s care plans lacked important information which meant there was the possibility of care being overlooked. Three people did not have care plans to manage their anxious behaviour, which could at times be challenging to themselves and other people.

Risk was not always managed safely. Most people had risk assessments for specific areas such as moving and handling and nutritional concerns. However, some areas of risk had not been identified and assessed properly, which could place people at harm of injury.

We found some areas of recording required improvement such as daily recording of the care given to people and monitoring charts when people were at risk regarding food and fluid intake.

The above three concerns were breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Overall governance had improved, shortfalls identified and action planned, however, the provider needed to follow through with these plans to make sure they were completed. We have given a recommendation about this. The new manager in post was aware of the shortfalls and was to be supported by a regional manager to implement the improvement plan. The quality monitoring system consisted of audits, meetings and questionnaires to gain people’s views about the service. There had been an issue with not following through action plans in a timely way.

Staff spoken with told us the new manager was supportive. However, there had been lots of changes in a short space of time and they also spoke of the need for team building and improvements in communication.

Staff were recruited safely and although there had been some concerns with staffing numbers, these had been addressed. The new manager used a tool to calculate staffing numbers and was to monitor this to ensure the levels remained safe. They told us they would continue to hold discussions with staff about their views regarding safe numbers. We will continue to monitor safe staffing numbers during our discussion with the provider.

Staff had received training in how to safeguard people from the risk of abuse. They knew what to do if they had concerns.

People received their medicines as prescribed.

Staff had access to training, support and development. Formal supervision meetings and appraisal had not been held with all staff but this had been identified and included in the improvement plan. We have made a recommendation that the provider follows through with the action plan to ensure all staff receive supervision and appraisal to aid their development.

People’s health and nutritional needs were met. Staff supported people to access health professionals when required and they could remain in the service for end of life care if this was their choice. People liked the meals provided to them, although some people said they could be hotter when served. The new manager told us they would address this with catering staff.

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

People who used the service and their relatives had positive comments about the staff team and their approach when supporting people. People’s privacy and dignity was respected.

There was a complaints procedure displayed in the service and people felt able to raise concerns and complaints.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection.

St Marys Nursing Home is a single storey, purpose-built home, situated in its own extensive grounds in a residential area of west Hull. The service can support up to 48 people who may have a range of physical health needs. There are 40 bedrooms; some have en-suite facilities and some are for shared occupancy. There is a large communal room divided into distinct areas for dining, watching television, relaxing quietly and enjoying a chat and a coffee with friends and family. There are plenty of bathrooms, shower rooms and toilets within easy reach of bedrooms. There is a large enclosed, landscaped garden and patio, which provides a secure area for people to enjoy the outdoor space.

The service had 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.

During the inspection, we found some concerns regarding the management of medicines. People had not always received their medicines as prescribed due to stock control or administration practices.

There was an inconsistency in the implementation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This had led to some people potentially being deprived of their liberty unlawfully as staff had not recognised they met the criteria for a DoLS. Not everyone who lacked capacity had best interest meetings to record how decisions were made on their behalf. However, staff had a good understanding of the need to gain consent from people prior to carrying out care tasks.

People had assessments of their needs completed and care plans developed but these were not always thorough and information was missing from them. This had the potential for important care to be overlooked and also care to be delivered which wasn’t in line with people’s preferences.

Although we recognised there was a quality monitoring system that had just been started, which consisted of an audit timetable, surveys and meetings to gain people’s views, this had not been embedded into practice yet. This had resulted in shortfalls being missed when audits and checks were completed and when some issues were identified, these had not been addressed in a timely way. We could see this was a result of changes implemented since the new provider had taken over the service and their priority had been focussed on upgrading the environment. The refurbishment plan was well underway and some areas were looking very nice.

You can see what action we have asked the provider to take in response to concerns about medicines management, consent, care planning and quality monitoring at the back of the report.

We found staff had received training in how to safeguard people from the risk of harm and abuse. They knew what to do if they had concerns and how to report them. Staff had completed risk assessments for people, which helped to identify areas of concern and how to help minimise them.

We found staff were recruited safely and there were sufficient staff on duty to meet people’s needs. Some people told us response times to call bells could be improved. This was to be checked out by the registered manager.

People who used the service and their relatives were complimentary about staff approach. They said staff were kind and caring and respected people’s privacy and dignity.

People’s nutritional needs were met and menus provided a range of meals and alternatives over a four-week period. There were some mixed comments from people who used the service about the variety of meals; the registered manager told us they would complete a survey to check out people’s views and address any issues.

We found people’s health care needs were met. They had access to a range of community health care professionals for advice and treatment. The four health care professionals spoken with said staff referred to them in a timely way although one had a concern about how staff managed an on-going health care issue. This was discussed with the registered manager during the inspection and the person’s records checked to ensure appropriate care and support had been provided to them.

Staff had access to training, supervision and support. Gaps in training had been identified, plans made and courses booked to address shortfalls. Staff told us they felt very supported by the registered manager and were able to raise concerns. There were staff meetings which enabled them to receive information and express their views.

The provider had a complaints procedure and people spoken with felt able to raise concerns and complaints. People who used the service named specific members of staff that they would talk to if they were worried about anything.

A visiting relative commented, 'Staff always inform us regarding hospital appointments for our family member We are generally told after care is delivered and we trust the staff implicitly to provide care first and tell us later.'

We spoke with four members of staff and they were able to describe the procedures in place to report any safeguarding incidents they may witness or become aware of.

Staff were provided with opportunity to undertake further professional development in the form of recognised qualifications appropriate to their role, for example National Vocational Qualifications in health and social care.

Although people were aware they could make a complaint there was no evidence that complaints were monitored or recorded which ensured comments were listened to and acted on effectively.

We looked at care records and found them to be maintained on a daily basis and legible. Nursing notes were legible and accurate relevant to a person's level of care needs.