St Cecilia's Care Home

About the service: St Cecilia’s Care Home is a residential care home that can provide personal care for up to 21 people aged 65 and over, some of who may be living with dementia. 21 people lived in the service when we inspected

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

Staff had basic knowledge to know how to keep people safe. Work to improve assessment of risk was needed to further develop staff knowledge. We made a recommendation about this. Lots of checks were completed to ensure people were safe and that their experience was positive. All actions identified were not always completed and this system needed to be reviewed. This would ensure appropriate governance was in place.

People said staff knew them very well and could anticipate their needs and that support was delivered in a timely way. People described that activities were developed around their preferences. People were supported through technology to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing.

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 were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

The environment supported people to have time on their own and time with other people if they chose this. The registered manager agreed that more work to help people living with dementia to navigate their way in the service would be beneficial. Cleanliness and health and safety were well managed.

Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. Staff recruitment was safe. The registered manager used information following accidents and incidents to reduce the likelihood of future harm.

The registered manager and management team were well respected. They supported the team to deliver high quality person centred care. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

A full description of our findings can be found in the sections below.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

St Cecilia’s is registered to offer care and accommodation for up to a maximum of twenty one people. The home provides care to older people who are living with dementia. Dementia is an umbrella term used to describe the range of conditions that cause changes in memory and other cognitive abilities that are severe enough to interfere with daily life. The service does not offer nursing care.

There were 20 people resident on the day we inspected. There was a manager employed at this service who had applied to be registered with the Care Quality Commission (CQC). The previous registered manager had recently retired from the service. The provider had maintained a dialogue with CQC whilst going through the recruitment process for a new manager and had acted in a timely way to replace the previous 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.

The provider had taken account of current good practice to make the environment as dementia friendly as possible. The service was two nineteenth century houses which had been converted to one home. The environment was dictated by the existing building which provided spacious communal rooms. There was no lift so people at the service had to be mobile if they had a bedroom upstairs. There were bedrooms on the ground floor for those people who were less mobile. Although the décor was not always reflective of best practice for people living with dementia in every area everyone appeared happy and calm. There was an outdoor area where people could walk and sit. The service had received a gold award for the best kept care home garden in the Scarborough in Bloom ‘Muck and Magic’ awards.

The staff were working within the principles of the Mental Capacity Act 2005. We saw staff give people choices and allow them to make their own decisions. We saw evidence of best interest decision making in the care records.

People’s needs were assessed by staff before they went to live at the service. This information was used to develop peoples care plans which were personalised. The reviews were not all up to date.

The service provided a range of more meaningful activities to support people living with dementia. We saw that one person liked to help with domestic tasks and staff were supportive of anyone who wished to carry out everyday activities such as this.

No recent complaints had been received at the service but people knew who to speak to if they wished to raise concerns.

People were provided with a choice of food and drink at mealtimes. People at risk of weight loss had been referred to their GP and the appropriate health professionals

Staff undertook training to learn new skills that kept them up to date. They had been trained in safeguarding adults and could describe the signs of potential abuse.

Risk assessments were undertaken to determine the risks present for people and action was taken to help minimise those risks. People had personal individual evacuation plans in their care records to assist staff in the event of a fire. Equipment was properly maintained. A recent fire visit had identified some areas for attention and the provider was working with the fire service to make sure these items were addressed.

Staff had been recruited safely and there were sufficient staff on duty to meet people’s needs. Checks of people’s history had been carried out prior to them working at the service.

Medicines were managed safely. Senior care workers administered medicines and audits were completed. An audit of medicines had recently been completed by a pharmacist.

Staff treated people with kindness and spoke respectfully to them. It was clear that they knew people well.

People were well supported at the end of their life. Staff worked with the care homes team from the local hospice to ensure people received good care. Training was being carried out by the care homes team for staff.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

We visited this service following inspection visits in August 2013 and February 2014 when we had found that people were been washed and dress from 0600 onwards but there was no clear rationale for this and no documentation to evidence the decision making. At that visit we also discovered that staff were not been trained and supported at this service.We made a compliance action and served a warning notice telling the provider that they must make some improvements. When we visited in April 2014 we found that the service had made improvements.

Is the service safe?

Every person in this service had a diagnosis of dementia and people who supported them told us that they felt that people were safe. and well supported. One person told us, " The staff really look after my relative well. The manager comes to talk to me and they involve me in all the discussions about their care".

Staff knew about risk management plans for some people and we saw that they were been followed. People were protected from risks to their health and well being by the use of telecare which alerted staff but did not interfere with the persons ability to move freely around this environment. This was not always backed up with a best interest decision that was recorded. The manager told us that they would be contacting the appropriate person within the local Social Services department to discuss if that paperwork was necessary.People who used the service remained in control of everyday decisions such as what to wear and what to eat as far as possible. We saw staff asking people what they wanted to eat and drink.

The manager completed staff rotas and ensured that there were sufficient staff on duty to ensure the safety of people living at this service. We saw that there was a team leader on duty , care assistants, domestic and kitchen staff. This ensured that peoples needs were met.

Is the service effective?

When people did not have capacity to make their own decisions others acting on their behalf were consulted in relation to their care and support and acted in their best interests. This meant that National Institute for Health and Care Excellence (NICE) guidelines which stated that, 'If the person lacks the capacity to make a decision, the provisions of the Mental Capacity Act 2005 must be followed' had been followed by staff.

Relatives of people who used the service were involved in planning the persons health and care plans with the staff. We saw that their discussions had been clearly recorded in the care files and the information used to ensure people had their needs met. One person told us, "The care here is excellent".

Is the service caring?

We spoke with a district nurse who visited the service and they said, " You always feel as if you have come into a family home". A relative told us, " Staff are so caring". We observed interactions between people who used the service and carers and saw that staff did not rush people, they were patient and spoke politely and kindly to people as well as enjoying a joke with them.

One persons wife said, "My husband has always woken early. The manager and staff have discussed his needs with me". This information reflected what was written in the care plan for this person.We saw that people were encouraged where appropriate to make everyday decisions for themselves. For instance one person was encouraged to choose what clothes he wore each day.

Is the service responsive?

One person told us, "The manager comes to talk to me at any time and is around at different times". During our visit staff checked to ensure that people were comfortable and had what they needed.

We saw the complaints procedure displayed in the hall for anyone to see when they entered the building. There were no complaints logged when we visited but people were able to do so if they wished.

We spoke with a nurse who told us,""Staff are very proactive and communicate well with the surgery". This meant that staff were seeking advice from health professionals when people who used the service needed medical support.

Is the service well led?

On the day of our visit we spoke with staff who were able to tell us how they would raise a concern and showed a good understanding of the people who used the service. This meant that staff were been supported and trained properly.

The service had a quality assurance system which was being reviewed. There were audits carried out to check that systems were in place to protect people who used the service from harm. For instance we saw that a medication audit had been carried out. Staff were able to feedback to manager and providers at staff meetings so that their experiences were taken into account.

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We found that three people had been dressed and sat in a chair. Staff told us that the reason for getting people dressed early was to prevent further distress to them later in the morning.By dressing people and getting them up this early staff are not treating people with consideration and respect and not taking account of their dementia type condition.

We looked at pre admission assessments which were very detailed but some useful information had not been transferred to care plans. Without this background knowledge and understanding people staff do not have relevant information to support the person.

During the visit we spoke with one person's relative and they told us 'Staff are kind, some have a good understanding of dementia and others do not '

We saw evidence that the environment was well maintained and there was some sensory equipment in one room to provide some stimulation. There was evidence of telecare equipment being used.

Medicines were handled appropriately but not all staff that administered medication received appropriate training to enable them to deliver treatment safely.

Staff were not supported through supervision and personal development planning.

We did note that when providing personal care and support at other times, all staff took their time and treated people with respect and maintained their dignity. We saw that care plans contained information pertinent to the individual. There was nothing in the care plans about people getting up, dressed and returned to bed.

During the visit we spoke with four relatives and they told us 'X is really well looked after, the staff really care and we are always made to feel welcome' and 'They make it very easy to visit especially as we have young children. They are always friendly and approachable.' They also told us that they attended regular relative meetings. These meetings meant they were able to keep in touch with what was happening at St Cecilia's. One person said 'These meetings make us feel involved in the care and support our relative receives'.

We saw evidence that the environment was well maintained, and some effort had been made in providing stimulating material, equipment and artwork. There was no evidence that any sort of environmental assessment had been carried out in line with guidance issued by the National Institute for Health and Care Excellence in relation to supporting people with dementia.

We saw that people were asked their opinion about the service and comments included comments from a visiting doctor 'Excellent care of patients who, at times can be very difficult to manage ' well done'. Someone who visited the service monthly said 'At St Cecilia's it is the aim to do the best for the residents. There are some dedicated staff who work hard to achieve a happy home'.

The relatives told us "The quality of care is very good, the staff are excellent" they also told us "Staff keep in contact with us and tell us if the person in the home is poorly or has had a fall" Another relative told us "Staff keep the relatives informed and they are honest about what has happened" they also said "I have raised a couple of issues with the provider and they have sorted things out straight away"

We saw that the care plans outlined the help and support people required. Staff were observed supporting people in the way described in the care plan. The staff were seen to be very knowledgeable about the people they cared for. They also had time to spend with people. The meals were seen to be well presented and people's dietary needs were catered for.

Staff received regular training and supervision. Supervision involved direct observation by the manager or a senior care assistant as well as more formal one to one supervision.

A complaints procedure was in place and people were aware of how to make a complaint. Relatives had raised concerns and these had been dealt with directly rather than going down the complaints procedure.