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Archived: St Bathens Care Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 21 April 2015

We carried out this inspection on 3 February 2015. Our last inspection to the service was in November 2013. The visit in November 2013 was to check that the provider had made improvements to the management of medicines. The provider had taken action to address all shortfalls we previously identified.

St Bathens Care Home provides accommodation to people who require personal care without nursing. The home is registered to accommodate up to 16 people. On the day of our inspection, there were eight people living at the home. St Bathens Care Home is a large, three storey Edwardian building consisting of single bedrooms, each with an en-suite facility. Some rooms are on a split level and can be accessed by a stair lift. A passenger lift is available to access the main floors for people with mobility difficulties. There is a spacious lounge leading to an enclosed garden and a separate dining room. There is a shower room on the first floor and an assisted bathroom on the ground floor.

There was 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. The registered manager was present during the inspection.

The registered manager was open and transparent and explained the challenges the home was facing. This included general lack of investment and unclear future direction and vision. There were eight people living at the home and eight vacancies. This meant that the home was running at low occupancy, which lessened the income available to support the service. The environment was not well maintained with chipped paintwork and wall paper coming off the wall. Carpets were stained and frayed in places. The stair lift to access rooms on the mezzanine floor was taped up as it was not working. It had not been repaired. The registered manager was aware that investment was required to enhance the general environment. However, this was not forthcoming and action plans to address the issues were not in place. The environment did not attract new people to the service. The manager told us that this and insufficient marketing of the service did not enhance the home’s future.

Audits to monitor the service in terms of quality and risk were not in place. Risks associated with hot surfaces, hot water and falling from a height had not been identified and addressed.

Staffing levels were maintained at two care staff on duty throughout the waking day. Feedback indicated that these levels were sufficient to meet the basic care needs of people currently in the home. However, the lack of a cook after 2pm, impacted on the care staff as they were responsible for all teatime arrangements. There was no activities organiser which compromised the social opportunities available to people. There was only a small team of care staff which impacted upon the registered manager’s ability to ensure staffing levels were maintained. There was no flexibility to manage staff sickness or annual leave. Staffing levels were insufficient in the event of occupancy increasing within the home.

Staff told us they felt well supported by the registered manager and the team. However, formal systems such as staff supervision and appraisal to discuss work performance and development, were not in place. Staff had undertaken some training in 2014 but this was limited. Training in topics such as manual handling and infection control and those areas associated with older age had not been undertaken.

Arrangements had not been made to ensure the safe storage of people’s medicines, as the medicine trolley was stored in the shower room. This environment was too damp and warm, which presented a risk that the quality and effectiveness of the medicines, would be compromised.

People told us they felt safe and were happy with the care they received. Staff were attentive to people’s needs and showed consideration and respect. Staff undertook natural conversation and spoke to people in a polite, friendly and caring manner. They showed a desire to ensure people’s wellbeing and were clear about the ways to promote rights such as privacy and dignity.

People were encouraged to make decisions within their daily lives. Individual preferences and the support people required were clearly detailed within individual care plans. These were well written, up to date and easy to follow. Care charts were consistently completed and demonstrated areas such as adequate food and fluid intake and effective bowel management.

People were offered nutritious food, which was appetising and of a good quality. Snacks were served between meals and drinks were available at regular intervals and when requested. There were no meal or dessert choices routinely offered but people were offered alternatives if they preferred something different. Those people at risk of malnutrition were appropriately assessed and supported to gain weight by high calorie snacks and drinks.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Inadequate

Updated 21 April 2015

The service was not safe.

Not all risks to people’s safety had been assessed and appropriately addressed. This included the risks associated with hot surfaces, hot water and trip hazards.

Staffing levels were sufficient to meet people’s basic care needs, as there were only eight people living at the home. There was minimal flexibility to provide staff cover at times of sickness or annual leave. This resulted in the use of agency staff or the registered manager completing care shifts themselves.

People told us they felt safe. Staff were aware of their responsibility to identify any poor practice and to report any suspicion or allegation of abuse. Written policies were not up to date and had not been reviewed, presenting the risk of inaccurate information.

Robust recruitment and selection processes were in place, which minimised the risk of people being supported by unsuitable staff.

Effective

Inadequate

Updated 21 April 2015

The service was not effective.

There was not a staff training plan in place and staff had completed limited training to enable them to undertake their job effectively.

Staff felt well supported but formal systems of staff supervision and appraisal where work performance could be discussed were not in place. This did not enable staff to develop their skills or to address any shortfalls.

People were provided with a range of nutritious food and snacks between meals. There was only one choice of main meal although people were offered alternatives if they did not like this. People who were at risk of poor nutrition were assessed and provided with high calorie foods and drinks.

Caring

Good

Updated 21 April 2015

The service was caring.

Staff spoke to people in a friendly, respectful and caring way. They respected people’s privacy and dignity and encouraged people to make choices in their daily lives.

Staff were attentive to people’s needs and undertook any requests without delay. Staff showed consideration and undertook conversation in a natural and relaxed manner.

Responsive

Requires improvement

Updated 21 April 2015

The service was not responsive.

People looked well supported and were happy with the care provided. However, the lack of investment and associated issues such as the environment and staff shortages, impacted on the ability of staff to provide personalised care.

The home was quiet and people were generally happy following their own solitary interests. However, opportunities to participate within recreational activities or community involvement was limited.

Care plans were well written and identified people’s preferences and the support they required. Action plans were in place to address issues associated with older age such as falling and the development of pressure ulceration. Care charts were consistently completed to monitor effective food and fluid intake.

Well-led

Inadequate

Updated 21 April 2015

The service was not well-led.

The service lacked investment and forward vision. The home was operating on reduced capacity with eight vacancies. This impacted upon the financial accountability of the service but no action plans were in place to address this. The registered manager was not being supported to undertake their role effectively.

The environment was not well maintained and shortfalls were not being addressed. Audits were not taking place to monitor the service in terms of quality or risk. People were being asked informally to give their views about the service but formal systems to gain feedback were not in place.