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Archived: St Bathens Care Home Inadequate


Inspection carried out on 3 February 2014

During a routine inspection

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 carried out on 26 November 2013

During an inspection looking at part of the service

We carried out this follow-up inspection to check the provider had achieved compliance with Regulation 13 Management of Medicine. On the previous inspection we judged the provider was not fully meeting the requirements of regulation 13.

The two people we spoke with said the staff administered their medicines and they were �happy for the staff to do it.� One person told us �I know what my medicines are for and when I am to have them.� The other person said �I don�t know what my tablets are for. I trust my GP.�

Safe systems of medicine management were in place. We looked at the home�s medicine procedures and saw safe systems of administrations, storage and disposal. Staff who administered medicine had attended accredited medicine training.

Inspection carried out on 24 July 2013

During a routine inspection

The people we asked about their experiences of living at the home said the staff were kind and their care was good.

People told us the meals were good. They told us the chef ensured they were served with the meals they liked and they had snacks between meals to ensure adequate nutrition. One person said �the chef is very good and if I don�t like what is served he will prepare what I like.� Another person said �the chef always asks me if there is anything I fancy to eat.� A third person said �the food is good and there is nothing to complain about.�

People told us their medicines were administered by the staff. One person said �I am happy for the staff to give me my medicines then I don�t have to remember to take them.� Staff were not provided with guidance on the prescribed medicines they were administering and protocols on administering �when required medicines� were not in place.

People told us the home was kept clean and staff used the correct equipment when they provided personal care. Overall the home was clean but in need of more thorough cleaning. Chemicals hazardous to health needed to be kept locked.

People told us they would approach the manager with complaints and they felt sure their concerns would be taken seriously and acted upon.

Inspection carried out on 13 February 2013

During a routine inspection

We carried out a follow up visit in response to a previous inspection undertaken on the 29 November 2012 and where compliance actions were made.

We spoke with three people who lived at the home and two relatives visiting the home during our visit. The people we asked told us the types of decisions they were able to make and who would support them with more difficult decisions. One person told us �the staff listen to me, I tell what I think and then together we agree on the way forward.�

People we asked told us the staff knew how to care for them and the manager discussed their care with them. Two relatives told us that �keyworking� had been introduced, which was where staff were spending specific time with each person. Two people told us it was their choice to spend their days in their bedrooms and told us how they kept themselves occupied during the day.

People told us they were well cared for and gave us examples of the preventative equipment used to ensure they did not develop pressure ulcerations.

People said they felt safe at the home and knew who to approach with complaints.

We saw staff supporting people to settle and to have their meals. Staff interacted well with people and used a gentle approach to encourage them. People told us the staff including catering and ancillary staff were good.

Inspection carried out on 28, 29 November 2012

During an inspection looking at part of the service

The purpose of this visit was to follow up the compliance actions set at our previous inspection. During our visit we observed people participating in a group activity. We saw members of staff supporting people to attend appointments, eating their meals and we heard staff interacting with people. We heard staff use a gentle approach to help people remember where they were and to explain what was happening. We saw families visiting their relatives and we heard staff discussing their relatives� current needs. This was a positive interaction and we heard families thank staff for their support.

Although people who lived at the home were socially supported, they were not receiving care which reflected their needs. Their care records lacked detail about how to deliver the care needed to meet their needs and there was no system in place for monitoring their safety and welfare.

Inspection carried out on 20 June 2011 and 20 June 2012

During a routine inspection

We spoke with four people about their experiences of the care provision delivered by the staff. We were told the staff respected their rights and their visitors were welcome to visit. They said for additional privacy they met with visitors in their bedrooms.

We were told the food at the home was good. They said the cook asked them each day about the meals to be served and if necessary they would prepare alternative meals.

The four people we asked were unaware of a care plan. They were not involved in the planning and delivery of their care and they were not invited to review meetings. People said the staff knew their needs and how to care for them.

We spoke with a family visiting their relative at the home. We were told they were kept informed about important events such as accidents and incidents. When we asked about their involvement with care planning they said they had not been involved. They told us they were not asked how their relative liked their care needs to be met and they were not asked to attend a review of their relatives needs.

People we asked told us they made decisions about all aspects of their lives. Other evidence did not support this comment for people who lacked capacity to make decisions.

When we asked people how they kept themselves occupied, we were told there was an activities coordinator who arranged entertainment, outings and spent one to one time with them. For example people told us they watched television in their rooms and read books. One person told us although they spent their time in their room, they would go on outings organised by the activities coordinator and join in when there was an outside entertainer. Another person told us the activities coordinator spent one to one time with them every Friday.

People said they felt safe at the home and they would complain to the manager if they were not happy. A family visiting their relative told us they would approach the manager if they had concerns about the care provision.

We were told the home had been short staffed and agency staff were used to maintain staffing levels. One person told us the manager took prompt action when concerns were raised about specific agency staff. We were told staff answered call bells promptly.

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