St Catherines Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation to the safe management of medicines, staffing and safeguarding. Sufficient improvements were found at this assessment and the provider was no longer in breach of these regulations.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was developing a proactive and positive culture of safety based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had made improvements since our last inspection to ensure staff recorded accidents and incidents. The registered manager undertook monthly audits to analyse these and to identify any themes or trends. Minutes from meetings, demonstrated lessons learnt and areas for improvement were discussed and shared with staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The management team were working closely with commissioners of services to ensure systems were in place to support people moving to the service in future.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People we spoke with told us they felt safe living at the home, Comments included, “The staff are very caring, and my [relative] comes to visit me every day. I feel very safe here” and “I am safe and secure here and I don’t have any problems with the staff.”

Since our last inspection, the provider had made improvements to ensure staff appropriately followed safeguarding procedures. Managers were maintaining safeguarding records, and any relevant issues had been reported appropriately to the local authority. However, improvements to recording needed to be fully embedded. For example, we saw one person had a bruise, which we confirmed was not due to a safeguarding concern, however, this was not fully recorded in their care plan. Whilst the provider had notified CQC of certain incidents as required, not all had been submitted in relation to safeguarding concerns. This appeared to have been an oversight and they were submitted during the inspection.

Staff undertook training in safeguarding and records indicated some staff would shortly require refresher training. Managers had arranged face to face safeguarding training in partnership with the local authority. Staff told us they knew how to report any concerns and felt able to report concerns if they needed to.

The provider worked with people to understand and manage risks by thinking holistically. However, staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff carried out risk assessments for people and kept these under review. However, where actions had been identified to mitigate identified risks, staff had not always ensured these plans were followed. For example, where one person required a room sensor to alert staff when they moved, this had not been switched on. In other cases, we saw staff had taken action to reduce risks to people. We saw food and drinks were accessible to people, the registered manager confirmed they had considered any potential risks to people requiring a modified diet especially if they were living with dementia, however, this had not been recorded. Following our feedback, they completed a risk assessment to record this assessment, and any mitigation required.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.There were appropriate checks and maintenance of the environment, and the home was clean and tidy. The registered manager completed regular walk around checks of the environment.

However, staff had not always followed plans to reduce environmental risks. For example, small kitchens were accessible on both units and contained items which could pose risks to people. These had keypad locks, but occasionally we found these had not been fully closed. Following our feedback, the registered manager told us new locks were being fitted. For safety reasons, people’s prescribed creams were stored in lockable boxes in their bedrooms, however, we found some had been left unlocked and therefore accessible to others. The registered manager had been monitoring this and said they would continue to do so.

The provider had arranged some refurbishment, and gardeners had made significant improvements to outside areas. A relative said, “They have been doing some refurbishment, which has improved the place.” However, areas of the building remained in need of refurbishment, for example, a bathroom and toilet were out of use. This amounted to a significant amount of work for the one maintenance person to undertake along with their other tasks. Managers told us the provider had a regional facilities support team, who would be able to offer support moving forward.

The provider was sourcing face to face fire marshal training for staff. Staff took part in fire drills and during our assessment the registered manager updated the log of completed and scheduled drills, to help ensure all staff were included.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

The provider assessed staffing levels required using a dependency tool. Overall, during our visits, we found staff were able to respond effectively to people’s needs. The provider had amended staffing numbers due to fewer people living at the service. However, we received mixed feedback from staff about staffing levels and they were unclear about the levels required, which could vary from day to day. For example, sometimes staff worked a twilight shift and other times not. A staff member told us, “Sometimes it’s challenging.”

Feedback raised concerns about the impact of unexpected staff absences. The provider had a process for covering absences, however, on 2 recent occasions it had not been possible to provide cover, which meant there was only 1 female staff member in the building on one occasion, which could impact on meeting people's preferences with personal care.

Some people felt staff were busy especially in a morning, having to wait for their call bells to be answered, and some raised concerns about staffing and management support at the weekend. However, others said staff were available to respond to their needs. Managers were embedding a ‘whole home’ approach to staffing, where staff from both units supported each other when needed. They were reviewing call bells response times to help plan staffing and were planning future recruitment needs. The provider was changing management shifts, to ensure there was management presence during the weekends. This needed to be kept under review.

Staff undertook training through eLearning, refresher training was in progress and being monitored by managers. There remained some gaps in training identified for clinical staff and this was in the process of being undertaken. We noted, staff training in the use of the electronic recording system could be more effective. Indeed, experienced staff showed new staff how to use the system, however, staff felt this was variable and some were not as knowledgeable or as confident as others. We shared this feedback with the registered manager.

Since our last inspection managers had focused on providing staff support through individual supervision meetings and staff had been recruited safely.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The premises were clean and odour free. People told us the overall cleanliness of the premises had improved. The provider had undertaken infection control and prevention audits and was continuing to take identified actions in response. Staff had access to PPE and undertook relevant training. One person said, “There is a new cleaner who is spot on.”

Overall, the provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. However, improvements in staff following procedures and recording systems needed to be fully embedded and sustained.

Since our last inspection, the provider’s oversight and monitoring of the ordering and administration of medicines had improved. Managers told us they had focused on the safe administration of medicines and regular audits had been undertaken. They had introduced daily checks on medication stocks and ordering requirements. However, we found where people required topical creams and ointments, in some cases very little had been used, despite records suggesting it had been applied. Managers told us they planned to refer these people to the GP, to clarify whether these creams were still required.

Staff were trained in medication administration and people safely received their medication. Competency assessments were in progress. Audits showed managers were continuing to monitor closely to ensure people received their medicines in line with instructions, such as at specific times or with food. One person told us, “I have plenty of medication and some of it I have to have before food, which they [staff] sort out. As I said they are very conscientious.”