• Care Home
  • Care home

Archived: St Anne's Residential Home

Overall: Requires improvement read more about inspection ratings

Whitstone, Holsworthy, Devon, EX22 6UA (01288) 341355

Provided and run by:
Mr & Mrs H J Medland

Important: The provider of this service changed. See new profile

All Inspections

8 and 9 July 2015

During an inspection looking at part of the service

This was an unannounced inspection on 8 July 2015 and 9 July 2015. St Anne’s Residential Home provides accommodation for up to 36 older people who require support in their later life or are living with dementia.

There were 25 people living at the home at the time of our inspection.

The home is on two floors, with access to the upper floors via a passenger lift, chair lifts, or wheel chair lift. All bedrooms have en-suite facilities which have a toilet and wash basin. There are shared bathrooms, shower facilities and toilets. Communal areas include four sitting areas, a conservatory and a dining room. The home is in a rural location, with country views and outside courtyard space.

After our last inspection in March 2015 we took enforcement action. We told the provider to take action to make improvements to how risks to people’s care was managed and reviewed, how people’s consent to their care was obtained, and how people’s care plans were reviewed and updated. We also told the provider to take action in relation to how people’s medicines were managed, to address the dignity and respect of people and review staffing numbers. The provider was also asked to make improvements to how the quality of the service was monitored.

The provider sent us an action plan on 8 June 2015 and confirmed on 25 June 2015 all the improvements had been made. During this inspection we looked to see if these improvements had been made. We found some improvements had been made, however further action was required.

People told us staff were kind and caring. People told us there were sufficient numbers of staff to meet their needs and we found staff had time to speak with people. People had call bells which they could use to ask for assistance. However, people told us their call bell was not always answered quickly which meant they could be waiting for a long time for assistance. Staff told us the position of the call bell system meant they may not always hear the call bell ringing which caused delay.

There was a clear management structure in place and staff received training and supervision to carry out their role. However, some staff had not completed the required training to ensure they had the skills and knowledge to effectively care for and support people. Staff told us they felt supported by the registered manager. Staff, were able to explain what action they would take if they suspected abuse was taking place. People were protected by safe recruitment procedures as all employees were subject to necessary checks which determined they were suitable to work with vulnerable people. People told us, if they had any concerns or complaints, they would speak with the registered manager, staff or their relatives. People told us they felt confident that their complaints would be listened to. There was a complaints policy which outlined the procedure which was to be followed and complaints were recorded so themes could be identified and action and improvements taken.

People told us they lacked confidence in the laundry service, because their clothes had been lost or damaged. People’s privacy and dignity was not always protected as there were no locks on people’s bedroom doors and some bathroom locks did not work.

The registered manager and staff did not fully understand how the Mental Capacity Act 2005 (MCA) and deprivation of liberty safeguards (DoLS) protected people to ensure their freedom to make decisions and choices was supported and respected. This meant decisions were being made for people without proper consultation.

People’s independence and social life were promoted. People told us there were enough social activities. People’s end of life wishes were not documented or communicated. People’s care planning documentation was not reflective of their wishes. This meant people were at risk of not having their choices and wishes for the end of their life met, because there was no written information for staff to follow.

People’s individual nutritional needs were known and taken into consideration and associated risks were monitored. People were supported to eat and drink, but at times staff were not always focused on the person they were helping, which resulted in the person loosing interest and not eating all of their meal. People had access to health care services. However, services were not always contacted in a timely manner because of communication difficulties between the staff team and the registered manager. People’s medicines were managed to help ensure they received them safely; however, documentation was not always accurate or robust.

People and their families were involved in their care plans to help ensure their care plan included their wishes and desires for later life. Care plans and risk assessments were in place, reviewed and updated. However, they did not always give clear direction to staff about how to meet a person’s needs. This meant the care being provided was inconsistent between staff. People had personal evacuation plans in place which meant in an emergency, peoples individual care needs, could be shared with emergency services.

Falls and accidents were monitored and were used effectively to identify required changes. The quality monitoring systems in place did not help to identify concerns and ensure continuous improvement. People’s confidential records were stored securely. The Commission was notified appropriately, for example in the event of a person dying or experiencing injury.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

17 and 19 March 2015

During a routine inspection

This was an unannounced inspection on 17 March 2015 and 19 March 2015. St Anne’s Residential Home provides accommodation for up to 36 older people who require support in their later life or are living with dementia. There were 26 people living at the home at the time of our inspection. The home is on two floors, with access to the upper floors via a passenger lift, chair lifts, or wheel chair lift. All bedrooms have en-suite facilities which have a toilet and wash basin. There are shared bathrooms, shower facilities and toilets. Communal areas include four sitting areas, a conservatory and a dining room. The home is in a rural location, with country views and outside courtyard space.

At our last inspection in July 2014 we told the provider to take action to make improvements to how they respected and involved people, how the quality of the service was monitored and how records relating to people’s care were documented. The provider sent us an action plan on 25 August 2014 confirming how improvements were going to be made, and advising us that these improvements would be completed by October 2014. During this inspection we looked to see if these improvements had been made. We found they had not all been completed.

There was a registered manager in place. 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.

People told us there were not always sufficient numbers of staff to meet their needs. We found staff did not always have time to speak with people, which meant people were not always treated with consideration, respect and dignity. We heard call bells ringing for 15 minutes and over before staff went to assist people. People’s comments about the staff were variable; some people told us staff were kind and caring, whilst others felt differently.

Staff received training and supervision to carry out their role, and staff told us they felt supported by the registered manager. Staff were able to explain what action they would take if they suspected abuse was taking place. People were protected by safe recruitment procedures as all employees were subject to necessary checks which determined they were suitable to work with vulnerable people. People told us, if they had any concerns or complaints, they would speak with the registered manager, staff or their relatives. There was a complaints policy which outlined the procedure which was to be followed. However, the registered manager told us that complaints and concerns were not always written down, but dealt with at the time. This meant we were unable to review how many complaints the provider had received and how they had responded to complaints.

The registered manager and staff did not fully understand how the Mental Capacity Act 2005 (MCA) and deprivation of liberty safeguards (DoLS) protected people to ensure their freedom to make decisions and choices was supported and respected. This meant decisions were being made for people without proper consultation. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People’s end of life wishes were not documented and communicated. People’s care planning documentation was not reflective of their wishes. Consideration had not been given to train staff in end of life care. This meant people were not well supported at the end of their life and did not always receive consistent and compassionate care because staff did not have the necessary knowledge or skills.

People told us they did not always get their medicine when they should. Ordering and administering of people’s medicines were not managed effectively. Documentation relating to medicines was inaccurate.

People’s individual nutritional needs were not always known and taken into consideration. People were not always supported to eat and drink. People had access to health care services however services were not always contacted in a timely manner.

Care plans and risk assessments were not always in place, reviewed and updated. They did not give clear direction to staff about how to meet a person’s needs. This meant the care being provided was inconsistent between staff. People’s care plans were not reflective of their choices because they were not involved in creating and reviewing their own care plan. People did not have personal evacuation plans in place which meant in an emergency, peoples individual care needs, were not shared with.

People’s independence and social life were not always promoted. Although there were activities planned and the registered manager was making improvements, people told us there were not enough activities and there were no opportunities to go out.

The quality monitoring systems in place did not help to identify concerns and ensure continuous improvement. Falls and accidents were monitored; however the system in place was not used effectively to identify required changes. The Commission was notified appropriately, for example in the event of a person dying or experiencing injury.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.

14 July 2014

During a routine inspection

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

This is a summary of what we found-

Before our inspection we received some information of concern about the service, the areas of concerns related to care and welfare, ethos and culture of the home, lack of choice for people around nutrition, concerns regarding care documentation, lack of training, staff shortages and equipment not working correctly. These areas were looked at as part of our inspection and shared with the local authority as part of our multi-agency agreement with regards to safeguarding.

Is the service safe?

At the time of our inspection we did not find the service to be safe.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The recent judgement made by the Supreme Court on 19 March 2014 places a responsibility on providers to ask two key questions; is a person subject to continuous supervision/control? and is the person free to leave? If a person is subject to both continuous supervision/control and not free to leave, then a person is being deprived of their liberty. We found people who lived at St Anne's were not subject to restriction. However, it was not clear from people's care plans how the provider had considered this having regard to the DoLS legislation particularly as some people who lived at St Anne's had a form of dementia.

We found people were not protected from the risks of unsafe and inappropriate care and treatment because accurate and appropriate records were not maintained. We found care plans were not always reflective of people's current health and social care needs and did not always give clear direction to staff about how to meet a person's care needs.

We found people's confidential personal information (CPI) could be at risk as it was not always held securely.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People we spoke with told us they were generally happy living at St Anne's. Comments included, 'very comfortable' and 'everything is first class'.

People who used the service, staff and visitors were protected against the risk of unsafe or unsuitable premises.

The care home was accessible to people who had mobility difficulties, for example there was a lift in place and a specialist adapted wheelchair lift. There were bath hoists for people to use to support them with bathing. We saw documentation was in place to show that equipment was serviced in line with operating standards.

Is the service effective?

At the time of our inspection we found the service to be effective.

People's health and care needs were assessed and individual care plans were in place to guide and direct staff to meet a person's health and social care needs. However, improvement was required as care plans were not always reflective of a person's current care needs. We also found that the Mental Capacity Act (MCA) had not always been considered in line with people's decision's regarding end of life care.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with a selection of staff, staff confirmed that before they commenced employment they were asked to complete an induction and associated training. We were told that there were training opportunities available, and that training had improved lately. Staff confirmed the arrangements for supervision and that staff meetings took place.

Is the service caring?

At the time of this inspection we did not find the service to be caring.

People's privacy, dignity and independence were not respected. People's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

People who lived at St Anne's were generally positive of the care staff who supported them. Comments included, 'staff are very good', 'no complaints at all'. Although people told us they were happy and felt safe living at St Anne's comments included, 'extremely nice, some more than others' and 'I like gentleness, some are brisk'.

People we spoke with were not sure about what they were having for lunch, there were no menus in place to prompt or remind people about the choices available. We spoke with the chef who confirmed that the menu was not based on people's choices but on her knowledge of people's likes and dislikes and the catering order. We spoke with people about the meals at St Anne's, comments included, 'the grub is good' and 'varied'sometimes they are good sometimes they're not'. One person we spoke with told us, 'I hope we've got something nice for lunch', after saying this we observed this person to cross her fingers.

Is the service responsive?

At the time of our inspection we did not find the service to be responsive.

People we spoke with told us that staff did not always come quickly when they pressed their call bell. Comments included, 'sometimes they are quite a while' and 'you can go over half an hour before someone comes to help you'.

We were told by one member of staff that at times they felt rushed because of staff shortages and gaps in the rota because of unpredicted sickness. We were also told that increased care needs also placed additional time resources on staff which could be difficult when facing shortages.

We saw from care records that people were able to access external health care professionals such as GP's and district nurses. We also read that the out of hours GP service had been utilised.

Is the service well-led?

At the time of our inspection we did not find the service to be well-led.

The provider had systems in place to monitor the quality of the service being provided, however, these systems were not always effective in identifying areas which required improvement.

The service had a manager who was registered with the Care Quality Commission.

Overall staff told us they enjoyed working at St Anne's, comments included, 'a nice place' and 'I enjoy it' and 'I love it'.

It is a requirement of the Health and Social Care Act 2008 that providers inform us of particular incidents when they occur. We found that the manager had failed to report two incidents which should have been reported to the Commission. Following our inspection the notifications relating to these incidents were forwarded to us.

12 November 2013

During an inspection looking at part of the service

When we visited the home on the 03 May 2013 we were concerned that the staff were not being suitably trained and supported to carry out their role effectively and safely. We wrote to the provider and asked them to look at this matter. We requested they complete an action plan with a date when they felt they would have addressed our concerns and put the situation right. We received an action plan that stated they would have completed this by the end of July 2013.

We carried out a follow up visit on the 12 November 2013 to check that the concerns had been addressed.

We found that staff continued to not be suitably trained, supervised and appraised. As a consequence people living in the home may not be having their needs met to an appropriate standard and may be unsafe.

3 May 2013

During a routine inspection

During this inspection we toured the premises and met with 13 of the 29 people who were living in the home, either in their private room or in the lounge or dining room. We met with relatives of two people who lived in the home, two health and social care professionals who had visited recently, four staff, the registered manager and the provider. We looked at a sample of care records, staff training records, and looked at the way that medication was managed in the home.

People living in the home told us, 'Everything's lovely. You couldn't wish for anything better.' One person said, 'They see to my comfort.' Another told us they had "a comfortable room and good food.'

One person told us that their relative had been cared for in bed for several months at the end of their life. They 'were well hydrated', they told us, 'there was not a mark on their skin.' By this they meant that the care provided had been very good.

Another relative told us they had seen that activities were provided 'nearly every day.' People told us they had enjoyed a trip to a local garden centre the day before this visit.

We saw that people's health and well being were promoted by having their medication delivered to them in accordance with their doctors' prescriptions. Some staff training needed to be provided or updated, including training in first aid, and safe moving and handling, to ensure that staff would able to carry out their work in a safe way.

3 August 2012

During an inspection looking at part of the service

On the first day of this visit we were supported by an expert-by-experience who gave people living in the home an opportunity to share their thoughts about the service they received in an informal way, in order to help us gain a clear picture of life in St Anne's. On the second day, two inspectors visited to assess the quality of the care provided to people in the home.

We spoke with eleven people in the home and observed several more. Some people could express their views clearly. One person said, 'I'm happy here. The days go quickly. I join in some things, like bingo. I would like to out more. Six of us went out about three weeks ago to the seaside in two cars. We go to the pantomime each Christmas, and we have birthday cakes.'

People's appearance was well cared for, clean and tidy. A regular visitor to the home commented how nice it was that their relative and their room always looked nice.

At mealtimes we saw that staff helped people in a sensitive way, giving the support they needed. People were clearly able to choose where to eat ' in the dining room, lounge, or in their own room.

We observed people in the lounge while they were being helped by staff, to move from their wheelchair to an easy chair, using a hoist. We saw that staff carried out these tasks safely, while talking to the people being moved to reassure them about what was happening.

Some people told us that they appreciated the links with local churches. The Anglican and Methodist ministers gave services in the home on alternate weeks. People were also supported to attend local churches if they wished and people said that ministers from other denominations of the church visited freely.

We saw that the registered manager was introducing a system of quality monitoring, to check the performance and quality of the service provided in a systematic way. However, we found that checks had not been made on the record of care of very frail people in their rooms. Because the record keeping was inconsistent we could not be confident that care had been provided in accordance with the care plans.

16 February and 6 March 2012

During an inspection looking at part of the service

The people who live at St Anne's told us that they were happy with the care and support they receive and how they live their lives. Comments from people included 'You just have to ask' and 'Nothing is ever any trouble'. One person told us that they thought the place was like a prison and that he/she was loosing independence. We saw no evidence of this, and no one else made a similar comment.

People told us that staff ask about the help they need when they are providing care, however the care plans we looked at did not show that people were involved in planning care. People told us that the staff are excellent at providing care, however we found that the documents that ensure that people receive consistent care were not very good.

5, 13 October 2011

During an inspection in response to concerns

The people we spoke with about St Anne's told us that this it is a very good home. Staff were described as being 'helpful' and of always being respectful. One visitor told us how much she appreciated that St Anne's is a Christian based home, but that people also have a choice about this.

We were told that there are no rules about times to get up or to go to bed, and that whilst people knew how to make a complaint, they had no need to. One person described the home as a '100%' another person said that 'the place is lovely, you couldn't say a bad word about it, a third said that they could think of no improvements and that they were 'quite content'. We were told that visitors always received a tray of tea or coffee, and that the food was very good, with choices.