Archived: St Luke's Care Home

St Luke's Care Home provides accommodation and residential for up to 31 people. At the time of inspection there was 27 people living in the service.

We found the following examples of good practice.

• The provider ensured there was sufficient stock of Personal Protective Equipment (PPE) in place including masks, gloves, aprons and hand sanitiser. Infection control polices had been updated to reflect the current

national guidance and staff were wearing this appropriately.

• There were PPE stations throughout the service where staff could use hand sanitiser and change their PPE. This was to reduce the potential for infections spreading through different parts of the service.

• The provider ensured staff were skilled in infection prevention and control. This included training about infection control specifically relating to 'Donning and Doffing' which is how to put on and remove PPE safely.

• There was a clear procedure in place to ensure people were admitted to the service safely.

• There was a testing programme in place for staff and people living in the service. This was to ensure if any staff or people had contracted COVID-19 and were asymptomatic, this was identified and acted upon in a timely way.

• The provider had set up a visiting room to facilitate visits between people and their relatives. This included an outside access point to the room. PPE was available to visitors and there was a perspex screen between social distanced chair clusters. These measures meant people and their relatives could safely spend time together. Staff facilitated these visits in line with national guidance.

Further information is in the detailed findings below.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring, that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was 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 continued to feel safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs and that staff had received training to ensure they had the knowledge to protect people whilst providing care.

People were protected from the risks of infection as the service employed dedicated cleaning staff to ensure the environment was clean and had appropriate policies and procedures to monitor and reduce the risk

Systems were in place to support people to take their medicines safely. Staff received relevant training and felt well supported. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions where possible and respected the choices they made. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were robust quality monitoring procedures in place. The management structure of the service was clear.

Further information is in the detailed findings below

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI) in the dining room. SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them, a visiting health professional and a health and social care student on placement. We also looked at four care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The service had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We saw the home had a programme of regular audit and risk assessments to ensure people were cared for in a safe environment.

The service was safe, clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. A visiting health professional told us they had no safety concerns about the care people received.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift and updated peoples care records at least twice a day.

We found staff attended training courses to meet the individual needs of people in their care such as the care of a person living with dementia.

We spoke with one person's relatives who told us, 'At first XX couldn't walk, they're really good, slowly got XX back on their feet.'

Is the service caring?

We observed staff speak with people in a kind and caring way and give them time to answer questions. We saw no one was rushed and staff helped people to do things in their own time. We saw all staff had a very good rapport with people and there was a lot of chat and laughter.

We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent.

The people who were able to communicate with us told us they well were cared for.

Is the service responsive?

A visiting health professional told us staff were responsive to people's needs and made appropriate and timely referrals to them.

A member of bank staff told us, 'I think the home is very responsive to people's needs. One person was dying and we called their family. The staff sat with XX and their family. It was a peaceful death.'

We saw when care workers raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

We found there was no registered manager in post. During our visit we spoke with the provider who assured us the acting manager who had been in post since November 2013 would be submitting their application to the Care Quality Commission to be registered as the manager of the service.

We spoke with visiting relatives who told us that they could approach the manager at any time. One relative said, 'XX is very busy but we can go to them in the office at any time, can do that with most of them - the nurses.'

Nursing and care staff told us leadership in the service was very good. One staff member said, 'XX is very good, very knowledgeable, organised and excellent with residents.'

We saw care files were reviewed regularly. People were involved in their review and had signed their care plan agreement.

We saw a programme of monthly, quarterly and bi-annually audits had been introduced for medication, record keeping, health and safety training and staffing levels. We saw actions plans had been completed and evaluated for each audit undertaken.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People told us they had seen their care plans and staff gave them information and explanations about the care they received. Comments included, "The staff listen to me and do what I ask' and 'I'm very happy with my care, the care staff know what help I need.'

People spoken with told us they were well looked after, they saw their GP and nurse when required and their health needs were met. Comments included, "I am looked after well.'

People told us they received their medicines on time but we found problems with the handling and auditing of medicines.

People spoken with told us they liked their home. They said it was comfortable and homely. Some people told us how they had been consulted about redecoration and they were pleased with the results.

Records and discussions showed staff had received more training, which enabled them to be skilled and confident when supporting people.

We found aspects of the home's management systems such as checks; audit and review programmes were not effective in protecting people's safety. We identified concerns in relation to areas such as care records and the environment.

Since the last inspection the provider had employed a consultant to work with the manager to ensure the necessary improvements were made to meet these outcomes. The provider was also visiting the service on a regular basis to monitor the improvements needed.

People spoken with told us they were consulted about their care. They said they were happy with their home and environment. Comments included, "We are asked what we think of things" and 'Feel listened to, the manager is very open.'

We found improvements had been made to the quality and accuracy of the care records. New care records had been put in place for all people who lived in the home. We spoke with people about their care records. One person told us their key worker had involved them with writing the new care plans.