Archived: St Lukes Care Home

Regulation 9 Person centred care as we found people's preferences were not achieved and their needs were not been met. Care plans were not person-centred and did not accurately identify people's care needs.

Regulation 12 Safe care and treatment as we found PRN protocols were not in place and staff medication competency had not been assessed. Pain assessments had not been completed.

Regulation 18 Staffing as we found there were insufficient numbers of suitably qualified, competent, skilled and experienced staff deployed in the service.

Following our October 2016 inspection, the registered provider sent us an action plan detailing the changes and improvements they intended to make in respect of each of these breaches of regulation. We took this into account when planning this inspection to make sure we checked these actions had been completed. At this inspection, we found the provider had made all the required improvements and addressed all the concerns that had been highlighted last time we visited the service. The management team were also responsive to concerns we raised during our inspection.

St Lukes Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 40 people in one adapted building. At the time of this inspection there were 20 people using the service.

The service did not have a registered manager. 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.

In September 2017, the registered provider went into administration. The administrators had employed a care company to run the home while a buyer was sought and had oversight of their management. The home manager remained in post and a regional manager for the care company employed by the administrators visited weekly. There had therefore been some changes at the home in the months preceding this inspection. Due to various factors, a number of staff had left the service since the last inspection. Recruitment for a number of posts continued, although this had been challenging due to the registered provider's administration status.

Concerns we identified about the administration of medicines at the home were responded to promptly by the management team. This was because care staff had not completed the appropriate training with regards to supporting nursing staff with the administration of controlled drugs. However, this was arranged whilst we were onsite.

The provider did not have a policy in place regarding the Accessible Information Standard. We have made a recommendation about this.

Risks to people were assessed and recorded, and staff acted to manage identified risks safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take if they had any concerns. There were systems in place to ensure people were protected from the risk of infection. The environment was tired in places and required updating. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place.

Although appropriate numbers of staff were observed to be on duty throughout the home to meet people's needs, they had not been deployed effectively. We have made a recommendation about the deployment of staff.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. The manager ensured staff received the training and supervision they needed to provide effective care. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005. Staff were also aware of the conditions under which a person may be deprived or their liberty, and acted in accordance with the Deprivation of Liberty Safeguards, to ensure people were only lawfully deprived when this was in their best interests.

People's nutritional needs and preferences were met and people had access to health and social care professionals when required.

People told us staff treated them with kindness and their privacy and dignity was respected. People were involved in day to day decisions about their care and had care plans in place which reflected their individual needs and preferences. People were supported to maintain relationships with relatives and friends. Activities were available to meet people's interests and to promote stimulation. However, feedback from people using the service suggested activities did not always meet their needs.

The service provided appropriate care and support to people at the end of their lives. People's needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people's needs were met.

There were systems and processes in place to monitor and evaluate the service provided. People's views about the service were sought and considered through residents meetings and satisfaction surveys.

St Luke’s Care Home provides accommodation for up to 34 people. The home is on one level and provides 22 single bedrooms and six double bedrooms.

At the time of this inspection the home had 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.

Staffing levels were not sufficient to meet the needs of people living in the home. A dependency tool was in place, although we found this had not accurately assessed people’s needs. People, relatives and staff told us there were not enough staff on shift. Following our inspection, the registered manager informed us staff levels had increased.

Systems to ensure the safe management of medicines were not fully effective. We identified gaps as the service did not have protocols for ‘as and when’ (PRN) required medicines and staff did not receive medication competency checks. Following our inspection we saw evidence which showed staff had their competency checked and PRN protocols were also introduced. Medicines were stored correctly and MAR charts showed people received their medicines as prescribed.

Care plans lacked person-centred detail and were not consistent with the care provided by staff. There was limited evidence of involvement from people and families in care planning. Since our inspection, the registered manager had put steps in place to address our concerns which they had identified before our inspection.

Staff knew about people’s likes and dislikes and how they wanted to receive their care. Concerns were identified regarding the level of stimulation people received as activities were not regularly taking place. Following our inspection, a full schedule of activities has been introduced.

Recruitment procedures followed were found to be safe as relevant background checks had been carried out. Most risks to people had been identified, assessed and reviewed, although we found some gaps which we discussed with the registered manager. Mental capacity assessments had been completed, although these varied in quality and Deprivation of Liberty Safeguards (DoLS) authorisations and applications were monitored.

Relatives were able to visit their family members at all times and they spoke positively about the care provided by staff. Staff received support through their induction and supervisions. Staff appraisals were scheduled to take place in January 2017. We found gaps in staff training, although the registered manager had already booked staff on to courses to fulfil training needs. Team meetings had started since the registered manager joined the service and staff felt they could approach the registered manager and senior operations manager.

A number of quality management systems had been introduced by the registered manager which we found were effective as they contained evidence of actions which had been completed. Feedback through meetings and surveys was acted on. People and relatives were aware how they could complain if they were dissatisfied and systems were in place to record and respond to any concerns.

Relatives and staff felt people living in the home were safe and protected from harm. The privacy and dignity of people was well managed by staff. Relatives and staff told us people’s privacy and dignity was respected.

The living environment was clean and all maintenance certificates were up-to-date. Fire safety was well managed with evidence of staff training, regular checks of equipment and personal emergency evacuation plans.

Prior to our inspection concerns had been raised about the quality of food, although during our inspection people were satisfied with their meals. Healthcare professionals were complimentary about staff who ensured people had access to healthcare when they needed this.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

We observed staff were kind and respectful and we saw people were offered a choice of food and drinks throughout the day. Relatives told us they had been involved in reviewing people's care plans and said staff sought their views about the person's care and treatment.

People said more could be done to provide meaningful activities and give people the opportunity to go out more. One person who used the service said 'We don't do much, just chatting'.

We found people were supported to meet their care and welfare needs but there was still work to be done to make sure this was accurately reflected in everyone's care records.

We found the safety and security of the premises had improved. We saw the fire exits were free from obstructions and a key pad had been fitted to the front door.

We found staffing had improved. Visitors told us there had been a couple of occasions, usually, at weekends, when there did not seem to be enough staff. However, they also said 'Since the last (inspection) report staff seemed more attentive to making sure there was someone in the lounge with residents.'

We found the provider had improved the systems in place to assess and monitor the quality of the service.

On the day of our visit we found there were 24 people living at St Lukes. Fourteen people were sat in the lounge/dining area. Ten people were in their rooms, being assisted to get up or being cared for in bed. We spoke with three people who were sat in the lounge. They said that the staff were nice. They said the lounge was a peaceful without to much noise.

We found that although the number of staff scheduled to be on duty had been increased since our last visit, the number of staff actually on duty was sometimes still below the level necessary to meet peoples' needs.

We saw some examples of good interactions between staff and the people who used the service. But there were also some inappropriate comments by some staff who did not show appropriate respect when speaking to people.

We found that the some of the fire exits were partially obstructed and the provider had not checked that people could evacuate the building in an emergency. Security door alarms had been also been disabled and the provider was unable to monitor visitors to the home.

The provider had sought the views of people who used the service and their relatives. We saw two letters that had been sent to the home by relatives. One said 'I have the utmost praise for the way they run the home.' Another wrote 'The care my mother has received at St Lukes has been marvellous.'