St Matthews Limited - The Avenue

St Matthews Limited – The Avenue is a residential care home providing personal and nursing care to 31 older people living with dementia and/or mental health needs at the time of the inspection.

St Matthews Limited – The Avenue, accommodates up to 33 people in one adapted building, across two floors.

People’s experience of using this service and what we found

Staff knew how to minimise risks for people and followed good practice guidance as detailed within risk assessments and support plans.

People were supported by sufficient numbers of staff who had undergone a robust recruitment process. Medicines were stored and administered safely, and staff were trained to support people effectively. Staff were supervised well and felt confident in their roles.

The service was clean, and staff understood infection control procedures and followed them. Staff wore appropriate personal protective equipment.

People’s needs were assessed, kept under review and support plans were adapted to suit people’s individual needs. Staff received ongoing support through training and supervision, to enable them to provide good quality care.

Governance systems, including quality assurance policies and practices, were embedded to ensure good outcomes for people. Systems to monitor the quality of the service were used to drive improvements, and included seeking the views of people, family members and stakeholders.

The registered manager was aware of their role and responsibilities in meeting legal obligations and was supported by the head of service to achieve these.

Rating at last inspection

The last rating for this service was Good (published 20 December 2019).

Why we inspected

The inspection was prompted due to concerns received about the provider’s other homes in the area. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Matthews Limited – The Avenue is a residential care home providing personal and nursing care to 29 younger adults and older people with dementia and mental health needs at the time of the inspection.

St Matthews Limited – The Avenue, accommodates up to 33 people in one adapted building, across two floors.

People’s experience of using this service and what we found

Improvements had been made to quality assurance systems and processes which enabled the registered manager to identify areas for improvement. The registered manager had identified where further improvements needed to be made and had plans in place to action these. People knew the management team by name. The registered manager sought feedback from people about their care experience to ensure any issues were promptly addressed. People, relatives and staff told us they would recommend the service.

Improvements had been made to the safety of medicines systems and processes. People received medicines on time and as prescribed. People were supported by staff that had been safely recruited and who kept them safe from harm and abuse. The registered manager checked nurses were appropriately registered with the Nursing and Midwifery Council (NMC). Staff had a good knowledge of risks associated with providing people’s care and had received adequate training to meet people’s individual care needs.

Staff were kind, caring and compassionate. Staff enjoyed their work and treated people as if they were a family member. People and staff had built positive relationships together and enjoyed spending time in each other’s company. Staff were respectful and open to people of all faiths and beliefs. People’s privacy and dignity was respected, and their rights upheld.

People were supported by staff who knew their preferences, wishes, hobbies and interests and supported them to engage in these. A variety of home-based and community activities were available for people to choose from. People knew how to raise a concern or make a complaint and felt confident concerns would be addressed.

People were supported to have maximum choice and control of their lives and staff supported them in the

least restrictive ways possible; the policies and systems in the service supported this practice. People’s needs were assessed before they moved to the service to inform the development of their care plans. People were supported to eat and drink enough and received healthcare support as needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 December 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Matthews – The Avenue is in a residential area of Northampton and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for people with mental health needs and can accommodate up to 33 people at the home. When we visited there were 33 people staying there.

At our last inspection in September 2017 we rated the home as ‘requires improvement’ and found that there had been a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Safe care and treatment. This was because we identified unsafe practices around medicine administration.

At this inspection we found that improvements had been made to the management of medicines, and the home was no longer in breach of this regulation. However further improvements were required to how the service recorded the administration of medicines and we have made a recommendation for the provider to address this.

Improvements were required to staffing arrangements. In the morning there were not enough staff to support people to have their medicines at the time they preferred and a student nurse who was supernumerary had been left to support one person who required one to one care, and observe and support other people in the lounge area.

Risk assessments were in place which covered people’s known risks. Improvements were required to ensure all staff, including student nurses were aware of each person’s potential risks. Improvements were required to infection control practices to ensure the home was free from unpleasant odours and to ensure staff followed hygienic practices.

The service did not have a registered manager in post however there was an appointed manager who was in the process of registering with the CQC. The culture within the home was very task focussed and further improvements were required to ensure each person’s individual needs and preferences were acted on.

Improvements were also required to the auditing procedures in place. The audits did not always identify where improvements were required, for example, with infection control practices. And, the audits did not always ensure that any actions that had been identified, were carried out in a timely way. In addition, improvements were required to review and action the records that were maintained, for example, the bathing records to ensure that everyone at the home had their personal care needs met sufficiently.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Staff induction training and on-going training was provided to ensure staff had the skills, knowledge and support they needed to perform their roles.

People's consent was gained before their care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

A process was in place which ensured people could raise any complaints or concerns and there were opportunities to provide feedback about the home. Concerns or suggestions were reviewed and acted on where possible.

At this inspection we found the provider to be in breach of one of the regulations relating to improvements needed in the Well Led domain and having good governance systems. This is the second time this home has been rated as Requires Improvement and we have issued a requirement notice and requested an action plan from the registered provider to show how they will achieve a Good rating.

At the last inspection, the service was rated Good. At this inspection we found some areas of concern and the service was rated as Requires Improvement.

St Mathews, The Avenue, provides accommodation for up to 33 people with dementia or other mental health needs who require support with their personal care. At the time of our inspection there were 30 people living at the service.

During this inspection we found that medicines were not always managed safely and medication protocols were not always followed consistently. In addition, Medication Administration Records (MAR) records were disorganised which had the potential to create confusion.

This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found mixed approaches to interaction with people from the staff team. Daily routines were not always person centred but were often task-led by some staff. People’s care needs were not always carried out in line with their preferences.

The service had a manager but they had not registered with the Care Quality Commission (CQC) 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. We found that audits in place did not always identify areas for improvement and management systems in place had not identified areas of poor practice.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety. There were sufficient staff, with the correct skill mix to support people with their care needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Staff received a comprehensive induction process and on-going training. Staff said they were well supported by the registered manager and had regular one to one time for supervisions and annual appraisals. Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people. They were supported to make decisions about aspects of their life; this was underpinned by the Mental Capacity Act 2005. People received enough to eat and drink and staff gave support when required. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People’s privacy and dignity was maintained by staff.

People were involved in their assessments and in putting together their support plans. The support plans were regularly reviewed and updated to reflect people’s current needs. People were encouraged to participate in a range of activities. Information was available for people on how to raise any concerns or complaints about the service they received. The provider responded to complaints following their policies and procedures.

A variety of quality audits were carried out, which were used to drive continuous improvement and used to good effect in supporting people and staff to express their views about the delivery of care.

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website.

We observed that all staff on duty had a calm and kind manner when working with individual people. We observed that there was a high emphasis placed on doing different activities with people using the service in the home and in the community

People and relatives of people living at the home also provided positive feedback about living at the home. Some of the comments included: 'The food is very good and I love it here'. 'I have no complaints but I do know how to complain and I have done it in the past and it was resolved'. 'The home is lovely and always clean'. Relatives of people using the service also told us that their family member received a good standard of care at the home and that staff were considerate of their needs.

Several people were not able to hold meaningful conversations with us, but we saw from their responses and body language that they were happy with the way staff were looking after them.

We found that people had received appropriate care and that staff had administered medicines correctly. We also found that good standards of cleanliness were maintained at the home and that the provider had an effective complaints system in place. We found that staff were supported with adequate training and supervision to undertake their jobs.