Archived: St Mary's Care Home

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

Some people had experienced safeguarding incidents, but appropriate actions had not always been taken in line with the provider’s safeguarding policy. This inconsistent approach meant that the provider could not be assured that people were always protected from abuse or improper treatment. This was a breach of regulations.

Medicines were managed safely but protocols were not in place to guide staff in when PRN (as required) medicines should be administered. Some people had not received PRN medicines as prescribed and records were inconsistent in identifying how decisions had been made. We have made a recommendation about the management of PRN medicines.

The provider had management systems for monitoring quality. Some systems did not provide effective governance and oversight and had failed to identify the shortfalls that we found.

People and their relatives told us they felt safe at St Mary’s Care Home. One person said, “St. Mary’s is a safe secure place to live.” Risks to people were identified and managed. When people’s needs changed, or things went wrong, risks were reviewed to ensure that lessons were learned. There were enough staff to care for people safely and people were protected by the prevention and control of infection.

Staff received the support and training they needed to be effective in their roles. People and their relatives said they had confidence in the staff. One person said, “The Staff are exceptional and work very hard, you cannot fault them.” Assessments were holistic and care plans provided clear guidance for staff in how to support people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests, the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and to access the health care services they needed.

Staff knew people well and supported them to be involved and to express their views. People told us the staff were kind and caring. One person said, “They show such kindness and compassion.” People were treated with dignity and respect and staff knew them well.

People were receiving a personalised service that was responsive to their needs. Improvements had been made in planning activities and it was evident that people’s social needs were supported. One relative told us how their relation, “Really enjoys all the activities, that is good because she is stimulated by them.”

People’s communication needs were identified and supported. People had been supported to plan for end of life care and their diverse needs and wishes were recorded and respected. People told us they knew how to complain and would feel comfortable to do so. One relative told us they would raise concerns with the registered manager, saying, “She listens and acts quickly.”

People, their relatives and staff spoke highly of the management of the home and described the registered manager as approachable. One person told us, “It is a nice well run place and I have a cosy room with a view, I have no worries and everyone around me is nice to me.”

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

Rating at last inspection The last rating for this service was requires improvement (published 27 September 2018). The service remains rated as requires improvement. This service has been rated as requires improvement for the last two inspections.

At this inspection some improvements had been made but we found other areas of practice that needed to improve and one breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Mary’s Care Home on our website at www.cqc.org.uk.

We have identified breaches in relation to safeguarding service users from abuse and improper treatment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager who was present throughout the inspection. 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.

At the last inspection on 4 April 2016 the home was rated Good overall. At this inspection on 11 July 2018 we identified some areas that needed to improve.

People’s care plans were not always personalised to reflect what was important to people, their likes and dislikes, hobbies and interests. Staff knew people well and were providing care in a person-centred way but this was not reflected in people’s records. People told us they didn’t always have enough to do. Activities were organised but people’s individual interests were not always considered and this meant that some people felt activities organised were not relevant or meaningful for them. We have made a recommendation about providing meaningful activities for people.

People’s care records were not always maintained in good order and information was difficult to find. This was identified as an area of practice that needed to improve.

At the last inspection on 4 April 2016 we found inconsistent practice about the requirements of the Mental Capacity Act 2005. At this inspection on 11 July 2018 the provider had made improvements. 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 and their relatives told us they felt safe living at St Mary’s Care Home. One person said, “I feel safe because the staff care about me here.” Staff demonstrated a clear understanding of the responsibilities for safeguarding people. Risk assessments were clear and guided staff in how to support people to be safe whilst respecting their freedom. People were receiving their medicines safely and there were enough suitable staff to care for them safely.

People’s needs were assessed in a holistic way and in line with current legislation and good practice. Staff had received the training and support they needed to be effective in their roles. One person told us, “I think they are very well trained. They seem to know what they are doing.”

People were supported to access health care services when they needed to. Staff recognised changes in people’s health and made appropriate referrals. People told us they had enough to eat and drink and spoke highly of the food on offer. One person commented, “The food is excellent and the meals times are sociable.”

Staff were kind and caring and knew people well. People and their relatives spoke highly of the care. One person said, “The staff are fantastic, brilliant, really lovely. They’ll do anything for you.” People were supported to express their views and to be involved in planning their care and support. A staff member explained, “We see it as fundamental to ensure people remain as independent as they can be.” Staff encouraged and supported people to be as independent as possible. People and their relatives were supported to plan for care at the end of life.

Complaints were recorded and responded to appropriately. People felt confident that their concerns would be addressed.

There was a clear management structure and people knew who the registered manager was. Staff reported effective communication systems and spoke positively about partnership working. A visiting health care professional confirmed that staff worked in partnership to achieve good outcomes for people. The registered manager provided visible leadership and people, relatives and staff spoke highly of them. All the people that we spoke with said that they would recommend the home to other people. One person said, “I wouldn’t change a thing, the service is great. I‘ve only got praise for the home.”

The home had a registered manager. A registered manager is a person who has registered with the CQC 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 home is run.

Not all best interest decisions had been made involving people who knew the person well. We saw evidence that best interest decisions had been made in respect of, for example, the supervision of medicine but not all best interest decisions were decision specific. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and how DoLS is assessed and authorised in other settings such as supported living or people’s own homes. People can only be deprived of their liberty in order to receive care and treatment when this is in their best interest and legally authorized. Not all applications for DoLS were made. We have therefore identified this as an area that required improvement.

We found that further adaptions and adjustments could be made to ensure that people with living with dementia and those that had physical or sensory disabilities could orientate themselves around the building, fully access all areas and therefore retain their independence. There was a general lack of signs to indicate to people the function of a room or to help them to know if they were approaching a particular communal room, corridor or floor. The garden was locked to people. The registered manager told us that this was to prevent falls in the garden. However, we could not identify risk assessment for people that evaluated the risk of falls in the garden as a particular risk or other, less restrictive options had been considered. We have therefore identified this as an area that required improvement.

People at the home told us that they felt safe. There were safeguarding policies and procedures in place that were followed and staff were fully aware of their responsibilities in reporting safeguarding incidents. The provider had a whistleblowing policy in place and staff told us they knew how to use it if they needed to.

People’s needs were assessed and care plans provided staff with guidance about how individual needs were met. Plans we looked at placed the person at the centre of all planning and contained the necessary risk assessments to keep people safe. They were reviewed and amended to ensure they reflected people’s changing support needs.

Essential training was up to date for all staff. Staff received training specific to people’s care and treatment needs, including specific health conditions. One member of staff said, “We have lots of training and everything you can think of is included in the programme. The recent training about dementia was very interesting.” People told us they felt the staff were well trained and able to meet their needs. The relative of a person commented, “Staff appear to be skilled and well trained.”

People were very complimentary about the friendliness and professionalism of the staff. One person said, “The staff look after me very well indeed. This is why I’m doing so well at my age.” Staff interacted with people in a warm and friendly manner. A health care professional told us, “The Nurses/Health Care Assistants I observe are kind, gentle and very respectful towards the patients.”

People had access to GPs and other health care professionals. Prompt referrals were made to health care professionals. One person told us, “Oh yes, the doctor has just been actually. They get you seen to, you just need to say if you’re not feeling well.” We sought feedback from health care professionals. They were positive about the home and staff responsiveness, one health care professional said, “Staff are always happy to assist and always refer to other agencies.”

People were able to participate in activities of their choice. Activity co-ordinators organised a programme of activities for people that included gentle exercises, arts and crafts, film nights and outside entertainers. They also carried out one-to-one sessions with people. The relative of one person said, “[My Relative] is in bed all the time now. I know they come in at least every two hours and they also give head massages and hand massages and they don’t even charge for it. Sister is very attached to [my relative] and comes in to pray with them.”

The provider had systems and processes in place to audit and monitor the quality of the service. Issues identified for development were recorded and an action plan put in place. People were supported to remain in regular contact with families and friends. There was open communication between family members and the home. People and their relatives told us they knew how to complain and were confident in doing so.

Staff were positive about the registered manager and the support they provided. The registered manager responded to staff suggestions and requests. A member of staff said, “The manager is a lovely, lovely nurse, very professional, helpful, approachable, treats everyone fairly and both residents and staff can talk to her about any concerns.”

Below is a summary of what we found. The summary describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the assessment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We spoke to staff about their understanding of safeguarding procedures. They had an awareness of the different types of abuse and what to do if they witnessed abuse.

Equipment was available and safe for people to use. We heard from a person who said, '[My relative] is quite tall and they use a walking aid. The home took it to pieces to adjust it to make it just right for [my relative] and made sure it was labelled so it's solely for their use.'

Is the service effective?

People who used the service and their relatives told us that they were happy with the care provided and felt their needs had been met. Staff told us they understood people's care needs and that they knew them well. We read the following feedback, 'The staff have all been so gracious and friendly. It is a peaceful, safe, caring, loving and spiritually fulfilling.'

We observed how people were supported with their care needs with the aid of suitable equipment. We found that there was sufficient equipment in place to meet people's needs safely and in a timely way.

We saw that there were systems in place to support staff. These included regular handover meetings and team meetings.

People who used the service and their relatives commented on the training within the home. One person told us, 'I was a manager myself so I have done the job and I consider the carers to be extremely well trained.'

Is the service caring?

We saw that staff communicated with people at a suitable relaxed and considerate pace. All of the people we spoke with told us they were happy at St Mary's Care Home. A relative told us, 'The staff are so kind and friendly. Every aspect of the home is excellent and I could not ask for more. [My relative] is in good hands here.'

Is the service responsive?

Care and nursing staff told us about each person's care needs and support required. One member of staff told us, 'People are well cared for here, we know their needs.'

Is the service well-led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Quality and compliance audits were regularly conducted and included medication, accident and incidents, care plans and maintenance reviews.

We looked at the care records relating to people's care and support and saw that people's wishes had been taken into account in planning their care, with the help of relatives if necessary. Risks to people's health had been assessed and managed and care was delivered in a way that promoted people's independence. People were cared for by staff who had undergone an effective recruitment procedure.

We spoke with seven people and six relatives about the care provided in the home. One person said "I can't fault them on asking my permission. They tell us everything". One relative said "It's absolutely excellent. It's like a five star hotel".

We spoke with six staff who had different levels of experience of working in the home but all said they were well supported with training. One member of staff told us "training is continuous".

The people we spoke with were happy living at the home. One person said "Undoubtedly the care is very good", and another told us "It's a smart operation".

We spent time observing the care that people received, and saw that people's needs were met quickly by staff who understood their needs, and people were always treated with dignity and respect. People's care was assessed, planned and delivered effectively. People were protected from abuse and their human rights were upheld. Staff told us they received the training they needed. We saw that the quality of care was monitored and lessons were identified and shared.

There was no registered manager in post for this service at the time of our inspection. We have asked the service what action they will be taking to address this as it is a condition of their registration that one is registered with the CQC.