Archived: St Martins

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 service is run.

Staff understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Risks to people’s health and safety were regularly assessed and action taken to reduce the risks.

There were sufficient numbers of staff employed and people’s needs were met in a timely manner because staff were organised and well deployed. People received their medicines when they needed them and medicines were stored and recorded appropriately.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. There were systems in place to ensure people were not deprived of their liberty unlawfully. People were supported to provide consent for the care they received.

Staff were provided with relevant training, supervision and appraisal. There was a plan in place to ensure any gaps in training provision were rectified. People had access to sufficient quantities of food and drink and told us they enjoyed the food. People had access to a range of healthcare services and staff followed the guidance that was provided.

There were caring and friendly relationships between staff and the people living at St Martins. People were empowered to make day to day decisions about their care and staff respected the choices people made. People were treated with dignity and respect by staff and their right to privacy was upheld.

Staff were aware of people’s care needs and provided responsive care. However, people’s care plans did not always contain sufficient information about their current support needs. There was a limited range of activities provided which some people felt did not meet their social needs. People told us they would feel comfortable making a complaint to the registered manager.

There was an open and transparent culture at the home, people and staff felt comfortable speaking up if they wanted to. People and staff commented positively on the registered manager, who provided clear and positive leadership. People were able to provide their opinion on the quality of the service they received and their views were acted upon. The registered manager had implemented effective quality monitoring systems which identified areas for improvement and ensured action was taken.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Improvements had been made to the quality monitoring systems as the manager had introduced a new system of quality audits. We saw that, where issues were identified, action had been taken to bring about improvements. However, not all of the quality audits were fully effective.

Improvements had also been made to people’s care records, although further work was required to ensure they fully reflected people’s needs. There was an open and transparent culture at the home and people told us they felt comfortable living at St Martins.

The service had not had a registered manager for a period of one day prior to our inspection, although they had left their position two months before. A registered manager is a person who has registered with the Care Quality Commission (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 service is run.

At our inspection in June 2015 we asked the provider to take action to make improvements in respect of providing safe care and maintaining a safe environment. During this inspection we found that sufficient improvements had been made because a risk assessment of the water supply at St Martins had been carried out. The recommendations made by the contractor had been implemented. Steps had been taken to reduce the risk of people sustaining injuries should they fall. However, improvements were still required to further mitigate the risks of people falling.

Medicines were administered and stored appropriately however information about people’s medicines was not always available. People were protected from abuse and staff understood their responsibilities to keep people safe. There were sufficient staff to meet people’s needs in a timely manner during our inspection.

Staff had not received all relevant training or regular supervision. There were measures in place to rectify this and some progress had already been made. People’s right to make their own decisions was respected, however where there were doubts about a person’s capacity to make decisions a capacity assessment had not always been carried out.

People received sufficient quantities of food and drink and told us they enjoyed the food. People had access to a range of healthcare professionals.

Staff supported people in a kind and caring manner and had developed positive relationships with people. Staff gave people choices about their care and respected the decisions they made. People were treated with dignity and respect by staff.

People were positive about the care they received, however staff did not always have access to comprehensive information about their care needs. People told us they would feel comfortable making a complaint. Any complaints received had been investigated however we couldn’t be sure that they had been properly responded to.

At our inspection in June 2015 we asked the provider to take action to make improvements in respect of the systems in place to assess and monitor the quality of the service and to reduce risks to people. During this inspection we found that sufficient improvements had not been made.

The quality assurance systems in place were not robust and had not been effectively used to identify when improvements were required. There had not been any meetings for people and their relatives to attend to provide their views since our previous inspection. This was a breach of Regulation 17 and you can see what action we told the provider to take at the back of the full version of the report. A survey had been distributed recently and responses were positive. There was an open and transparent culture and staff felt their input was valued.

You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

This is a summary of what we found-

Is the service safe?

We carried out a tour of the building and saw that the provider had carried out improvement works to the building as specified in their action plan. A new wet room had been installed which was used on the day of our inspection.

The provider had made improvements to the recruitment process by introducing a new application form and interview question document. We saw that these were now being used and had resulted in a better quality of information being supplied by job applicants.

Is the service effective?

Since our previous inspection, various assessments of people's capacity to make particular decisions had been carried out. These demonstrated that attempts had been made to enable the person to make the decision themselves.

People's care plans did not contain the necessary information to enable staff to provide appropriate care and support. We saw that care plans also contained conflicting and out of date information.

People were supported by staff who were not appropriately supported in relation to their duties. Staff had not received all of the training relevant to their role. Appropriate arrangements were not in place to ensure that all staff received supervision and appraisal.

Is the service caring?

We spoke with three people who were using the service and asked if staff treated them with dignity and respect. One person said, 'The staff are all lovely, it's alright here.' The other people we spoke with also confirmed that staff treated them with dignity and respect.

We observed the care and support that was provided to people in communal areas throughout our inspection. We saw that staff were kind and patient when supporting people with various tasks. Staff spoke with people in a polite and friendly manner and we saw that some people using the service responded warmly to this.

Is the service responsive?

We saw that, whilst care plans were being reviewed on a regular basis, changes had not always been made when required. On the day of our inspection care staff were responsive to people's needs.

Is the service well-led?

We saw that there had been recent meetings for people using the service and their relatives as well as staff.

A suitable system was not in place to enable the provider and management of the home to regularly assess and monitor the quality of the service in order to make improvements. The complaints procedure was not accessible to people and no surveys had been made available for people to complete. This meant that the provider would not be aware of people's views of the service being provided.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

This is a summary of what we found-

Is the service safe?

The people we spoke with told us they felt safe living at the home. Staff demonstrated their understanding of safeguarding procedures. The provider had taken steps to ensure staff had the required information about their responsibilites to safeguard vulnerable adults.

Improvements had been made to the administration and recording of medication. People were protected from the risks of unsuitable equipment because required safety checks had been carried out.

We have asked the provider to make improvements relating to the safety and suitability of the premises.

We saw that improvements needed to be made to the recruitment procedures operated by the provider. This was because there was insufficient space for applicants to provide information about their employment history on the application form. No interview notes were available for staff who had been recently recruited.

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.

Is the service effective?

We spoke with three people who were using the service and asked if they felt staff treated them with dignity and respect. One person said, 'Yes they are very nice, I am happy here.' The other people we spoke with also indicated that they felt staff treated them with dignity and respect. However there was limited evidence to demonstrate how people were involved in planning their care.

Appropriate arrangements were not in place to obtain people's consent for their care plan. Where people lacked the capacity to provide consent, the provider had not always acted in accordance with the law.

People told us they were satisfied with the care they were receiving. However, we saw that staff were not always providing the care that was detailed in people's care plans or the information in care plans was incorrect.

Staff had received training since our previous inspection, however it was apparent that training was not always effective and staff had not received all training relevant to their role. Staff had received a supervision meeting with their manager since our previous inspection. We did not see evidence of how the supervision process was used to assess staff's performance.

Is the service caring?

We spoke with three people who were using the service who told us they were happy with the care they were provided with. One person said, 'I am happy here, I've got everything I need.' We spoke with the relative of a person who used the service and they told us they thought their relative was well cared for. We have asked the provider to make improvements in the way people are involved in planning their care. We have also asked the provider to make improvements to the care and support that people receive.

Is the service responsive?

We saw that, whilst care plans were being reviewed on a regular basis, changes had not always been made when required. On the day of our inspection care staff were generally responsive to people's needs.

Is the service well-led?

The service had a range of audits that were being used. The records seen by us showed that not all of the shortfalls identified during our inspection had been addressed. The service's quality monitoring systems did not systematically ensure that staff are able to provide feedback to their managers, so their knowledge and experience is not being properly taken into account.

People who were using the service or their relatives were not involved in making decisions about their care and support. People's dignity was not always respected. People were provided with sufficient quantities of food and drink. There was not sufficient information in place in people's care plans to assist staff in meeting people's care needs.

People were not fully protected from abuse or the risk of abuse because staff did not have the knowledge and information required to do so. Appropriate arrangements were not in place in relation to the management of people's medication.

The provider was not carrying out appropriate pre-employment checks before new staff started work. Staff had not received all appropriate training. Staff were receiving regular supervision however it was not being utilised effectively.

The provider did not have an effective system in place to assess and monitor the quality of the service provided. Accurate records were not being maintained in respect of the care being provided to each service user.

Since our last inspection the manager had sent out satisfaction surveys to relatives of people using the service. The results of these surveys indicated that people were happy with the service being provided.