Saint Lawrence Residential Care Home

Saint Lawrence Residential Care Home provides accommodation and personal care for up to 23 older people, including people living with dementia. Accommodation is provided over 2 floors. At the time of our inspection 15 people were living at the service.

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

There was a lack of effective monitoring in place and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection.

Information about risks and safety was not always comprehensive or up to date and full information about risks to people's safety was not always communicated to the staff.

Medicines were not always managed safely.

Infection control was not always promoted to ensure a safe environment. Areas of the service were odorous and some furniture did not support effective cleaning to take place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff had been recruited safely however, records were not always thorough in relation to induction and supervision.

Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. The service had enough staff to keep people safe. Staff respected people's privacy and dignity when providing care and support.

Staff spoke positively about working for the provider. They felt well supported and could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their roles.

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

Rating at last inspection

The last rating for this service was good (published 31 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Saint Lawrence Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, risk management, consent, infection control and good governance at this inspection. We have also made a recommendation in relation to training and induction.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection took place on 14 and 20 December 2017 and was unannounced. At the time of our inspection, 12 people were using the service.

At the last inspection on 12 and 16 December 2016, the service was rated Requires Improvement due to issues raised at a previous inspection. We saw improvements had been made and sustained.

A condition of the provider’s registration was for the service to be managed by a registered manager. There was a manager who was responsible for the day-to-day running of the service and we saw they had submitted their paperwork for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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.

People told us they felt safe living at the service and we saw staff were trained in safeguarding and protecting vulnerable people. There were few accidents and incidents, and individual risk assessments were in place.

Staffing levels were sufficient for the number of people currently using the service and their dependency levels were assessed. This helped the provider ensure there were sufficient staff to meet people’s individual needs.

Staff were recruited safely and received an induction which was linked to the Care Certificate. Staff knowledge and training were good and they received regular supervisions, however these were not always fully documented. Competency assessments were completed to check staff used the skills they had learnt in practice.

The service was safe, clean and tidy and staff were trained in infection control. Personal, protective equipment (PPE) such as gloves and aprons was used and stored safely. Appropriate safety certificates were in place, however the fire extinguishers had exceeded their service requirement date. During our inspection, the manager arranged for this to be completed. Afterwards we received assurances these had been done and were sent a copy of an updated audit to ensure these would not be missed in future. Fire safety plans were sufficient although evacuations needed further recording. People had personal emergency evacuation plans (PEEPs) in place so staff were aware of their individual needs in an emergency situation.

The environment was being updated and we spoke with the manager about ensuring the decoration followed best practice guidance for being dementia friendly. People’s bedrooms were personalised and they were involved in colour choices in their rooms.

The manager and staff had good knowledge of mental capacity legislation and consulted and involved relevant parties when people lacked capacity to make their own decisions. 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 did support this practice.

People’s health and nutritional needs were met. People received their medicines as prescribed, and were referred to healthcare professionals in a timely manner. People could also access community services independently if they wished. The food was nutritious and healthy, and staff catered for people’s individual dietary needs.

People were supported by staff who were caring and kind, respected their privacy and dignity, and cared for their individual needs. People were encouraged to express their views and opinions, and regular questionnaires and meetings enabled them to do this. People told us they had a good relationship with staff, and staff listened to their needs and concerns. People could be as independent as they wished, and make choices regarding their care. Cultural, spiritual and other equality and diversity needs were catered for.

Care was person-centred and staff responded to people’s changing individual needs. Assessments were detailed and included people’s life history and preferences. End of life care enabled people to be supported to have a comfortable, dignified and pain-free death.

There were activities for people to participate in, and people could access the community, conservatory or secure garden areas independently. People were encouraged to maintain contact with their relatives, and also to access hobbies and interests in the community or the service.

Few complaints were received and people told us they would contact the manager if they wanted to discuss any concerns. The service provided information in accessible formats according to people’s needs.

The manager had submitted notifications to CQC as required which helped us to monitor how accidents and incidents were managed. There was an open management culture and people told us both the manager and provider were accessible and approachable.

Some policies and procedures were not up-to-date and did not reflect best practice. The manager informed us they were in the process of updating these, and would include current best practice. The manager had developed quality assurance and governance systems to highlight shortfalls and drive improvements within the service. Accidents and incidents were analysed for any patterns or trends so improvements could be made. Records were stored securely and computers were protected by passwords.

Saint Lawrence Residential Care Home is registered to provide care for up to 23 older people, some of whom may be living with dementia related conditions. The home is situated near the town centre of Scunthorpe and is close to local amenities. The building consists of a large residential house with a purpose built extension, providing care over two floors, which are accessible by a lift. There is a large communal lounge with a dining area and a conservatory and small garden. At the time of our inspection there were 16 people living in the service.

We undertook this unannounced inspection over two days, on the 12 and 16 December 2016. The service was last inspected on June 2015, when we identified a breach of Regulation 15 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because there were concerns from the fire service in relation to the maintenance and upkeep of the building and the operation of the governance systems did not enable the quality of the service to be effectively monitored. Other improvements were also required to ensure people received effective care that was responsively delivered.

During this inspection we found improvements had been made in all domains and that action had been taken to address the breaches of the above regulations. We have changed the rating in two of the key domains that were previously rated as Requires Improvement to Good. We have not changed the rating in the safe and well-led domain, because we need to ensure the service is able to develop and sustain the improvements that have been made.

We found there was no registered manager in post. A new acting manager had been appointed to this role 12 weeks prior to our inspection visit, following the departure of the previous acting manager. There is a legal requirement for services to have a registered manager in place and we asked them to submit an application for this post within the next month. 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.

A range of health and safety checks of the building and equipment were carried out to ensure people were kept safe from potential harm. Contracts were in place to ensure equipment was satisfactorily maintained. Improvements were needed to ensure the water supply was delivered at consistent temperature levels, although the acting manager took action to address this shortfall. Improvements had been made in relation to the operation of the governance systems to enable the quality of the service to be effectively monitored. This included a programme of audits and analysis of incidents and accidents, to enable trends or patterns to be identified.

Recruitment checks were appropriately followed to ensure care staff were safe to work with people who used the service. Dependency levels of people were monitored and we were told about plans to deploy a further member of staff to ensure there were suitable numbers of staff available to meet people’s needs.

People’s medicines were administered in a safe way by care staff who had received training on this aspect of their role. Risks to people were monitored and action was taken to ensure these were safely managed. Safeguarding training had been provided to ensure care staff knew how to recognise and report potential signs of abuse. Care staff were familiar with their responsibilities for raising whistleblowing concerns and they said they were supported and listened to by the acting manager.

Care staff had received training on the Mental Capacity Act 2005 to ensure they knew how to promote people’s human rights and ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests.

A range of training opportunities had been developed to ensure care staff were able to safely carry out their roles, although further work was needed to fully implement the programme of supervision for them to help them develop their careers.

We observed care staff demonstrated a positive regard for people’s needs and treated them with kindness and consideration. People were supported to make choices about their lives and provided with a range of wholesome meals. People’s health and nutritional needs were monitored with involvement from health care professionals when this was required.

People were supported to make informed decisions about their lives and a programme of activities was being developed to ensure their health and wellbeing was promoted. People’s concerns were listened to and they and their relatives knew how to raise a complaint and have them investigated and resolved wherever this was possible.

We saw there was a system in place to record when GPs made changes to people's medicines regime. We saw records of discussions with a person's GP and the medications administration record MAR record altered to comply with this new arrangement.

We saw that rooms were personalised for example, with family pictures, people's own furniture and TV's. This showed the service promoted people's independence and supported their daily living activities.

Staff were complimentary about the service and told us, 'I like working here, it's not just a job, it's like we are family.'

A relative we spoke with commented, 'Our relative didn't really want to be in here but he has got to know the staff and we can't believe how he's bounced back.'

The care files reflected a system of assessing need, taking peoples' wishes into account, developing and using a personalised plan of care and monitoring of peoples' daily activities and condition. The premises were clean, tidy and there was evidence of systems in place to minimise the risk of spread of infection.