Archived: St Martins

Updated 9 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Day one of the inspection was conducted by two inspectors. One inspector returned for a second day to complete the inspection.

Service and service type

St Martins is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection management support was being provided by an acting manager. The acting manager is referred to as the manager in this report.

Notice of inspection

The inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection and sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with six people and a relative about their experience of the care provided. We spoke with 12 members of staff including the nominated individual, the operations manager, the manager, senior carers, care staff, a domestic assistant and the cook. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with an occupational therapist who visited the home.

We reviewed a range of records. This included six people’s care records and medication records. We looked at three staff files in relation to recruitment and support and a range of records relating to the management of the service, including audits and checks, policies and procedures, training data, and quality assurance records.

After the inspection

We continued to seek clarification from the nominated individual, operations manager and manager to validate evidence found. We looked at training data, risk assessments, mental capacity assessments and quality assurance records.

Updated 9 December 2021

About the service:

St Martins provides accommodation and personal care for up to 16 adults and older people, some of whom may be living with dementia, mental ill health, physical or sensory disabilities. At the time of our visit 14 people lived at the home. This included two people in short term discharge to assessment beds which are used to support timely discharges from hospital. One person was in hospital. Accommodation is provided in a single storey converted house.

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

Ineffective governance and lack of provider and management oversight meant previously demonstrated standards and regulatory compliance had not been maintained. The provider’s systems and processes designed to identify shortfalls to ensure the service was delivered safely, and to drive improvement were ineffective. This demonstrated lessons had not been learnt since our last inspection. The introduction of new systems and processes were not well-managed. This meant staff did not have all the information they needed to provide safe care. Systems used to share information with staff were not effective.

Risk associated with people's care and the environment were not always identified, assessed and well-managed. The prevention and control of infection was not managed safely and in line with government guidance. Staff had been recruited safely and understood their responsibilities to keep people safe. People felt safe. However, people's quality of life was negatively affected by staffs’ limited availability. The provider was exploring a range of ways to try to address staff recruitment challenges. People's medicines were not managed and administered safely in line the provider's procedure and best practice guidance.

Staff training was not up to date and some staff had not completed an induction to ensure they had the information, knowledge and skills to fulfil their role. 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. People had access to health and social care professionals.

People and relatives spoke highly of the staff who cared for them. Staff were caring in nature but did not have the time needed to provide person centred care. People’s rights were not always promoted and upheld. Confidential information was securely stored.

People's needs were assessed prior to moving into St Martins. However, assessments needed to be further developed to ensure protected characteristics under the Equality Act 2010 were fully considered. The manager was planning action to address this. Care records did not always provide staff with the information they needed to deliver personalised, safe care or contained out of date and conflicting information. People and a relative felt able to raise any complaints and concerns. People had limited opportunities to take part in meaningful activities.

Feedback from people, relatives and staff was used to drive service improvement. Despite our findings, people and a relative told us they were satisfied with the service provided and staff felt supported by the manager.

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 good (published 7 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety, poor environmental standards and staffing levels. 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and responsive and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to governance of the service, management or individual and environmental risk, including fire safety, staffing and restrictions on people’s liberties.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.