St Anthony's Residential Home Limited

St Anthony’s residential home limited is a care home that provides personal care for up to 16 predominantly older people. At the time of the inspection 13 people were living at the service. Some of these people were living with dementia.

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

The inspection was prompted following concerns raised to the Care Quality Commission in relation to the governance of the service, risk for the safety and welfare of people using the service, kitchen environment, food portions and lack of choice in meals.

Prior to the inspection we had received concerns that the service was not being governed effectively. At the inspection, there was no evidence of how the registered manager was running the service. There was no evidence of the registered manager making decisions about the future growth and development of the service. There were gaps in audits, people’s views were not sought or considered. The registered manager had not identified issues we found during the inspection.

Medicines were not being managed safely. An unsecure box of medicines ready for return to the pharmacist was left outside the locked cupboard, where it should have been stored. This meant there was a potential risk to people. Where people were administered medicines ‘when required’, staff had not recorded the reason they were administered or whether they were effective.

The service had begun the transition from a paper care planning system to an electronic recording system. Some care records were not complete. One person had been in the service for four months on a respite basis. However, there had been no formal care plan put in place. Staff understood the person’s needs and daily records were kept. Falls and incidents were being recorded as well as advice from professionals involved in the person’s care. However, not having a detailed care plan meant staff did not have the necessary level of detail to respond to the person’s needs.

The service did not have effective systems to monitor equipment and utilities. There was no current gas service certificate and the stair lift had not been serviced. This meant there was potential for risk. The nominated individual took action to arrange the gas system service the same day. Other service certificates were in place.

Not all people had emergency plans in place outlining how to support them should they need to evacuate the building in an emergency.

Recruitment records were generally satisfactory with checks evident. However, one member of staff did not have references in place to support the providers decision to employ them. This meant they may not have been suitable to work with vulnerable adults.

Prior to the inspection we received concerns the kitchen area was not hygienic; portions of food were small and meal choices were limited. We spoke with the cook, observed the kitchen area and looked at portion sizes. These concerns were unsubstantiated. The lunch was observed, portion sizes were good, and consideration was given for people’s individual choices and appetites. The service had a 5-star food hygiene rating and the kitchen area was clean.

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.

There were enough staff to meet people's needs and ensure their safety. Staff told us, “Not been here long but yes, there are enough staff” and “We have time to do our jobs”.

People made choices about where and how to spend their time. People told us they were happy with the care they received and believed the service was a safe place to live. Where people were unable to tell us about their experiences, we observed they were relaxed and at ease with staff.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The deputy manager maintained oversight of training to ensure staff had the necessary training, knowledge and skills to provide consistent care.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

The building was clean, and there were appropriate procedures to ensure infection control risks were minimised. Some parts of the environment were cluttered. A vacant room was being used to store equipment. The nominated individual told us additional storage was being created by erecting an outhouse. Some walls in the lounge and entrance had outdated newspaper articles and dated information leaflets.

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 good published (19 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about governance, medicines, staffing and people’s choices. 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.

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

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

Enforcement and Recommendations

We have found breaches in relation to the management of risk, management oversight and incomplete records at this inspection.

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

Notice of inspection

This inspection was unannounced.

Follow up

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

St Anthony's is a care home that provides personal care for up to 16 predominantly older people. At the time of the inspection 11 people were living at the service. Some of these people were living with dementia.

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

There was a relaxed and friendly atmosphere at the service. People made choices about where and how to spend their time. People told us they were happy with the care they received and believed it was a safe environment. Staff were supportive and attentive to people’s needs and wishes.

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.

There were enough staff available to meet people’s needs and people received timely support from staff when needed. Staff had time to engage in social interaction and activity with people. Staff knew how to keep people safe from harm.

Records of people's care were individualised and detailed their needs and preferences. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

The programme to regularly review care plans and risk assessments had fallen behind. However, a plan to rectify this was in place and the care plans of people with the highest needs had been updated with the remaining care plans were due to reviewed within the next two months. In the meantime because staff knew people well, and any changes to people’s needs were effective communicated, people’s needs were being met.

Some care plans lacked details of people’s end of life wishes and life histories. We have made a recommendation about this.

The medicines system was well organised and staff received suitable training. People received their medicines on time.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. The environment was safe and people had access to equipment where needed.

Staff had received appropriate training and support to enable them to carry out their role safely.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

People were involved in meal planning and staff encouraged them to eat a well-balanced diet and make healthy eating choices.

People and their families were given information about how to complain and details of the complaints procedure were displayed at the service. The provider and staff knew people well and worked together to help ensure people received a good service. People and staff told us the provider was approachable and listened when any concerns or ideas were raised.

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. (Report published on 28 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

We carried out this inspection on 4 and 6 April 2017. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection on 19 October 2015. In October 2015 the service did not have robust recruitment processes. There were two new members of staff, who were providing personal care for people, without the appropriate pre-employment checks in place.

At this inspection we found improvements had been made to the recruitment processes and robust systems were now in place. Recruitment files we looked at contained all the relevant recruitment checks to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks.

Before the inspection concerns were raised with us that some staff were rude and shouted at people living in the service. There were also concerns raised about the staffing level at night and the inappropriate use of continence pads due to insufficient numbers of night staff on duty. At this inspection we did not find any evidence to substantiate these concerns.

People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people and relatives included, “It’s lovely here”, “I am very happy living here”, “Can’t fault it” and “No complaints.”

Due to people’s health needs some people were unable to tell us verbally about their views of the care and support they received. However, we observed people were relaxed and at ease with staff, and when they needed help or support they turned to staff without hesitation.

On the day of our inspection there was a calm, relaxed and friendly atmosphere in the service. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Comments from people and relatives included, “Staff are very good, all you have to do is ask and they will help”, “They [staff] have been very good to me”, “Staff are very attentive to Mum’s needs” and “Staff talk to me fine.”

People were able to take part in a range of activities of their choice. Where people stayed in their rooms, either through their choice or because they were cared for in bed, staff spent one-to-one time with them. This helped to prevent them from becoming socially isolated and promoted their emotional well-being. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

Staff knew how to recognise and report the signs of abuse. Staff received appropriate training and supervision. New employees completed a thorough induction and had the opportunity to attain a Diploma in Health and Social Care. However, the induction was not in line with the care certificate, which is an industry recognised induction that replaced the Common Induction Standards in April 2015. The provider assured us that all staff, who were new to the care industry, would complete the care certificate.

People had access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. People were given plates and cutlery suitable for their needs and to enable them to eat independently wherever possible.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Any risks in relation to people’s care and support were identified and appropriately managed.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA). Where people did not have the capacity to make certain decisions the management and staff acted in accordance with legal requirements under the MCA. Staff applied the principles of the MCA in the way they cared for people and told us they always assumed people had mental capacity.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Staff told us they felt supported by the management commenting, “I get on well with the owners”, “I think the home is well managed” and “You can always get hold of management when you need them.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Management worked alongside staff, regularly providing care for people and this enabled them to check if people were happy and safe living at St Anthony’s.

We made contact with all ten people but due to the ages, health and frailty of four people we could only communicate with six people who shared with us their experience of what life was like at the home. People made comments such as "I am very comfortable living here". One person said "the staff are very kind and I am well cared for and very comfortable".

We spoke with two relatives who visited the home at least once a week. One relative said they "the staff are brilliant and I have no concerns whatsoever". Another relative said "it has taken me time to get used to my relative living in the home but I am very satisfied with the care". Both relatives said the providers and staff were excellent and they were very satisfied with the care and attention their family member received.

We saw staffing ratios which evidenced that people were protected because there were sufficient numbers of staff on duty to fully meet their needs.

During our observations we saw staff help two people to mobilise. We also saw staff conversed with people when they were laying up tables for lunch. We saw people talked to each other at lunch.

We witnessed staff interactions with people which were generally positive. People told us staff answered call bells promptly. One person said the staff were 'polite and friendly'. Another person said, 'I am very happy here, no complaints'. People told us the food was good and they were offered choices. We were told visitors were welcome. One person said 'I can go to bed when I want, if I wanted to go out someone would take me'.

We heard care workers ask people what they would like to do and they gave them ideas if people could not make a choice.

We found staff were recruited in an appropriate way.

We observed a new member of staff complete an initial induction process which lasted over two hours.