St Mary's Nursing Home

We found the following examples of good practice:

The home had procedures in place to protect residents from the risk of infection from any visitors. These included screening and testing for COVID-19 and providing visitors with appropriate personal protective equipment (PPE) to use whilst at the home.

Staff were aware of the signs to look for which may indicate a person had COVID-19 and were aware to follow national guidelines if they identified anyone with symptoms. People were safely admitted to the home, in line with current national requirements relating to care home admissions during the pandemic.

The home was regularly cleaned by staff and the registered manager had purchased additional cleaning apparatus to help maintain a hygienic environment. The living space was used in ways which promoted social distancing and minimised the risk of the spread of infection.

People and staff were regularly tested for COVID-19. Staff had completed training in donning and doffing PPE and infection. They demonstrated a good understanding of the princples of this training during our inspection.

The registered manager carried out regular infection control audits and was aware of the action to take in the event of a potential COVID-19 outbreak. The home had up to date infection control policies and procedures which reflected current national guidelines.

At the last comprehensive inspection in December 2016 we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because of issues in the way people’s medicines had been managed. Following that inspection the provider wrote to us to tell us the action they would take to address our concerns. At this inspection we found that the issues we had identified had been addressed, in line with the provider’s action plan.

The service had a registered manager in post. 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 this inspection we found that people were protected from the risk of abuse because staff were aware of the different types of abuse that could occur, the signs to look for, and the process for reporting and escalating any allegations, should they need to do so. There had been no allegations of abuse involving people at the service in the time since our last inspection.

People told us there were sufficient staff on duty during each shift to ensure their needs were safely met. The provider followed safe recruitment practices. Risks to people had been assessed and management plans put in place to ensure any identified risks were safely managed. Medicines were safely stored and appropriately recorded. People confirmed they were supported to take their medicines as prescribed. People were protected from the risk of infection because staff were aware of the provider’s infection control procedures.

The registered manager reviewed the details of any accidents that occurred at the service to help reduce the risk of repeat occurrence. People’s needs were assessed, and care and treatment delivered in line with nationally recognised guidance and standards. Staff received an induction when they started work at the service and were supported in their roles through a range of training in areas considered mandatory by the provider, and through regular supervision and an annual appraisal of their performance.

People told us they were happy with the décor at the service. They were supported to maintain a balance diet and spoke positively about the food on offer at the service. They also had access to a range of healthcare services when needed and staff worked to ensure people received co-ordinated care across different service types in support of their health.

Staff were aware of the need to seek consent from people when offering them support. 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 supported this practice. Staff were aware of, and worked in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) where people lacked capacity to make specific decisions for themselves.

Staff treated people with kindness and consideration. They respected people’s privacy and treated them dignity. People were involved in decisions about their care and treatment. They told us that the care they received met their individual needs and preferences. The provider offered a range of activities for people to take part in, in support of their need for stimulation. People were also supported to maintain the relationships that were important to them and relatives confirmed they were welcome to visit the service whenever they wanted.

The provider had a complaints policy and procedure in place which provided guidance on how to raise concerns. People and relatives expressed confidence that any issues they raised would be addressed by the registered manager. They told us that the service was well managed and that staff worked well as a team. The registered manager confirmed that the staff worked with the GP and local hospice team to ensure people received appropriate and dignified support at the end of their lives, although none of the people living at the service required this at the time of our inspection.

The registered manager held regular staff meetings to discuss the running of the service and to remind staff of good practice. The service worked in partnership with other agencies including local authority commissioners, and the local Clinical Commissioning Group (CCG), in support of people’s needs. People’s views on the service were sought through regular discussion and an annual survey, and they told us they were happy with the service they received. Staff worked well as a team in an open culture that was welcoming and compassionate. The provider had systems in place to monitor the quality and safety of the service, and improvements were made were issues were identified through the monitoring processes.

We undertook this focused inspection, on 13 April 2017, to check that the provider met our legal requirements. This report only covers our findings in relation to the key question well led and breaches identified in the warning notice. We will follow up on the other breaches of legal requirements in relation to medicines management at a later date. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'St Mary’s Nursing Home' on our website at www.cqc.org.uk.

St Mary’s Nursing Home provides nursing and personal care for up to 20 people. At the time of our inspection 13 people were using the service.

At this inspection, we found that action had been taken to improve the quality monitoring of the service in that audits undertaken in respect of care records, health and safety and recruitment of new staff were operating effectively.

However, the ratings for the key question well led at this inspection remain ‘Requires Improvement’ at this time as systems and processes that have been implemented have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

At our previous comprehensive inspection in November 2015 we identified a breach of regulations because risks relating to the safety and security of the premises were not safely managed. We took enforcement action with regard to these concerns, serving a warning notice on the provider.

We also identified further breaches of regulations because the premises were not always clean and hot water was not always available when required. Staff had not always taken appropriate action to protect people from the risk of abuse and records relating to people’s care and treatment were not always secure. Recruitment practices were not always robust, medicines were not always stored safely at the correct temperature and we identified concerns with infection control practices in the home. Following the inspection, the provider wrote to us and told us the action they would take to address these concerns.

We carried out a focused inspection in April 2016 and confirmed that the provider had acted to address the issues relating to the safety and security of the premises.

At this inspection we found that the provider had taken action and that the premises was clean and hot water available when required. Staff were aware of the action to take if they suspected abuse and knew the signs to look for which may suggest abuse had occurred. Records relating to people’s care and treatment were stored securely and the provider had implemented appropriate infection control practices.

However, whilst we found the provider had taken action to ensure people’s medicines were stored at the correct temperature, we found a breach of regulations because records relating to the administration of people’s medicines had not always been accurately maintained. We also found a further breach of regulations because the systems used for monitoring the quality and safety of the service, including the system of identifying risks when recruiting new staff were not always effective.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Risks to people had been assessed and staff were aware of how to manage identified risks safely. There were sufficient numbers of staff deployed within the service to meet people’s needs and staff were supported in their roles through regular training and supervision. People were supported to maintain a balanced diet and had access to a range of healthcare services when required.

Staff were aware of the importance of seeking consent from the people they supported and the service acted in accordance with the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). People told us the staff treated them with kindness and consideration, and that staff respected their privacy. They were involved in day to day decisions about their care and support.

The provider had a complaints procedure in place and people told us they knew how to raise a complaint. People had care plans in place which were reviewed on a regular basis and reflected their individual needs and preferences. There were a range of activities on offer for people to participate in to reduce the risk of social isolation.

People and relatives told us the service was well managed and that staff were open and friendly. The provider had systems in place to seek feedback from people using the, service and people expressed a high level of satisfaction with the care and support they received.

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

We took an enforcement action and served a warning notice on the provider in respect of more serious breaches with regards to the risk associated with unsafe or unsuitable premises and required them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 07 January 2016.

We carried out this unannounced focused inspection of the service on 07 April 2016 to check that the requirements of the regulations had been met in response to the enforcement action we had taken. This report only covers our findings in relation to the follow-up on the warning notice we served on Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of unsafe and unsuitable premises. The provider had sent us an action plan to tell us of how and when they will be compliant with other breaches we found in Regulations 12, 13, 15, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches will be followed-up at our next comprehensive inspection of the service.

St Mary’s Nursing home provides accommodation and nursing care for up to 20 older people who have nursing or residential care needs. At the time of our inspection, there were 15 people using the service and the home also provides respite care.

There was a registered manager in post. 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 this focused inspection on 07 April 2016 we found that the provider had addressed the issues we raised in the warning notice we served under Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, our rating of the key question “Is the service safe” have not been changed from ‘Required improvement’ because we found other breaches under this key domain and we are yet to follow up on the other key lines of enquiry at our next comprehensive inspection because the systems and processes that had been implemented have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

We found that the provider had put systems in place to assess and monitor the quality and safety of the service in regards to ensuring the premises was safe and suitable for people using the service, staff and others visiting the home. We saw that fire signage were pointing people in the right direction, the sluice door was locked and the fire escape door on the first floor was secured with an alarm in place to alert staff. Appropriate storage space was in place to ensure that equipment such as wheelchair and hoist were stored safely and not obstructing fire exit points.

Staff told us that they helped people to make decisions for themselves and to be as independent with their care as they were able. They told us that they would not undertake any tasks without the consent of people. One person who used the service told us; "I choose what I like to do."

We looked at records and saw that where it had been possible people signed the care plans giving consent for their care and other support required. People told us that they saw the general practitioner and other healthcare professional when they needed to.

We saw that staff spoke to people in a kind and courteous manner, addressing them politely and using their preferred names. We observed positive interactions between staff and people who used the service.

We made observations of the environment in order to check that they were suitably clean and fit for purpose and saw that the home was visibly clean and tidy.

We spoke to three members of staff who told us there were good opportunities for training. They said they enjoyed their work and were well supported by the manager.

Staff told us that the quality of the service was discussed by the manager at residents and staff meetings.

We found people using the service were involved in decisions about their treatment and care, and were treated with dignity and respect. Medicines were managed safely and there were recruitment procedures in place so that people were cared for by suitably qualified, skilled and experienced staff. Records were fit for purpose.