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Inspection carried out on 16 March 2021

During an inspection looking at part of the service

St Mary's Nursing Home is a care home which provides accommodation and support in one adapted building for people in the London Borough of Bexley. The home is registered to provide support to up to 20 people. There were nine people living at the home at the time of our inspection.

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.

Inspection carried out on 9 January 2018

During a routine inspection

This inspection took place on the 09 January 2018 and was unannounced. St Mary's Nursing Home is a 'care home'. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Mary's Nursing accommodates up to 20 people. There were 14 people living at the home at the time of our inspection.

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 support

Inspection carried out on 13 April 2017

During an inspection looking at part of the service

We carried out an unannounced focused inspection of this service on 08 and 09 December 2016 and found breaches of legal requirements 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. We took enforcement action and served warning notices on the registered provider in respect of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

Inspection carried out on 8 December 2016

During a routine inspection

This inspection took place on 08 and 09 December 2016 and was unannounced. St Mary’s Nursing Home provides nursing and personal care for up to 20 people. At the time of our inspection 12 people were using the service. There was a registered manager in place. 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 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

Inspection carried out on 7 April 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 14, 17 and 18 November 2015 at which breaches of legal requirement were found. We found breaches in areas such as risk associated with unsafe or unsuitable premises; the safe management of medicines; risk associated with the spread of infection including those that were health care associated; inappropriate systems and processes to safeguard people using the service; the risk of unclean premises and equipment, the secure maintenance of contemporaneous records and inadequate staff recruitment and selection procedures.

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.

Inspection carried out on 14, 17 and 18 November 2015

During a routine inspection

This inspection took place on 14, 17 and 18 November 2015 and was unannounced. At our last inspection in October 2013, we found the provider was meeting the regulations we inspected.

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 about 16 people using the service as the home also provided respite care. The home 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.

The service was not safe, we found breaches in legal requirements in a number of areas including some risks to the health and safety of people using the service were not always identified, assessed or action taken to prevent or reduce the likelihood of them occurring. Medicines that required refrigeration were not always stored within the required temperature. Infection control protocols were not always followed to prevent the spread of infections. Parts of the home were not clean although the home had a full time housekeeper in post. We found that the hot water in the home was temperamental and the water did not always turn hot when needed.

We also found the provider had not followed procedures for the safeguarding of adults. People’s health charts were not always kept confidential. The provider regularly assessed and monitored the quality of the service but the systems in place were not always effective to identify shortfalls. The provider had recruitment protocols in place however we found gaps in staff’s employment history.

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

The provider had a system in place for assessing the number of staff needed to support people. However staffing levels did not always meet people’s needs.

People and their relatives we spoke with were complimentary about the home. People felt the place was “homely” and they felt safe at St Mary’s Nursing Home. Staff treated people in a caring manner. Apart from the health and safety risk we found, where other risks to people were identified, appropriate risk assessments and actions plans were in place to mitigate these risks. Checks were carried out on equipment to ensure they were safe to use. We found that medicines were administered, dispense and recorded to meet people’s needs.

Staff were supported through an induction, training and supervision to ensure they had appropriate skills and training to perform their roles. People were supported to eat sufficient amounts of food and fluids for their wellbeing. People had access to a range of healthcare professionals when they needed it. People’s privacy and dignity were respected and people were supported to express their views through surveys, residents and relatives meetings and their views were taken into consideration and acted upon. People’s spiritual needs where relevant were met. People were encouraged to maintain relationships with their family and friends and a range of activities were available to them.

People and their relatives knew how to make a complaint if they were not happy about the service. Each person using the service had a care plan in place specific to their individual care needs and the care plans were reviewed monthly to meet people’s changing needs.

Inspection carried out on 22 October 2013

During a routine inspection

People who used the service told us that they were happy about the care they received from staff. One told us "I enjoy it here", and another said; "The staff are very good here." We saw written comments from a relative which said 'many thanks for all your help looking after my mother.'

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.

Inspection carried out on 3 January 2013

During a routine inspection

People using the service and their relatives we spoke with told us they were very happy with the care and treatment people received. They told us the staff were good at what they do and that there were enough staff on duty. One person said; �The staff did everything they could so we could have a lovely Christmas.� Relatives told us the home was always welcoming and friendly, and that they were reassured by the high standard of care people received. One relative said; �St Mary�s is hard to beat, especially the staff�. Another relative said; �I�ve never had any worries about my mum, and some of the ladies here look better than I do!�

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.

Inspection carried out on 12 March 2012

During a routine inspection

During our visit on 12 March 2012 the people we spoke with who used the service told us they were quite happy with the home.

Staff were respectful and kind towards people who used the service. However, there were a few occasions when we observed people not being treated with dignity.

Activities we saw had limited success in engaging people who used the service and some people took little part in any activities.

Reports under our old system of regulation (including those from before CQC was created)