St Ronans Nursing and Residential Care Home

We found the following examples of good practice.

The provider had implemented an external visitors’ checklist which was completed before and following all visits. This included the completion of a screening questionnaire and health declarations. All visitors, including contractors and visiting professionals were by appointment only and the service ensured there was only one visit in the building at any one time, to help ensure social distancing could be maintained.

Individual risk assessments were completed for each person in relation to them receiving visitors. These gave clear guidance for staff on how visits should be managed to ensure safety for all. In addition, there were detailed and robust risk assessments in place to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

Safe visiting had been considered to allow people to stay connected to loved ones. A visiting pod had been put in place which included full screens, heating and an intercom system to help ensure safe visits. Virtual visits with loved ones had been implemented. Additionally, people were supported to stay connected to the community through digital connection. This had included, concerts from local schools and choirs, reading clubs and a Pantomime from the local theatre.

The care home was kept clean. Staff kept detailed records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. We also saw communal areas were kept uncluttered so cleaning could take place effectively. There were appropriate laundry processes in place.

The service had an adequate supply of personal protective equipment (PPE) to meet current and future demand. Staff were using this correctly and in accordance with current guidance. Staff had received training in relation to Covid-19 which included, infection control and use and donning and doffing of PPE. Staff infection control practices and PPE use was closely monitored by the management team, to ensure correct procedures were being followed.

The provider routinely tested people and staff for Covid-19. Staff had access to rapid response lateral flow tests (LFT) as well as standard Polymerase Chain Reaction (PCR) tests.

The registered manager and provider had systems to ensure there was clear oversight in relation to infection prevention and control. There were robust infection control audits in place.

St Ronans Nursing and Residential Care Home is registered to provide accommodation and nursing care for up to 46 people, including people living with cognitive impairments and physical needs. There were 42 people living at the home at the time of the inspection.

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

People and their families had mixed views on the staffing levels in the home. However, we found during the inspection there were sufficient staff to meet people's needs. Staff had the opportunity to interact with people in a relaxed and unhurried manner and respond to people’s needs in a timely way. Recruitment checks were carried out before new staff started working at the service.

There were suitable systems in place to ensure that medicines were securely stored, ordered and disposed of correctly and safely and people received their medicines as prescribed. However, some areas of medicine management required more robust systems to be put in place to ensure the management of medicines remained safe.

There were clear processes in place to monitor risks to people which helped to ensure they received effective care to maintain their safety and wellbeing. People were protected from avoidable harm and infection control risks were managed appropriately. Systems were in place to monitor incidents, accidents and near misses. These were recorded, acted upon and analysed to identified themes and trends. Where these were noted, actions were taken in a timely way.

People were supported to access health and social care professionals if needed, received enough to eat and drink and were happy with the food provided. Staff had received appropriate training and support to enable them to carry out their role effectively. They received regular supervision to help develop their skills and support them in their role.

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.

People said that the staff were caring and kind and that they were treated with dignity and respect. Staff’s knowledge of people’s history, preferences and risks associated with their care and support needs was good. People were involved in planning their care and the support they received. Care plans contained detailed personal information about how people wished their care to be provided.

The service had a strong focus on inclusion and the prevention of social isolation and offered people a range of personalised activities.

The management team were open and transparent. They understood their regulatory responsibilities. People and their relatives said the management team were open, approachable and supportive. Everyone was confident the management team would take the necessary actions to address any concerns promptly. There were effective governance systems in place to identify concerns in the service and drive improvement.

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 requires improvement (published August 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

There is no required follow up to this inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

St Ronans Nursing and Residential Care Home is registered to provide accommodation for up to 46 people. There were 41 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over three floors with bedrooms on all floors. Floors could be accessed by people, staff and visitors via a passenger lift, staircases and stair lifts. The majority of bedrooms were for single occupancy and had ensuite facilities. There was a number of communal areas available to people, including two dining areas, one of which was also used as a cinema room and three lounges. The garden area was accessible and well-maintained with a number of seating areas for people to enjoy.

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.

Processes in place to monitor risks to people were not always robust and did not ensure that people received effective care to ensure their safety and wellbeing. Staff were not always provided with consistent and detailed information and guidance about how people’s needs should be met to mitigate risks.

There were a number of audits in place to check the quality and safety of the service, however, some of these were not always robust or effective in identifying concerns. Some areas of the home were not clean and some practices did not protect people from the risk of cross infection. The provider had failed to act on the issues in relation to the cleanliness of the home prior to the inspection and the infection control audit had failed to highlight the issues raised by the inspectors. Care file audits had not always identified the inconsistencies within the care files or that capacity assessments and best interest decisions had not been completed or made following the principles of the Mental Capacity Act.

The principles of the Mental Capacity Act 2005 were not being followed as required to ensure people were only cared for with consent; capacity assessments had not always been completed and best interest decisions were not in place for all people that required them.

Information within peoples care files did not always contain detailed, person centred or consistent information about people’s needs and care monitoring records had not been put in place or did not always confirm that care had been provided as required to meet people’s individual needs.

People felt safe living at St Ronans Nursing and Residential Care Home. Staff knew how to identify, prevent and report abuse. Safeguarding investigations were thorough and identified learning to help prevent a reoccurrence.

There were enough staff to meet people’s needs in a timely way and staff were able to support people in a relaxed and unhurried way.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. People had access to health professionals and other specialists if they needed them. Procedures were in place to help ensure that people received consistent support when they moved between services.

People were cared for by staff who were competent and appropriately trained. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

People were cared for with dignity and respect and were treated in a kind and caring way by staff. Staff knew people well and encouraged people to remain as independent as possible.

Staff protected people’s privacy and dignity and responded promptly when people’s needs or preferences changed.

Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

People had access to a range of activities. They knew how to make a complaint and felt any concerns would be listened to and addressed effectively.

People and their relatives had confidence in the management. There was a clear management structure in place

The service worked in partnership with a number of organisations to provided them with the opportunity to share knowledge and ideas with others to aid the delivery of effective care.

People, their families and staff had the opportunity to become involved in developing the service.

At this inspection we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection on 26 November 2013 we found the service to be compliant with all of the regulations we assessed at that time.

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.

People living at the home said they felt safe. The visiting relatives we spoke with also said they felt their family members were safe as a result of the care provided.

We looked at four staff personnel files and there was evidence of robust recruitment procedures in place. Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service. People living at the home said they felt there were enough staff working at the home and did not have to wait long periods for assistance.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The home had a whistleblowing policy in place and this told staff what action to take if they had any concerns. The staff we spoke with had a good understanding of safeguarding, abuse and how they would report concerns.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition. Accidents and incidents were recorded correctly and included a record of the accident or incident, a summary chart and action plan.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use.

We saw that quarterly infection control audits were in place and an annual infection control statement was produced. Staff were aware of precautions to take to help prevent the spread of infection. The premises were clean throughout and free from any malodours. There was an up to date fire policy and procedure.

Medicines were managed safely. Medicines which were stored on the medication trolley and treatment room were stored safely and at appropriate temperatures which were monitored daily. There was information available to guide nurses when a variable dose of medicine was prescribed to support nurses to administer the most appropriate dose of medicine. Documentation of creams didn't enable staff to sign each time it had been administered as it was only documented on the chart once.

Shortly after the date of the inspection the service contacted us to identify a number of actions they intended to take to rectify the issues we identified.

People told us they felt staff had the sufficient skills, knowledge and training to care for them effectively. Staff told us they received an induction when they first started working at the home which gave them a good introduction to working in a care environment.

Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role, such as food hygiene, dementia, infection control, fire safety, first aid, safeguarding, equality and diversity and medicines handling.

Staff had access to regular supervision and appraisal as part of their on-going development.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations. Staff demonstrated a good understanding of MCA/DoLS and told us when they felt a DoLS authorisation might be required.

People living at the home told us staff always sought their consent before delivering care to them. Staff were aware of how to seek consent from people before providing care or support and told us they would always ask before providing care.

The people we spoke with told us the food provided at the home was of a good quality. People had nutritional care plans in place and care plans also contained records of visits by other health professionals. We saw that staff provided assistance to several people at meal times. Conversations were warm and unrushed and staff ensured they were at the same eye level of the person they were assisting. The atmosphere was calm and there were no intrusive noises or unnecessary interruptions.

We saw there were some adaptions to the environment, which included pictorial signs on some doors.

We saw staff showed patience and encouragement when supporting people. We observed people were treated with kindness and dignity during the inspection. Care staff spoke with people in a respectful manner. The people we spoke with told us they received good care whilst living at St. Ronans. The people we spoke with described the staff as kind and caring.

People said they felt treated with dignity, respect and were given privacy at times they needed it. Staff were also able to describe how they aimed to treat people in this manner when delivering care. We saw staff knocked on people’s bedroom doors and waited for a response before entering. We saw people living at the home were well groomed and nicely presented.

Throughout the course of the inspection we overheard lots of chatter and laughter between staff and people and there was a positive atmosphere within the home. We found the service aimed to embed equality and human rights though good person-centred care planning. People said staff tried to promote their independence when delivering care and allow them to try and still do things for themselves.

Staff were also clear about how to promote independence when providing assistance to people. People’s care files contained end of life care plans, which documented people’s wishes at this stage of life where they had been open to discussing this. Staff told us they involved families when developing care plans or carrying out assessments.

People living at the home told us they received a service that was responsive to their needs. Care plans we viewed all had a range of thorough initial assessments. This enabled staff to establish what people’s care needs were and the type of individual care people required. Within people’s care plans, it identified who was important to the person and what they wished to be involved in.

The home had systems in place to seek feedback from people living at the home. We looked at the most recent feedback received and saw it was positive and complementary from all groups involved.

There was a system in place to handle and respond to complaints. We saw the home had an appropriate policy and procedure in place, which informed people of the steps they could take if they were unhappy with the service they received. The people we spoke with said they would feel comfortable speaking with staff and raising concerns and one person told us they had recently raised a complaint about a staff member.

The home employed an activities co-ordinator who told us they carried out group based activities such as bingo and arm chair exercises, trips to the sea front, and card/board games. Information regarding activities was displayed throughout the building on various notice boards.

People living at the home said they knew the manager and thought highly of them and the care staff. The staff we spoke with told us they enjoyed working at the home and that there was an open transparent culture. We found the registered manager was very approachable and engaging and facilitated our requests throughout the inspection. Staff also told us leadership and management at the home was good. Staff said they felt able to approach the manager, report concerns and also felt supported to undertake their roles to the best of their ability.

We looked at the systems in place to monitor the quality of service. The registered manager undertook regular audits covering areas such as infection control, staff performance, systems and processes, finance systems, health and safety management systems and care files.

Staff had access to a wide range of policies and procedures. These could be viewed by staff if they ever needed to seek advice or guidance in a particular area.

The service worked in partnership with a number of organisations and was a member of the Hampshire Care Association (HCA) executive board. St Ronans also facilitated seminars and invited guest speakers to deliver presentations on topical issues in addition to organising local workshops on a specific needs basis.

At the time of the inspection the home was sharing their experience of developing and embedding the Level 3* nursing assistant role to help other providers develop this resource within their organisations. The Home was ‘research ready’, working with Portsmouth University and the National Institute for Health Research. Partnership working with other relevant professionals took place at multi-disciplinary team (MDT) meetings.

To keep up to date with best practice the senior team regularly attended care events and seminars to ensure the service keep up to date with current and future changes in legislation.

The two health professionals we spoke with who were visiting the home commented that the provider had good links with the general practitioner (GP) and community psychiatric nurse (CPN). A relative of a person living at the home told us that the privacy and dignity of their family member was respected by the care staff and that they were "very pleased" because the staff "really looked after Mum".

We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people were protected from the risk of infection because appropriate guidance had been followed.