St Anne's Residential Care Home

St Anne’s Residential Care Home is a residential care home that was providing personal care for up to nine people with learning difficulties, mental health, autism and other complex needs. At the time of the inspection nine people were living at the service. Some people had limited verbal communication, so we captured their experience through observations.

People’s experience of using this service:

People told us they were happy living at the home and they felt safe. All people were comfortable in the presence of staff. Medicines were administered safely. The management were already aware of improvements which could be made with the management of medicines to make sure it reflected current best practice. Most risks had been identified with ways to mitigate them. Records and processes around the management of behaviours which could challenge were continuously being developed.

The provider and management had completed a range of audits to identify concerns and issues at the service. They strove to be open and constantly develop and improve the support people were received. When systems had identified issues, actions were being taken to rectify them. The registered manager was aware of their responsibility to notify the Care Quality Commission of certain events in line with their statutory obligations.

When a person had fluctuating capacity to make specific decisions records did not always reflected the knowledge, understanding and actions staff had taken. When people were deprived of their liberty systems were in place to ensure it was lawful. Any person living at the home was involved in making choices about their day to day care and these were respected by staff.

People and staff felt there were enough staff. During the inspection people were able to participate in a range of activities due to positive staffing levels. Staff had received a range of training considered mandatory by the provider. Plans were in place to further develop more senior staff to specialise in specific areas.

People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. There were good links with other health and social care professionals which was important due to the complex needs of anyone living at the home. However, some information sharing was not always in a timely manner.

Staff were kind and caring and knew the people living at the home incredibly well. Staff respected privacy and dignity throughout the inspection. Strong links had been developed with the community which had a positive impact for people.

More information about the detailed findings can be found below.

Rating at last inspection:

At the last inspection the home was rated good. It was published on 23 May 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

St Anne’s had a registered manager. 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.

St Anne’s was last inspected on 23 and 26 August 2016. At that inspection, the service was rated as good overall, but we found the service required improvement to ensure it was well-led. A breach in Regulation 19 of the HSCA 2014 Regulations was identified. This regulation related to staff recruitment. This focussed inspection was to review the provider’s progress on meeting this breach, and improvements in quality monitoring.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Anne’s on our website at www.cqc.org.uk.

The provider had met the breach in Regulation 19 in full. All staff now had necessary evidence on file to show relevant documentation about them had been sought. Staff employment files were regularly audited.

The provider had embedded their quality monitoring processes, to ensure people received safe and quality care. Audits included reviews of relevant areas relating to people’s needs, and the management of the service. These reviews took place regularly. Improvements in service provision, where relevant, were identified and took place in a timely way.

Management supported an open and inclusive culture for both people and staff. People and staff said management supported them. Links were established with people’s families and other supports, such as healthcare agencies, to ensure people were able to live the life they chose.

We carried out an unannounced comprehensive inspection of this service on 1 and 5 June 2015. Three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check they had followed their plan and to confirm that they now met legal requirements.

The home had a registered manager. 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 considerable improvements had been made. However, we found the provider had breached a different regulation. Not all of the appropriate recruitment checks had been completed before staff began work, including disclosure and barring service and employment history. If a member of staff had a criminal conviction, the provider had not completed the relevant risk assessments to make sure staff were suitable to work with vulnerable people.

At the inspection in June 2015 we found essential maintenance had not been completed around the home. This included gas, electrical and fire systems safety. At this inspection we found the provider had taken appropriate action and all of the relevant maintenance was up to date. There was also a robust schedule in place to make sure maintenance was kept up to date in the future.

At the inspection in June 2015 we found the provider did not have a robust quality monitoring system in place. At this inspection we found the provider had made good improvements to the quality monitoring processes in place. However, these processes needed time to be developed and improved further.

At the inspection in June 2015 we found that while care workers demonstrated they had the skills to meet people’s needs effectively, they were not well supported with training, supervision and appraisal. Most training needed refreshing and supervision and appraisals had not been completed regularly. The provider did not have a schedule in place for when this should happen. At this inspection we found the provider had supported and encouraged staff to complete a variety of training. This included safeguarding, health and safety, moving and handling, and food hygiene. Staff were also given specific training so they could effectively meet the individual needs of each person. This included supporting people with autism and/or behaviour that may challenge people and others. Staff gave us positive feedback about the training and support they received.

People experienced excellent care and support. They were supported to live safe, and meaningful lives in the way they wanted to. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were well managed and people were able to stay safe without having their freedoms restricted. Managers and staff promoted peoples independence and encouraged people to develop a skills to help them live a more independent life. If an incident or accident did occur, they were well reported and investigated. Staff understood the importance of learning from incidents, so they could reduce the risk of them happening again.

Staff were very caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person living in the home. People had developed positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well supported to do the things that were important to them, such as going to college, church or out for lunch. Staff were well supported with training, supervision and appraisal which helped them to ensure they provided effective care for people. There was always enough staff on duty to safely support people.

Person centred care was important to the service and staff made sure people were the main focus of their practice. Care plans focused on the whole person, and assessments and plans were regularly updated. People’s individual preferences, needs and choices were always taken into account by the caring and compassionate staff and managers.

The registered manager and staff had a good understanding of the Mental Capacity Act (2015) (MCA) and gained consent from people in line with legislation. Deprivation of Liberty Safeguards (DoLs) referrals had been made to the appropriate authorities. The registered manager knew who to involve if a best interest decisions needed to be made on behalf of a person who could not make the decisions themselves.

People’s medicines well managed. Staff were properly trained and people received their medicines safely and on time. Staff understood when they needed to give people medicines on an ‘as and when basis’, and how people communicated this was what they needed.

The registered manager and staff ensured everyone was supported to maintain good health. They took a positive approach to making sure people’s health needs were met, and ensured that when people needed specialist input from health care professionals they got it.

People were well supported to eat and drink enough. Food was homemade and nutritious and people were involved in making decisions about what they wanted to eat. People were supported to eat healthy food and maintain a healthy weight, with specialist diets when required.

People and those important to them, such as their relatives, were asked for feedback about the quality of the service. Any feedback received was acted on, and any concerns were dealt with quickly before the formal complaints procedure was needed. The registered manager and staff knew what they should do if anyone made a complaint.

There was an open culture in the home, and staff said they felt well motivated and valued by all of the managers. Staff said they would be happy to discuss any concerns they might with any of the managers and said they would act on them. Senior staff all knew people who use the service very well, and were clear about each individual’s care needs. All of the registration requirements were met.

We have made a recommendation to the provider about quality assurance processes. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Not all of the appropriate recruitment checks were completed before staff began work. You can see what action we told the provider to take at the back of the full version of this report.

We visited the home and were introduced to four of the six people who lived in the home. People said they were happy living in St Anne's and that the staff were very good.

We spoke with four care workers, the two deputy managers and the provider. We observed that staff were mindful of people's individual needs and were respectful when offering support.

We contacted four relatives after the inspection. They told us that St Anne's supported people to be independent and make choices. One person said, 'They are supported in a safe way, particularly when they go out, to develop their skills and become more independent.'

We looked at two care plans and found them to be person centred, with relevant risk assessments and guidelines for staff to follow.

We looked at the systems and processes that the home had in place to ensure the people who used the service were protected from abuse. We found these ensured that staff knew what constituted abuse and what to do if it was suspected.

Staff said that they needed to update some training and the provider was aware of this. We saw that staff training had been reviewed and a training programme had been developed.

A complaints procedure was available for people who lived in the home, staff and relatives.