St Paul's Residential Home

St Paul's Residential Home is a residential care home providing care and support for up to 32 older people across four adapted buildings. At the time of our inspection, 29 people were living at service.

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

We saw substantial improvements had been made since our last inspection. Since the last inspection, quality assurance systems to monitor the safety of the home through audits, had been strengthened. However, we found some more time was needed to ensure the recording of the provider's medicine systems, repositioning records and recruitment processes were effectively implemented and embedded in practice.

We have made a recommendation about the recruitment of staff.

Aside from the concerns we noted and shared on inspection, risks to people were now assessed and managed safely and monitored routinely.

People were protected from the risk of abuse, and the provider had systems and processes in place to safeguard people. People and relatives told us they felt safe and were positive about the staff who supported them.

People, relatives, staff and professionals spoke positively about the leadership of the service and told us they had seen significant improvement.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (15 November 2022). 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 Regulation 12 of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2014 or Regulation 18 (Notifications) of the Care Quality Commission (Registration) Regulations 2009.

At this inspection we found the provider remained in breach of regulation 17. Although we found substantial progress had been made, more time was needed for some actions to be completed and embedded before we could judge that the provider's actions had been effective in making and sustaining improvement.

When we inspected 5 July 2022, we recommended the provider consider current guidance related to legionella risk management and take action to update their practice accordingly. In our subsequent inspections risks relating to the management of legionella had not improved. However, at this inspection we found improvements had been made to legionella risk management and practice.

When we inspected 5 July 2022, we also recommended that the provider strengthen the systems in place to gather and communicate how feedback has led to improvements. In our subsequent inspections we found the provider had not made the necessary improvements. However, at this inspection we found improvements had been made to strengthen their system in relation to feedback.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified a continued breach in relation to good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Paul's Residential Home is a residential care home providing care and support for up to 32 older people across four adapted buildings. At the time of our inspection, 28 people were living at service.

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

The provider had made some improvements to the service. However, not all the requirements of the warning notices had been met.

The provider and manager had implemented systems to monitor, assess and improve the quality of people's care, people's prescribed medicines and the environment. However, these systems were not always effectively embedded and sustained at the time of this inspection. Concerns we identified at this inspection had not been identified by the provider’s own systems.

People had not always received their medicines as prescribed. Systems to ensure people received their medicines safely had not always been followed.

Improvements had been made to the environment since our last inspection. However, there were still actions required to ensure people were fully protected from environmental risks, including fire and legionella.

People's care plans had been reviewed since our last inspection. Everyone living at St Paul's now had a care plan. However, care plans were not always current and reflective of people's needs.

The management were reviewing their processes and were working to engage care staff with the required changes so these were embedded in practice. A staff survey had been carried out and the manager was planning to work through this feedback.

People's relatives talked positively about improvements at St Paul's and about the management team.

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 15 November 2022).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last rated inspection, by selecting the ‘all reports’ link for Fern Court on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Paul's Residential Home is a residential care home providing care and support for up to 32 older people across four adapted buildings.

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

Care plans and risk assessments were not in place for all people. Some people's care plans, and risk assessments had not always been reviewed and contained inaccurate or conflicting information.

People were not always protected from the risks of their environment as effective maintenance had not always been carried out. The provider had not undertaken effective measures to ensure that service users would be protected from risks associated with fire safety and legionella.

Systems to monitor and improve quality and safety of the service were not always effective. Records to support management of the service had not always been maintained. In response to our last inspection the provider sent us an action plan which stated they would meet the regulations in full by the end of August 2022. At this inspection we found the provider had not fulfilled all the actions outlined and remained in breach of the relevant regulations.

People and their relatives felt the provider was approachable, however had raised issues regarding communication. The provider was aware of these concerns and were aiming to improve communication with relatives and healthcare professionals by reviewing their governance systems and management structure.

Staff told us they felt supported and enjoyed working at St Paul’s Residential Home. We observed people being treated with dignity and respect.

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 requires improvement (5 July 2022).

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 the provider remained in breach of these regulations.

At our last inspection we recommended the provider consider current guidance related to legionella risk management and take action to update their practice accordingly. Risks relating to the management of legionella had not improved since our last inspection.

At our last inspection we also recommended that the provider strengthen the systems in place to gather and communicate how feedback has led to improvements. At this inspection we found the provider had not made the necessary improvements to strengthen their system.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, good governance and reporting incidents at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Paul’s Residential Home is a residential care home providing care and support for up to 32 older people across four adapted buildings. At the time of our inspection there were 30 people living there.

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

People, their relatives and staff spoke positively about the leadership in the home and the quality of care people received.

We found some improvements were needed to ensure infection control practices related to Covid-19 government guidance were followed and records related to people’s medicines were always completed. The registered manager did not always have robust oversight of the quality assurance activities to ensure when these were delegated, they would be fully effective in identifying and addressing quality and safety concerns.

We have made a recommendation about the systems for gathering and communicating how feedback has led to improvements.

People felt safe living at St Paul’s Residential Home. Staff understood people's needs and how to assist them to protect them from avoidable harm. Care plans and risk assessments were in place, which provided staff with guidance on how to meet people's needs and manage identified risks.

Staff had received training to administer medicines and their competency was assessed. People’s relatives told us that medicines were administered on time.

We have made a recommendation about legionella risk management to support improvement.

People received care and support from a consistent staffing them who understood their needs and how to assist them and knew them well.

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.

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 (published 29 September 2020).

Why we inspected

We received concerns in relation to fire safety following a visit to the home from the fire service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection prevention control, medicines records and good governance at this inspection. We have made recommendations about the legionella risk management and the systems in place to gather and communicate how feedback has led to improvements.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Pauls Residential Home provides residential care and support for up to 32 people in four adapted buildings. At the time of our inspection there were 27 people living there. The service provided care for people with long term health conditions, older people, people living with dementia and people needing end of life care and support.

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

Since our last inspection, improvements had been made to the way in which peoples care and support was documented. A new electronic care plan and record system had been implemented. This electronic system had ensured that accurate records relating to people’s care were in place.

Since our last inspection, the service had ensured that any reportable incidents such as injuries or safeguarding incidents had been reported to the appropriate authorities (such as CQC) without delay.

The service provided sufficient numbers of trained staff to meet people's needs. People's relatives told us there was always enough staff who provided high standards of care which benefited their loved ones.

Staff had received training to ensure they could recognise the signs of abuse and told us how they would report these. Risks associated with people's care were managed. Records showed people had risk assessments in place and that these were reviewed regularly.

Peoples relatives told us that their loved ones were supported to take their medicines safely. Staff received training to enable them to administer medicines and processes were in place to ensure staff were competent. Accidents and incidents were recorded and reported. Systems were in place to ensure lessons were learnt when things had gone wrong.

Effective systems were not always operated to ensure that identified areas of improvement such as maintenance works were completed in a timely manner.

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 17 May 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection effective action had been taken to meet the relevant regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met the legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Paul’s Residential 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 Paul’s Residential Home accommodates 32 people in four adapted buildings. At the time of our inspection there were 31 people using the service.

At our previous inspections in April 2016 and March 2017 the service was rated "Good". At this inspection we found the service was rated Requires Improvement.

St Paul’s Residential 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.

People received their medicines as prescribed, but some improvement was needed to ensure best medicine management practice would always be followed. When people fell, regular observations had not been completed and recorded to support staff to identify injuries. We made a recommendation about people’s post falls management.

The provider had completed pre-employment checks to protect people against the employment of unsuitable staff. Some improvement was needed to ensure when information of concern was identified records would be kept of how risks had been mitigated.

Effective systems were not always operated to monitor and improve the quality of care people received. The provider had not identified the shortfalls we found prior to our inspection.

People were protected from harm and abuse through the knowledge of staff and management.

Staff were supported through training and meetings to maintain their skills and knowledge to support people. Sufficient staff were deployed to support people.

We found the environment of the care home was clean and had been well maintained. People were supported to eat a varied diet which met their needs and preferences.

People received personalised care and support from caring staff who respected their privacy, dignity and the importance of independence. 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.

People had opportunities to take part in a variety of activities. People were supported to maintain contact with their relatives. There were arrangements in place for people and their representatives to raise concerns about the service. Care was provided for people at the end of their life.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. In January 2017 we received concerns about the techniques staff were using when helping people to move. The provider investigated and wrote to us to inform us of the action they were taking, to make sure the way people were moved was safe and appropriate. We also checked these actions had been completed during this inspection. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Paul’s Residential Home on our website at www.cqc.org.uk

St Paul's Residential Home provides care to older people with a physical and/or sensory disability. At the time of our inspection 31 people were living in the home and of these 30 people were living with dementia.

The registered manager was present during the inspection. 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.

This unannounced inspection was carried out on 28 March 2017. At the inspection on 22 and 25 April 2016, we asked the provider to take action to make improvements to staff recruitment checks. In particular to account for gaps in staff employment records. We found that the actions in the provider’s plan had been completed.

Staff recruitment processes had been reviewed and a new application form was in use. This included information to explain gaps in prospective staff members’ employment history. Gaps in employment history had also been recorded for three existing staff members, where this information had not previously been documented. One new staff member had been employed since our last inspection and we found legal requirements for recruitment checks had been met.

The moving and handling techniques used by staff were safe and appropriate. Information about people’s individual needs was recorded in their moving and handling assessment records. Staff were clear about their responsibility to report poor practice to the registered manager.

There was a registered manager in post, who was also the owner of the company. 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.

People had not been protected against the risks of employing unsuitable staff. Safe recruitment and selection procedures had not been followed. This was a breach 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 the report.

People’s care was highly personalised reflecting their individual wishes, likes, dislikes and the way in which they had previously lived their lives. People and their relatives were involved developing their care and support and took part in reviews. People’s care records had been kept up to date with changes in their needs and provided an individualised record of their needs. People were protected against the risk of harm and supported to take risks whilst staying as safe as possible. Their independence was promoted and they were encouraged to help around their home, to maintain their mobility and to do as much as they could for themselves. Staff had a good understanding of people’s needs, treating them with dignity, respect and compassion. When people were upset or unhappy staff knew how to help them to deal with their emotions. People had access to healthcare professionals and their medicines were administered satisfactorily.

People had access to a range of meaningful activities which reflected their interests and preferences. External entertainers provided music and exercise alongside craft sessions and games. Students from colleges and children from schools visited the home, keeping people company and playing music or singing to entertain people. People’s cultural needs and diversity were considered and celebrated. The diversity of the staff team reflected people’s backgrounds. People were able to talk with staff in their first language and staff respected their nutritional and religious needs. People enjoyed their meals and had access to snacks and drinks throughout the day and night. They were able to help themselves to drinks and help to prepare their meals. People knew the registered manager well and would talk to her about any concerns or issues they might have.

People benefited from staff who felt supported to develop in their roles. They had access to a range of training to equip them with the skills to meet people’s needs. Staff were observed delivering care and support to make sure they were able to put this knowledge into practice. There were sufficient staff to meet people’s needs. Staff worked together as a team. They said they worked hard, were happy in their roles and were confident raising concerns or expressing their views to the registered manager.

People were asked for their views about their experiences of living in the home. They took part in annual surveys and had individual meetings with the registered manager. When shortfalls were identified actions were taken to remedy these. Quality assurance audits monitored the quality of the service provided and strove to make improvements when needed. The registered manager’s visions for the home to treat people as we would wish our own relatives to be treated were endorsed by staff. Comments about the service provided included, “This little home is a gem” and “It is one of the best.”

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. When people displayed behaviour, which challenged others, staff dealt with it effectively and respected people's dignity and protected their rights.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed. The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant people were protected from discrimination and their human rights were protected.

People received their medicines as prescribed. Prescribed medicines (including controlled drugs) were stored and administered safely in line with current and relevant regulations and guidance.

The service followed safe recruitment practices. People were safe because the service had considered the skill mix and experience when arranging staffing.

Is the service effective?

We found the service to be effective because care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention.

People's health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were quickly made to health services when people's needs changed.

People's choices for end of life care were respected by staff. People had access to the specialist palliative care services they needed. Staff received training in 'end of life care'.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be.

People, and those that matter to them, were involved in the assessment and planning for their end of life care. People's expressed preferences and choices for their end of life care were clearly recorded and acted on.

Is the service responsive?

We found the service responsive because people had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People had privacy, dignity and a dignified death. Emotional support was available to people, their families, friends and staff.

People felt confident to express any concerns or complaints about the service they received.

There was an advocacy service available if people needed it. This meant when required, people could access more support.

Is the service well-led?

There was a registered manager in post on the day of our visit.

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff knew and understood what was expected of them.

Senior management were aware of the culture of the service and they kept this under review. There was an emphasis on fairness, support and transparency and an open culture. The manager enabled and encouraged open communication with people, those that mattered to them and staff.

The service worked in partnership with key organisations, including the local authority to support care provisions and service development.

We also spent time with people in the lounge and dining room and observed people having lunch. We observed staff interacting with people respectfully, offering people choices and communicating at a pace and manner suitable for their needs.

During our inspection we spoke with 15 relatives of people living in the home. Everyone we spoke with had only positive feedback about the home. Comments made by relatives included: 'the best care home in Gloucester', 'extremely pleased with the home ' staff are very kind' and 'We can visit anytime we want to and are always made welcome'.

We looked at the care records for six people and spoke with or observed these people to see if records accurately reflected their needs. We found care plans were detailed and personalised to the individual, reflected people's needs and were regularly reviewed.

Care was provided in an environment that was safe, well maintained and met people's needs. Staff were appropriately trained and supported to meet the needs of people living in the home. The provider sought the views of people who used the service and used these comments to improve and develop the service.