Santa Care

Santa Care Home is a care home providing accommodation and personal care for up to four adults with learning disabilities or mental health needs. At the time of the inspection, three people with mental health needs were using the service.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right care

Systems to protect people from the risk of infection were not always effective. We found that, apart from the kitchen, the home required deep cleaning and repair.

There were systems to manage risk and keep people safe. However, these had failed to identify some safety issues. Risk assessments were in place, but these were not always reviewed and updated.

There were systems in place to monitor the quality of the service but these were not always effective as they had failed to identify where improvements were needed.

Medicines were managed safely and people who used the service received these as prescribed.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles.

Right support

People who used the service did not always receive the right support and were not always supported in a person-centred way and given choices. People were not always supported to maintain their independence.

People’s healthcare and nutritional needs were met. People were supported to access healthcare professionals and to attend appointments as needed.

People's needs were assessed before they started using the service and care plans were developed from initial assessments. People and those important to them were involved in reviewing care plans.

Right culture

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

Staff told us they were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had procedures for recruiting and inducting staff to help ensure only suitable staff were employed.

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 13 February 2018). The rating for the service had changed to requires improvement.

Why we inspected

We carried out this inspection based on the date of the last inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections 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 safe care and treatment, person-centred care and 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.

We found the following examples of good practice.

Disposal of used PPE prevented cross-contamination and followed local protocols, in particular single use items.

All care home workers had a Covid-19 test without delay once they became symptomatic of Covid-19 infection.

Managers and staff had processes in place to help ensure they knew how to access the online self-referral portal for Covid-19 test kits.

Communal areas such as outdoor spaces and garden areas were used creatively to help with social distancing.

The design, capacity and layout of the home allowed the safe isolation of people into separate floors.

All members of staff worked in only one care setting and the provider did not employ agency staff.

Santa Care is a ‘care home’ for up to four adults with learning disabilities or mental health needs. 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. At the time of the inspection, three people were using the service. Two of the three people living in the home used British Sign Language (BSL) to communicate which staff had also been trained to use.

The home is one of three owned by the provider who is also the 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.

During the inspection on 22 December 2017, we saw the provider had made improvements to how they monitored the service. However, we saw a number of gaps in the records of people using the service and in staff records. This included not all reviews being up to date, care plans not addressing people’s wishes for end of life care and not all staff training was up to date. This meant the service could not ensure a consistent quality of care.

The provider had procedures in place to protect people from abuse. Care workers we spoke with knew how to respond to safeguarding concerns. People had risk assessments and management plans in place to minimise risks. There had been no incidents and accidents since the last inspection but the provider had a procedure in place to mitigate the risk of reoccurrence of incidents if they did occur.

Care workers followed procedures for the management of people’s medicines and underwent medicines training and competency testing. Weekly medicines audits indicated that people were receiving their medicines safely as prescribed.

Care workers had completed training in infection control and used protective equipment as required.

Care workers had an induction and up to date relevant training to develop the necessary skills to support people using the service. Safe recruitment procedures were followed to ensure care workers were suitable to work with people using the service.

People were supported to have maximum choice and control of their lives and care workers were responsive to people’s individual needs and preferences. However there was no indication that people’s end of life wishes had been considered as part of the care planning.

People's dietary and health needs had been assessed and recorded and were monitored to make sure their nutritional needs were met.

People were involved in their care plans and making day to day decisions so the care was reflective of their preferences and wishes.

There was a complaints procedure in place and the service had not had any complaints since the last inspection. The deputy manager was available and people using the service and staff told us they were approachable and supportive.

The service had a number of systems in place to monitor, manage and improve service delivery so a quality service was provided to people.

Santa Care is a home for up to four adults with learning disabilities or mental health needs. Two of the three people living in the home used British Sign Language (BSL) to communicate which staff had been trained in to various levels of competency to use.

The home is one of three owned by the person who is also the 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.

During the inspection, we observed that not all risk assessments were robust and up to date.

Ongoing medicines competency testing was not undertaken, the service did not have a PRN (as required) medicines policy and were not recording the temperature of the medicines cupboard.

We recommended the service use analysis of incidents and accidents to contribute to safe and effective service delivery.

The service did not always follow the principles of the Mental Capacity Act (MCA) 2005.

There were no written records of supervisions or appraisals so we could not be confident staff were receiving the support they needed to deliver care as required by the people using the service.

The service had some systems in place to monitor how the service was run to ensure people’s needs were being met and they were being kept safe, however there were no medicines or service user file audits.

The service had safeguarding and whistle blowing policies and staff knew how to respond to safeguarding concerns.

Safe recruitment procedures were followed and there was sufficient staff to meet people’s needs.

People were involved in menu planning and cooking and had access to the kitchen.

People were supported to maintain good health and access healthcare professionals.

People using the service told us staff were kind and caring and could communicate with them.

Care plans were person centred and reviewed in a timely manner.

The service had a complaints procedure and people we spoke with said they would raise any concerns with the deputy manager.

We found breaches of regulations in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to access activities and visit family and friends in the community. We saw that people's needs had been assessed and each person had a care plan that informed staff about the action they should take to meet these needs. Identified risks had been assessed and plans were in place to support staff in minimising these.

The service was well maintained and checks were taking place at regular intervals to ensure that the premises remained safe and suitable for the people using the service.

There were enough staff on duty at the time of our inspection who had the skills and knowledge to meet people's needs effectively.

Systems were in place to enable people to make a complaint if they were unhappy about the service. People told us they knew how to make a complaint but had not had to do so.