St Quentin Senior Living, Residential & Nursing Homes Also known as St Quentin Nursing Home

St Quentin Senior Living, Residential & Nursing Homes is a care home providing personal and nursing care to up to 73 people across 3 individual buildings located next to each other. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 71 people using the service.

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

The provider had made improvements since our last inspection; however, the quality assurance systems in place were still not robust enough to ensure improvements were identified and made. We identified where some people’s care plans still contained conflicting information.

The provider had made improvements to the detail of people’s risk assessments, since our last inspection. The provider had made improvements to the management of people’s medicines since our last inspection. People were safeguarded from abuse and avoidable harm. The provider ensured there were enough suitable staff. This included the use of some agency staff supporting people with 1:1 care. People were protected from the risk of infection as staff were following safe infection prevention and control practices. The provider learnt lessons when things went wrong.

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.

There was a positive and open culture at the service. The provider understood their responsibilities under the duty of candour. People and staff were involved in the running of the service and fully understood and took into account people’s protected characteristics. The provider had created a learning culture at the service to help improve care people received. The provider worked in partnership with others to meet people’s needs.

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 (published 10 October 2023) and there was a breach of regulation. At this inspection we found improvements were made and the provider was no longer in breach of regulation.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-Led.

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 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 Quentin Senior Living, Residential & Nursing Homes on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Quentin Senior Living, Residential & Nursing Homes is a collection of three individual buildings providing personal and nursing care to up to 73 people. The buildings are located next to each other and are called, St Quentin’s, The Hawthorns and Langley House. The service provides support to older people who may be living with dementia or those with a physical or sensory disability. At the time of our inspection there were 71 people using the service. Each building had its own care manager. The registered managers worked across all three buildings.

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

Medicines were generally managed safely; however, some improvements were needed. People were protected from risks, however there was a range of levels of detail in some care plans and risk assessments. Some people had detailed information available; however, others did not always contain sufficient detail. Quality assurance systems in place did not always consistently identify and improve the quality and safety of the service. We received mixed feedback about whether people and relatives felt engaged and involved in the service, although we saw evidence of attempts to engage with relatives.

People were protected from the risk of cross infection. Work was ongoing to improve the physical environment to ensure it could be kept hygienically clean. People were protected from the risk of abuse by staff who had received training and understood their responsibilities. People were supported by enough safely recruited staff and did not have to wait long for support. Lessons had been learned when things had gone wrong. Registered managers understood their duty of candour. The home embraced working in partnership with other organisations and worked to continuously improve.

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. However, we received feedback that one person was not having their needs met and professionals were taking action about this.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 (published 2 December 2021) and there were 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 the provider remained in breach of a regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 September and 1 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance processes. This inspection was also, in part, prompted due to some concerns raised to us about alleged poor care. This inspection also examined those risks, as well as reviewing the previous breaches.

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 requires improvement following this inspection.

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

We also 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Quentin Senior Living, Residential & Nursing Homes on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the quality assurance systems in place not always being effective at identifying areas for improvement. We issued a warning notice in response to this breach.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Quentin Senior Living is a care home providing personal and nursing care, the home accommodates up to 73 people in three separate buildings. These buildings are located next door to each other, they are named St Quentin, The Hawthorns and Langley house. At the time of the inspection, the service supported 67 people. Each building had its own care manager. The registered managers worked across all three buildings.

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

We found risks to people were not always monitored. People's medicines were not always managed or administered in a safe way. Some items, which could cause significant harm if ingested, were not stored securely.

The registered managers, home managers and nurses carried out quality assurance processes, including internal audits. However, we saw these were not always effective. This meant errors were missed that could potentially cause harm.

Relatives did not always feel engaged in the service. They did not feel the registered managers had sought their opinions or views to inform service delivery.

Staff felt supported and received regular training. The service worked in partnership with other professionals in order to achieve good outcomes for people.

People felt safe living at the home and with the staff who supported them. People felt supported and listened to as individuals. There were sufficient numbers of trained staff to meet people's needs in a safe way. The home had safe recruitment procedures and training in place to protect people from abuse. Staff followed good infection control procedures.

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. Staff gained consent from people before assisting them and respected their privacy.

Care plans were in place to manage risks, these were detailed and clear to follow. People were included in their care planning process. Staff had a good knowledge of each person's care needs, including their likes, dislikes and preferences. People experienced positive mealtimes.

Staff monitored and reviewed people's health and well-being and worked with other professionals to make sure they received the care and treatment they needed. People were supported by kind and caring staff.

There were opportunities for social stimulation and people could see their friends and family in line with COVID-19 visitors’ policy.

People and their relatives felt confident and comfortable to discuss any concerns with staff. People were confident their wishes for end of life care would be respected by staff.

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

The last rating for this service was Good (published 4 December 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

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 changed from Good to Requires Improvement. This is based on the findings at this inspection. The provider took effective action to mitigate some of the risks during the inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the way people’s risks were monitored and mitigated, medicines management, and governance systems at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Quentin Senior Living 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in 2017 we rated the service as requires improvement. At this inspection we found that improvements had been made, although some improvements were still required to ensure that systems for monitoring and improving the quality of the services provided were robust and encouraged continuous improvements.

St Quentin Senior Living, Residential & Nursing Homes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Quentin Senior Living accommodates up to 51 people in two separate buildings. At the time of the inspection, the service supported 48 people. Each building had its own manager.

The service 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. The registered manager worked across both buildings.

Some improvements were required to ensure that systems in place to monitor the quality of services were effective in identifying areas for improvement and ensuring that action was taken. Some people and relatives did not feel engaged and involved in the service and able to approach the management team with any concerns, whilst others did feel the management were approachable and responsive.

People were protected from the risk of harm and staff were trained to recognise the signs of abuse. People’s risks were assessed and managed to help keep them safe. There were enough suitably skilled staff to meet people’s needs. People were protected from the risk of infection and they received their medicines as prescribed. There were systems in place to learn when things went wrong.

People’s needs were suitably assessed before they moved to the service and care plans were developed in line with best practice guidance. Staff were trained and suitably skilled. People had their nutritional needs met and there were systems in place to ensure people received consistent care and support. People were supported to have healthier lifestyles by having timely access to healthcare services and professionals.

People had their consent sought in line with the principles of the Mental Capacity Act 2005. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People received support that was delivered in a caring and compassionate way and people were treated with dignity and respect. People, where possible were consulted about how their care was provided and were given choices in their day to day lives. People’s communication needs were met.

Staff knew people well including their likes, dislikes and preferences. People had access to activities. There was a complaints procedure available to people and their relatives and people were supported at the end of their life to have a dignified and comfortable death.

Staff felt the management team were approachable and supportive. People and relatives’ feedback was requested via questionnaires but improvements were required to ensure that action taken in response to feedback was shared with people and their relatives.

The service worked in partnership with other organisations to improve outcomes for people. They participated in partnership working with other agencies to help improve the services provided.

St Quentin Senior Living, Residential & Nursing Homes provides support and care for up to 51 people, some of whom may be living with dementia. At the time of this inspection 46 people used the service.

The service 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.

People’s medicines were not consistently managed safely. People were at risk of not receiving their prescribed topical creams in a safe or effective way.

There was not always sufficient staff available to meet people's individual support or nursing needs.

People's risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed plans. People were safeguarded from the risk of abuse as staff and the management knew what to do if they suspected or identified abusive situations.

The principles of The Mental Capacity Act (MCA) 2005 were being followed as the provider was ensuring that people were consenting to or when they lacked mental capacity, were being supported to consent to their care.

People were supported with their nutritional needs and monitoring was in place to ensure people ate and drank sufficient amounts.

Advice was sought from health and social care professionals when people were unwell. This advice was documented and followed by staff to maintain and support people’s physical and emotional wellbeing.

Staff had been recruited using safe recruitment procedures to ensure they were of good character and fit to work with people who used the service.

People were treated with dignity and respect and their right to privacy was upheld. People chose whether or not to participate in the daily activities arranged.

The provider had a complaints procedure and people knew how and who to complain to.

The provider had systems in place to assess, monitor and improve the quality of care.

People and staff told us that the registered manager and the senior management team were approachable and staff felt supported to carry out their role.

Fifty one people can be accommodated within the two units at the same location. One building provided accommodation and care within a residential setting for 20 people. The other building provided nursing care and accommodation for up to 31 people. At the time of this inspection 47 people used the service, 20 people in the residential unit and 27 people in the nursing care unit.

At our previous inspection in July 2014 we judged the service as Requiring Improvement overall and in each of the five key questions. We issued four requirement actions in relation to assessing the risks to people, consent and medication, staff training and the quality assurance processes. At this inspection we found improvements had been made in all areas.

The service 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’. The registered manager is the registered provider for this service. 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. In this report we will refer to the registered provider as the registered manager.

Staff were aware of the actions they needed to take if they had concerns regarding people’s safety. Risks to people’s health and wellbeing were identified, recorded, reviewed and managed. Procedures were in place that ensured concerns about people’s safety were appropriately reported to the registered manager and local safeguarding team.

There were enough suitably qualified staff available to maintain people’s safety and meet their individual needs. Staff received regular training and supervision that provided them with the knowledge and skills to meet people’s needs. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed.

People were supported to make important decisions about their care and treatment. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People’s medicines were managed safely, which meant people received the medicines they needed when they needed them.

People told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. Health care professionals were contacted when additional support and help was required to ensure people’s health care needs were met.

People were treated with kindness, compassion and respect, and staff generally promoted people’s independence and right to privacy.

People told us that staff arranged a range of social and leisure activities that met people’s hobbies and recreational preferences. These were arranged either on a one to one basis or in groups. People could choose whether they wished to participate or not and staff respected their choices.

Some people were aware of the complaints procedure and knew how and to whom they could raise their concerns.

The registered manager was aware of the requirements of their registration with us and notified us of significant events related to care provision. The registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained.

We found that the provider had systems in place to gain consent to care and treatment from people who use the service. People we spoke with told us that they consented to their care and treatment. Staff explained how they followed the principles of the Mental Capacity Act 2005.

We observed people who used the service being treated in a caring and respectful way. One person told us, 'I'm well looked after here. The staff are very pleasant and helpful'. Another person told us, 'It's very good I am well looked after'.

We viewed records that showed care was planned and delivered in line with people's preferences. Staff we spoke with knew the needs of people who used the service and how they preferred care to be carried out.

We saw that the provider had systems in place that prevented the risk of cross infection. We saw staff used protective equipment during our inspection and staff we spoke with understood the importance of infection control.

The provider had a recruitment system in place. We saw that staff had been checked to ensure that they were suitable to provide support to vulnerable people.

We saw that the provider had an effective complaints system in place. People we spoke with told us that they knew who to complain to if they needed to.

The atmosphere of the home was friendly,informal, open and inclusive. People who used the service told us that they felt well cared for and that the staff were caring and attentive to their needs. A person said, "It's very good here, they look after us well." Another person said, "All the staff are lovely."

Staff delivered care and support according to people's preferences and wishes and people were supported to maintain their social and therapeutic needs and hobbies. Staff were supported to develop their skills and were suitably trained, supervised and appraised. Staff felt that the providers had a good staff training and development programme in place. A staff member told us, "The training and support is very good here."

The providers sought help and advice from other other relevant health care professionals to ensure that people's health care needs were monitored and met. Specialist advice was also obtained where people were in need of this so that people received best practice coordinated care, treatment and support.

People who used the service and their relatives were encouraged to participate in the development and review of care plans. Relatives told us that they felt informed and involved and able to talk to staff including raising concerns and suggestions regarding their relative's care and support.