St Mary's Care Home

St Mary's Care Home is a care home providing personal and nursing care for up to 86 people. At the time of our inspection, there were 84 people using the service. The service supported older people living with dementia and nursing needs. The home is split into five different units, each with their own separate adapted facilities.

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

People were provided with safe care because staff received regular support and knew their care needs very well. However, some records and guidance needed reviewing to ensure continuity of care delivery. We will check the provider's taken actions to address this area when we next inspect.

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 felt valued and safe living at the service supported by staff who were considerate, kind and caring. Healthcare professionals told us their working relationships with the provider were at a high standard and effective.

People's risk assessments included mitigating strategies to keep people safe. There was enough staff to meet people's care needs in good time and staff spent time with people having conversations. People's medicines were managed safely and as prescribed. Staff were aware about the infection control procedures and hygiene requirements.

There was a clear leadership structure at the service with set values for inclusion and empowering of people. Quality assurance systems and processes were in place to ensure safe management of people's care. The management team told us that going forward they will not only act on individual people's feedback but analyse their feedback so that the necessary improvements to the quality and safety of the services could be made.

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 overall rating for this service was good (published 24/02/2021).

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

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Visitors were only allowed in exceptional circumstances. They were required to wear a face covering when visiting, and wash hands before/after mask use. Facilities were in place to wash hands for 20 seconds or use hand sanitiser on entering and leaving the home. All visitors were screened for symptoms of COVID-19 before being allowed to enter the home.

Alternative forms of maintaining social contact were used for friends and relatives; for example: keeping in touch using video calls, visiting in communal garden or in a specially adapted pod which had been procured by the provider to ensure people could meet with family members in a safe space. Remote considerations were also considered by other visitors such as professionals and clinical consultations.

Staff had access to and wore appropriate Personal Protective Equipment (PPE) such as fluid repellent surgical mask, gloves and apron when delivering personal care to all people. Staff have received training from an Infection Prevention and Control (IPC) specialist at Clinical Commissioning Group. Signage on donning/doffing (putting on and taking off) PPE and handwashing was visible in all required areas, including for visitors.

The service ensured people were tested for COVID-19 by the hospital and from the community before agreeing to admit them. New residents were required to isolate for 14 days within their own room. There were clear procedures from point of entry into the care home that minimised risk of transmission when moving people to their rooms. Residents were monitored for the development of COVID-19 symptoms. Symptomatic residents were isolated in single occupancy rooms. Residents in isolation did not attend communal areas and alternative facilities were provided.

The home was taking part in testing for staff and residents – known as ‘whole home testing’. Care home managers had or knew how to apply for coronavirus testing kits via the online care home portal.

Cleaning staff had cleaning schedules, which they are required to complete and that includes frequency of cleaning of high touch areas, e.g. light switches, keyboards, door handles. Records/checks of cleaning showed compliance with the cleaning schedule.

The service had put forward the use of a 7 bedded unit as a designated setting, in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. Although this was self-contained, it was not physically separated from the rest of the home. However, we were reassured that the provider had put in place measures to ensure people and staff in this unit would not mix with people and staff in the main part of the home. For example, access to this unit, now known as TADD (Temporary Alternative Discharge Destination) was via a separate entrance away from the main part of the home. We asked the provider to consider the risk this could pose to people as the pathway leading to the TADD was uneven in parts and a trip hazard to people, especially those with limited mobility. The provider took our feedback on board and confirmed they had put down rubber matting to level up the pathway. We also advised the provider to put up barrier screens and clearer signs to prevent the crossover of people and staff, so access to the TADD was restricted to people and staff who needed to enter to perform their duties. Managers reassured us that staff were only allowed to work in the TADD and would not work in any other unit or part within the care home. Managers also confirmed the service did not currently use any agency staff. People were accommodated in a large single unit, separated by screens. There was a shared bathroom and toilet facility which would be subject to enhanced cleaning in between each episode of personal care that took place.

• St Mary’s Care Home is a residential and nursing care home.

• The home accommodates up to 80 people in one adapted building, and is split into five different units.

• At the time of our inspection 72 people were living at the home.

People’s experience of using this service:

• The provider had made good improvements to the service since our focused inspection on 14 August 2018.

• People were safely protected from the potential risk of abuse, and staff were clear on how to identify and report concerns.

• Medicines were now well managed to ensure that people received them safely and in line with best practice.

• Quality assurance systems had improved to ensure that any improvements required were promptly identified and implemented.

• Sufficient risk assessments were in place to ensure that people were safely supported.

• People received support in order to meet their nutritional needs, with good access to other healthcare professionals.

• People’s capacity to consent had been assessed in line with legal requirements.

• People told us that staff were kind, compassionate and attentive to their needs.

• People were treated with dignity and respect.

• Activities were provided to ensure people received appropriate stimulation, and people were consulted on their views about their care.

• The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

• More information is in our full report.

Rating at last inspection:

• At our last focused inspection, the service was rated “requires improvement”, where we inspected the key questions ‘Safe’ and ‘Well-led’ only. Our last report was published on 18 September 2018.

• Our last comprehensive inspection was published on 20 January 2018, where the home was rated ‘requires improvement” overall.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection was prompted by a whistle-blower notification that people were at risk of ill-treatment. The concern also highlighted issues with manual handling practices and the prevention and control of infection. We also checked that improvements to meet legal requirements planned by the provider under ‘Safe’ and ‘Well-led’ after our 13 December 2017 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe.

No risks, concerns or significant improvement were identified in the remaining key questions,effective, caring and responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At our last inspection we found that the provider did not operate effective staff recruitment and quality monitoring systems. We found recorded evidence was not always available in staff's files to show the provider had obtained two professional or character references for all new staff. Although we saw systems had been established to monitor and review the quality and safety of the service people living at the care home received, the provider had failed to pick up most of the issues we identified during that inspection, specifically in relation to staff recruitment. Staff were not clear on how to manage behaviours that could be considered challenging, and appropriate guidance was not in people’s care plans to guide staff on how best to support people.

St Mary’s Care 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 Mary’s Care Home accommodates up to 80 people in one adapted building. The home was split into five different units. At the time of our inspection 76 people were living at the home.

At this inspection of 14 August 2018 we found a breach of regulations in relation to safeguarding people from abuse and improper treatment. People were not always protected from the risk of ill-treatment. During the inspection one person disclosed an allegation of abuse, and another told us that staff did not always treat them well. You can see the action we have told the provider to take about this breach at the back of the full version of this report.

At this inspection of 14 August 2018 we found that the administration of medicines required improvements. Regular stock balance checks were not always taken and recorded, staff did not always sign people's medicines administration records (MAR) to show that people’s medicines had been given. We spoke to the provider about these identified issues, and will check on their progress at our next inspection.

We also reviewed areas in need of improvement from our last inspection of 13 December 2017 in relation to staff recruitment records, the provider’s quality assurance systems and guidance for behaviour that could be considered challenging. Some improvements were still required in the provider’s audits, in that they needed to be prompt in taking action to address any identified issues. We will check on their progress with this at our next comprehensive inspection.

Staff recruitment records now included copies of two appropriate references, as well as staff employment histories and appropriate vetting checks. People’s risk assessments were comprehensive and included guidance for staff on how to manage behaviours that may be considered challenging in order to de-escalate and support people in line with their preferences.

Infection prevention and control was appropriately monitored across the home, with suitable personal protective equipment (PPE) available for staff to use.

There were appropriate levels of staff to meet people’s care needs at the home. Enough staff were on shift to ensure that people’s moving and handling needs were met as required. The provider responded to incidents and accidents as they were raised, and investigated appropriately.

There was a registered managed in post at the time of our 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.

Staff were positive about the improvements management had implemented since the last inspection, and spoke well of the management support that they received.

Feedback was sought from people and relatives through regular surveys. Staff were encouraged to share their views through regular team meetings.

The provider worked in partnership with other agencies, such as commissioning teams and other healthcare professionals to ensure that people’s needs were met effectively.

The care home can accommodate up to 82 people across five separate units, each of which have separate adapted facilities. The two units known as Rose and Lavender wings specialise in providing care to older people living with advanced dementia. The three other units, known as Orchid, Jasmine and Daffodil wings specialise in supporting older people with personal care needs. At the time of our inspection 78 people resided at the care home.

At the last comprehensive CQC inspection of this care home in September 2015 we rated the service ‘Good’ overall and for each of the five key questions. We carried out a focused inspection in June 2016 in response to concerns we received about there being a lack of competent staff working in the care home to meet people needs. We found there were enough suitably trained staff on duty at the time of that inspection. At this inspection we have changed the care home’s overall rating and for the three key questions is the service Safe, Effective and Well-led? to ‘Requires Improvement’.

We rated the service ‘Requires Improvement’ because the provider did not operate effective staff recruitment and quality monitoring systems. We found recorded evidence was not always available in staff’s files to show the provider had obtained two professional or character references for all new staff. This meant the provider had not done enough to satisfy themselves of the suitability of staff working at the care home. Furthermore, although we saw systems had been established to monitor and review the quality and safety of the service people living at the care home received, the provider had failed to pick up most of the issues we identified during this inspection, specifically in relation to staff recruitment and the support they received from management.

These failings represent two breaches of the Health and Social Care (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.

We have also made a recommendation about the home’s environment and design not being as dementia ‘friendly’ as it could be. Although we saw there were some signs displayed throughout the care home to help people identify toilets and bathrooms, most bedroom doors lacked any visual cues in order to make the room more recognisable to people. We also saw communal areas had all been painted in identical neutral colours. This lack of visual stimulation might lead to people living with dementia becoming disorientated.

The service had a newly registered manager who had been in post since August 2017. This is the third registered manager the service has had in the last seven years. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People and their relatives told us they were happy with the standard of care provided at the home. We saw staff looked after people in a way which was kind and caring. Staff had built up caring and friendly relationships with people and their relatives. Our discussions with people living in the home, their relatives and community health care professionals supported this.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe. The premises and equipment were safe for people to use because managers and staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs and preferences. They also received the support they needed to stay healthy and to access healthcare services.

Staff were caring, treated people with dignity and respect and ensured their privacy was maintained, particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.

People received personalised support that was responsive to their individual needs. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff that knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in meaningful leisure activities that reflected their social interests and to maintain relationships with people that mattered to them.

People felt comfortable raising any issues they might have about the home with managers and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff.

We undertook a focused inspection on 9 June 2016 due to concerns we had received about the service in May 2016. There were concerns that people were not receiving safe care and treatment due to staffing levels at the service. This report only covers our findings in relation to these concerns.

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

St Mary’s Care Home provides accommodation for persons who require nursing and personal care for up to 82 people. On the day of the inspection, 78 people were using the service.

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.

During this focussed inspection, we saw the action the registered manager had taken to mitigate the effects of staff shortages due to staff leaving the service. The registered manager had recruited nursing and care staff to ensure there was sufficient staff to provide safe care to people. The provider had not successfully recruited a replacement for the deputy manager and recruitment was underway. Staff had the right skills and knowledge to provide people with safe care and treatment. People received the support and care they required although some people might have experienced delays. The provider had appointed an operations manager to provide management oversight at the service and to support the registered manager. The registered manager had taken appropriate action to address the concerns and develop the service.

There were procedures in place to identify whether people using the service had the capacity to make decisions about their care. Where people did have capacity they were involved in their care planning and identification of their support needs. The provider liaised with a person's relative to discuss care needs if the person was unable to do this themselves.

Care plans were put in place with information about how to support a person to maintain their safety and welfare. The care planning process addressed people's physical and mental health, their social needs, and their spirituality.

The provider liaised with other health and social care professionals to ensure people were provided with the care and treatment they required. The service liaised with specialists for advice and further support if they had concerns about a person's health.

Staff felt well supported and there were supervision processes in place to regularly discuss their performance. Staff received a range of training and were able to attend additional training to ensure they had the skills and knowledge to support people using the service and aid career progression.

The manager regularly took time to speak with the people using the service, their relatives and the staff to obtain feedback about the service and identify areas for development. There were processes in place to manage and monitor complaints and incidents.

People, and relatives, told us that they were happy with the care provided at the home. "They look after me very well. They are very kind, like family".

We found that people were kept safe from harm and that they had adequate food and drink throughout the day.