St Leonards Care Home

St Leonards Care Home is a residential care home providing the regulated activity accommodation and personal care to up to 45 people. The service provides support to older people, including people with dementia. At the time of our inspection there were 44 people using the service.

St Leonards care home accommodates people across 2 units. 1 of the units specialises in providing care to people living with dementia. Each unit has a communal sitting and dining room facilities, with people having access to an enclosed outside space.

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

Risks to people were not consistently identified, mitigated, and reviewed.

Staff were not suitably recruited and did not have their competencies assessed for the tasks they were involved in, including administration of medicine. However, medicines were given as prescribed and the service took action to complete staff competencies.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Auditing was taking place and shortfalls in the service were identified. However, timely action was not taken to address the outcome of the audits to mitigate risks to people. Records were not consistently managed, with some records not updated in response to changes in people's needs and other records were contradictory.

People were supported by a consistent staff team. Whilst records and feedback from people and staff indicated staffing levels were suitable, some staff felt staffing levels were not sufficient to enable them to provide the high-quality care they aspired to, because of the volume of administration tasks. This was fed back to the provider to explore further with staff.

Systems were in place to safeguard people and actions were taken to prevent reoccurrence of incidents which impacted on people’s safety.

People were assessed prior to moving into the service and their health and nutritional needs were met. The service had established community links and people had access to regular, varied, and engaging activities.

Whilst we found some areas for improvement within the service, people and their relatives told us they were happy with their care. They felt they got safe care and that their needs were met in a service that was well managed. People commented, “All I can say is that I feel privileged I am so well looked after. Staff who help me are kind, they do their job with pride,” and “The carers here are like my family. Whatever I need, I get. If I need to talk, staff are there to sit and ask if I need anything, they are there for me.”

The registered manager was actively involved in the running of the service. They were passionate in providing person centred care and had positive relationships with people, relatives, and staff. They acknowledged the shortfalls we found and was committed to make those improvements.

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 14 November 2017).

Why we inspected

We received concerns in relation to the care people received and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. 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 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, and well- led sections of this full report.

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

The registered manager took immediate actions to make the improvements and ensure these are embedded and sustained.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, recruitment and training of staff, consent to care, and good governance.

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.

Visits to the home had currently been suspended for people's relatives, except for people at the end of their life. Prior to the current visitor suspension and once visiting restarts the home had a strict visiting policy and processes in accordance with recognised safe visiting guidance. Alternative ways, including the use of technology, had supported people's ability to remain in contact with their relatives.

The home had supported people to self-isolate where possible. People were being supported in their rooms. Well stocked Personal Protective Equipment (PPE) stations were in place throughout the home to support staff with appropriate barrier care.

People's health and wellbeing was monitored. People were observed for symptoms of COVID-19 and other potential infections. Healthcare professionals had continued to provide clinical support to people as this was required. The vast majority of people that used the service and staff had recently received their COVID-19 vaccination by visiting healthcare professionals.

The provider's policy for managing COVID-19 and related infection prevention and control procedures had been reviewed and kept up to date. COVID-19 guidance was also kept up to date for staff reference.

Staff had received training and support in relation to infection control and COVID-19. The provider and staff had taken immediate action to manage an outbreak situation and they recorded the ongoing actions taken to support people and staff through an outbreak of COVID-19.

At the start of the pandemic, the group (B&M Investments Limited) and the individual homes appointed small teams of COVID-19 champions and specialists, these roles were referred to as 'Rainbow Leads'. St Leonards Care Home had a designated 'Rainbow Lead' and they supported the registered manager and peripatetic manager to ensure correct infection control standards and protocols were in place and being adhered to. At the time of the February 2021 inspection, other Rainbow Leads from homes within the group were supporting St Leonards in managing a COVID-19 outbreak.

At the time of this inspection, a peripatetic manager was supporting the home during the COVID-19 pandemic, specifically, the peripatetic manager was providing managerially oversight as the registered manager was absent.

The inspection took place on 3 and 6 October 2017 and was unannounced.

The service was previously inspected in August 2016 where it was found the provider was not meeting the regulations. Risks were not assessed appropriately for people receiving care and support. We asked the provider to complete an action plan to address our findings. We found during this inspection improvements had been made and the service was meeting the requirements.

St Leonards Care Home is a traditional style care home that is registered to provide accommodation for up to 45 older people some of whom are living with dementia. At the time of our inspection there were 41 people using the service. The service 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.

We saw people were well cared for and comfortable in the home. Everyone we spoke with told us they felt safe living at St Leonards. Comments we received were, “I do feel safe here they look after me well” and “Yes very safe.”

People were safeguarded from abuse and neglect as staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. Medicines were managed safely and people received their medicines as prescribed by the GP. Staff received training in the administration of medicines and were assessed as competent before they supported people with their medicines.

Care records were personalised, up to date and accurately reflected people’s support needs. Information in care plans included life history, interests, likes and dislikes and provided staff with sufficient information to enable them to provide care effectively. We saw people were treated with kindness and compassion. We saw one person who was walking up and down the unit and did not appear to be settled. We saw staff intervene and encouraged the person to help them by carrying a folder into the office to distract them. 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 were cared for by staff that were well trained and motivated. One member of staff told us, “If you want to progress they are good.” They went on to say they were on the management pathway. Staff received supervisions from their line manager to ensure discussions could take place to highlight any concerns or training requirements.

Managers provided effective leadership and held regular meetings with staff and people who use the service to ensure everyone was involved in the running of the home.

The service was cleaned to high standards and we saw there were three members of domestic staff employed by the provider and were engaged in cleaning duties throughout the day.

People were actively involved with the local community and encouraged to engage in activities and entertainments available within the home.

Professionals who regularly visited the service told us they had no concerns. One told us, “They prefer to call us out to be on the safe side, which is fine by us.”

There were systems in place for monitoring and auditing to ensure the service delivered high quality care.

Regular fire testing and drills were carried out and people had individual emergency plans in place in the event of an emergency.

The home has two units; one supports people living with dementia, whilst the other is a residential unit where people live as independently as they are able.

The inspection took place on 18 and 19 August 2016 and was unannounced. The inspection was carried out by one inspector. The service was previously inspected in May 2014 when it was found to be fully compliant with the regulations. At the time of our inspection there were 45 people using 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 feedback regarding the home was complimentary one person told us, “Yes fine, very good, I am lucky”. Another person told us, “Everyone’s lovely, I don’t think we could find a better place”. We saw people were cared for with compassion and respect. Staff were well trained and motivated. The registered manager provided effective leadership to the service and held regular residents meetings to ensure people were involved in the running of the home. One member of staff told us, “Although the job is challenging, I feel supported, the registered manager is very hands on”.

People were safeguarded from abuse and neglect as staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider was reporting instances where this had occurred to the local authority.

Staff had received training in safe handling of medicines and had been competency assessed to support them in the role. However, medicines were not always managed effectively. Staff had received training in areas such as fire safety, mental capacity and moving and handling. Regular supervisions and appraisals were taking place to ensure staff felt supported in their role.

People’s privacy was maintained and they were treated with respect.

Care plans and risk assessments required improvement to ensure high quality care was provided. We found examples where the risks identified were not followed through in people’s care plans. One person we spoke with told us “I think I have got a care plan I’ve heard them talk about it”. Whilst family members told us they were involved in regular reviews with their relatives care plan.

Activities were planned and people were encouraged to participate either in groups or on a one to one basis. We found people’s care was person centred; people were involved in activities or spending time on a task of their choice as they wished.

The atmosphere in the home was warm and welcoming one person told us their family chose this particular home because it was homely.

There were systems in place for monitoring, and auditing to enable improvements in the quality of care. However, internal audits did not always identify shortfalls.

We have made recommendations that care plan audits and medication audits are robust, to ensure areas for improvement are identified and action plans implemented as required.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to assessing the risks to people and ensuring care meets people’s needs. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. This is based on our observations during the inspection and discussion with people using the service, their relatives, the staff supporting them and management team. Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

Care and support was planned and delivered in a way which ensured people's safety and welfare both within the home and in the wider community. We saw any risks to providing people's care and support had been considered. Guidelines were in place to inform staff what measures were to be taken to manage the risk safely whilst maintaining people's independence.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Seven people who lived in the home had a DOLS in place. Correct procedures had been followed in that a referral to the Local Authority (as "Supervisory Body") had been made and all were approved. This showed the provider had identified seven people could have potentially been deprived of their liberty and understood that an application was to be made and knew how to submit one.

The provider had safe and thorough recruitment procedures in place to ensure only suitable people worked with people who lived in the home.

Is the service effective?

People told us someone from the home had visited them to assess their health, care and social needs before they moved into the home. They told us they were involved in the process as well as family members. This enabled the home to access any equipment prior to them moving in and to write an initial care plan according to people's preferences and wishes.

Where people lacked the capacity to make decisions and consent about particular aspects of their care and support, suitable arrangements were in place. This was to ensure the service acted in accordance with legal requirements and appropriate consultation had taken place to ensure people's best interests had been taken into account.

We found the care and support provided was reflective of people's needs, detailed in their care plans and were regularly updated where any changes in health were evident. Any accidents or incidents were recorded appropriately. They detailed the actions taken and risk assessments had been updated to document any further measures put into place to prevent a recurrence.

Is the service responsive?

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required. Where there had been a change in people's care and treatment, their care plans had been updated accordingly. This showed staff worked jointly with other health care professionals to meet people's needs in the most appropriate way.

From observation of the staffing levels during the day, speaking with people who lived in the home and from looking at the staff training matrix and rotas there appeared to be enough qualified, skilled and experienced staff to meet people's needs appropriately. However, it was not apparent that there was a needs analysis in place to help inform of the required staffing levels to meet people's needs appropriately.

Is the service caring?

People said they were happy with their care and support and their needs were well met. Comments included ''The staff are really lovely...they talk 'with' you not 'at' you.'' ''Everyone is so kind.'' ''The food is excellent, if there's anything we don't like we only have to say and they will change it.'' ''The staff are wonderful. I couldn't grumble about anything.''

Staff showed they had a good understanding of people's needs and knew them well. We observed staff were gentle and patient with people and provided assistance to those who required help. They were respectful when they spoke with people and did not hurry them but enabled them to answer at their own pace.

Is the service well led?

People we spoke with told us they were consulted with about the care and support they were provided with and their views and choices were acted upon. We were told their views were sought through talking to people and their representatives on a day to day basis, during their reviews of care, through the use of surveys and regular quality review meetings.

There were a range of audits and systems in place to monitor the quality of service. The manager completed regular monthly audits to include health and safety, accidents and incidents, records and complaints. These were then collated and where any shortfalls were found an action plan was put in place to address them. This ensured they had a continuous regular system to assess and monitor the service and make changes to improve outcomes for people who used the services.

There were clear procedures in place for the management of people's medicines, which were monitored and reviewed regularly to ensure people received their medication safely and according to the GP's instructions.

We saw people were supported to attend a variety of social activities both within the home and in the local community if they wished to take part.

We saw adequate staffing levels were maintained to meet the needs of people who used the service. Staff had received training and supervision to support them in delivering care and support safely.

We spoke with seven people during our visit and one relative. People told us they were treated with respect and their privacy was respected and maintained. They told us they were well looked after and said the staff knew how they needed and wished to be supported. They told us they felt safe living at St Leonards care home and knew who to speak to if they had any concerns. One person said ''they take good care of me and I am convinced I made the right decision...all in all I am very happy.''