The inspection took place on 3 and 7 November 2014 and was unannounced. St Cuthberts was last inspected in June 2014 and was found to be breaching three regulations. In particular, we found medicines records were incomplete and people did not receive the consistent and uninterrupted support they needed to meet their nutritional needs. There was also a lack of social interaction or an activity programme and audits had not been successful in identifying shortfalls in the quality of people’s care records. We found the provider had made progress with the action they had committed to undertake and were no longer in breach of these regulations.
St Cuthberts is registered to provide nursing or personal care for up to 39 people. At the time of our inspection there were 20 people living at St Cuthberts, some of whom were living with dementia. The home did not have a registered manager. A new manager had been appointed and had been in post three weeks 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.
During this inspection we found the provider had breached Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because staff were not receiving regular one to one supervision from their line manager. You can see what action we told the provider to take at the back of the full version of the report.
The provider had systems to ensure new staff were suitable to work with vulnerable adults. Staff told us they felt supported and had recently had an appraisal. We viewed training records which confirmed that staff had completed training to help them fulfil their caring role.
We viewed medicines administration records for people who used the service. The quality of medicines records had improved. We found these had been completed accurately to confirm whether people had been given their prescribed medicines. We observed during a medicines round that medicines administration was not always carried out in line with best practice.
People who used the service and family members told us the home was a safe place to live. One person said, “Staff are nice to me.”
Staff had a good understanding of safeguarding and whistle blowing and knew how to report any concerns they had. Staff told us they felt the management team would take any concerns seriously and would deal with them appropriately.
There was usually enough staff to meet people’s needs and to maintain their safety. However, on the second day of our inspection we found the home was operating with one less staff on the dementia floor.
We found the home was clean and tidy. However, we observed the home was in need of refurbishment. Staff described the environment as “lacking stimulation” and “bland.” The clinical lead told us a refurbishment plan was being developed, including redecorating the upstairs lounge.
During our observations over lunch time we found staff were present in the dining room for most of the time to ensure people were supervised to keep them safe. We found people who required one to one assistance received this uninterrupted and at a pace that was appropriate to their needs. We found people still had to wait to receive their lunch, however not as long as when we observed lunch time during our previous inspection. During our observation we found one person did not receive prompts and encouragement to eat their lunch. We saw from viewing people’s records that where they had been assessed as at risk of poor nutrition, action was taken to support them to meet their nutritional needs.
People were asked to give their permission before they received any care. Staff told us that if a person refused they would respect their decision. One staff member said, “We cannot force a person.”
Staff told us they knew how to support and manage people’s behaviours that challenged the service. However, we observed this was not always carried out in line with people’s agreed care plans. People had access to a range of health professionals when required. This included speech and language therapists, the falls team, the challenging behaviour team and specialist nurses.
Family members told us their relatives received good care. One family member said, “Care in this home is excellent”. They told us about how [their relative] was treated “with dignity and respect.” They also said, “Care was exceptional. [My relative] was always clean, tidy and well-presented and their hair and nails always clean.” Another relative said, “I find the staff very caring people and supportive. [My relative] is always well-presented, clean and tidy, and the staff keep me updated on how she has been.”
We observed people received one to one interaction from staff to varying degrees. Staff interaction was done in a friendly and professional manner. Staff were kind, caring and considerate towards people. During our inspection we observed two occasions where staff did not respond to people’s needs in a timely manner.
Staff described how they treated people with dignity and respect. We observed staff talking to people and found they were respectful and polite. Staff also described to us how they promoted people’s independence and supported them to make choices. These included what clothes they wanted to wear, food choices and whether they wanted to go out or stay in.
People had their needs assessed and care plans had recently been updated to reflect people’s current needs. Care plans we viewed were person centred and contained details of people’s preferences including their likes and dislikes. We found the clinical lead (deputy manager) and qualified nurses evaluated care plans monthly. However, we found the quality of the evaluation record required improvement by providing more meaningful information about each person. People had the opportunity to take part in activities, such as playing games, painting, watching a film or receiving one to one time with staff. One staff member said, “We try and do as much as we can.” Staff told us one to one time usually included hand massages, manicures and chatting.
The manager and clinical lead were both new to the service and were still settling into their role. Staff told us the manager and clinical lead were supportive and approachable. We found the provider had specific values that it expected staff to work towards. We found these were not embedded into care delivery at St Cuthberts.
The provider had a system of checks and audits as part of its quality assurance programme to assess the quality of care provided. We found that because of a number of changes to the management team over recent months, these had not been effective in driving forward improvements.