Archived: St Mary's Nursing Home

St Mary’s Nursing Home is required to have a registered manager and a registered manager was in place. 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 service is registered to provide accommodation and nursing care for up to 35 older people, however the service operates to take up to 32 people. On the first day of our inspection 31 people were using the service.

Risk assessments and care plans were not always in place to ensure people received safe care. Where care plans and risk assessments were in place, they were not always up to date or accurate and not all risks to people’s health and safety were identified and reduced. People had access to healthcare services, however people sometimes experienced delays to receiving their treatment.

Staffing arrangements had not been calculated based on meeting the needs of people using the service. Staff were not always deployed in a way so that people received timely support. Staff recruitment practices had not recorded how gaps in staff employment histories had been considered satisfactory.

The proper and safe management of medicines were not followed and therefore risks associated with medicines were not reduced. Records did not support that people received their medicines as prescribed.

Staff training records did not always identify which staff required refresher training in certain areas. Records did not demonstrate staff had or were completing training expected of them by the provider. Not all staff received supervision on an individual basis.

The principles of the Mental Capacity Act 2005 (MCA) were not fully understood and embedded in the service, nor had the principles of the MCA been followed for people’s decision making. The service did not assess people effectively for Deprivation of Liberty Safeguards (DoLS) applications.

People felt listened to however we found people were not always invited to contribute to improvements at the service. Staff interactions with people were mixed. We saw some staff always spoke with people as they walked past, however other staff gave no greeting or acknowledgement to people seated in the main hallway.

Audits and systems designed to check on the quality and safety of services people received were not always effective at identifying shortfalls in the quality and safety of services. Records were not complete, accurate, stored securely or completed at the time care was provided. In addition, the provider had not fulfilled its responsibilities to send statutory notifications about events that they are required to tell us about.

Where people had expressed a preference for a female carer this had not always been respected. People were not always given support when they raised issues of concern. People had opportunities to take part in activities organised by the activities coordinator or to spend time in their own rooms as they chose.

Not all people had the support to eat in a stimulating dining environment and some people fell asleep without eating their meals when they were hot. People’s views on the quality of food were mixed with some people commenting on food being cold when it arrived. People’s choices for food and drink were respected. Menu options offered a healthy and balanced diet, however not all people ate their meals.

The registered manager was supported by a Deputy manager and a supportive staff team.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.

We did not visit the service for this review. People that we spoke with at our visit in June 2013 confirmed that they were happy with the support and services provided to them.

At our visit in June 2013 we identified that the recruitment practices needed improvement to ensure that new staff employed were safe to work with people using the service. This was because thorough checks on staff's previous employment was not fully explored and recorded, before they began working at the home.

We have now received evidence to demonstrate that the three staff files that had gaps in their employment histories have been amended and now include full employment histories, including information as to the reasons for any gaps in employment. Since our visit in June 2013 one new member of staff has been employed and we have received evidence to demonstrate that they supplied a full employment history prior to commencing work at St Mary's nursing home.

People talked positively about the activities that were available to them. The activities coordinator provided a variety of activities to support people's therapeutic needs.

Information in the care records seen was sufficient to ensure people could be supported appropriately according to their needs and preferences. Improvements had been made in care records about people's life history, this supported staff in providing individualised care.

Medicines were managed appropriately, this ensured people received their prescribed medication in a safe way.

We found that the recruitment practices needed improvement to ensure that new staff employed were safe to work with people using the service. This was because thorough checks on staff's previous employment was not fully explored and recorded, before they began working at the home.

People spoke highly of the care and support they received and told us that meals were enjoyed and confirmed a variety of meal choices were available. The lunch time meal was presented attractively which encouraged people to eat as the meals looked appetising.

People told us that activities were provided. From discussions with the activities coordinator and observations of the activities provided, it was evident that a variety of activities were available to support people's therapeutic needs.

People said the home was kept clean. Positive comments were made regarding the laundry services. Records and observations demonstrated the environment was maintained.

Although people's support needs were recorded, there was limited information about people's life history to support staff in providing individualised care.