Background to this inspection
Updated
5 April 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
An adult social care inspector conducted the inspection on 12, 19 and 24 February 2016. The visits to the home were unannounced.
The registered provider completed a provider information return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.
During the visit we spoke with nine people who used the service, four relatives, the registered manager, the quality manager, a nurse, a senior carer, four care workers, two activity coordinators, the cook and a two domestic staff member. We also undertook general observations of practices within the home and we also reviewed relevant records. These included six people’s care records, staff files, audits and other relevant information such as policies and procedures. We looked round the home and saw people’s bedrooms, bathrooms and communal areas.
Updated
5 April 2016
The inspection of St Mary’s Nursing Home took place on 12, 19 and 24 February 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.
St Mary's Nursing Home cares for up to 40 people. The home provides services for older people, people with nursing needs, people living with dementia and people living with a learning disability. Accommodation is provided over two floors. All of the bedrooms are single occupancy. Three of the bedrooms have en suite facilities which consist of a bath, toilet and hand wash basin. There are communal lounge areas and a dining room on both floors. The service is situated in Linthorpe Village and is close to shops, pubs, public transport and Middlesbrough town centre. At the time of our inspection the home 39 people were using the home.
The home had a registered manager 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 care staff were one of five care home teams nominated for the registered provider’s national award.
We found that a range of stimulating and engaging activities were provided at the home. People told us that staff worked with them and supported them to continue to lead fulfilling lifestyles. People told us how they were able to go out and about as well as participate in the activities in the home. We noted that the staff needed to develop the way they worked with people who lived with a learning disability. The registered manager had identified this was an issue and had planned that a wide range of training around supporting people living with a learning disability was put in place. The registered manager was very skilled at working with this group of people.
The registered manager had put in place a range of one-to-one support and access to personal assistants. A third of the people who used the service received regular support to complete activities in the community. The activity coordinators worked with staff to ensure each person using the service was able to go out on a weekly basis and also enjoy a range of activities within the home.
People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.
People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. A nurse, a senior care staff and five care staff were on duty during the core part of day and a nurse, a senior care and two staff on duty overnight. The operated extended hours so a care staff member commenced at 7am and one finished at 10pm.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and saw that audits of infection control practices were completed.
Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care. We found that the registered manager not only ensured staff received refresher training on all training on an annual basis but had introduced checks to make sure staff understood how to put this training into practice. Each month the registered manager questioned staff about different aspects of the courses and when staff struggled to find the correct answer they ensured staff received additional training.
Staff had an understanding of the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed. However the provider’s template for completing capacity assessments did not meet the requirements of the Mental Capacity Act 2005 code of practice. The form made staff judge capacity on people’s physical ability to complete a task which is incorrect. The registered manager recognised that this was a problem and told us the registered provider had set up a working group to develop a new template.
People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the home. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; and sensitively supported people to deal with their personal care needs.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People’s needs were assessed; care and support was planned and delivered in line with their individual care needs. The care plans were comprehensive and risk assessments contained person specific actions to reduce or prevent the highlighted risk.
We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. The registered manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
The registered provider had a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.