Archived: St Catherines Care Home

St Catherine’s is a care home providing personal and nursing care for up to 40 people across two units, with one specialising in providing care to people living with dementia. At the time of the inspection there were 33 people using the service.

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

People received care and support which was person-centred, safe and was delivered by a competent staff team who knew them well. Systems were in place to protect people from the risk of abuse. People felt safe. Medicines were managed and administered safely. Effective measures were in place to prevent and control the spread of infection.

Each person had an individualised care plan which provided staff with guidance about their needs, wishes, likes and dislikes. The impact of the COVID-19 pandemic on visiting arrangements had been managed by the implementation of window visits, telephone and video calls. The registered manager was pro-actively planning for visiting arrangements as the weather becomes colder. Policies and procedures were in place to handle and respond to complaints. People and relatives told us they felt able to speak up if they had any concerns.

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.

Effective systems were in place to assess and monitor the quality of the service. There was a strong team spirit amongst staff and feedback was unanimously positive about the difference the new registered manager had made since their arrival. The service had established strong links with partner agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (02/09/2019) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 10/06/2020 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing, dignity and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St. Catherine’s is a care home which provides personal and nursing care for up to 40 people. At the time of the inspection there were 35 people using the service. The service is in one adapted building which provides accommodation over two separate units. Meadows provides general nursing care to people, and Weaver provides care to people living with dementia.

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

Staffing levels were insufficient and people did not always feel safe. Although agreement had been given for staffing levels to increase, these had not been implemented. Security at the front entrance had caused concern. Following our discussions with the management team, improvements were made to security with the installation of a key code entry system. Accidents/incidents were not always recorded which meant that analysis to identify themes and trends would not be effective. Staff received training to ensure people received their medicines safely and as prescribed. Some improvements to the way in which medicines were managed on receipt from the pharmacy were implemented during the inspection. Staff demonstrated a clear understanding of the procedures to follow to protect people from abuse.

The service did not have consistent and stable management and feedback received indicated it was not always well-led. The systems in place for monitoring the quality and safety of the service were ineffective as they failed to identify areas for improvement.

We have made a recommendation about the management of Deprivation of Liberty Safeguards (DoLS). A DoLS for one person had not been renewed. Staff sought people’s consent before care interventions. People’s capacity to make decision for themselves was assessed and, where appropriate, decisions made on their behalf were made in their best interests. Staff received training to enable them to carry out their roles. People received a nutritious diet, although mealtime experiences varied between the two units. People had access to a range of external professionals to support their health and well-being.

Care was not always person-centred to meet people’s individual needs and people were not always treated with dignity and respect.

We have made a recommendation about the management of complaints. Complaints were not always listened to and acted upon to improve the service.

People and relatives told us there was a lack of activities available to people. There had been no designated activity co-ordinator for some time. The lack of activity provision had resulted in a condition of a DoLS authorisation not being met. Care planning, including ongoing review, was not robust enough. People’s care records were not always up to date, and some records were completed retrospectively. People, relatives and staff told us they did not feel listened to when they raised concerns as nothing changed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (Published 20 June 2018). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulation 17 (Good governance) in addition to breaches of regulation 9 (Person-centred care) regulation 10 (Dignity and respect) and regulation 18 (Staffing).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Catherine’s 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 Catherine’s is registered to provide accommodation with nursing and personal care for up to 40 people. There are currently 39 bedrooms, one of which is for double occupancy. There are two units within the home which are all based on one floor. On the day of our inspection there were 27 people living in the home.

St Catherine’s has a registered manager, however they had resigned from their post two weeks prior to our inspection. There was an interim manager in post who had been in the home just under a week. 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 last inspection took place on 2 and 6 November 2017. At that inspection we identified four breaches of the relevant regulations in respect of the safe management of risk, not acting within the principles of the Mental Capacity Act 2005, poor paperwork and ineffective quality assurance systems. The service was rated inadequate overall and placed in special measures. We took further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection, we found that significant improvements had been made and the service is no longer in special measures. We found that the provider was still in breach of one regulation. You can see what action we told the provider to take at the back of the full version of the report.

We found that care records were not always being updated following any changes or when advice had been given by professionals. Care plans did reflect people’s preferences as well as life history and their needs. We found additional monitoring sheets where people were identified at high risk were not consistently completed.

We found that the provider had no effective systems to monitor and improve the standard of care provided in the home. The manager did not have oversight of the risks to people within the home and subsequently actions had not been taken to address these risks.

The registered provider had some quality assurance systems in place. Some shortfalls were identified through these systems and these were being to be addressed. However, we continued to find other shortfalls in the quality and standards within the service that were not identified by the provider’s quality assurance systems. We saw that there had been improvements since the last inspection and these needed to be sustained and built upon.

Relatives and people living there were positive about the permanent staff working at St Catherine’s and we observed positive relationships between permanent staff and people living in the home. However, we also received a number of negative comments about the high agency staff usage and how their approach was variable dependent upon how many times they had visited the home. There were sufficient staff to meet the needs of the people living in the home. We did receive negative comments from relatives about the levels of agency staff working within the home as this impacted on the quality of the care given as they were not familiar with their family members. The provider had met with the agencies that they used to try and ensure that the same agency staff attended the home provide consistency. The provider was actively recruiting for more staff and recruitment of staff within the home was safe.

Risks to people were managed safely and risk assessments were in place to provide guidance to staff as to how to manage risk. We did find some inconsistencies with these and found one care plan that needed improvements to provide more detail. We raised this with the deputy manager to address.

Staff had completed safeguarding training and safeguarding incidents were appropriately referred to the local safeguarding team. There was managerial oversight of these incidents so learning on how things may be improved or prevented in the future could be gained.

Medication was being stored and administered safely. Regular medication audits were being conducted and issues identified were being actioned.

Complaints were managed effectively within the home and people and their relatives felt confident that issues that they raised would be addressed.

The provider was acting in accordance with the Mental Capacity Act 2005 to ensure that people were receiving the right level of support with their decision making. Mental capacity assessments and best interest decisions were present on care files, however the provider had identified improvement in how best interests were recorded and plans were in place to address this.

Staff members confirmed they received regular training and we verified this in the provider’s records. We saw that further improvements were needed as regular supervision with staff was not consistently carried out.

We saw regular checks on the property were undertaken and the premises were safe without restricting people’s ability to move about freely.

People had access to various activities within the home and were observed to enjoy these on both days of our inspection.

St Catherine’s Care Home is a nursing home based in Nantwich and is registered to provide accommodation with nursing and personal care for up to 40 people. There are currently 39 bedrooms, one of which is for double occupancy. There are two units within the home which are all based on one floor. On the day of our inspection there were 31 people living in the home.

The home does not have a registered manager. The manager in post who assisted with this inspection was applying to be registered but has now resigned from the service. 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 last inspection took place on 23 January 2017. At that inspection we identified four breaches of the relevant regulations in respect of the safe management of medicines and people’s risk assessments not being followed, people being restrained without best interest decisions being recorded, people’s privacy not being respected and actions had not been acted upon when improvements to the service were needed and identified by the provider’s audits. At this inspection, we found that there were improvements in some areas; however the provider was in breach of four regulations.

We are taking further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Risks to people were not managed safely and there was no clear guidance for staff on how to reduce the risks identified. There was no oversight or learning from incidents and accidents that happened in the home.

Staff had completed safeguarding training and we saw instances where incidents had been recorded, however the provider’s systems for reporting to the local authority were not robust. We found some safeguarding incidents had not been appropriately referred to the local safeguarding team. There was no managerial oversight of these incidents so there was no learning on how things may be improved or prevented in the future.

We found that there had been some improvements in the management of medication such as medication was being stored and administered safely, but further improvement was required. Topical creams were not dated when opened and charts indicating where topical creams needed to be applied were not always completed. This meant we could not be confident that people’s skin care needs were not always met.

The provider was not acting in accordance with the Mental Capacity Act 2005 to ensure that people were receiving the right level of support with their decision making. We found that capacity assessments and best interest decisions were not clearly recorded. There was a tracker in place to alert the manager when DoLS applications expired, however this was not effective as we found a number of applications for DoLS which had not been updated when they had expired.

We received a complaint and information about some people not being able to have baths or showers and only having access to bed baths. The manager acknowledged that equipment had been ordered and bathrooms were being refurbished in order that everyone would have this choice.

We found that care records were confusing, disorganised and often contained conflicting information. It was not clear that these were being reviewed on a regular basis. We found that advice given by other professionals was not always reflected in care plans and was not always being followed. Where risk assessments had been completed, care plans did not address how those risks to people would be reduced or managed.

People’s preferences were not always respected in relation to their care and their care was not always given as described in their care plan.

We found that the provider had no effective systems to monitor and improve the standard of care provided in the home. The manager did not have oversight of the risks to people within the home and subsequently actions had not been taken to address these risks.

The registered provider did not have an effective quality assurance system in place. Where audits had been completed, actions were not followed up. Little progress had been made since the inspection earlier in the year and the provider remained in breach of a number of the same regulations.

We asked the people living at St Catherine’s and their relatives about the home and the staff members working there. Relatives gave high praise to the permanent staff working at St Catherine’s and we observed positive relationships between staff and people living in the home.

There were sufficient staff to meet the needs of the people living in the home. We did receive negative comments from relatives about the levels of agency staff working within the home as this impacted on the quality of the care given as they were not familiar with their family members. At times agency staff did not attend for their shifts. The provider was actively recruiting for more staff and had addressed the issues with the agency around staff not attending. Recruitment of staff within the home was safe.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year. We saw that further improvements were needed as regular supervision with staff was not consistently carried out. The provider had identified additional core training that staff needed to attend and plans were in place for this.

We saw regular checks on the property were undertaken and the premises were safe without restricting people’s ability to move about freely.

People had access to various activities within the home and were observed to enjoy these on both days of our inspection.

St Catherine’s Care Home provides support and care for up to 40 people, some of whom may be living with dementia. At the time of this inspection 39 people used 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.

Risks to people's health and wellbeing were assessed but not always managed to keep them safe from harm. Staff did not always follow the plans put in place to reduce and mitigate risks for people. Accidents and incidents were not thoroughly reviewed to try to avoid repetition. Staffing levels were not reviewed when there were changes in people’s level of need.

Medicines were not managed safely. People did not always receive their medicines as prescribed and the systems in place to manage the risks associated with them were not always followed.

The principles of The Mental Capacity Act (MCA) 2005 were not consistently followed. The provider was not ensuring that people were consenting to, or when they lacked mental capacity were being supported to, consent to their care.

People offered positive and negative comments in regard to the food. Where people were at risk of malnutrition care plans were in place to ensure people were eating sufficient amounts to keep them healthy.

People were supported to access other healthcare professionals to maintain their health and wellbeing. However not all concerns were followed up in a timely way.

People’s privacy, dignity, preferences and views were not always respected and upheld. Leisure and social activities were provided, but not all people received the support they needed to engage in meaningful activity.

There was a complaints procedure but not all people were aware of it.

Audits and quality monitoring systems were completed but did not always record all relevant information so they were not effective in driving improvements. Improvements were needed to ensure the systems in place adequately assess, monitor and improve the quality of care.

We found breaches of the Health and Social Care Act 2008 (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 saw evidence and were told by relatives that the staff liaised with them about any changes in their family members' care with them and would review care plans with them. All relatives told us they felt involved with the home, staff and their family member. All five relatives said that they felt the staff liaised well with GPs and external professionals. We saw staff maintained records of this in the care plans.

Staff told us they had plenty of time to assist those who needed help to eat their meal and to encourage those who had a poor appetite, we saw evidence of this. We observed staff assisting one person who was blind whilst eating and drinking; she explained clearly to the person what she was eating and gave her clear instructions when trying to assist her. We saw staff were aware of people's individual needs.

All medicines were appropriately prescribed, for example, by their respective GPs. All the medication charts contained the required information about the service user in order to be able to administer medication safely. When asked, staff were aware of the risks and side effects associated with certain medication, for example, anti-coagulants.