Archived: St Lukes Care Home

St Luke's Care Home provides nursing care for older people who have Alzheimer's disease or other forms of dementia. St Luke's is located in Runcorn close to local amenities. It is a two storey purpose built property comprising of 4 separate units and 56 single bedrooms. It has a range of communal spaces in each unit including: lounges; dining rooms; sitting areas, kitchen, conservatory and a courtyard garden. A car park is provided for visitors.

The service had a registered manager. A registered manager is a person who is 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.

St Luke’s accommodates 56 people across four separate units, each of which have separate adapted facilities. All the units specialise in providing care to people living with dementia, people who mental health needs, people who have a sensory impairment and people who have a physical disability. At present there are 33 people who are being cared for. 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. St Luke’s provide a range of facilities including a cinema, indoor gardens and reminiscence rooms. They also have an in-house hairdressing salon.

People who used the service and their relatives had a positive attitude about the service being delivered and about the standard of care and support provided by the staff team. They acknowledged improvements since the registered manager had commenced working at St Lukes Care Home.

Risks to people's health and wellbeing were managed to keep them safe from harm. Potential or actual risks were assessed and staff followed the plans put in place.

People's medicines were managed safely.

There were detailed systems in place to monitor the quality and safety of the service. The service was safely managed.

People were supported by a team of staff that had had appropriate training and support to maintain their skills and knowledge to meet their needs.

The service was working within the principles of the Mental capacity act (MCA) and any conditions on authorisations to deprive a person of their liberty were being met.

People were treated with respect, consideration and kindness. Care was provided in a personalised way from staff who knew people’s needs and preferences.

People were provided with a varied recreational and leisure activity programme. The activity organiser's were caring and took time to meet people’s needs.

Information and arrangements were in place for the staff team to respond to concerns or complaints from people using the service and their representatives.

Staff told us the registered manager was supportive and approachable and that they had noticed big improvements in the service since their arrival.

St Luke's Care Home provides nursing care for older people who have Alzheimer's disease or other forms of dementia. St Luke's is located in Runcorn close to local amenities. It is a two storey purpose built property comprising of 56 single bedrooms. It has a range of communal spaces including: lounges; dining rooms; sitting areas and a courtyard garden. A car park is provided for visitors.

There was a registered manager in post at the time of this inspection, but they were on leave and subsequently resigned. 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 a 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 was last inspected in July 2016. At the last inspection we found the service was not meeting the requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance) because care plan audits had not identified changes in people’s dietary needs had not been recorded appropriately.

At this inspection we found that the quality and safety of the service had deteriorated.

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.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to safe care and treatment, staff training and support and good governance. We also identified an offence under the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of matters they were required to.

We found the checks completed by the registered provider to assess and improve the quality of the service were not effective to ensure people were protected against the risk of inappropriate or unsafe care.

We found that there was a risk that people's behaviour was not managed consistently and the risk to their health, welfare and safety was not managed effectively. Accidents and untoward occurrences were not monitored by the registered provider to ensure any trends were identified.

Shortfalls in recording meant that we could not be sure that medicines were always given to people as prescribed by their doctor.

Although people told us they felt safe, at the start of the inspection we found that people were not safeguarded from the risk of harm. We saw the service had not always followed the local safeguarding protocols and made a safeguarding alert in line with the local multi agency agreement. This had been addressed by the third day of the inspection.

Not all staff were familiar with the codes and principles of the Mental Capacity Act 2005 and could potentially provide care or treatment without lawful consent. Not all people who lacked capacity to make decisions about their care had Deprivation of Liberty Safeguards in place.

Staff were not receiving sufficient training or supervision.

People’s care needs were not always reassessed regularly which resulted in their care plan not reflecting all of their current needs. This could potentially put them at risk of inconsistent care and/or not receiving the care and support they need.

The complaints system was not widely publicised and the provider did not review complaints to identify areas for improvement.

Staff recruitment records showed that the correct information was obtained about staff prior to employment. This meant we could be confident that people were cared for by suitably qualified staff who had been assessed as safe to work with people.

People spoken with were satisfied with the care they had received and were complimentary about the staff at the service. We observed that interactions between people who used the service and staff were positive. People's relatives and visitors were greeted in a friendly way.

People's dietary preferences and needs were being met.

In people's record we saw evidence of involvement from other professionals such as doctors, opticians, dietitians and speech and language practitioners.

St Luke’s provided a ‘dementia friendly’ environment. A varied programme of activities was provided at the service to provide stimulation and meet the social needs of people living at the service.

Equipment was well maintained.

The home was last inspected on 19 May 2014 and required improvement under staffing. At this visit we found improvements had been made.

St Luke’s nursing home provides nursing care for older people who have Alzheimer’s disease or other forms of dementia. The service is owned by (CIC) Community Integrated Care. St Luke’s is located in Runcorn close to local amenities. It is a two storey purpose built property comprising of 56 single bedrooms. It has a range of communal spaces including: lounges; dining rooms; sitting areas and a courtyard garden. They have a large car park provided for visitors. During our visit there were 54 people living in the home.

The home did not have a registered manager who had been assessed by the Care Quality Commission as fit to manage the service. There was a manager who was in the process of applying to register with the Care Quality Commission. 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 identified two breaches of the relevant legislation, in respect of accuracy of care records and effectiveness of monitoring and auditing. You can see what action we told the provider to take at the back of the full version of the report.

We found that the storage arrangements for medicines and health care products were limited.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People’s needs were assessed and care plans identified people’s needs whilst fostering and maintaining independence where possible. We found three care records when needs had not been updated following changes to their condition.

Staff were knowledgeable about the risks of abuse and the reporting processes.

The organisation had thorough recruitment practices so that suitable staff were employed.

Staff received suitable induction and training to meet the needs of people living at the home. Staff were well supported by the manager. This meant people were being cared for by suitably qualified, supported and trained staff.

People’s health care needs were met and their medicines were administered appropriately.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

There were systems and processes in place to monitor the quality of the service and to address any shortfalls however these were not always effective.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff had received training in safeguarding and felt confident in being able to maintain people's safety. Staff were confident they would be listened to by the provider and supported with reporting procedures to safeguard people living at the service. They told us they would not hesitate to report any concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The staff had a good knowledge base regarding these safeguards. Staff had access to appropriate policies and procedures including guidance on the Mental Capacity Act. These policies are necessary to ensure the protection of vulnerable people who lacked the ability to consent on various issues.

Changes regarding the staffing levels on the first floor raised some concerns about how they were being implemented as there was no evidence to show how the levels had been assessed as appropriate or how they would meet the dependencies and needs of people living in the top floor units. Staff had mixed concerns about the proposed changes to staffing levels and felt it was happening due to the arranged interviews for the new senior care staff posts to replace trained staff hours.

Is the service effective?

Eleven relatives told us they were happy with the care that had been provided to their relative and they felt their needs were being met. We observed the support being provided. and saw examples of good communication and patience by staff.

Staff discussed the individual needs of people they supported. Staff described the support they provided on a day to day basis including daily choices and they were knowledgeable about people's needs and requests.

The service had developed areas within the environment to support people with dementia. They had developed an open plan cinema; a fully adapted bar in one of the units; an open plan kitchenette and lounge and a sea side themed sitting area. They had also developed specialised picture signs as a way of advising people regarding were services are located such as; toilets, bathrooms and each person's bedroom. These signs helped people with dementia to be orientated and reminded about their surroundings.

Is the service caring?

We observed staff speaking respectfully to people as they approached them so they were aware who was supporting them. Staff were friendly and helpful to the people they were supporting. We observed that people being supported were relaxed and happy in the company of their staff.

We spoke with six relatives of people living at the service. They made various positive comments such as:

"The staff are very good, the care is good here"; I am always made to feel welcome whenever I visit" and "We have regular meetings I can always go to the manager to discuss anything with them".

Is the service responsive?

People living at the service had a detailed care plan in place to help to show how their needs would be met while living at St Lukes. These records were detailed and showed that people's choices and diverse needs were identified and care plans were regularly reviewed.

Is the service well-led?

Relatives told us they were always kept informed and updated regarding their relatives support and needs.

A recent survey sent to relatives and people living at the service provided positive results regarding their opinions about St Lukes. The staff had displayed the results in the main reception on large visual charts to ensure people were kept informed of the overall results and the providers' response to their suggestions and comments.

We saw examples of good communication and patience by staff, who interacted with people in a quiet and reassuring manner. Staff were friendly and respectful to the people they were supporting. We also noted staff knocking before going into people's bedrooms. We noted that people living at the service were well dressed and had clean laundered clothes. We observed that staff carrying out caring interventions told people they were supporting what they were going to do and why in an appropriate manner. They talked to people throughout, explaining what they were doing and offering re-assurance.

The service had developed areas within the environment to support people with dementia. They had developed an open plan cinema and a fully adapted bar in the units. They had also introduced specialised picture signs as a way of advising people regarding daily services like meals and were facilities were, such as were toilets and bathrooms were located. These tools for communication helped people with dementia to be orientated and reminded about their surroundings and living space respecting their individual communications needs.