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Archived: St Lukes Care Home Good

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Reports


Inspection carried out on 5 September 2018

During a routine inspection

The inspection took place on 05 and 06 September 2018 and was unannounced. At our last inspection in October 2017 we found that the service was not meeting the required standards. We had found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating 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. Following the inspection in October 2017 the provider implemented an action plan to show what they would do and by when to improve the service. At this inspection we found that the actions had been met and the provider was no longer in breach of the regulations.

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.

Inspection carried out on 2 October 2017

During a routine inspection

This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The inspection took place on 2 and 3 October and 18 and 19 December 2017.

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 en

Inspection carried out on 11 July 2016

During a routine inspection

The inspection tool place on 11 & 18 July 2016 and was unannounced.

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.

Inspection carried out on 19 May 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask;

� 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.

Inspection carried out on 6 June 2013

During a routine inspection

Relatives told us they had been involved in discussions about care and support prior to their relatives admission and confirmed that this was an ongoing process. One person advised: �They always explain fully if you ask why something has not been done or care has changed.�

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.

Inspection carried out on 28 June 2012

During a routine inspection

People who used the services at St Lukes Care Home had a diagnosis of dementia and other age related conditions. This meant it was difficult for people to give their verbal opinions on the service they received. We spoke with people living at the home; we looked at people�s records and how people interacted with the staff. General observations were made throughout the visit and we had discussions with staff and visiting relatives to obtain their views.

We spoke with six relatives and visitors who told us what it was like at the home and how staff provided the care and support. Relatives and visitors we spoke with made the following comments:

�We came to have a look around and we chose this one.�

�We looked at other homes but we chose this one.�

�This unit is like one big family.�

�They always look after my relative very well.�

�The staff are marvellous. I couldn�t ask for more.�

�They even take the residents out on their day off.�

�The staff helped us to celebrate a very special occasion.�

�I always feel welcome and I call everyday.�

�I have been visiting here for years and go to other homes as well. The staff are all lovely.�

�The staff are very supportive.�

�I wouldn�t hesitate to talk with someone if I had any concerns.�

�You only have to say and they will do whatever to put it right.�

�If I have any problems I would see the staff and they will sort it out.�

�I have been involved in her care plan and have read through it and checked it all.�

�I have looked at her care plan and signed it.�

�Regular staff get to know the relatives and residents.�

"The staff have a lovely attitude and are caring to the residents.�

�My mum has a key worker. If I have any issues I see her.�

�The staff are like our friends. They are very approachable.�

�My relatives are safe and cared for.�

�They will always get a GP for her if she needs one.�

�The staff always let me know if my mum is ill and needs a Dr.�

�The manager is great.�

Inspection carried out on 6 December 2011

During an inspection to make sure that the improvements required had been made

Halton Borough Council's Contracts Monitoring Team have made frequent visits to the home since concerns were identified in September 2011 that led to the Council suspending placements there. These concerns were outlined in the last Review of Compliance by the Care Quality Commission. Halton Borough Council have reported ongoing improvements to the service and have recently removed the suspension of placements meaning that the service can now accept new admissions.

The people using the service that we spoke with described the staff positively. Some comments were:

"The staff are lovely."

"The staff are smashing and the care is good."

The relatives we spoke with made positive comments about the care provided by

staff. They reported an improved atmosphere at the home with staff morale being better. They praised the attitude of staff and their hard work.

Records showed that relatives have been kept informed about the concerns around the operation of the service held by Halton Borough Council and the Care Quality Commission. Relatives meeting minutes showed that although relatives were concerned about the issues addressed and generally about the levels of staff they were positive about the service.

Inspection carried out on 13 September 2011

During an inspection in response to concerns

A Strategy Meeting was convened by Halton Borough Council on 31st August 2011 due to a number of concerns about the operation of St Lukes that are detailed in this report.

Community Integrated care have developed an action plan to address the shortfalls identified. Halton Borough Council are working with Community Integrated Care to ensure the full implementation of the action plan so that service users� needs are met and they are safeguarded from abuse.

We spoke with one person who told us that they liked living in the home, they said staff were kind considerate, and helpful.

We spoke to 8 relatives. All had positive comments to make about the care provided by staff and the general service provided. However, 6 of the 8 relatives expressed concern about the levels of staff at the service and how this impacted on the management and prevention of challenging behaviour by service users.

Our observations indicated that at busy times staffing levels and staff deployment did not always meet peoples needs.

Inspection carried out on 19 April 2011

During an inspection to make sure that the improvements required had been made

We spoke with several people who lived at St Luke�s Care Home. One person told us they were happy living there and that nursing staff looked after their medicines for them and that they had no problems. We found it difficult to speak with some people because of their complex health needs but generally we found people to be relaxed and comfortable. One relative we spoke with we said their mother had been well cared for and she said the staff were very kind.

Inspection carried out on 22 February and 2 March 2011

During a routine inspection

Relatives spoken with said that the staff are always polite and friendly and respectful towards the people using the service. They said that they are asked their views about the care provided to their relatives.

Relatives spoken with said that people have their needs met by caring and attentive staff. Our observations showed that staff are respectful towards the people who use the service. Throughout the visit we observed people being treated in a friendly and dignified manner by the staff team.

Relatives spoken with said that the food appeared to be of a good quality and that their relatives seem to enjoy the meals provided.

Relatives spoken with praised the standards of cleanliness at the home. They said there is evidence of ongoing improvements being undertaken to maintain and improve standards.

We spoke with three people who lived in the home about their medicines and observed some medicines being given to people. One person said they were happy and comfortable living in the home and another person said they thought their medicines were given to them properly.

We spoke with a visiting Doctor who said care workers always seemed very caring and she thought residents were generally well looked after. She said in her experience medicines were handled properly.

Our observations showed that other than during lunch time on one unit, there appeared to be sufficient staff to meet people�s needs. Relatives spoken with said that there is always a member of staff available if they are needed.

The last routine monitoring visit carried out by Halton Borough Council took place on 25th November 2010. This indicated that the home was clean and welcoming. There had been improvements to the activities on offer which several relatives commented positively about. The service had progressed since the previous monitoring visit in areas of training, medication and activities. There was greater structure in the service in terms of reviewing outcomes, care plans and risks for the service users. The managers and deputy staff had a greater presence, which was making a difference. The menu wasn�t appetising and did not look appealing. This was addressed with the senior managers on the day who agreed to rectify this matter. Service user, relative and stakeholder comments were also recorded in the report and were very positive about the service being provided.

Reports under our old system of regulation (including those from before CQC was created)