St Faith's Nursing Home

St Faith’s Nursing Home is a residential care home which can provide personal and nursing care to 69 people aged 65 and over. At the time of the inspection 59 people lived in the home.

People are accommodated in one adapted building. Each person is provided with their own private bedroom with toilet and washing facilities. Additional toilets and bathrooms are available and are adapted to accommodate people’s needs. A choice of communal areas provides additional places to sit, eat and take part in social activities. There is easy access to a garden with adaptions to the home’s entrances to accommodate wheelchairs. Car parking is on site.

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

The process for monitoring the administration of people’s medicines had not been effective enough to identify that two people, had not been receiving some of their medicines as prescribed. A delay in senior managers being aware of this meant action was not taken in a timely way to review this and ensure, these people, were protected against the potential risks associated with not receiving medicines as prescribed. A process for identifying gaps in staff signatures, on people’s medicine administration records (MARs), was in place. However, this was not leading to effective action being taken, in a timely manner, to follow these recording errors up and to ascertain if people had received their medicines or not. No harm had come to people, but these processes were not robust enough to protect people from, potential risks, associated with not receiving their medicines as prescribed.

During the inspection and after, immediate action was taken to ensure these two people’s medicines management was reviewed. Action was also taken to improve the monitoring of people’s medicines administration and the action taken when recording errors were identified. It was too early for us to make a judgement about whether the action taken would be effective in reducing risks to people.

The provider’s quality monitoring processes, for monitoring other areas of the service and making improvements where needed was working well. In all other ways the service was being well managed. People told us they would recommend the service to others. A senior management structure was in place providing consistent leadership for staff who were being supported to work in such a way which resulted in good outcomes for people. There were effective communication processes in place to ensure people, their relatives and staff felt well informed of any changes to the service.

An open and transparent culture had been developed where staff were confident to challenge poor practice and people and their relatives felt able to report any concerns they may have. Staff felt well supported and valued by both the registered manager and provider. They told us they felt proud to work at St Faith’s Nursing Home. People considered the home to be well-led and they confirmed senior managers were visible and approachable. Managers engaged with people and their relatives to seek their views on the services provided to them. They were keen to learn from areas of dissatisfaction or when things did not go to plan.

Other medicines had been administered to people as prescribed. Medicines were received into the home in time for administration and they were stored according to pharmaceutical guidelines. Risks to people’s health and potential environmental risks were identified, assessed and managed to reduce or mitigate risks altogether. People lived in a clean home where arrangements were in place to prevent and control infection. There were processes in place to learn from errors and near misses, so staff practice, and the service people received could continually improve.

People told us they were well looked after, and they had confidence in the staff to meet their needs. Staff received training and support to be able to meet people’s needs safely and lawfully. People told us they received plenty of food and drink and had a choice in what they ate and drank. People’s nutritional health was supported, and any associated risks to this assessed and managed.

People confirmed they had access to healthcare professionals who helped them maintain their health. Staff worked with commissioners of adult social care and acute health care to ensure people could access support when they needed it. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive was possible and in their best interests. The policies and systems in the service supported this practice.

People told us staff were kind, caring and supportive. Care was delivered in a way which maintained people’s dignity and privacy. People told us staff explained things to them in a way they could understand. Staff supported people to maintain their independence and, where possible, to retain skills they already had. Those who mattered to people, family, representatives and friends were made welcome and could speak on behalf of people where needed. There were no restrictions on visiting.

People’s care was planned and designed around their needs and personal preferences. People or their representatives were included in this planning and in the review of their care. Care was reviewed and altered to accommodate changes in health, abilities and risks. People told us they were treated as individuals and their care was personalised.

People had access to social activities and supported to take part in activities which suited their abilities and preferences. There were arrangements in place for people, their representatives and others to raise a complaint and for this to be investigated and addressed. People’s end of life wishes were explored with them, or their representatives, and they were supported to have a dignified and comfortable death.

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

Rating at last inspection

The last rating for this service was Good (published 17 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the ‘Is the service well-led?’ section of this full report. Effective action was taken during the inspection to reduce and mitigate potential risks to people.

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

Follow up

We will discuss with the provider their progress on the improvements they made during and after the inspection, about the monitoring of people’s medicines administration, to ensure this action leads to the service improving their rating in well-led to at least Good. We will continue to monitor information we receive about the service. We will return to visit the service as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection on 1 and 2 April 2015 we found accurate records had not been maintained relating to decisions made in people’s best interests, their care planning, risk assessments and the support staff received. The provider forwarded to us an action plan of how this would be addressed. They told us this would be fully completed by 31 August 2015. During this inspection we found this breach in regulation had been fully met.

The care home provides care to up to 69 people. People who received care were predominantly older people and some lived with dementia. At the time of this inspection there were no vacancies and there was a waiting list.

The registered manager had been in post since June 2015 and just after our last inspection in April 2015. 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 kept people safe and there were arrangements in place to ensure this remained the case. These ensured people were protected from abuse, discrimination and poor practice. People also lived in a safe, well maintained building, which was kept clean and where good infection control practices protected people from avoidable infection. People received their medicines safely and when needed. There were plenty of staff to meet people’s needs and staff were exceptionally well trained and supported to do this. People and relatives told us staff were caring and compassionate. One relative said, “They care for [name] as if [name] were their own Mum, they go above and beyond”. People’s dignity and privacy were maintained at all times.

People told us their health and care needs were met consistently and met to a high standard. The service was able to be extremely effective. One relative said, “I want the best for [name] and I can’t fault one of them [the staff]. They do everything well” and one person said, “They really treat me well, I have not looked back since I have been here”. Staff supported people to make independent decisions about their care and treatment and to have these respected. People had good access to health care professionals and staff acted as advocates for people ensuring they gained access to NHS health support when required. Proactive measures were in place to identify a decline in health quickly and prevent an admission to hospital if possible.

Where people were assessed as lacking mental capacity they were fully protected by staff who adhered to the appropriate legislation. People who were at risk of not eating and drinking enough had individual support to maintain their nutritional well-being. People’s choice of food was extremely good and the service went out of their way to accommodate all food preferences and wishes. Staff promoted independence and supported time with family and friends. Where people could not engage in care planning or care reviews their relative and representatives were actively encouraged to be involved on their behalf.

The service was extremely well managed with staff fully engaged and committed to the manager’s vision and expectations. The registered manager provided exceptional support to the staff and in turn they were able to carry out their work to a high standard which people benefited from. There were numerous comments about the registered manager’s exceptional management skills and support. These included: “It’s run very well”, “There is a chain of command which is followed and everyone works as a team”, “She’s a tonic to everyone”, “I’m able to see her any time, communication is good and things get done” and “I have not met anyone or any member of staff who has a bad thing to say about [name of registered manager]”.

Robust quality monitoring arrangements were in place which resulted in continued improvement to the service. Consistent and constructive communication started at the top and filtered down to all staff levels. The views of people, relatives and other visitors to the care home were sought in order to help gauge the performance of the service and to improve it further.

As part of this inspection we spoke with eight people who use the service, three relatives, one visiting health care professional, the registered manager and 10 members of staff. We also observed how people were cared for. We reviewed records relating to people's care such as people's care plans, risk assessments and medicine administration records. We also reviewed records relating to the management of the service. For example, a selection of policies and procedures and quality assurance and monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff had been given information about people's risks and strategies had been put in place to manage these. For example, specialised equipment had been introduced to reduce the risk of people developing pressure ulcers.

The service was safe because staff adhered to the policies and procedures which underpinned the service's aims and objectives which was to keep people safe. For example, staff followed procedures that safeguarded people from abuse. The staff we spoke with were aware of the kinds of abuse people could be at risk of. They knew what to do if they witnessed, suspected or received an allegation of abuse. Two people who use the service told us they felt safe.

The service had a safe system in place for the storage of and recording of medicines, but guidance for staff relating to when some medicines should be given and for what reason was missing. This increased the risk that people would not receive their medicine correctly and safely. A compliance action has been issued in respect of this and the provider must tell us how they will address this.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

The service was effective because people received care that met their individual needs, choices and preferences. Care plans did not reflect people's individuality but gave staff basic guidance on how to meet the person's care needs. One person said, 'I can say I'm happy and well-cared for'. Another person said, "I consider myself extremely lucky because I'm being well looked after. I get on well with the staff and people like coming here to see me'.

The service was effective because staff were aware of people's preferences, abilities and behaviour's. One person said, 'I tell them when I can do things and I tell them what I can do and what I can't do. They (the staff) realise I can do a certain amount myself'. The person said 'they recognise my difficulties'

The service was effective because it delivered care with people's consent and where consent could not be given care was delivered in people's best interests.

The registered manager explained that between 80% and 90% of the people who use the service had dementia. The service was effective because it involved the people who knew the person well, usually a close relative, in the planning of the person's care. Where possible they included the person receiving the care.

Is the service caring?

The service was caring because we observed people being treated with respect. Arrangements were in place to preserve people's privacy. We did not observe any situations where a person's dignity or privacy was compromised.

The service was caring because people who could no longer look after their appearance looked well presented. On the day of the inspection a hairdresser was in attendance. We noticed a variety of hair styles which indicated that the hairdresser had taken into account personal preferences and individuality.

The service was caring because care was delivered in a respectful, thoughtful and kind manner.

The service was caring because they wanted to improve people's quality of life and did this by ensuring those closest to the person remained actively involved in their relative's life.

The service was caring because it recognised that when able, it was important for people to be independent. Examples of this were seen during mealtimes, activities and in the opportunities given to people to make simple choices.

Is the service responsive?

The service was responsive because it responded to people's altered needs.

The service was responsive because staff provided individualised care and support recognising people's diversity although the completed care plans did not always record this well.

The service was responsive because it sought additional support or intervention when needed. Referrals were made to health care professionals when needed and advice followed. One relative said 'yes they're very good' when we spoke to them about staff calling the person's GP when needed. A visiting health professional said "they (the staff) are knowledgeable about their residents and they make appropriate referrals to us"

Some people had been identified as having potential problems relating to one area of bodily function, their bowel actions. Some of the care records did not always demonstrate adequate monitoring or action being taken when there was a potential problem relating to this. It meant the service potentially may not be as responsive to organising the proper treatment to avoid, for example, further constipation. We spoke with the registered manager about this and they told us they would put actions in place to address this.

The service was responsive because people, predominantly their relatives, knew how to share their concerns or raise a complaint. People who use the service and their relatives said they were happy to speak to the registered manager or staff if something concerned them. Examples were given to us of where relatives had raised concerns and these had been acted on. This meant the service had been responsive to people's individual concerns in order to improve people's experiences.

Is the service well led?

The service was well led because the registered manager provided strong leadership and was approachable. Feedback from people who live in the home, their relatives and staff confirmed this. One relative described the registered manager as "a brilliant fellow".

The service was well led because staff felt valued and wanted to carry out their tasks well. When asked two members of staff said "yes I feel valued here" and one went on to say, 'I have been supported and encouraged'.

The service was well led because it had a system to manage and report accidents and incidents. These were monitored and action taken to make sure they did not happen again.

The service was well led because there were arrangements in place to monitor and improve the services provided. Complaints and concerns were listened to and responded to in order to improve the service.

The service was well led because the provider was actively involved in monitoring the services provided and the performance of the registered manager.

You can see our judgements on the front page of this report.

People were receiving their medicines safely and correctly and their health needs were being addressed. One visitor told us they had noticed a marked improvement in the care being provided by St Faith's compared to the person's previous care home.

We found that staff were provided with appropriate support and training so that they could look after people safely and to a good standard.

There were arrangements in place to assess and monitor the quality of care and services being delivered. This meant that people were cared for in a service that was able to proactively identify shortfalls, address them and make improvements to the services provided.

In particular there were good arrangements to manage people's complex nutritional needs that sometimes arose from having dementia. There were systems in place to manage allegations of abuse which included evidence that the service had liaised appropriately with external agencies. Staff were recruited in a robust manner and received appropriate induction training. People's complaints were correctly acknowledged, investigated and responded to. There was evidence to show that the service had taken relevant action following a complaint in order to learn from it and improve the service.