Archived: St Catherine's Care Home

St Catherine’s is a care home providing personal and nursing care, treatment for disease, disorder or injuries and diagnostic and screening procedures to up 60 people. The service provides support across three units to older people who need residential and nursing care and to people living with dementia. At the time of our inspection there were 53 people using the service.

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

People and their relatives felt care was provided safely within the home. Medicines were managed safely, and competency checks were carried out. Analysis of accident and incidents had been carried out to identify any areas of improvement. Staffing levels were sufficient to meet the assessed needs of people. Staff had a good understanding of how to raise safeguarding concerns and had received safeguarding training.

People’s dietary requirements were being met and people’s preferences around meals were respected. People were supported to access medical treatment when needed. Staff received a robust induction and compliance with mandatory training courses was high. Some staff felt additional training to dementia training already carried out would be beneficial when they were supporting people with heightened anxieties. We have made a recommendation the provider provides further training in this area.

People and relatives felt care was provided in a warm, patient and friendly manner. Staff were praised for the care they provided to people and relatives valued staff support and communication throughout the COVID-19 pandemic.

Activities had been and continued to be developed within the home. Activities were carried out with individuals’ specific needs in mind. Funding was being sought to develop activities further, including the outside garden area which was not yet being utilised to it’s full potential. Relatives felt included in people’s care and support planning

The providers auditing systems were robust and the registered manager and area manager both had good oversight of the standard of care within the home. Audits were used to inform improvements and create action plans of how improvements would be made. There was a person-centred culture throughout the home and this was evidenced in peoples records and from feedback from people, relatives and staff. Care records were generally good; however, some care plans needed organising to better reflect the person-centred care at the home. We have made a recommendation the provider reviews and organises care plans.

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.

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 13 February 2020). The service was inspected more recently and was found to no longer be in breach of regulations. This inspection report was published on the 15 September 2020. At this inspection we found further improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Catherine's Care Home is a two-storey purpose-built home that provides personal and nursing care to 60 people. The home is situated in the centre of Horwich, Bolton, and is close to local amenities, public transport and motorway networks. At the time of the inspection there were 53 people living at the home.

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

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.

Risks to people’s health and wellbeing were assessed and mitigated. People's medicines were managed safely; there was appropriate documentation in place to support the safe administration of medicines. Medicines records were audited regularly.

People received the correct diet types and care records included eating and drinking risk assessments. Care plans contained the relevant instruction regarding what people ate and drank.

The home was clean, and staff followed procedures to prevent the spread of infections.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service. More robust quality assurance systems were now in place to ensure any shortfalls were identified and to drive continuous improvement within the service.

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 14 February 2020) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the safe management of people’s medicines and governance arrangements within the home. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Care Home is a two-storey purpose-built home that provides personal and nursing care to 60 people. The home is situated in the centre of Horwich, Bolton, and is close to local amenities, public transport and motorway networks. At the time of the inspection there were 54 people living at the home. One area within the home, Pike View specialised in providing nursing care for people living with dementia.

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

Medication was not always safely managed. However, actions were taken immediately following our inspection to address these concerns.

People were mostly protected from the associated risks of infection. However,, some areas of the home were tired and required attention. Pike View did not provide a fully dementia friendly environment, it was lacking appropriate signage, adaptations and reminiscence aids.

Staffing numbers tallied with staffing rotas, however, it was discussed with the registered manager to look at how staff were deployed throughout the home. Staff were safely recruited. Staff completed an induction on commencing work at the home and training was ongoing.

Health and safety checks were completed, and valid certificates were in place. Each person had a personal emergency evacuation plan (PEEPs). On checking the main file there were too many PEEPs for the number of people living at the home.

Activities were offered at the home. However, these were group activities and people cared for in bed did not have access to quality activities on a one to one basis. We recommended appropriate equipment was sought to provide a range of stimulation and enjoyment.

Care plans contained detailed information, including a pre-admission assessment and risk assessments were in place. People’s oral health care had been assessed. However, our checks found people were not always in receipt of oral care as documented.

Staff were trained in equality and diversity and people told us the staff were kind. We saw people were well-groomed and appropriately dressed. Staff interactions with people were friendly and respectful.

People and their relatives told us the food had improved. However, there were issues raised regarding the suitability of fork mashable diets. We recommended the registered manager ensured people were offered food to meet their dietary needs.

Staff supported people with access to other healthcare professionals when required. Staff worked with other agencies to meet people’s assessed needs.

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.

Systems were in place to receive and respond to complaints. The service had received several compliments from relatives.

Staff had an awareness of safeguarding and whistleblowing and knew how to raise concerns. Policies and procedures were in place for staff to refer to when required.

Staff felt supported by the registered manager. Residents’ and relatives’ meetings were held; however, these were not well attended.

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 requires improvement (published 20 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made however, the provider was still breach of two regulations. The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 namely safe care and treatment and good governance.

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.

We will arrange to meet with the provider and request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

St Catherine's Care Home Horwich, Bolton is a purpose built two storey care home. The home is close to Horwich town centre and close to a bus route and the motorway network. The home provides nursing care or personal care for 30 people and cares for 30 people living with dementia in a separate area of the home called Pike View. On the day of the inspection there were 58 people living at the home.

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.

This last inspection took place 7 December 2017 and the overall rating was Requires Improvement. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to Person centred care, dignity and respect, safe care and treatment, medication, governance and staffing.

At the inspection on the 29 August 2018 we found that some of the breaches had been met. However, we found continued breaches in medication, person centred care and governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service 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.

There was an appropriate safeguarding policy and procedure in place, staff had undertaken safeguarding training and had a good understanding of how to report any concerns.

Staff recruitment was robust and staffing levels were good on the day of the inspection. There was a good induction programme for new staff and training was on-going.

There had been improvements to the overall cleanliness of the building. There was a rolling programme of refurbishment following the installation of a new heating system. The hot water in some of the bathrooms was extremely hot and could be potentially dangerous to people. Medicines were not safely managed.

Health and safety certificates were in place and general risk assessments and individual risk assessments had been completed.

People told us the food was ‘awful’ and we found choices were limited. This was due to the catering contractors that the home was instructed they had to use. The mealtime experience could have been improved. People were waiting for long periods of time to receive assistance with their meals.

People had mixed views about the care provided at the home, some people thought that care was task orientated and staff had not enough time to spend with people who used the service. We saw visitors were welcome at any time.

There were up to date policies on privacy, whistleblowing, medication and confidentiality. Residents’ and relatives’ meetings were held; however, these were poorly attended. The registered manager held a ‘drop in’ meeting so people could speak with her if they wished.

Some of the care files we looked at did not always show evidence that collaborative needs had been assessed and there was limited evidence to suggest people’s preferences had been addressed.

There was an up to date complaints procedure in the reception area and this was also in the information provided to people living at the home and their relatives.

The service was working within the legal requires of the Mental Capacity Act 2005 (MCA) and the deprivation of Liberty Safeguards (DoLS).

People we spoke with said the registered manager was approachable. We saw evidence of staff supervisions and appraisals. Staff meetings took place; however, these were poorly attended.

The service worked in partnership with other agencies and were involved with the Bolton Care Homes Excellence programme.

This inspection took place on 07 December 2017 and was unannounced. The last inspection took place on 10 January 2017 and the overall rating was good.

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.

The service had 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.

At this inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medication, infection control, governance, staff training, mitigating risk, person centred care and dignity. You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

Systems were in place to ensure staff were safely recruited. Staff told us they received the training and supervision they needed to be able to carry out their roles effectively. Staff completed an induction on commencing work at the home.

The training record provided by the registered manager highlighted there were gaps in essential training for staff.

People who used the service and their relatives told us they felt safe and their relatives were well cared for.

We found that medicines were not managed safely and people did not always get their medicines in a timely manner.

We found that the home was not clean and systems were not being adhered to reduce the risk of cross infection in the home.

Health and safety checks were in place with regard to equipment and servicing of appliances.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People who used the service told us staff were kind and caring. We observed staff interacted well with people throughout the day. People’s privacy was respected. However, people’s dignity was not always maintained. For example it was noted that faeces was on bedding and mattresses in people’s rooms when beds had been made and not cleaned.

We saw a good range of information in care plans, including care plans for pressure ulcers and wound care. These were not all completed accurately and fully. Care plans had been reviewed as required.

There was a range of activities provided both in the home and trips out to local venues

The service had an up to date complaints procedure for receiving, handling and responding to complaints.

A service user guide was available. This provided information about the home and the care people could expect to receive.

The home is registered to provide care and support for 60 people. The home is split in to two areas. On the day of our inspection 28 people were living in Pike View, which is on the ground floor and provides nursing care for people living with dementia. On the first floor there were 25 people who required nursing care.

The home has a registered manager at the time of the inspection. 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 and associated Regulations about how the service is run.

The home has a large reception area with appropriate information to inform people about the home and the services provided. The last inspection report and the home’s CQC ratings were displayed on the notice board.

During this inspection we found that medicines were being administered in a safe and timely manner. The home worked with other healthcare professionals to ensure that people received appropriate care and treatment.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) although staff spoken with were not clear of what this meant.

Staff were able to demonstrate their understanding of the whistle-blowing procedures and they knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled staff who were safely recruited. We saw that staff received essential training and support necessary to enable them to do their job effectively and care for people safely.

People we spoke with told us they felt the staff had the skills and experience to meet people’s needs. People spoke positively about the kindness and caring attitude of the staff.

We saw that there were risk assessments in place for the safety of the premises. All areas of the home were clean and well maintained. Procedures were in place to prevent and control the risk of cross infection.

People’s care records contained enough information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate risk. People were involved and consulted about the development of care plans. This helped to ensure people’s wishes were considered and planned for.

Staff spoken with had a good understanding of the care and support that people required. We saw that people looked well cared for and there was enough equipment available to promote people’s safety, comfort and independence.

Food stocks were good and meals were varied and nutritionally balanced. People told us the food was very good and nicely presented.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home and there were opportunities, such as surveys and meetings for people to comment on the facilities of the service and the quality of the care provided.

People who used the service told us, 'I have been here for about seven years. I am treated with respect'. Another said, 'The dinners are nice and staff help me eat my dinner. The staff are very kind to me'.

One relative spoken with told us 'The management and the staff are very good. It's very friendly here'. Another said, 'I looked at other care homes and felt this was far the best. The family are very happy with the care'.

Another relative told us,' We visit every day; we have seen the care plan and signed it. My X has gained weight which is brilliant. I have no problems with the care. My X is always clean and if I mention anything to the staff they attend to it immediately. I have seen some changes here and they are all positive. It's now a five star'.

We looked at six care records and found they contained enough information to show the care and treatment and support required.

We found people who used the service were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

We saw sufficient numbers of staff were on duty. Staff spoken with told us they received training relevant to their role and they felt supported by the manager.

We saw regular monitoring of the records and services provided were in place to protect people who used the service from any risks or unsafe care.

As some of the people living on one of the units at St Catherine's had some degree of confusion or a dementia type illness, they were not able to tell us about their experiences of living at the care home. It was evident from our observations staff understood people's needs and were helpful and polite when assisting people.

We also spoke with a group of people on the residential unit. They told us; 'I'm very thankful I am here', 'They [the staff] provide great satisfaction' and 'They care about what they do'. Visitors also commented, 'It's very settled, there are some good staff', 'The manager is very approachable', 'Nothing is too much trouble' and 'They call me or I call them if there's anything we need to discuss'.

We found that clear documentation was in place detailing how people were to be supported, taking into consideration their individual needs and wishes.

Records showed that where possible people had been consulted with about their care and support. Suitable arrangements were in place to assist those people who lacked capacity to make decisions for themselves.

The home provided suitable aids and adaptations to meet the physical needs of people.

Systems to monitor and review the service were in place ensuring people received a good standard of service.