St Patrick's House

St Patrick’s House is a care home providing accommodation and personal care for up to eight people with a learning disability in one adapted building. At the time of the inspection six people were living in the home.

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

At the last inspection we told the provider they needed to improve the way they supported people with medicines. At this inspection we found the provider had made the improvements necessary to meet legal requirements. Medicines were safely managed. People were supported to take the medicines they had been prescribed and staff completed records of the support they provided. Staff had received additional training and managers regularly checked to ensure the systems were working well.

The provider had developed systems to manage infection prevention and control, in line with national guidance. These systems were working well in practice.

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 11 March 2020) and there was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 to the way medicines were managed and the provider was no longer in breach of regulation 12.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 February 2020. A breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found, and we served a warning notice against the provider.

We undertook this targeted inspection to check they had taken action to address issues in the warning notice in relation to medicines management. In addition, we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Patrick’s House 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 Patrick’s House is a care home providing accommodation and personal care for up to eight people with learning disabilities in one adapted building. At the time of our inspection there were six people living at the service. There were communal rooms such as a dining room and lounge areas and a small garden which was accessible.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People’s medicines were not always managed safely. At our last inspection we found concerns with regards to medicines records. At this inspection we saw the required action had been taken in part. This meant there was still further improvement required with medicines recording.

Risks were assessed and managed and people were supported to take positive risks. Staff had been recruited safely and there were enough staff to meet people’s needs. Staff had been trained and felt supported in their roles and they had opportunity for supervision. The service was clean and there were health and safety checks being carried out.

People’s needs were assessed and if needed referrals were made to healthcare professionals. Staff communicated with each other about changes to people’s 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. People had meals they had chosen and ate when they wished. There was always choice available.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Staff encouraged people to do what they could for themselves and offered support when necessary. People could follow their interests and maintain relationships with their friends and family members.

People had a personalised care plan and health action plan which outlined people’s needs and the care and support required. These had been reviewed when needed. People had a care review which involved healthcare professionals and others who were important to people such as family. Staff kept daily records which were appropriate and legible. People had chosen to record their wishes for end of life care.

There was a new manager in post who had made some positive changes. People and staff told us the manager was approachable and they enjoyed living and working at St Patrick’s House. People and relatives knew how to make a complaint but had not needed to. Quality monitoring was in place and the manager had an action plan to monitor improvements. The service supported people to access their community and had community links with services in the local area.

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 8 February 2019). At that inspection we found the service was in breach 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 there had not been enough improvements made and the provider was still in breach of regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines management at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Follow up

We will request an action plan for 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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Leadership and management of the service had not ensured people always received a high-quality service. The quality assurance systems in place identified shortfalls in the service, but there was not always effective action to make the necessary improvements.

The provider did not have effective systems to plan how the risks people faced were going to be managed. Risk assessments were not always kept up to date and reviewed when people’s needs changed.

Staff did not always keep accurate records of the medicines they supported people to take. Systems in place to check medicine records at the end of each shift were not effective and did not always identify errors.

Despite the shortfalls in risk management records, staff demonstrated a good understanding of people’s needs and how to meet them.

People were confident that staff had the right skills and felt safe in the service. People felt staff treated them in ways that maintained their dignity and privacy.

Staff were well trained and there were enough of them to provide the support people needed. Staff were thoroughly checked before they worked at the service.

People were confident any complaints would be investigated and action taken to resolve them.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 2 June 2016).

About the service:

St Patrick’s House is a care home for people with a learning disability. Six people were living in the home at the time of the inspection. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have told the provider they must improve the service.

This inspection took place on 30 March 2016 and was announced. We gave the service short notice of the inspection to ensure people would be available to speak with us.

There was a registered manager in post at 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 and associated Regulations about how the service is run.

At the last inspection in January 2015 we found medicines were not always securely stored. The provider wrote to us following the last inspection and said they would take action to store medicines safely by May 2015. At this inspection we found the provider had taken action to address this and medicines were safely stored.

At the last inspection we found incidents in which staff had provided physical interventions when people were distressed or angry were not always accurately recorded and followed up to ensure people were safe. The provider wrote to us following the last inspection and said they would take action to keep accurate records of physical interventions by May 2015. At this inspection we found the provider had taken action to address this and ensure clear information was recorded when any physical interventions were used.

At the last inspection we found support plans had not always been kept up to date and accurate. Some of the plans contained contradictory information. The provider wrote to us following the last inspection and said they would take action to update all of the information in support plans and introduce a clearer process by July 2015. At this inspection we found the provider had taken action to address this and support plans were accurate and up to date.

At the last inspection we found the provider had not notified the Care Quality Commission about changes to the management of the service. The provider wrote to us following the last inspection and said they would appoint a new manager who would submit an application for registration. An application for registration by the new manager was successful and the new registered manager was in post and available throughout this inspection.

The provider had taken action to address all of the breaches of regulations associated with the Health and Social Care Act 2008 that we identified at the inspection of January 2015.

People who use the service were positive about the care they received and praised the quality of the staff and management. Comments from people included, “I feel safe and like living here” and “The staff here are very good and know my needs”. People appeared comfortable in the presence of staff. We observed people smiling and laughing with staff.

People told us they were involved in developing and reviewing their support plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were supporting. People told us staff provided the support and care they needed in a kind way.

Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

There was strong management in the service and the registered manager was clear how they expected staff to support people. The provider assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

We saw some people were able to access the community independently. One person told us they 'went out every day.' They said they travelled on public transport and kept the staff team informed of their whereabouts, using their mobile phone.

People spoke positively about the food they received at the home. People were able to choose meals for the menu and there were alternative choices available, if required. Staff told us people were encouraged to make healthy choices.

We toured the building and some people invited us to see their bedrooms. We saw people kept their rooms in the way they preferred. One person explained they liked their room to be 'in a bit of a mess.' They said 'it's how I like it.'

People told us they had what they needed in their rooms, such as televisions and CD's.

The manager said they had recently experienced some issues with staffing levels. They told us the staff team were flexible and had all 'pulled together' to cover any shifts. Staff said staffing levels rarely impacted on people attending social activities.

Systems were in place for people to be able to raise any concerns or complaints, if needed. People told us they would speak to the manager or their key worker.