St Martins Residential Home

St Martins Residential Home is a care home providing accommodation and personal and care to 16 people with mental health needs. At the time of the inspection there were 13 people living in the home.

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

Risks in relation to people's care had not been effectively assessed and medicines were not always managed safely. There was a lack of understanding around the Mental Capacity Act 2005 and, it's application. The provider did not show the appropriate knowledge around their responsibilities in relation to finance and consent. The systems in place to monitor the quality and safety of the service were not always used effectively to identify and mitigate risks. We have made a recommendation regarding recruitment.

People were not supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice.

The registered manager had improved the environment and the safety checks where up to date however we identified additional fire safety improvements were required.

Staff received regular training, supervisions and attended staff meetings and there were enough staff on duty on the day of inspection to meet people's needs. Referrals were made to other professionals in a timely when people living in the home were in need.

Feedback we received from staff, people and relatives was positive in regard to the registered manager. We observed support being provided in the home and saw this was done in a caring, responsive, and patient manner. We saw people were comfortable in the presence of staff and positive relationships had developed between people receiving support and staff.

People were consulted with in the form of residents meeting s and quality assurance questionnaires. There was evidence of how the registered manager acted on people’s opinions.

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 20 May 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about fire safety. A decision was made for us to inspect and examine those risks. 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, consent and governance at this inspection.

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

St Martins Residential Home is a care home providing accommodation and personal and care to 16 people with mental health needs. At the time of the inspection there were 14 people living in the home. The home is situated on a residential street and accommodates people over three floors with stair access to each floor. There is a lounge, dining room and garden with seating areas.

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

Whilst we had noted some improvements within the service, the systems in place to monitor the quality and safety of the service were not always effective. They did not cover all aspects of the service and did not identify the concerns we highlighted during the inspection. The manager acted quickly to address the issues raised during the inspection.

Risks regarding the environment and facilities had been assessed and most were well managed. However, the gas certificate had recently expired; we raised this with the provider who ensured this was addressed straight away. Risk assessments had been completed to assess individual risks to people and records showed how these risks should be managed. Personal emergency evacuation plans were in place, to ensure people could evacuate the home in the event of an emergency.

People told us they received their medications when they needed them. However, records regarding medication administration were not always maintained accurately as stock balances were not always correct. The manager created a new audit tool to help improve this. Staff had received training and had their competency assessed and medications were stored securely.

People and their relatives told us the home was a safe place to live. Staff had completed safeguarding training and knew how to raise any concerns they had. There were sufficient numbers of safely recruited staff available to support people when they needed it.

Infection prevention and control (IPC) was managed well in the home and effective systems were in place to minimise risks regarding COVID-19. Staff had completed infection control training, had access to adequate supplies of personal protective equipment (PPE) and a COVID-19 testing programme was in place.

The manager was aware of events and incidents that needed to be notified to CQC and had submitted notifications appropriately. Feedback from people and their relatives regarding the service provided was positive. Regular meetings enabled people to provide their feedback and have their voices heard. The manager and staff team worked with other health professionals to ensure people's needs were met and made relevant referrals when required to ensure people’s safety.

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 30 July 2019). At that inspection continued breaches of regulation were identified, as risks were not always managed safely and systems in place to monitor the quality of the service were not always effective. 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 regulation regarding the management of risk. However, further improvements were required to ensure the provider had effective systems in place to monitor the quality of the service and they were still in breach of regulation regarding this.

Why we inspected

This was a planned inspection based on the previous rating. 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

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

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.

St Martins Residential Home is a care home providing personal and care to 16 people with mental health needs. At the time of the inspection there were 12 people living in the home.

The home is situated on a residential street and accommodates people over three floors with stair access to each floor. There is a lounge, dining room and garden with seating areas.

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

Systems in place to monitor the quality and safety of the service were not always effective. They did not identify all of the concerns we raised during the inspection. CQC had been notified of all but one incident as required. Systems were in place to gather feedback from people and people told us St Martins was a nice place to live.

Although individual risks to people had been assessed, risks in the environment were not always managed appropriately and people were at risk of avoidable harm. Not all safe recruitment practices were recorded and we made a recommendation about this in the main body of the report. There were enough staff to provide support to people when they needed it and staff were knowledgeable regarding safeguarding procedures.

Staff felt well supported and told us they had completed several training courses recently. However, these records were not available to view as they had been sent off for validation. We made a recommendation regarding the maintenance of training records in the main body of the report.

Care plans were in place that people had been involved in developing. However, some plans required updating to ensure they reflected people’s current needs. A complaints procedure was available, and people knew who to talk to if they had any concerns.

People had been involved in decisions regarding the recent redecoration of the home. Consent to care and treatment was sought and recorded. 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 enjoyed the choice of meals available to them and could prepare their own drinks and snacks throughout the day.

People were positive about the support they received and told us they got on well with the staff and that staff always protected their dignity and privacy.

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 1 August 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made/sustained, and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to Regulation 12 (risk management within the home) and a continued breach of Regulation 17 (the governance of the service) at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

St Martins Residential Home 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 home is registered to provide support for up to 16 people. At the time of our inspection 15 people were living there.

St Martins is a three-storey property in a residential area of Wallasey close to the town centre. There are 14 bedrooms, in the home two of which offered shared accommodation. The registered manager explained that two people chose to share and they do not use shared rooms unless people actively request to do so. The building contains a shared lounge, conservatory used by people who smoke, a dining room and bathrooms and toilets throughout the building. Externally there is some parking to the front of the building and an enclosed back garden to the rear.

The home has a registered manager who has been in post for eleven years. 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 last inspection of the service was carried out in January 2017 and the service was rated ‘requires improvement.’ At that inspection we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the fire risk assessment, the testing of the water for presence of legionella and some concerns with medication administration. After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of these regulations.

During this inspection we found breaches in relation to Regulations 15, and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. This was because the home did not meet standards for infection control and prevention and parts of the building, decoration and furnishings were not of a suitable standard. Quality assurance systems, although in place were not robust enough to identify and improve areas of the service that required improving.

We also found a breach in relation to Regulation 18 of the Care Quality Commission (registration) Regulations 2009. This was because the provider had not notified the commission of a notifiable incident as required by law so that we can effectively monitor the service provided.

The registered provider met the requirements of the Mental Capacity Act 2005 and people had choices in their everyday lives. The home did not have an ethos of offering people support to improve or maintain their everyday living skills. Although people were able to make choices in their everyday lives there were few opportunities for people to take responsibility for meals, food shopping or managing parts of their medication.

Posters and notices were prolific throughout the home and detracted from creating a homely environment. They were also instructive and not in keeping with an ethos of working in partnership with people.

Systems were in place for safeguarding people from the risk of abuse and reporting concerns that arose. People felt safe living there and staff knew what action to take if they felt people were at risk of abuse. A system was also in place for raising concerns or complaints and people living at the home told us they would feel confident to raise a concern.

People’s medication was safely managed and they received it on time and as prescribed. Staff provided people with the support they needed to manage their physical and mental health care needs.

People’s care and support needs were assessed. Where they required support, this was detailed in a care plan that staff followed

Internal and external checks had been carried out on the safety of the building to ensure it was safe.

St Martins had enough staff working on each shift to meet people’s care and support needs. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us that they felt supported and we saw that they had staff meetings and supervisions with senior staff.

People told us that if they wanted to take part in activities then these were arranged by the home and staff supported them to do so.

People enjoyed the meals provided and told us that they had a choice and this was regularly discussed with them at meetings. Access to drinks and snacks was available twenty-four hours a day.

People liked the staff team and told us that they were kind and helpful. Staff knew people well and communicated with people in a way that suited the person.

The views of people living at the home had regularly been obtained both formally and informally.

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 the time of inspection the service had a manager in post who was registered with Care Quality Commission since July 2011.

During our inspection, we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

These breaches related to the safety of the premises and the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

The service had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults and staff spoken with were knowledgeable with regards to safeguarding and whistleblowing.

During our visit we found that the water systems for legionella had not been tested and the service had not had an official fire risk assessment for a number of years. This meant we could not be certain the building was safe.

We checked the medication management arrangements at the home. We found that the balance of medication stock that we sampled did not match what had been administered. This indicated that medication had not been given correctly.

Risk assessments and care plans were in place for people living in the home, however the risk assessments documentation were not always used appropriately this meant if there were significant changes to a person’s risk assessment then this information would not be readily available to inform staff practice.

We identified that the reviewing systems of care plans and risk assessments had not been carried out according to the homes own policies and quality assurance processes that had been put into such as audits were not always effective.

We found that people had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime, these options had been chosen by the people who lived at St Martins Residential Home, however not all staff had knowledge of the dietary requirements of people living in the home. This meant that people could have been at risk of receiving inappropriate diets.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. We checked whether people’s legal consent to the care they were provided with, had been sought and we found that it had. The registered manager told us people at the home had capacity and were able to keep themselves safe outside of the home,. This meant that no one at the home required a deprivation of liberty safeguarding to keep them safe. The registered manager however was able to tell us of actions that could be taken regarding depriving someone of their liberty if this became necessary.

Staff were recruited safely and there were sufficient staff working at the home to support the people living there. Staff had received training and were supervised regularly. Part of this training was mental capacity act training and staff are able to tell us about the Mental Capacity Act and the deprivation of liberty safeguards.

People who lived at the home were able to tell us who the registered manager and their keyworker was and said they felt comfortable approaching any staff if they felt the need to complain. We saw that the registered manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home well.

Each person's bedrooms had been personalised by them people who lived in them and those who were able were able to lock their bedroom doors, choose who entered their rooms and go in and out of the front door freely.

The staff in the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful and the home supported the people to access health appointments and a range of activities. This promoted their independence and well-being. The people living in the home were able to express their views and were able to choose the way they spent their day. People’s views and opinions on the service provided were regularly sought. For example there were monthly resident meetings and satisfaction surveys were people were able to give their feedback on the quality and safety of the service provided.

The complaints procedure was accessible to people living in the home and had been followed by the service. There was a full description of the procedure in the service user guide and a shortened version available.

Is the service safe?

People who lived at the home required support due to long-standing mental health needs and their care needs were reviewed regularly by mental health professionals.

People were protected against the risks associated with medicines because appropriate arrangements in place to manage medicines and we saw that these were followed.

Regular safety checks were carried out by the home's maintenance person. These included the fire alarm and emergency lighting systems. Portable appliance testing was carried out annually and current certificates were in place for the electrical wiring and the gas boiler. Regular fire drills were held and recorded and these included the people who lived at the home.

Is the service effective?

People were registered with a local GP practice and the care plans recorded that people had a full health check at least once a year. People we spoke with were very satisfied with arrangements for their health and welfare and confirmed that there were no restrictions on their movements.

Is the service caring?

Staff provided encouragement to people to maintain an acceptable standard of personal care and to look after their health. They were available to accompany people to appointments if they wished.

People were able to pursue their hobbies and interests and to go out with their families. The manager told us that she was trying to encourage people to go out more often. Transport was available twice a week to take people for a trip out.

Is the service responsive?

People who lived at the home had a monthly meeting and the minutes of the meetings showed that they were well-attended and that people were able to raise any issues that they wished to discuss. Safeguarding was a standing item on the agenda.

People were able to help themselves to hot and cold drinks throughout the day. A choice of meals was always available and at the monthly residents meetings, people were able to make suggestions about dishes they would like to be included on the menu.

Is the service well led?

The manager had been in post for five years and was registered with CQC. She was working towards a management and leadership qualification. Two senior care staff had been appointed since our last visit which meant that the manager had been able to delegate some management tasks. Each of the senior care staff had specific responsibilities and shared on-call duties with the manager.

Monthly health and safety checks of bedrooms were recorded and monthly medicines, accidents and care plans audits were carried out and recorded.

All of the people who lived at the home had mental health needs and were supported by a community mental health team. They were also registered with a local GP and had regular health checks. Staff we spoke with had a good knowledge of people's individual needs.

Since our last visit to St Martins some of the furniture which was shabby and/or broken had been replaced. Stained carpets had been removed and laminate flooring fitted.

Robust recruitment practices were followed and new staff received induction training. Most of the staff had achieved a national vocational qualification in care.

Records were accurate, up to date and readily available for inspection.

All of the people living at the home had mental health needs and were supported by a community mental health team. Their care needs were reviewed by mental health professionals every ten months. Each person had a key worker and the staff we spoke with had a good knowledge of people's individual needs.

Some of the furniture in the bedrooms was broken and other items were shabby. Some of the carpets in the bedrooms were badly stained and in poor condition. There was an adequate number of bath or shower rooms and toilets but some of these were in need of upgrading.

The staff we spoke with said that they worked well together as a team and covered both care and domestic work. Staff were always willing to work an extra shift when needed to cover for holiday or sickness. Twelve of the staff had achieved an NVQ in care at level 2 and five others were working towards this.

There were regular meetings for staff and for the people who lived at the home and the records showed that people were able to raise any issues they wished to discuss.