You are here

St Katharine's House Requires improvement

Reports


Inspection carried out on 30 May 2019

During a routine inspection

About the service:

St Katharine’s House is a care home that was providing personal and nursing care to 46 people aged 65 and over at the time of the inspection.

St Katharine’s House accommodates up to 76 people in one adapted building. One unit in the service specialises in providing care to people living with dementia.

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

People were protected from the risk of harm by staff who understood their responsibilities to report concerns. Improvements had been made to risk assessments and risks to people were managed effectively. There were sufficient staff deployed to meet people’s needs. Medicines were managed safely. Improvements had been made to ensure people were protected from the risk of infection.

There had been changes in the management of the service which had resulted in improved systems to monitor and improve the service. Everyone was positive about the manager and the person-centred culture they promoted. The manager was improving links with health professionals and the local community.

People’s care plans had been updated and reflected current needs. Care plans included people’s wishes relating to end of life care. People enjoyed a range of activities and were encouraged to participate in the life of the home. People and relatives were confident to raise concerns and all complaints were dealt with in line with the provider’s policy.

People enjoyed the food and specific dietary needs were met. Staff were well supported and had the skills and knowledge to meet people’s needs. The provider ensured people’s needs were met in line with current practice and guidance. People were supported to have access to a range of health and social care professionals.

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.

Staff were kind and compassionate. People’s dignity and privacy were respected, and their rights upheld. Staff ensured people were involved in all aspects of their care and respected their choices. People were encouraged to maintain their independence.

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 inadequate (published 18 December 2018) and there were two breaches of regulation. CQC took enforcement action to ensure the provider took action to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 18 December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 4 October 2018

During a routine inspection

This inspection took place on 4 and 9 October 2018. It was an unannounced inspection.

St Katharine’s House is registered to provide accommodation for up to 76 people who require nursing care. At the time of the inspection there were 55 people living at the service.

At the time of the inspection there was no registered manager in post. 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 last carried out an unannounced inspection of St Katharine’s House in December 2017. Following our inspection in December 2017 we published a report in which we rated the service as requires improvement. During our December 2017 inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). This related to incomplete and inaccurate care records. At this inspection we found that the service had failed to address the concerns.

There was not an effective system in place to monitor call bell response times. The provider's procedures to formally assess, review and monitor the quality of the service were not always effective.

Risk assessments were not always accurate, complete or up to date. People were not always protected from risk due to environmental hazards. Medicines prescribed to people were not always held in stock and were not always stored securely.

People were not always protected from the risk of infection. The premises and the equipment were not always clean, and staff did not always follow the provider's infection control policy to prevent and manage potential risks of infection. Equipment was not always maintained in line with manufacturer's guidance.

Records relating to people’s care were not always accurate and complete. Care records did not always contain guidance provided by other healthcare professionals.

Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who understood the dietary needs of the people they were catering for. However, people did not always receive person-centred support at mealtimes.

People we spoke with told us there was a constant change in management and that the service was not always well led. Staff had not completed training on planned dates to ensure that their knowledge and practices were up to date.

The service did not always respond effectively to people’s changing needs. Care records did not always capture person centred information about people's backgrounds, hobbies and interest and daily routines.

People had access to activities that included live entertainment. We observed people enjoying some live entertainment. People knew how to make a complaint and information on how to complain was available in the home.

The service supported people in line with the principles of the Mental Capacity Act (2005) and the service followed the correct procedures when depriving people of their liberty.

People and their relatives told us they benefited from caring relationships with the staff who supported them. There was good communication between staff and the people who used the service. Staff received regular supervision, which is a one to one meeting with their manager.

The overall rating for this service is 'Inadequate' and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel their 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 inadequat

Inspection carried out on 13 December 2017

During a routine inspection

We inspected St Katharine's House on 13 December 2017. The inspection was unannounced. St Katharine's House 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.

St Katharine's House is a care home providing care for up to 76 people. At the time of the inspection there were 59 people using the service.

At the time of the inspection there was no registered manager in post. 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 home manager told us they would be applying to register with the CQC.

People's care records were not always kept up to date and did not always reflect changes in their care needs. Records relating to assessed risks were not always kept up to date and care plans did not always contain up to date plans relating to how risks were managed.

There were sufficient staff deployed to meet people's needs. People commented on the number of agency staff working in the service and the provider was proactive in looking for ways to recruit permanent staff. Changes had been made to the rota for permanent staff to ensure there was an appropriate skill mix to meet people's needs.

People received their medicines as prescribed by staff who were trained and competent to do so. Infection control measures were in place to protect people from the risk of cross infection.

We saw people enjoying their meals and they were positive about recent improvements made to the food and drink. Where people had specific dietary requirements these were provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported through regular supervision and had access to training and development to ensure they had the skills and knowledge to meet people's needs. Staff felt valued and were involved in the development of the service.

People were treated with dignity and respect by staff who were kind and compassionate. People were complimentary about staff and had developed positive relationships with staff and others. We observed many kind and caring interactions where staff displayed their understanding of people's needs and knowledge of them as individuals.

There were a range of activities taking place during the inspection and we saw people enjoying them. People were positive about the activities team and the effort made to ensure people were able to access activities that interested them.

The manager was passionate about the service and was committed to making improvements. Staff felt valued and listened to and were complimentary about the manager and the changes they had made.

There was an open culture which was promoted through the provider's vision and values. People were seen as unique individuals and the service promoted a culture of inclusiveness that valued everyone as individuals.

There were systems in place to monitor and improve the service and we saw that where issues were identified action was taken to improve. However, the systems had not identified the issues we found during the inspection.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 3 December 2015

During a routine inspection

We inspected this service on 3 December 2015. This was an unannounced inspection.

St Katharine's House is registered to provide accommodation for 76 older people who require nursing and personal care. At the time of the inspection there were 47 people living at the service. The home is arranged into three units; Willow Walk provides care for people living with dementia, St Lukes Wing provides nursing care for people and the ground and second floor of the main building provide residential care for older people.

At a comprehensive inspection of this service in November 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponded with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook a focused inspection in May 2015 to check that the provider had followed their action plan and to identify if the service met legal requirements. Although improvements had been made, the inspection in May 2015 found continued shortfalls in relation to people’s care records which meant people were at risk of inappropriate care or treatment. We told the provider they must continue to make improvements.

At this inspection on 3 December 2015 we found action had been taken to ensure peoples care records accurately reflected the care, support and treatment people were receiving. People had been involved in reviewing their care. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. People were assessed regularly and care plans were detailed. Staff followed guidance in care plans and risk assessments to ensure people were safe and their needs were met.

A manager was in post and was in the process of registering with the Care Quality Commission to become the registered manager. 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.

People, their relatives, staff and visiting professionals felt the service was well led and were complementary about the manager and staff team. People felt involved in the running of the service. The manager was continually striving to improve the quality of care.

People felt supported by competent staff. Staff were motivated to improve the quality of care and benefitted from regular supervision, team meetings and training to help them meet the needs of the people they were caring for.

There was a calm, warm and friendly atmosphere at the service. People were cared for in a respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff knew people well and understood their individual preferences.

People were supported to have their nutritional needs met. People were complementary about the food and were given choice and variety. The menu was flexible to ensure people were able to have what they wanted at each mealtime. Where people required support to eat this was done in a dignified way.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people these had been legally authorised and people were supported in the least restrictive way.

Inspection carried out on 5 and 6 May 2015

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

We inspected this service on 5 and 6 May 2015. This was an unannounced inspection.

St Katharine's House is registered to provide accommodation for 76 older people who require nursing and personal care. At the time of the inspection there were 55 people living at the service. The home is arranged into three units; Willow Walk provides care for people living with dementia, St Lukes Wing provides nursing care for people and the ground and second floor of the main building provide residential care for elderly people.

At a comprehensive inspection of this service in November 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with three compliance actions in relation to staffing, equipment and quality assurance. We also issued a warning notice in relation to records stating the service must make improvements by 31 January 2015. After the comprehensive inspection, the provider wrote to us to say what they would do to continue making improvements to meet the legal requirements in relation to those breaches. We undertook this focused inspection in May 2015 to check that the provider had followed their action plan and to identify if the service now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Katharine's House on our website at www.cqc.org.uk.

This inspection was the eighth inspection of St Katharine's House since December 2012. At each inspection we saw changes had been made to bring the service up to the required standard but also highlighted further areas for improvement. There has not been a stable management team at the home during this time, which meant the improvements had not all been sustained or embedded in practice. At this inspection in May 2015 a new manager was in post because the registered manager had left the service three weeks prior to this 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 2008 and associated Regulations about how the service is run.

At this inspection people, relatives and staff were complimentary about the management team. The management team sought feedback from people and their relatives and was continually striving to improve the quality of the service.

There were continued shortfalls in relation to care records. Some care plans and assessments had not been completed or updated. Records did not always accurately reflect the care, support and treatment people were receiving. This meant people were at risk of inappropriate care or treatment.

Action had been taken to ensure there were enough staff to meet people’s needs. The manager had recruited further staff, reviewed people's dependency needs and looked at how staff were working together to meet those needs.

Equipment had been serviced in line with nationally recognised schedules and a plan was in place to ensure future services would take place when they were due.

Since our last inspection we had received concerns about how people medicines were managed. We were accompanied on this inspection by a specialist pharmacy inspector. The service was meeting the legal requirements in relation to medicines.

Although some of the required improvements had been made we have not changed the ratings for this service, because we want to be sure that improvements continue to be made and will be sustained and embedded in practice. We will check this during our next planned comprehensive inspection.

Inspection carried out on 17 and 18 November 2014

During a routine inspection

We visited St Katharine's House on 17 and 18 November 2014. St Katharine's House is registered to provide accommodation for 76 older people who require nursing and personal care. At the time of the inspection there were 53 people living at the service. The home is arranged into three units; Willow Walk provides care for people living with dementia, St Lukes Wing provides nursing care for people and the ground and second floor of the main building provide residential care for elderly people. This was an unannounced comprehensive inspection.

We have carried out six inspections of St Katharine's House in the last 18 months to follow up on areas of concern. At each inspection we saw changes had been made to bring the service up to the required standard but also highlighted further areas for improvement. There has not been a stable management team at the home during this time which has meant the improvements had not all been sustained or embedded in practice.

Our last inspection was in July 2014. Two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were identified at that time. These were in the regulations relating to consent and to records. The provider sent us an action plan and told us what actions they would take to rectify the breaches. We found actions had been completed in relation to consent.

There were continued shortfalls in relation to care records. Some care plans and assessments had not been completed and did not provide instructions to staff on how to support people. Some people’s food and fluid charts had not been completed accurately.

There were not always enough staff to meet people’s needs.  

People were at risk because equipment used to support people’s care had not been properly maintained. The six monthly services due on 5 September 2014 had not taken place.

Medicines were not always stored at the correct temperature because one of the fridges was not working effectively. We raised this with the registered manager and they took immediate steps to rectify the matter.

Improvements were required to ensure the service was effective by supporting staff to improve the quality of care through the appraisal process. The registered manager was developing a plan to ensure all staff would receive an appraisal.

Improvements were required to ensure the service was well led. The registered manager and provider did not have robust quality assurance systems in place.

There was a new registered manager who had been in post since August 2014. 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 registered manager had a clear understanding of the changes and improvements that were required. People, their relatives, visiting health professionals and staff recognised that improvements were taking place.

Staff were caring. People were treated with warmth and affection. People were supported with their personal care discretely and in ways which upheld and promoted their privacy and dignity.

People felt safe and told us they were supported by competent staff. Staff had completed a range of training to help them care for people’s specific needs. Staff were knowledgeable about people’s individual needs and preferences. They took the time to understand people where they had communication difficulties. People were supported to make decisions about their care.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.

Peoples nursing and health care needs were met. People were supported to eat and drink enough and to maintain their physical and mental health. Where required staff involved a range of other professionals in people’s care to ensure their needs were met. Visiting health professionals told us staff followed their guidance and were quick to identify and alert them when people’s needs changed.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 24 June and 1 July 2014

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

When we previously inspected the home on 25 November and 5 December we identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. The provider sent us an action plan to tell us how they would make improvements. We carried out this inspection to check the improvements had been made.

St Katharine's House is registered to provide accommodation for 76 older people who require nursing and personal care. The home is arranged into three units; Willow Walk, on the first floor of the main building provides care for people living with dementia, St Luke’s Wing provides nursing care for people with nursing needs, whilst the ground and second floor of the main building provide residential care for elderly people.

On the day of our visit there were 51 people living at the home. We spoke with ten people who used the service, three people’s relatives and twelve staff. We observed care and treatment and looked at ten care records. We also carried out a short observational framework for inspection (SOFI). A SOFI is used to capture the experiences of people who use the service who may not be able to express this for themselves.

The inspection team who carried out this inspection consisted of three inspectors and a specialist advisor in dementia care. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There was no evidence that care was not safe. However, although significant improvements had been made to peoples care records we found that some people were still at risk of inappropriate care because accurate and comprehensive information about their care was not being always being recorded. We spoke with senior management who advised us that the continued issues with the care records had been identified in the manager’s audit and raised at staff meetings. We have asked the provider to continue making improvements and we will return to the home to check these have been made.

Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The provider understood their responsibilities under the Mental Capacity Act 2005 in relation to the Deprivation of Liberty Safeguards (DoLS). The acting manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and told us that in light of the judgement they were reviewing whether some people would require a DoLS application to be made.

Is the service effective?

Effectiveness relates to how well the planned care works for people. Because record keeping was not always complete it was not possible to assess if planned care was always effective. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with nurses and care workers that they understood people’s care and support needs and that they knew them well. We found that nurses and care workers had received training to meet the needs of the people living at the home.

At our previous inspection we found that nurses and care workers did not demonstrate a good understanding of consent, mental capacity and how these applied to their practice, and to people's needs. At this inspection we found that the provider/service has made progress in supporting people to be involved in decision making, and further improvements are planned. However, they have not yet achieved this to a satisfactory standard and we would want to continue to monitor this.

We had also previously found there were not suitable arrangements in place to ensure that nurses and care workers were supported to deliver care through receiving appropriate supervision and appraisal. At this inspection we concluded that nurses and care workers received appropriate support to enable them to undertake their duties.

We have asked the provider to continue making improvements to the effectiveness of the service and we will return to the home to check these have been made.

Is the service caring?

The service was caring and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We spoke with people about the care they received. One person said, “I like living here, the carers are really nice”. Another said, “It’s absolutely perfect”. Another said, “there have been lots of changes, it’s been worrying because I’ve been here a long time, but it has been for the better”. We spoke with a relative who said, “staff are lovely, very caring, really know what they are doing”. Another said, “I am very pleased with the care, I can’t fault it”. During our SOFI observation we saw that people were given choices, supported to make decisions and care workers took time to understand people where they had communication difficulties. Throughout our inspection the atmosphere was pleasant and we observed many interactions between care workers and people that were caring, relaxed and friendly.

Is the service responsive?

The home was responsive. We saw evidence that nurses and care workers recognised when a person’s condition changed or their health had deteriorated and sought the help and advice of the medical team or other professionals.

We found that people were mostly engaged in meaningful activity. However, we found that people living with dementia on St Luke’s nursing wing did not benefit from the same type and level of activity as those living with dementia on the Willow Walk dementia unit and we have asked the provider to take note of this.

Is the service well-led?

We cannot say this service was well led, despite the improvements and changes that had been made. This was because this service is required by law to have a registered manager and has not had one since September 2013. The interim management team were continuing to take appropriate steps to improve the service and lead its development, however it was too soon to be able to see if these changes were embedded and sustained.

At our previous inspection we found that the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. Following our visit we issued the provider with a warning notice stating that they must take action to address these risks. At his inspection we saw that significant improvements had been made. We spoke with the acting manager who outlined the range of quality monitoring systems in place to review the care and treatment offered at the home. We saw evidence of how these quality monitoring systems were used to make improvements to the home. The provider may find it useful to note that although a monthly audit of the care records was completed a follow up of individual records did not take place to check that any identified actions had been carried out.

Inspection carried out on 3 March 2014

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

We visited St Katharine’s to follow up on concerns that had been identified with respect to people’s health and welfare. During our visits on 25 November and 5 December 2013 we identified specific concerns that related to some people who were at risk of choking. Following our visit we issued the provider with a warning notice stating that they must take action to address these risks, by 17 January 2014.

At our visit on 3 March 2014 we found that action had been taken by the provider in relation to the concerns raised. An assessment of the risks associated with one person’s choice not to follow professional recommendations with respect of drinking had been undertaken. Measures had been put in place to reduce and manage these risks. We spoke with care workers who understood the risks and were able to describe the actions they would take to ensure that people who were at risk of choking were safe.

During our visit on 3 March 2014 we also looked more broadly at the care and welfare of people who used the service. We spoke with seven people who used the service and three people’s relatives. People told us they were happy living at St Katharine’s House. Comments included; “you won’t get a better home than this” and “it’s very good. No complaints”. Relatives gave us a mixed opinion. Whilst one raised concerns that their relative was not supported to drink enough , others were very positive about the care provided. One said “staff are good, everyone knows her [their relative], knows how to look after her and they look after her very well”. We spoke with eight care staff, three kitchen staff and the senior nurse. Care staff told us there had been changes and improvements within the home, particularly with respect to planning and delivery of care. One said ““the care plans are so much easier to understand now. We had training on the care plans, a few months ago and now I know where to find all the information I need”.

We looked at how the risk of people not eating and drinking enough was managed within Willow Walk. We saw that people, who had been assessed as being at risk, were having their food and drink intake monitored. We saw that where concerns had been identified that people might not be eating and drinking enough, appropriate action had been taken. Professional advice had been taken and the recommendations made were being followed by care workers in accordance with those recommendations. We found some specific concerns with respect of one person and passed these on to the unit manager so that they could be immediately assessed. We saw that where management plans had been put in place with respect of people’s skin integrity, appropriate equipment was in place and care workers were acting in accordance with the plans. Care and treatment was being planned and delivered in a way that ensured people’s safety and welfare.

Inspection carried out on 25 November and 5 December 2013

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

On 1 October 2013 we had visited St Katharine’s House and identified concerns with regard to planning and delivery of care, particularly in relation to nutrition and hydration. We issued a warning notice stating that action must be taken by 13 November 2013.

We visited St Katharine’s House on 25 November 2013 and found that improvements had been made. Staff had received training in nutrition. We saw that people’s nutritional and hydration needs were being assessed and care was planned and delivered to ensure people drank and ate enough. However, we found that two people, within the nursing wing, were not having the risks to their health and safety fully managed. We asked the provider to take action and they did. We shared our concerns about one person with the local authority safeguarding team.

We returned to St Katharine’s House on 5 December to look more broadly at the systems in place for meeting people’s needs and addressing issues of quality and safety. There were three inspectors who looked at care in each of the three separate units; nursing, residential and dementia care. We found that the care in the residential and dementia units was reaching the standard of care expected. However, issues remained in the nursing wing.

56 people were living at St Katharine’s House, we spoke with 10 people, one relative and six members of staff. A relative said “it’s definitely a lot better”. People we spoke with said “I’m very happy here”; “it’s okay, it’s a good place to be” and another said “the care team work very hard at putting things [activities] on”. We found evidence across all three units that people’s needs were assessed and care and treatment was planned and delivered on the basis of those assessments. We saw that whilst improvements had been made to ensure care and treatment was delivered in a way that met people’s needs, sufficient actions had not been taken to address the safety needs of two people on the nursing unit.

As a result of the concerns about two people’s safety identified on 25 November, we looked more broadly at the systems the provider had in place to identify, assess and manage risks. The provider was not operating systems in a way that ensured that they always identified risks for themselves. We were concerned that the provider was not always identifying the potential for people to be unsafe. We were concerned that because systems were not effectively operated, the provider had not been able to address why they had not met the regulations, set out to ensure people received safe and effective care, since 2011.

We identified concerns in three other areas of care and have told the provider to take action. These were: the system for obtaining informed consent and acting upon it, the provision of appropriate supervision and appraisal for staff and the accurate keeping of records in relation to care.

We found that staff knew their responsibility with respect to safeguarding people and the service acted in accordance with their policy and in conjunction with the local authority.

We liaised with the local authority quality and contracts manager who had received reports from a number of professionals involved with St Katharine’s House. They concluded that significant improvements had been made to the way people’s care needs were being met. However, further improvements were required, specifically with respect of identification and management of risk. For that reason the local authority were continuing to not place any new people at the home. This means that they will not support anyone else to live at this home until St Katharine’s have made the required improvements. In addition they have put monitoring arrangements in place. CQC have received written confirmation that St Katharine’s House would not be admitting any new people through private arrangements until they had put in place systems to ensure people’s safety. CQC can take additional enforcement actions if this service does not identify and manage risks and meet people’s needs safely.

In this report the names of two registered managers appear who were not in post and were not managing the regulatory activities at this location at the time of this inspection. Their names appear because they were still registered managers on our register at the time.

Inspection carried out on 1, 2 October 2013

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

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We visited to follow up on two areas of non-compliance identified at our visit in May 2013. These were in relation to the planning and delivery of care and the maintenance and reliability of the lift. We also looked at how the service respected and involved people. We spoke with four people who used the service, one relative and looked at 10 care plans. People told us that they were happy with the care they received. However, records indicated that care was not being planned and delivered to ensure the welfare and safety of people.

The risks to some people from becoming malnourished or dehydrated were not always being managed in a way that sufficiently reduced or managed the risks.

We found that improvement had been made since our last inspection with respect to the environment and activities within Willow Walk, the unit for people living with dementia.

The lift had been unreliable for a long period of time and the provider told us that the lift had been refurbished and would be operating by 26 September 2013. On 1 October 2013 the lift was not working and repair work had not been completed. However on 2 October 2013 we were told it was working and we confirmed this by visiting and checking.

Inspection carried out on 15 May 2013

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

We found people were involved in making decisions about their care and treatment. People we spoke with said that they were able to make decisions about how they wanted to spend their day. One person said “they’ll let you sit up if you want to chat and watch TV. They’ve never forced us to go to bed”.

We found care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. Where risks had been identified these had not always been addressed. The variable quality of entries meant that nurses and care workers could not be sure that care was being delivered in line with individual care plans.

We found that the lift had been out of order on 11 occasions since our previous visit. We spoke with one person whose relative was disabled and used a wheelchair. Their relative had been unable to visit on a number of occasions due to the lift breaking down.

We found that staffing levels in the home had improved since our previous visit. One relative we spoke with told us “there was a time when there weren’t enough staff, six months ago”.

We found improvement in record keeping. Records were organised in a way that made easily accessible for care workers. One care worker told us “the files have improved and it is easier to find records in the file”.

Inspection carried out on 11 December 2012

During an inspection in response to concerns

People told us that there was an inadequate water heating system to the dementia unit. People asked us during the visit when the water was going to be put back on. During the inspection we witnessed one lady being assisted down the stairs due to the lift not working her comment during this process was ' what a to do '.

People we spoke with during the visit expressed concern about the number of staff available to work on the dementia unit. Concern was also expressed about the imminent departure of the unit manager. We also found that a newly installed bath was out of order and the sluicing facilities were also not working.We asked for an action plan. We were told the hot water was back up to heat the following day. No action plan was received for the installation of the bath or sluicing facilities.

We have made compliance actions.

The home has been placed on Red Alert by Oxfordshire Social Services Commissioning who will not place anybody in the home until improvements have been made.

Inspection carried out on 18 July 2012

During a routine inspection

The inspection was carried out on 18 July 2012 as part of the schedule of visits and included reviewing information about the service received by the Care Quality Commission (CQC) during the last 12 months.

The last inspection of the service by the commission was carried out in 2011 and we have received routine information about the service since that period.

At the time of the inspection visit the home was not fully occupied as there had been a programme of refurbishment in the residential area of the building. 65 of the 76 beds were in use. There were 15 people living in the unit which provided support for people with dementia. 25 people were living in the part of the home that provided nursing care. We met and spoke with five people who used the service, two visitors to the home and eight staff.

We observed staff speaking to people respectfully and saw they encouraged them to make decisions about what they wanted to do. We found that staff ensured that personal care was provided appropriately maintaining peoples privacy and dignity. One person said that the move to the home was the ‘best thing’ for them as their health had greatly improved since being admitted and they were ‘not on their own.’

People told us that there were enough staff on duty to support them. We were told that they did not have to wait too long if they called for assistance. We saw staff were always in attendance in the lounges and communal rooms when they were in use. Staff answered call bells promptly and responded to requests for assistance quickly.

People told us they felt safe living in the home. Comments had included, ‘very safe’, ‘I can speak to staff.’ And ‘there is always someone around.’

Inspection carried out on 23 June 2011

During an inspection in response to concerns

Some of the people we spoke to were concerned that they were no longer involved in the future planning for the service. They were also concerned as they thought that no one listened to their views. They told us that they received the support that they needed for personal care. However, they stated that they were not receiving the assistance to maintain their interests and social lives that they had enjoyed.

They told us that the food was not as good as it used to be. They felt there was a lack of choice at mealtimes. People told us that they thought the home was kept clean and tidy and they were generally happy with the environment. They did state that they were not confident about the lack of fire safety practices in the home.

People living in the home thought that there were less staff working there than previously. However, they were complimentary about staff and used words such as ‘super’ and ’remain pleasant and cheerful’.