Archived: St Pauls Care Home

We inspected St Pauls Care Home on the 22 and 26 May 2015.

St Paul’s Care Home provides accommodation, personal and nursing care for up to 25 older people, some of whom have limited mobility, are physically very frail with health problems such as heart disease, diabetes and strokes. There were people at St Paul’s also living with dementia and receiving end of life care. There were 20 people living at the home at the time of our inspection. Accommodation is arranged over three floors and each person had their own bedroom. Access to the each floor is gained by a lift, making all areas of the home accessible to people. St Paul’s Care Home is a large detached house in a residential area of St Leonards on Sea, close to public transport, local amenities and some shops. The service is owned by New Century Care Limited and is one of six homes in the South East.

We last inspected the home 25 July 2013 and no concerns were identified.

People commented very positively about the care and support received and their experience at St Paul’s Care Home. However, the inspection highlighted significant shortfalls that had the potential to compromise the safety of people in the service.

A manager was not in post following the resignation of the registered manager in March 2015. The organisation have placed a relief manager from the organisation in place until they have recruited to the 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 and associated regulations about how the service is run.

People’s safety was being compromised in a number of areas. Whilst people’s medicines were stored safely and in line with legal regulations, we found shortfalls in recording, poor administration and medicines for some people were out of stock for seven days. We also found poor recording of skin creams, dietary supplements and ‘as required’ medication.

Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as wound care did not have sufficient guidance in place for staff to deliver safe care. Guidance for staff to follow to deliver end of life care with specific directives from the GP and hospital were not recorded and therefore we were not assured that their needs were being met. Not everyone had risk assessments that guided staff to promote people’s comfort, skin integrity and the prevention of pressure damage. This had resulted in potential risks to their safety and well -being. Staffing levels were stretched and staff were under pressure to deliver care in a timely fashion.

The provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the MCA Code of Practice.

The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Where people’s health had changed considerably, care plans did not reflect the changes and therefore staff were uninformed of important changes to care delivery. Information was not always readily available on people’s life history and there was no evidence that people were involved in their care plan. The lack of meaningful activities for people at this time impacted negatively on people’s well-being.

Whilst people were complimentary about the food at St Paul’s Care Home, the dining experience was not a social and enjoyable experience for people. People were not always supported to eat and drink in a dignified manner. The meal delivery was not efficient and people told us they often did not get a hot meal at lunchtime.

Whilst some quality assurance systems were in place, we found other organisational quality assurance systems had not been completed, such as wound care and accidents and incidents. The quality assurance systems had not identified the shortfalls we found in the care delivery

Arrangements for the supervision and appraisal of staff were not effective. Although staff told us that meetings took place about concerns, regular supervision and appraisals, intended to monitor the training, on-going development and the competence of staff, had lapsed.

Whilst the overall maintenance of the home was adequate, only one communal shower was working and no bath was available for use if people wished a bath.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated they had built rapports with people and people responded to staff with smiles. However we also saw that many people were supported with little verbal interaction and many people spent time isolated in their room.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by St Paul’s Care Home all had registration with the nursing midwifery council (NMC) which was up to date.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches 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 this report.