Archived: St Claire's Nursing Home

At the last inspection on 1 and 3 November 2016 we found that the provider was not meeting the standards of care we expect. This was in relation to the provider not taking into consideration the complex needs of people and there were insufficient staff to meet people’s needs. Also people had not been involved in the formation of their care plans, which had not been updated or adhered to by staff.

We undertook this focused inspection on 1 June 2017 to check that the provider had followed their plan and to confirm they now met the legal requirements. During this inspection on the 1 June 2017 we found the provider had made improvements in the areas we had identified.

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 Claire’s Nursing Home on our website at www.cqc.org.uk.

St Claire’s Nursing Home provides care for people who require personal care. It provides accommodation for up to 40 people. At the time of the inspection there were 36 people living at the home.

There was not a 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 current manager had commenced her application to become the registered manager with CQC.

On the day of our inspection we found that the registered provider had ensured that sufficient suitably trained staff were available to meet people’s needs. They had taken into consideration the complex needs of people and people’s needs were reviewed on a regular basis so staff were working with up to date information.

People and where necessary their family or other advocates were involved in the planning of their care. Care plans were updated on at least a monthly basis. A new system was being put in place so staff could access information more easily in the care plans and accurately record information.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some having loss of memory.

The provider is currently in administration and a management company is overseeing the running of the homes in the group. The management company keeps CQC informed of progress and their visits to the homes and ensures we have an up to date action plan for each location.

There was not a 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. A new manager had just been appointed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was one person subject to such an authorisation.

We found that there were insufficient staff to meet the needs of people using the service. The provider had not taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed and care planned, but not delivered in a consistent way. People and relatives were not involved in the planning of their care and had not agreed to the care provided. The information and guidance provided to staff in the care plans was clear but not always followed through in the records. Risks associated with people’s care needs were assessed, but the plans were not always followed by staff. This could put people at risk of harm.

You can see what action we asked the provider to take at the back of the full version of the report regarding insufficient staffing levels and the use of care plans to monitor people's needs.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives.

Activities were on offer for people to take part in, which some people declined, but others enjoyed. People had the opportunity to join a residents committee.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements. Some checks were not robust enough and senior staff did not highlight mistakes to staff to ensure people were safe.

The people we spoke with told us their care was personalised to their needs. They told us they knew staff kept records on them but most had not seen those records. They told us staff had however discussed their care plans with them. One person told us, "Staff are very attentive to me and I get what I need."

Records told us what equipment was is use, how it was checked to ensure it was safe to use and how repairs were completed. Each person had been assessed who needed equipment to aid their well being. One person said, "I was assessed for a new wheelchair and occupational therapists came to see me and staff here have helped me get used to it."

There were rotas in place showing which staff were on duty each day and night. People told us staff were not always available to meet their needs. One person said, "I sometimes have to wait for my meals." Another person told us, "I use my call bell and sometimes have to wait, staff don't always give an explanation of why they have taken so long."

The complaints process was on display and people knew how to use it.

People told us they felt safe and secure. One person said, "I feel more secure than in my own home."

Everyone told us their assessed needs were always maintained and staff answered their call bells promptly. One person said, "They come quickly day and night when I press my call bell."

Records showed people had been involved in the planning of their care and were regularly asked about those needs and the running of the home. One person said, "I like to keep involved in the home."