Archived: St Edmunds Nursing Home

At the last inspection on 4 October 2016 we found that the provider was not meeting the standards of care we expect. This was in relation to the registered persons not taking into consideration the complex needs of people. Therefore there were insufficient staff to meet people’s needs.

We undertook this focused inspection on 18 May 2017 to check that they had followed their plan and to confirm they now met the legal requirement. During this inspection on the 18 May 2017 we found the provider had made improvements in the area we had identified. The legal requirement for Regulation 18 was now met.

This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Edmund’s Nursing Home on our website at www.cqc.org.uk.

St Edmund’s Nursing Home provides care for people who require personal care. It provides accommodation for up to 49 people. At the time of the inspection there were 49 people living at the home.

There was 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.

On the day of our inspection we found that the registered provider had ensured that there were sufficient staff on duty to keep people safe and meet their needs. The manager ensured that people’s dependency levels were reviewed on a regular basis, in consultation with each individual. Staff were consulted about the staffing levels and told us they felt their opinions were valued.

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.

There was 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.

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 them. At the time of our inspection there was no one subject to such an authorisation.

We found that there was 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 and delivered through the use of a care plan. People were not involved in the planning of their care and had not agreed to the care provided. Some family members were involved in the care planning process, but this was a small number. The information and guidance provided to staff in the care plans was not always clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe. Staff did not always follow the advice in the care plans through to daily charts and observations.

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. People were supported to maintain their independence and control over their lives.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information. People who preferred to stay in their bedrooms were not offered one to one activities due to staff shortages.

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. People told us meals were sometimes bland and they had no menus to refer to each day prior to their meals. Staff did not ask people if they would like protective clothing when eating their meals, but assumed they would want to wear plastic apron bibs.

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, however their views were not always taken into consideration when planning staffing levels, refurbishment of the environment and equipment needs. Quality checks had been completed to test whether services were meeting people’s requirements. These were not always effective as there was no system in place to ensue staff were following people's needs, understood the training they had undertaken and ensured equipment and the environment was safe to live and work in.

People told us they had seen their care plans and staff looked after them well. One person told us, "I couldn't ask for better care."

Since our last inspection the management, administration and recording of prescribed medicines had improved.

People told us staff were knowledgeable about their illnesses and there were always sufficient staff on duty to meet their needs. One person said, "Staff come when I want them to." The provider had policies in place to ensure staff were safe to work in the home prior to commencement of training and they were trained to do their job. Staff were supervised and felt their opinions were valued.

People told us they felt confident any concern or complaint would be dealt with quickly and they knew the process to follow. One person said, "Staff make it possible for me to raise even minor concerns."

At our last inspection of St Edmunds in August 2012 we issued a compliance action, as we were concerned records were not fully completed putting people at risk of not receiving correct care.

Following the visit we received an action plan from the provider to address the issues. In the action plan the provider said they would ensure the care plans accurately reflected the needs of residents and highlight the importance of record keeping with care staff. We carried out this visit to check whether the home had taken this action.

During this visit we spoke with the registered manager and deputy manager. We checked three care plans and checked on the progress the manager had outlined at the meeting.

We found record keeping had improved in relation to nutritional records; however we found some gaps in people's turning charts.

We did not intend to follow up on outcome 4, but when we were checking the records we observed people's care plans were not always clear and accurately reflect the needs of people.

We also looked at how medicines were stored and administered. We conducted an audit of medicines and we were unable to account for some medicines that we looked at as there was no recording system in place to enable this. We also found gaps in the records when medicine was administered. We found the systems in place did not protect people against the unsafe use and management of medicines.

During this visit we spoke with the registered manager and deputy manager. We checked three care plans and looked at the records of people's care.

When we were checking the records we observed people's care plans were not always clear and did not accurately reflect the needs of people.