St Denys Care Home

We found the following examples of good practice.

The provider had established cleaning routines which were well documented and ensured all parts of the service were cleaned throughout the day.

Staff had clear infection control policies to follow and wore personal protective equipment (PPE) appropriately. We observed staff using PPE and saw there were PPE stations throughout the home where staff could easy access it. People said staff were diligent in wearing masks all the time. One person commented “They are on top on this, they know exactly what they are doing.” Another said “This is a great place to live I feel very safe.”

People were supported to have visits with their friends and family and visitors were asked to test for COVID-19 and to wear PPE throughout their visit.

The service had developed a testing regime for staff and people living at the service, in line with government guidance.

Rating at last inspection

At our last comprehensive inspection completed in November 2017 we rated the service as overall requires improvement with requirements in recruitment and good governance. In October 2018, we followed up with a focussed inspection to check they were meeting therequirements we had set. We found they had been met, which meant their overall rating had improved to Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

The service had a registered manager who was also the registered provider. 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 said they felt safe and well cared for by a staff group who understood their needs.

Care and support was being well planned with good liaison with healthcare professionals where needed. One healthcare professional said “I have been impressed with the way they have helped (name of person) settle in. They are doing better than I expected.”

People were supported by sufficient staff with the right skills. Staff treated people with respect and dignity. Care and support was being delivered in a kind and compassionate way.

Staff had support and training to help them do their job effectively. They felt valued and listened to. Staff said there was a good team work approach within the home. They worked in a way which encouraged people to retain as much independence as possible. Risks had been clearly identified and where needed measures had been put in place to reduce those risks.

People were supported to maintain a healthy balanced diet. Healthcare needs were monitored. Some people were supported to attend appointments and access the local community. Most people had a level of independence which meant they could organise their own social outings. Some activities were organised in house and for group outings to the local amenities.

Systems and audits ensured the quality of care and support were being reviewed and improved. People were enabled to have their voice heard.

Further information is in the detailed findings below

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection

Following the last inspection, we met with the provider to discuss their action plan. This included what they would do and by when to improve the key question(s) of well led and safe to at least good.

We found both key areas had improved to good and the breaches we identified had been met. Recruitment was robust and ensured correct checks and references had been obtained before a new staff member had been recruited. Improvements had been made to medicine storage. This included a air conditioner which kept the storage area cool at all times. Improvements had been made to the laundry area and the way laundry was handled. This ensured better infection control processes were in place. Improvements had been made to the governance systems. This included more regular audits and checks on records and provision of care to people.

St Denys is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 12 people in an adapted building. At the time of inspection, there were 11 people living at St Denys.

The registered provider is also 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 said they felt safe and well cared for. Comments included "This is the best place ever." Another said "We are very well looked after."

There were sufficient staff with the right skills to meet peoples needs. Staff felt valued and supported to do their job.

People risks were being well managed.

Staff understood what constitutes abuse and who and when they should report any concerns. they had received training and there were policies and procedures to direct them what to do if the registered manager was not available.

The home was clean and well maintained. There was a programme of refurbishment which had included improvements to the laundry, new carpets in some areas. The registered manager said this as a continual programme. They had recently repainted the front of the home and improved the patio leading to the laundry area.

Following the inspection, we also met with the provider and asked them to complete an action plan to show what they would do, and by when, to improve the key questions ‘Is the service safe?’; ‘Is the service effective?’; Is the service responsive?’ and ‘Is the service well led?’ to at least good. After the meeting, the home submitted an action plan showing how they were going to address each of the breaches. The action plan recorded that they expected to have completed all the actions and be compliant with the regulations by the middle of June 2017. This inspection was carried out to see whether they had made the necessary improvements to meet the relevant requirements.

St Denys is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 12 people in an adapted building. At the time of inspection, there were 11 people living at St Denys.

At this inspection, we found there were some improvements to the service, which meant the provider was now meeting some of the regulations. However, some improvements were still needed as we identified continuing breaches of three regulations. We have therefore rated the service as still requiring improvement overall. This is therefore the second consecutive inspection where the service has been rated Requires Improvement. The breaches of regulation at this inspection were related to quality assurance, staff recruitment and safe care, particularly in relation to infection prevention and control.

People and their relatives said they liked the home and the staff. Comments included “Won’t hear anything but good from me about this place”; and “Made friends so I’ve got company. Excellent food. Can’t think of anything to improve.” A relative commented “Very lovely staff…always helpful and chatty.” Health and social care professionals who visited the home said they thought there had been improvements to the home. A professional commented they thought the home was “Very good.”

The service had a registered manager who was also one of the providers. 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 was present in the home on most days of the week. They worked alongside staff which gave them an insight into working practices. The registered manager provided supervisions and appraisals to staff. This gave staff an opportunity to reflect on their work as well as identify training needs. The other provider visited the home each week and also worked in the home on some weekends. They provided a second tier of quality assurance in the home.

There were sufficient staff to meet people’s needs. The provider kept staffing levels under review to ensure they were able to support people to go to appointments and other events, when needed. However staff had not always been recruited safely. There was insufficient evidence to show that new staff’s employment history had been checked including any gaps in employment. References had not always been checked to ensure they were genuine. After the inspection, the registered manager sent us a new policy and procedure for recruiting staff which addressed these issues.

Staff had undertaken training to support them in their roles. New staff had received an induction which included training and working alongside experienced staff, shadowing to gain experience.

Staff had received training on how to safeguard vulnerable people and knew how to safeguard people from abuse. Staff understood how to report any safeguarding concerns they had. The registered manager understood their responsibilities to inform the local authority safeguarding team and submit notifications to CQC in line with regulations.

Most areas of the home were well maintained and kept clean and hygienic. However some areas needed refurbishing, including the laundry room, which posed a risk of infection. There were infection control risks as there were not appropriate procedures for staff to follow when undertaking laundry duties. By the end of the inspection, some improvements to the laundry area and the laundry procedures had been implemented.

Medicines were generally administered, stored and recorded correctly. However, the registered manager had not taken action when the temperature of the medicines room had been above the recommended storage temperature.

People had care plans which they had contributed to. Care plans were personalised and described people’s risks, needs and preferences. They gave guidance to staff about what they should do to support people with their care. Staff were very knowledgeable about people’s background, history and current presentation. Staff were able to describe how they supported people with their care which reflected what was in the care plans. Staff had received training in, and were aware of, the requirements of the Mental Capacity Act 2005; staff were able to describe what they needed to do to work within the Act. -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 support this practice

Throughout the inspection, staff showed concern and patience with people. Staff interacted with people in a kind and friendly way. Staff respected people’s dignity and right to privacy. People said they liked and felt supported by staff. Staff communicated using signs and by writing information down for one person who was unable to communicate verbally. There were regular resident meetings where people were able to put forward suggestions and ideas about the home and the activities they wanted to do.

People were supported to have a varied and healthy diet, eating food of their choice. People were involved in menu planning and choice of dishes offered. People were encouraged to get involved in food preparation. People were able to access drinks and snacks throughout the day. Where they were unable to get their own drinks, staff regularly offered them refreshments. People were supported to access their GP and other health professionals. Where necessary, people were supported to attend appointments.

The home had a procedure for staff to report incidents and accidents. These were reviewed by the registered manager, who considered ways to reduce the risks of recurrence. There was a complaints policy. People and relatives said they knew how to complain, but said they had not needed to. There had been one complaint which had been investigated and resolved.

We found continued breaches of regulations 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. We have also made recommendations about assessing environmental risks and the medicines policy. We will arrange to meet with the provider to discuss the findings and explain the actions we may take if the service continues to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

At the last inspection in December 2015 the provider was not meeting all the legal requirements in relation to staffing levels. We issued a requirement to ensure improvement. We asked the provider to take action to make improvements to staffing levels. We requested a report to say what action had been taken, however, no report was received.

This focused inspection took place on 6 December 2016 and was unannounced. Before the inspection we were made aware of concerns about the governance at the two GP practices which are owned and managed by the same providers. We also received concerns about staffing levels and unsatisfactory levels of activity for people using the service. As part of this inspection we looked at these concerns and found there had been no improvement to staffing levels. As a result we decided to change the focussed inspection into a comprehensive inspection. A second announced visit took place on 20 December 2016.

At the time of the inspection there were 11 people living at the service. This included one person who lived independently in an upstairs flat. The other 10 people had private bedrooms and shared living space consisting of a kitchen, dining room and sitting room. There was also an additional kitchen for people to make themselves drinks and a small conservatory in the backyard. This was used as a smoking room.

There was a registered manager in post who was also one of the two registered providers. 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 provider had not carried out an analysis of need and risk as the basis for deciding sufficient staffing levels. As a result, staffing levels were insufficient to fully support people’s needs. With only one member of staff on duty during the afternoon shift, this meant that activities for people were curtailed, as the member of staff had to undertake cooking, housekeeping and cleaning duties. There was no spare capacity to support people living at the service to undertake rehabilitation activities as part of the goal of achieving independence.

Staff and healthcare professionals commented on the absence of the registered manager who worked part time at the service. A lack of managerial presence had resulted in poor communication. Limited managerial time available meant that various quality assurance checks were not being consistently maintained. Auditing systems were not always being used nor being consistently monitored and reviewed to mitigate risks to people using the service.

An undertaking made at the time of the previous inspection in December 2015 to protect managerial time for the deputy manager had not been kept. Poor record keeping meant that it was not possible to establish that recruitment practices were consistently safe, nor which staff had received what training, including safeguarding and safe medicines administration. .

The service provided was kind and caring. People living at the service enjoyed the freshly prepared food and felt they were treated with dignity and respect by care workers.

People all had individual care plans which reflected their individual needs and wishes. Risk assessments had been undertaken on each individual but were not always reviewed and updated in a timely way.

The service had established relationships with local healthcare services so that people living there could benefit by receiving care as required. People received their oral medicines as prescribed.

However, not all aspects of the management of medicines were safe, in particular the use of prescribed creams and homely remedies. The registered manager understood the requirements of the Mental Capacity Act 2005, but not all staff understood the principles.

During the inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 CQC (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of this report.

We will be meeting the provider to discuss the findings of this inspection and will be visiting again within six months.

We spoke with eight people during this inspection. We heard how they were involved in the everyday running of the home, helping with cleaning, cooking and shopping. Everyone expressed satisfaction with their care and support. We heard from one person who was newer to the service about how they had been assisted to settle into their new environment. They told us ''staff have been very kind and helpful, I am glad to be here as I feel much safer now.'' Another person told us ''They staff are all good, they help me with my showers and look after my medications. They are a good lot.''

We saw care and support was being well planned and staff had training and support to do their job effectively. There is no registered manager in post at present, but the provider has put in place some interim arrangements to ensure care plans and risk assessments were being kept up to date. Staff we spoke with confirmed they were having regular meetings and supervision sessions to enable them to have in put into how the home was being run.