Saint Jude Care Home

Saint Jude Care Home is a residential care home providing personal care to 18 people aged 65 and over at the time of the inspection, including people living with dementia. The home can accommodate up to 22 people. The home is a domestic style property located in the Blundellsands area of Liverpool. Accommodation is provided over three floors and people have access to two communal lounges, dining area and enclosed garden.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Governance arrangements were not always effective at identifying concerns. A range of audits were in place. However, they did not identify all concerns found during the inspection such as concerns found with care planning and medicines records and staff ability to competently apply the principles of the Mental Capacity Act (MCA).

At our last inspection, we made a recommendation for the provider to improve the analysis of accidents and incidents. The provider failed to meet this recommendation as concerns regarding the consistent analysis of incidents remained. The provider was reactive to safety related incidents and action was taken to reduce the risk of similar incidents occurring. However, due to the lack of analysis of themes and trends, the systems in place did not always promote a preventative approach to risk. The provider was responsive to the concerns and improvements to governance arrangements were made during the inspection.

People's individual risks were assessed, and measures were in place to reduce risk. However, records did not always reflect this. We raised our concerns with the provider who took immediate action to improve the records. Staff understood people’s needs and risks and knew what action to take to keep people safe from harm.

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. However, the policies and systems in the service did not always support this practice. We found systems were in place to assess, review and report on people's mental capacity and decision-making abilities. However, staff responsible for assessing people under the MCA did not have full understanding of the principles of the MCA.

Overall, we were assured people received their medicines as prescribed. However, multiple gaps on medication administration records (MAR) evidenced they were not always completed when medicines were administered.

Staff were knowledgeable about people's dietary needs. Most people provided positive feedback about the quality of the food and told us their preferences were met.

Staff were safely recruited and deployed in sufficient numbers to meet people’s needs. Staff received an induction and completed mandatory training to enable them to carry out their job roles. However, when additional training was required to meet people’s specific needs, such as training for managing periods of emotional distress, we noted completion rates were low amongst staff.

Safeguarding systems were in place and worked effectively to ensure people were protected from abuse. Environmental risks were identified, and systems were in place to carry out regular safety related checks on the environment and equipment.

The home was clean and hygienic throughout. Domestic staff were on site and worked hard to maintain a clean environment. The home was nicely decorated throughout. People's individual rooms were personalised with items of their choice.

The manager worked well with other healthcare professionals to ensure people achieved good health outcomes. When people's needs changed, records showed they were referred to external health professionals in a timely manner.

The manager demonstrated a commitment to ensuring people received person centred care. People, relatives and staff told us the manager and the provider were visible and felt they could approach them with any concerns they had. The provider understood the need to gather feedback from people and use this to improve the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 26 July 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

At our last inspection we recommended the provider strengthened their accident and incident analysis to ensure patterns, trends and themes were identified and used to improve the safety of the service. At this inspection, we found processes to analyse incidents was inconsistently completed.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saint Jude Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Saint Jude Care Home is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 22 people. The service is a domestic style property and accommodation is over three floors.

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

There had been improvements in the home since the last inspection. Accidents and incidents were recorded, and appropriate actions were taken to ensure people were safe. We could see reviews of these incidents had been implemented since the last inspection. However, further improvement was needed to ensure patterns, trends and themes were identified and effectively used to improve the safety of the service. We made a recommendation about this.

Risks to people were assessed and appropriate plans were in place to keep people safe. Risk plans provided staff with more detailed guidance on how to support people safely. However, further improvements were needed to ensure all plans were person-centred and reflected individual needs.

Recruitment procedures had improved, and staff were recruited safely. There were enough staff to meet people's needs. Staff told us things had improved at the home. Staff were positive about the support they received from the registered manager, and from the provider. Staff told us they felt there was more responsive action taken by management when they raised concerns.

Infection control procedures had improved. Staff wore appropriate personal protective equipment (PPE) and the home was clean throughout. Visiting was safe and followed current guidance.

Medicines were managed safely. Improvements had been made to ensure staff had appropriate competency checks to administer medicines safely.

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.

Governance processes had improved. Audits were completed and identified concerns at the home. Action plans were in place to improve the quality and safety of the service based on these audits.

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 10th December 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service was placed in special measures after the last inspection. 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

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Saint Jude Care Home' on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We have made a recommendation about the analysis of incidents.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Saint Jude Care Home is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 22 people. The service is a domestic style property and accommodation is over three floors.

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

There were significant concerns with health and safety which put people at risk of harm. We found multiple fire doors that did not close, no fire evacuation drills, no record of checks on emergency lighting and missing radiator covers. We raised concerns with the local fire service and the provider responded immediately to address these.

Risks to people were not always appropriately assessed or managed. Care plans did not contain enough information to support people safely. The manager had identified this concern when they started in August 2021 and had plans to review care records.

Medicines were not always safely managed. There was no appropriate medicines policy to support the safe management of medicines. Not all staff administering medicines had been assessed as competent. There was a lack of guidance for to staff on administering as and when needed medication (PRN) to people. This meant people were at risk of not receiving medicines when they needed them.

There were no systems in place to effectively and consistently analyse incidents to ensure learning could be implemented at the earliest opportunity to prevent reoccurrence.

People were at risk of being supported by staff that had not been recruited safely. There were not enough staff to meet people's needs. There were ineffective systems to determine staffing levels and not all staff had completed training necessary for their role.

People were not always admitted to the home safely following current COVID-19 guidance. Infection and prevention control policies were not updated to reflect the current guidance to ensure this was managed safely.

There was a lack of leadership, oversight and governance in the home. There had been changes in the management team since the last inspection with no effective handover completed with the manager.

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 requires improvement (published 8th January 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 8th January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and fit and proper persons employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saint Jude Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the assessment, management and mitigation of risk, recruitment processes, staffing and governance and oversight of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Saint Jude Care Home is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 22 people. The service is a domestic style property and accommodation is over three floors.

People's experience of using this service and what we found

Although the care and support being provided to people was person centred and staff knew people well, Saint Jude Care Home did not always suitably manage risk.

People were not always safe. Pre-employment checks for new staff were not robust and safe recruitment practices were not always followed. People were sometimes exposed to a risk of harm. There was no overview of accidents and incidents and environmental, health and safety checks and fire checks were not up to date.

Medicines were not always managed in line with good practice. We have made a recommendation about this.

The service was inconsistently led and managed. Assurance and auditing processes were missing or in not place, and those that were, were not always effective and did not adequately mitigate risk to the health and welfare of people living at the service.

Systems and processes for reporting incidents to CQC were not always effective, meaning that we were not always made aware of significant events at the service.

The registered provider began to address our concerns immediately following the inspection, showing they were responsive to making the required improvements, and that the safety and quality of the service was a priority.

People and their relatives spoke positively about the care and support received by staff. The service appeared well maintained and clean. There were enough staff to meet people's care and support needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was Good (published 15 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines management and governance. A decision was made for us to inspect and examine those concerns.

As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saint Jude Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

A range of risk assessments had been completed to improve the quality and safety of people’s care.

There was sufficient staff on duty to meet people’s needs. Staff rotas showed that staff numbers were consistent each week to meet people’s needs. The call bell was answered promptly for staff to attend to people when they required assistance.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

Medicines were stored and administered safely. Staff received medicines training.

Measures were in place to ensure the environment was safe and suitable for the people who were living there. We saw that repairs to the building were recorded and attended to in a timely way. The home was clean, hygienic and odour free. Accidents were recorded and reviewed each month to look at any ways to prevent reoccurrence.

Care plans were completed to demonstrate the support required and were regularly updated to reflect people’s current health and support needs.

Staff received a programme of mandatory training, which was updated as required and regular supervision. New staff received an induction.

People were supported to make their own decisions in relation to their care and support received whilst living at Saint Jude’s. The registered manager was knowledgeable about the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) process.

People were supported to eat and drink enough to maintain a balanced diet; we found they received sufficient quantities of food and drinks throughout the day and had a choice of meals.

An activities coordinator was employed by the home. A variety of activities were arranged which provided stimulation and social interaction.

We saw that the staff, registered manager and the owner/provider showed kindness and compassion towards the people in the home. Staff had a good knowledge of people’s needs and circumstances.

People who lived in the home had the opportunity to voice their ideas and suggestions. The registered manager and owner had implemented some of the changes requested by people.

People received personalised care that was responsive to their needs. Care plans were written for the individual and informed staff of people’s preferences and wishes.

There was a complaints procedure; people’s concerns and complaints received had been investigated and responded to in accordance with the procedure.

People were supported at the end of their life to have a comfortable, dignified and pain-free death. We saw people receiving end of life care were cared for well.

There is a registered manager in post. They understood their role and responsibilities and were well supported by the owner/provider, who played an active role in the running of the home. Quality assurance and governance processes were in place to help assess and improve the safety and quality of the service.