Fern Brook Lodge

We found the following examples of good practice

A robust process was in place to help ensure visitors did not bring COVID-19 into the home. This included lateral flow tests and confirmation of vaccination status. People’s comments included, “I feel safe from the pandemic”, “COVID-19 is not one of my worries here. I feel safe” and, “I’ve got nothing to fear here.” A relative added, “They have everything covered.”

People and their relatives told us the home were supporting regular visits. One person told us, “My [relative] visits a couple of times a week.” A relative offered, “I feel safe when I go, and I feel my [family member] is being kept safe. You can stay as long as you want.”

People told us they were supported to have regular COVID-19 tests. Visitors and staff each had a dedicated room for this procedure. One relative said, “I’m an essential care giver and do the PCR testing on a Monday and Friday. That has meant I can see my [family member] every day.”

The home was visibly clean throughout with no malodours. Staff carried out frequent cleaning including of high touch point areas such as handrails, door handles and keypads. Records were kept of this with these spot checked by the registered manager. One person told us, “They clean the home regularly including the bathrooms.” A relative said, “There is always a cleaning team around the home.”

People told us they had been supported to have all the required COVID-19 vaccinations. Records confirmed this.

Staff were following current government guidelines with regard to wearing personal protective equipment (PPE). A relative said, “I’m in here every two days and staff are always wearing the PPE. They seem to be following all the rules.”

St Martins Grange is a care home providing personal and nursing care for up to 75 people aged 65 and over. At the time of the inspection they were supporting 22 people. The service is split over two floors which were all accessible by stairs or a lift.

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

The management of the service had experienced a long period of instability. Since the last inspection this had improved with the appointment of a management team including an experienced and enthusiastic registered manager. There were now robust governance systems which provided improved oversight and confidence in the quality of care people received.

A new accidents and incidents process had been introduced which was helping to reduce the risk of people coming to harm. Thorough analysis was helping to identify causes and trends with learning then shared with staff and the people affected.

Improved auditing was taking place in a number of areas including care plans, call bells, health and safety and infection prevention and control. At the previous inspection we noted identified actions were not always followed up. Action was now taken consistently.

People, relatives and staff spoke positively about the changes at the home and felt there was a joyful atmosphere and improved staff morale. People and relatives said they felt listened to and involved. They expressed confidence in the registered manager and deputy manager. A relative said, “It’s changed so much. It’s a fantastic home.”

Medicines were managed safely by staff who had received the necessary training and ongoing competency assessments. Where people’s needs changed timely referral was made to health and social care professionals including GPs, community nurses and dentists.

There were enough staff on duty. The home regularly completed a dependency tool to help match staffing levels to people’s needs. Staff received regular supervision and annual appraisals which were used as an opportunity to reflect on their practice, career aspirations and care industry developments.

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. Staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and how it translated into the care they provided for people.

People told us the staff treated them with kindness, respect and compassion. Our observations confirmed this. Staff had got to know people well which supported mutually beneficial interactions. One person said, “It’s marvellous here. They [staff] couldn’t do anything more for me.”

The home had established and maintained good working partnerships with other agencies and community organisations such as GP surgeries, a local authority quality improvement team and a dementia charity. The latter link demonstrated the home’s contribution to helping change society’s perception of people living with dementia.

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 9 July 2019).

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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to accommodate up to 75 people and provides care, treatment and support for older people. The service is split over three floors which were all accessible by stairs or a lift. There were 45 people using the service at time of inspection.

People’s experience of using this service

The management of the service had been unstable, there had been three managers since the last inspection. This meant that governance systems had not been effective. People, staff and relatives commented negatively about the unstable management but were positive about the recently appointed management team.

Safeguarding processes were managed to keep people safe from harm and abuse. Staff received training and knew who to report concerns to.

Accidents and incidents were not always managed correctly which meant people were at risk of harm. Analysis took place however the data used for this was not always accurate or up to date.

Medicines were managed safely as staff had their competency assessed.

There were enough staff on duty. The home completed a dependency tool to support their staffing levels. Staff were recruited safely, and the necessary checks carried out before they started work.

The home involved people, relatives and staff in the service by holding meetings and sending questionnaires.

The home worked well in partnership with others and continued to build community links.

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 January 2019). We issued a warning notice at the last inspection requiring the provider to make improvements to safeguard people from abuse we also asked the provider for a report detailing how they would ensure good governance of the service. At this inspection although some improvements had been made, the provider was still in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether improvements had made as required at the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led.

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 has not changed. 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 St Martin’s Grange on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the governance of the service.

Follow up

We will continue to monitor the service and will undertake another inspection to ensure improvements have been made and sustained.

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

People living at St Martin’s Grange receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to accommodate 75 people and specialises in providing care, treatment and support for older people. The service was split over three floors which were all accessible by stairs or a lift. There were 57 people using the service at time of inspection.

We last inspected St Martin’s Grange in November 2017. At that inspection the service was rated overall requires improvement with a rating of good in caring. At our last inspection we found that there were breaches in regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the third consecutive time the service has been rated requires improvement.

At this inspection we found the provider had made improvements to meet the requirements of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some improvements had been made but further improvements were required to demonstrate how the provider was meeting the requirements of regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not always protected from avoidable harm as safeguarding concerns had not been identified by management staff and referrals were not made to the local authority in a timely manner.

The registered manager had left the service and we had not received notification of this.

Accidents and incidents were not always reviewed and analysed to identify actions or trends.

There were quality assurance and auditing processes in place but they were not always effective. The service carried out a number of audits including infection control and medicines management, However, some audits had not always been completed or actions carried out fully. Following the inspection the interim manager supplied evidence that the outstanding audits had been completed and were up to date.

Improvements had been made to infection control procedures. However, actions identified in the audit were not carried out. People knew their responsibilities about the prevention and control of infections within the service. Staff had received training and there was protective equipment readily available.

Improvements had been made to risk assessments and they were individual and detailed which meant that staff understood safe practices which helped keep people safe.

Improvements had been made and medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with regular audits undertaken by clinical staff to ensure safety with medicines.

Staffing levels were adequate to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. Registered nurses had the necessary permissions to practice.

The service understood their legal responsibilities for reporting and sharing information with other organisations but this was not always identified and done in a timely manner.

People had been involved in assessment of their care and support needs. They had their choices and wishes respected. The service had made improvements to work in partnership with professionals.

People were involved in what they had to eat and drink and were encouraged to do this independently. People were happy with the quality, variety and quantity of the food.

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 supported this practice.

The service actively sought to work in partnership with other organisations to improve outcomes for people using the service.

Care and support was provided by staff who had received an induction and continual learning that enabled them to carry out their role effectively including clinical training for registered nurses. Staff felt supported by their colleagues and were confident in their work. However, supervisions with management staff were not regular in some cases.

People, their relatives and professionals described the staff as kind and caring. People had their dignity and privacy respected and their independence promoted.

People had their care needs met by staff who were knowledgeable about their individual needs and how they communicated.

People had access to a wide range of both group and individual activities within the service. The service was working to involve people in the community.

The service had a complaints procedure and people were aware of it. People knew how to make a complaint and felt comfortable to do so.

The service had made improvements and a variety of activities were available and people could decide what they wanted to do. The service actively encouraged people to be involved.

Relatives were happy with the service. Professionals told us their confidence in the service was improving. The interim home manager and had an open, honest and positive culture that encouraged the involvement of everyone.

The service had undergone recent changes to the senior management but leadership was visible within the home. Staff spoke positively about the new management team and felt support was improving. The senior nurse actively kept themselves updated. The service was being supported by a peripatetic home manager who was supporting training within the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.

This inspection took place on 14, 16 and 23 November 2017 and was unannounced.

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.

We last inspected St Martin Grange in June 2017. At that Inspection the service was rated overall requires improvement with a rating of good in caring. At our last inspection we found that there were breaches in regulations 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found the provider had made improvements to meet the requirements of regulations 9 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some improvements had been made but further improvements were required to demonstrate how the provider was meeting the requirements of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements had been made to how risks were identified and managed. However further improvements were required to ensure risks to people were consistently monitored and managed.

Staff knew how to identify and respond to abuse. They knew which agencies they should report concerns about people's care. However not all concerns had been shared with the local authority. The provider took action to report these concerns during our inspection.

People received their medicines when required but some improvements were required to the recording of prescribed creams. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

Improvements had been made to the cleanliness of the home and training and guidance had been provided to staff on their responsibilities for infection control. However further improvements were required to support staff understanding of their roles and responsibilities in relation to infection control and hygiene.

People had care plans which contained detailed information about their needs and interventions required. Improvements had been made in planning and reviewing of people's needs but further improvements were required to ensure all care plans were detailed and relevant. People’s preferences and choices for their end of life care were discussed with them and recorded in their care plans.

Improvements had been made in developing opportunities for people to attend activities in the home. Further improvements were required to support people to follow their own personal interests.

People received support to ensure they had enough food and drink. However improvements were required in the monitoring of food and fluids.

The provider had systems to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and incidents and accidents. We found the audits were not always effective at identifying shortfalls in the service. Improvements were needed to make sure quality monitoring processes were effective in identifying and addressing shortfalls in the service and improving the service people received.

People told us they felt the service was well managed. Improvements were required in how the home worked with visiting health care professionals and how staff were supported.

At the last and this inspection people told us staff treated them with kindness and respect. People told us they felt safe living at St Martins Grange

Staff communicated with people in accessible ways that took into account any sensory impairment which affected their communication.

People were supported by staff who had been through robust checks on their suitability to work in the home.

The provider had systems in place to learn from safety incidents and concerns.

Improvements had been made to the environment to meet the needs of people with dementia and promote their independence.

Staff told us they had under taken training that provided them with the necessary knowledge and skills. They understood how the Mental Capacity Act 2005 provided a framework for the care they provided and encouraged people to make decisions about their care.

People had access to health care professionals and were supported to maintain their health by staff.

The provider had arrangements in place to respond to complaints and a complaints procedure. The provider had systems in place to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.

We inspected St Martin Grange November 2015. At that Inspection the service was rated overall good with improvement required in well led. At this inspection we found some improvements were required.

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.

The provider had systems to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service. Improvements were needed to make sure quality monitoring processes were effective in identifying and addressing shortfalls in the service and improving the service people received.

People were at risk as individual care records were not consistently kept up to date or instructions from other health professionals followed. Where risk assessments were in place they did not always contain accurate guidance for staff to safely support the person.

People's health was monitored by registered nurses and senior staff to make sure they received effective care and treatment to meet their physical and mental health needs. However records had not been consistently completed in line with care records. One health professional told us, “Documentation is poor, there seems to be an overall problem in regards to staff being able to ensure records are kept up to date”.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. New members of staff received an induction which included shadowing experienced staff before working independently. However there was currently a number of vacancies which meant many shifts were being covered by agency workers.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. Where concerns were identified with people’s nutrition, staff sought support from professionals such as GP’s and speech and language therapists. However the guideline provided was not always followed. Where people required special diets due to risk of choking, we observed guidance was not always followed.

Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely and medicine administration was recorded on an electronic system. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff said they knew how to report any concerns, and people who lived at the home said they would be comfortable to discuss any worries or concerns with staff.

People’s relatives told us they were made to feel very welcome when they visited St Martins Grange, they could visit at times convenient to them, there were no set visiting times or unreasonable restrictions.

People and their relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. The provider had systems in place to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.