St Anne's Residential Home Limited

We found the following examples of good practice.

The staff were following up to date infection prevention and control guidance to help people to stay safe. The providers kept staff up to date through on-line training and the registered manager spoke to staff to update them. The registered manager ensured staff understood why every measure was in place.

The registered manager worked with the housekeeping team and care staff team to ensure infection prevention and control measures were followed.

The registered manager provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic. The registered manager ensured staff had access to additional support, including contact by phone and one-to-one meetings, with any emotional support needed in response to the pandemic.

Staff supported people to occupy themselves and provided activities whilst maintaining their safety. People who preferred to spend their time in communal areas were supported to do this whilst maintaining physical distancing.

Staff helped people to stay in touch with family and friends through phone and video calls. Visitors could also book appointments to visit people in a safe way. The designated visitors room was designed to keep both visitors and people safe.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of the precautions being taken, and how to keep people safe.

Further information is in the detailed findings below.

St Anne’s Residential Home Ltd provides accommodation with personal care for up to 37 people. There were 35 predominantly older people using the service at the time of our inspection. The service is situated in a rural area on the edge of the market town of Holsworthy, close to the town of Bude. The service has two floors reached by a passenger lift. It has been designed to accommodate people who may require specific aids and adaptations for their health and wellbeing. There are external grounds including a courtyard, which are private and not overlooked

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

People using the service consistently told us they felt safe and that staff were caring and respectful. Comments included “If I’ve got to live anywhere else I doubt they would be better”, “It’s a happy home” and “It’s not home but they do their best.” Relatives were also complimentary about the service.

We observed many kind and caring interactions between staff and people. Staff spent time chatting with people as they moved around the service.

Staff were proud to work at St Anne’s Residential Home and spoke of the people they supported fondly. Comments included, “The owners and managers see residents as a family” another said, “We are all one big family.”

Staffing levels had been increased since the last inspection. The management team continued to monitor staff levels to ensure there were sufficient staff on duty at all times to meet peoples current care needs. Staff and people were positive about the staffing levels. .”

All necessary recruitments checks had been completed and people were safely supported to take their medicines as prescribed.

The provider had effective safeguarding systems in place and all staff had a good understanding of what to do to help ensure people were protected from the risk of harm or abuse. People told us they felt safe.

Risks were identified, assessed monitored and reviewed.

Staff had received appropriate training and support to enable them to meet people needs.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The food provided by the service was enjoyed by people. Comments included “Its excellent” A relative told us “I feel [relatives name] health has improved due to her diet and the care she receives”.

People had access to a range of meaningful activities both in the service and in the local community that met their individual social and emotional needs.

People were involved in the development and review of their care plans. The registered manager was in the process of reviewing all the care plans to ensure they were more person centred and provided staff with enough information to enable them to meet people’s needs.

The service was well led. Management roles were clearly defined and there were effective quality assurance processes in place. People and relatives attended ‘resident meetings’ so that views on the running of the service could be shared. People were complimentary of the service and relatives told us, “Its five stars here”.

Audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Rating at last inspection and update:

At the last inspection the service was rated as Good (07 August 2017). At this inspection we found the rating remained as Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

St Anne’s is a care home for up to 36 people, some of whom were living with dementia. At the time of the inspection there were 34 people living at the service. This was the first inspection of the service since a change in its legal entity, from a sole provider to a limited company in December 2016.

The service is situated in a rural area on the edge of the market town of Holsworthy, close to the town of Bude. The service has two floors reached by a passenger lift. It has been designed to accommodate people who may require specific aids and adaptations for their health and wellbeing. There are external grounds including a courtyard, which are private and not overlooked.

At the time of the inspection visit the manager had been in post for three months and was in the final stages of their registration with the Care Quality Commission (CQC). This has since been completed. 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.

Systems for the operation and management of the service were being reviewed and audited to ensure they were suitable to meet the needs of people using the service and supported staff in carrying out their roles.

The service had moved to an electronic system to record care needs and interventions. Staff used electronic tablets to record all interventions of care and support. Generally, staff were familiar with the operation of the system. However, while the information was in place it was, at times, difficult to find. When we discussed this with the manager they were aware of these issues and were currently carrying out regular audits to pick up these instances and address them. This was important to make sure necessary information about the person that might have impacted upon the rest of the care plan, remained up to date.

Where appropriate and when available, relatives were included in the reviews of people’s care. A family member told us, “We are very involved in putting the care plan together.” People had access to healthcare professionals and their healthcare needs were met.

We reviewed the systems for the management and administration of medicines. There were suitable storage systems for keeping medicines safe and secure. Only staff with responsibility for medicine administration had access to medicines. There were clear records of medicines administered to people or not given for any reason. There had previously been a number of medicine errors. In order to ensure this was reported to the manager and acted upon there was now a medicine error record. A staff member told us they felt this was a good way of making sure errors were being managed safely and changes made through additional training where necessary. By introducing this system meant regular medicines audits were consistently identifying if any errors occurred.

We found two creams which had not been dated when opened. This meant staff would not be aware of the expiration of the item when the cream would no longer be safe to use. When raised with the manager they assured us it would be addressed with immediate effect.

The service acted within the legal framework of the Mental Capacity Act (MCA) and Deprivation if Liberty Safeguards (DoLS). 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.

There were enough staff to help ensure people’s health and social needs were met. People were treated with kindness, compassion and respect. Staff showed affection for the people they cared for. People were relaxed and happy and moved around the service freely as they chose. Staff were effectively deployed across the service and people’s needs were met in a timely manner. People commented; “I feel my relative is very safe here. I have no concerns when I walk away” and “There are always staff around when we call and that’s at different times and often.”

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse. Some training updates were needed to ensure staff had the current knowledge and skills to respond to safeguarding concerns. This was being arranged by the manager. Staff supported people to keep in touch with family and friends.

There was a programme of meaningful activities. For example on the day of the inspection people were enjoying a monthly luncheon club. A small number of people and guests were enjoying a meal together. A relative said, “It’s such a lovely idea. Everyone looks forward to it.” Staff were familiar with the types of activities people liked either as a group or individually. Where people wanted to stay in their rooms this was respected by staff.

Staff were supported by a system of induction training, supervision and appraisals. Staff training had been reviewed and training dates put in place. Staff had recently received training in moving people safely. Staff meetings were held to share information and encourage staff to make suggestions regarding any issues or ideas they may have.

We observed regular drinks and snacks including fresh fruit were provided between meals to ensure people received adequate nutrition and hydration. Comments from people who lived at the service were positive about the quality of meals provided. One person said, “Very happy with the choice of meals. I can be fussy but I am happy with the food.”

People told us they knew how to complain and would be happy to speak with the provider if they had any concerns. There were no complaints currently being investigated.

Systems had been put in place to take people’s views into account through face to face discussions and formal meetings. There had been no formal survey of the views of people using the service since 2015. This was now being addressed being addressed by the manager. This would give people and their relatives the opportunity to have their say and give their views about how the service was run and the quality of the service.

People using the service described the management of the service as open and approachable and thought people received a good service. Comments included, “I’ve always found the manager very approachable. We’ve got every confidence in how the home is run.”

Equipment and supply services including electricity and fire systems were being maintained.