St Edmunds Residential Home

We found the following examples of good practice

The provider ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors on arrival.

There was enough PPE such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. Staff had undertaken relevant infection control training.

Staff and people were tested regularly for COVID-19. People were offered the choice to self-administer the tests if this was their preference. The registered manager told us ways in which they engaged with people to ensure they understood the need to comply with measures to minimise the risk of infection to themselves and others.

Staff had worked as a team to help promote people's wellbeing throughout the pandemic. We observed lots of positive interactions between staff and people.

St Edmunds is a residential care home providing accommodation and personal care to 37 people. The service can support up to 39 people. The majority of people living in the service were older adults.

The building was large with accommodation over three floors. There were two lifts and two stairwells granting access between the floors. There were variations in levels on all floors which were mostly accessed by means of shallow ramps.

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

Recruitment systems were in place; however, we found some checks on documentation needed to be more robust.

People were supported with their eating and drinking, and care plans were in place which included their preferences and any specialist dietary needs. However, where people were at risk of losing weight documentation needed to be clearer, so external professionals could determine treatment plans. Further training is required so staff understand the importance of this.

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. Some improvements were however needed to ensure that appropriate documentation was completed accurately and contained the most up to date information.

People told us they found their care and support to be safe and were satisfied with the care they received finding staff to be kind and caring. Staff were aware of their responsibility in relation to the reporting of any abuse. Newly appointed staff received induction training and worked alongside experienced members of staff.

People had access to activities provided by an activity co-ordinator. However, some people told us improvements were needed at the weekends, and we have made a recommendation about this.

Care records contained some person-centred information but were not always accurate. Staff were however able to tell us people's current needs and preferences.

There were governance systems in place which included quality audits. However, some had not identified the issues we found and therefore need to be strengthened in some areas. The registered manager and operations manager acted promptly to rectify areas identified as needing improvement, both during and following the inspection.

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 9 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 St Edmunds on our website at www.cqc.org.uk.

Enforcement

We have identified one breach in relation to 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 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 new manager was in post and an application for them to become registered was being processed by CQC. 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.

At our last inspection in June and July 2016, we found the provider was in breach of four of the

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

People were safe living in the home. The provider had completed the required remedial works to ensure the safe management of water systems and staff had completed training in Legionella.

The systems for medicines management and administration had improved. Medicines were managed safely and people received their medicines as prescribed. An air conditioning unit had also been installed in the medicines room, to ensure medicines were stored at the correct temperature. Staff who administered medicines had undergone competency assessments.

The management team were using a dependency tool to help ensure sufficient staff were on duty to meet people’s needs. Additional staff had been recruited to cover identified shortfalls in staffing levels. Staff deployment and staff breaks had been revised, to ensure enough staff were available to support people during mealtimes.

A proactive and positive approach to risks was being taken by staff and the management team. Staff and the management team worked collaboratively with other professionals to ensure risks to people were managed properly. Risk assessments had been reviewed and updated with people and their GPs, in respect of any possible adverse effects caused by drinking alcohol when prescribed certain medicines.

Infection prevention and control was being managed safely. The domestic team worked in accordance with advice received from the NHS Infection Prevention and Control Team.

Risks were identified and appropriate risk assessments were in place with regard to protecting people from developing pressure sores. Staff had received training in care planning and the format of care plans had been revised to ensure information regarding such risks would not be missed.

The risks to people from not eating or drinking enough were well managed. People’s weights were being recorded appropriately, to ensure people were protected from the risk of malnutrition and people had easy access to drinks when they wanted them. Staff had received training to ensure the correct and complete recording of people’s food and fluid intake and the management team ensured these records were appropriately maintained.

People were offered choices of food and drinks at mealtimes and menus were available in the dining and communal areas. The cook maintained an up to date list of people’s dietary requirements and diabetic diets were catered for appropriately.

Staff were recruited in a way that ensured proper checks were carried out. This helped ensure only staff who were suitable to work in care services were employed.

Staff knew how to recognise different kinds of possible abuse and understood the importance of appropriately reporting any concerns or suspicions that people were at risk of harm.

Staff were being trained well and were competent in meeting people's needs. Staff understood people's backgrounds and preferences and supported people effectively. New staff were required to complete a probationary period and induction and all staff received supervisions and appraisals of their work.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements had been made in this area. Staff and the management team understood the MCA and DoLS and how to provide support in accordance with it. People were supported to understand and make decisions regarding their care and support needs.

Staff understood the importance of supporting people to make their own choices regarding their care and support. Staff consistently obtained people’s consent before providing support and, if people lacked capacity to make some decisions, staff understood how to act in people’s best interests to protect their human rights.

Staff had developed respectful and caring relationships with the people they supported and consistently promoted people’s dignity and privacy. People were able to choose what they wanted to do and when. People were also supported to develop and maintain relationships with their friends and families.

Care plans had been revised and updated. These were accurate and were being reviewed regularly with people. Care plans provided guidance for staff on how to meet people’s individual needs.

A new activities coordinator had been appointed and people engaged in a number of activities both inside and outside of the home. People were also supported to maintain and enhance their independence as much as possible.

The service was being run well and communication between the management team, staff, people living in the home and visitors was frequent and effective. People and their families and friends were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.

Effective systems and processes had been introduced to monitor the quality of the service provided. Regular audits were carried out in order to identify any areas that needed improvement, which were then acted upon.

There was an inclusive and positive atmosphere in the service. The management team listened to people and staff and took action in response to their views. Staff spoke positively of the manager, as well as the management team as a whole, and the changes that had taken place since our last inspection.

The service had 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 not ensured that the water system in the home was safe. Following concerns raised by health professionals a full risk assessment of the system was carried out by an external contractor. This found that the water system was at high risk of the legionella bacteria. The legionella bacteria can cause Legionnaires disease. This is a pneumonia type infection that affects the lungs and respiratory system which can prove fatal in a small percentage of cases.

Hot water temperatures were very high in many people’s ensuite bathrooms. This presented a risk of scalding. These high temperatures had been known about for several months, but no corrective action had been taken.

In order ensure that no further people would be exposed to the risk of harm whilst the water system in the home was being made safe we issued an urgent Notice of Decision to prevent the provider admitting further service users to the home. This means that that the provider’s registration to operate the home is conditional upon no new service users being admitted.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This inspection found that the provider was in breach of four regulations. These related to safe care and treatment, staffing, meeting nutritional and hydration needs and governance.

Several people enjoyed alcoholic drinks. However, no risk assessments had been carried out to determine whether there were any risks to people from this, and if so, how these could be mitigated. For example, alcohol can adversely interact with medicines.

People were not always weighed on a regular basis. This meant that where people were at risk of not eating enough, it could have been identified earlier. Steps then could have been taken to provide additional support sooner.

Medicines were stored safely, but at a higher temperature than was desirable. Excessive temperatures can affect the stability or effectiveness of some medicines and prescribed creams. This could result in people’s not receiving effective relief for their symptoms.

Improvements needed to be made to ensure that enough staff were deployed to meet the needs of people in the afternoons and overnight. We observed a lunchtime where people would have benefited from more staff being present.

People did not always have access to extra fluids in hot weather, which put them at risk of dehydration. There was no separate provision for people requiring a diabetic diet in the home. A blanket approach meant that those who did not require a reduced sugar diet had desserts made with half amounts of sugar. This would not have been beneficial to those requiring gaining weight.

People living in the home had not been diagnosed with dementia. However, some people had poor short term memory, some lived with anxieties and some people periodically displayed behaviour that challenged others. We saw from people’s daily records that some situations could be handled in a more appropriate manner. Consequently we have made a recommendation regarding staff training for dealing with behaviour that challenges.

Staff were caring and we received positive comments from people. However, we observed some practices where it was evident that staff did not consistently respect people’s privacy, dignity or independence.

The standard of people’s care plans was variable. These were not always person-centred and care plans were not always in place to provide staff with the guidance they needed to be able to support people effectively with various physical or emotional health conditions.

People felt confident to raise any concerns if they had them and found that staff and the management team were approachable and friendly.