Archived: St Augustines Court Care Home

St Augustine's Court Care Home is a nursing home providing personal and nursing care for up to 40 people. On the first two days of inspection, 36 people lived at the care home. On the third day, 33 people were living in the care home. The service provides care to people, some of which are living with dementia. The service is a purpose-built property. Accommodation is split across two floors. There are several communal living areas, an accessible sensory garden, a cinema room and a sensory room.

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

People did not have good outcomes. Restrictive practice was used at the service, including locking people in rooms and physically restraining them without staff training. One person reported staff being “rough with me”. Another had bruising which supported a received allegation that the person had been restrained. These two concerns were reported to the management team, we returned 12 days later and were not provided with evidence that these allegations had been investigated. This left people at ongoing risk of neglectful care. We repeatedly observed staff not responding to people’s obvious distress and need for support.

Medicines were not managed safely. Staff had received training, however this was assessed as ineffective when observing the service. Care plans were generic and did not provide sufficient guidance for staff to provide safe and person-centred care. There were insufficient staff to respond to people in a safe way. We also observed staff not attend people who required urgent support. Lessons were not learnt when things went wrong. This meant people were at risk of incidents repeating themselves.

Poor leadership and oversight of the service had impacted on the quality of care and treatment people received. Staff reported that the management team shouted at them. There was poor morale at the service.

The service was inspected during the covid-19 pandemic. Staff were observed to wear personal protective equipment in line with government guidelines. People and staff were regularly tested for covid-19.

We communicated our concerns to the management team after the first two inspection days, they responded to our concerns stating that they would work to improve the service. We returned 12 days later and identified that minimal changes had occurred, this left people at ongoing risk of harm. We identified four breaches of regulation.

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 (Report published 23 October 2020).

Why we inspected

We last inspected this service on 8, 9, 10 and 17 September 2020. After our inspection, we received multiple concerns about the quality of care provided. This included allegations of: low staffing, poor management of incidents, the use of restraint and neglectful care.

As a result of these concerns, 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 requires improvement to inadequate. This is based on the findings at this inspection.

Enforcement

The previous inspection found no breaches of the Health and Social Care Act 2008 (Regulated Activities).

At this inspection we identified breaches of regulation 12 (Safe care), 13 (Safeguarding), 18 (staffing) and 17 (Governance). These are requirements for the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the first inspection site visit, we urgently imposed conditions on the providers registration. These conditions prevented the provider from admitting new service user's without CQC permission. They also required a review of the safety of the service. The provider did not appeal this urgent enforcement action.

When we returned to the service, we identified that improvements had not been made and people were still at risk of harm. We therefore wrote a letter to the provider, proposing that we would cancel their registration with the CQC. Cancelling a provider's registration would prevent them from legally providing personal care support from the premises. The provider informed us that they did not intend to appeal this proposal. We have therefore taken action to cancel the provider's registration.

Follow up

We have cancelled the provider's registration. This provider is therefore not legally allowed to provide personal care support from these premises. If they apply to register another service, this will go through our usual registration assessment processes.

St Augustine’s Court Care Home is a nursing home providing personal and nursing care for up to 40 people. There were 36 people living at the home at the time of our inspection. The service provides care to people living with dementia.

The service is a purpose-built property. Accommodation is split across two floors. There are several communal living areas, an accessible sensory garden, a cinema room and a sensory room.

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

Some improvements were still needed to ensure records were accurate and that audits identified shortfalls in records. These improvements were still needed to ensure effective governance and to consistently ensure the quality and safety of people's care. Some improvements were still required in falls management care to help ensure people were protected from the risk of falls.

The provider had notified the CQC of incidents and events as required. Staff understood their roles and the service was led with an open and honest management style. The provider was committed to provide personalised care in an environment that had been developed to suit their needs. Governance arrangements were in place to ensure health and safety practices were effectively operated on the premises.

People, staff and relative views were welcomed and listened to in the development of the service. Systems were in place to continuously review and learn. Effective working relationships were in place with other agencies involved in people’s care.

Systems and processes were in place to help protect people from abuse and harm. Sufficient staff were available to provide safe care to people. Medicines were administered and managed safely. Processes were followed to help prevent and control risks from infections. Systems were in place to review and learn from when things had gone wrong.

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 (Report published 18 July 2019).

Why we inspected

We completed this focused inspection due to a number of statutory notifications submitted for incidents that involved behaviours that challenge and falls. We had also received some information of concern regarding a person’s care, and this had been referred to the local authority safeguarding team.

This report only covers our findings in relation to the Key Questions Safe and Well-Led.

At our last inspection the service was rated as requires improvement, so we checked to make sure improvements had been made in these areas.

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 remained requires improvement. This is based on the findings at this inspection.

Enforcement

The previous inspection found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was for Regulation12 (Safe care and treatment). It also found one breach of the Care Quality Commission (Registration) Regulations 2009, Regulation 18, (Notification of other incidents).

At this inspection we found enough improvement had been made and the service was no longer in breach of regulation.

Follow up

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

People’s experience of using this service:

Medicines were not always provided in a safe way.

People’s needs were assessed, and risks identified, but the risk assessments were not always current and up to date.

People were not always protected against abuse as people were able to access other people’s rooms uninvited. The provider did not use a dependency tool, we could not identify if the level of staff was sufficient or if staff were deployed effectively.

There were measures in place to protect people from cross infection, but they were not always robust to ensure people were protected from harm.

Staff training was not up to date. We could not ensure staff had the skills and knowledge they needed to perform their roles effectively.

People were supported to make choices and have control of their lives. Staff supported people in the least restrictive way possible.

People received a nutritious diet and were kept hydrated at all times.

People were treated with kindness and staff respected their dignity at all times.

People their relatives and known advocates were involved in reviewing people’s care and making changes as required.

People’s needs were assessed, and people were supported to be independent and maintain their wellbeing.

Systems were in place to monitor and respond to complaints.

The provider did not always submit notifications to CQC. The providers monitoring systems were not robust to identify and manage all risks.

The last CQC rating of the service was displayed appropriately.

Rating at last inspection: Good last report published 16 February 2018

Why we inspected: Inspection was brought forward due to information of risk or concern.

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

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

The service did not have a registered manager at the time of our visit. The manager told us they were in the process of becoming registered and we received confirmation that they were registered shortly after our inspection. 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 were supported by staff who understood their responsibility and acted appropriately to keep people safe. Risks to people’s health and safety had been assessed, reviewed and mitigated to reduce the risk of harm as much as possible. People were supported by a sufficient amount of staff, received their medicines safely and lived in a clean and hygienic home.

People were supported by staff who received appropriate training and support. People were supported to eat and drink sufficient amounts and staff monitored and responded to changes in people’s health. People lived in a building which had been designed and adapted to meet their needs. 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 home supported this practice.

People were supported by a friendly, respectful and compassionate staff team. Staff took action to relieve people’s distress and provide comfort. The staff we spoke with were knowledgeable about the people they supported and ensured that people were involved in making decisions about their own care as much as possible. People could be assured that their privacy and dignity were respected by staff.

People received personalised care. An assessment of people’s needs was carried out before they moved to the home which considered the views and preferences of people and their relatives. People were engaged with by staff in appropriate activities and supported to maintain their interests. People were provided with opportunities to make a complaint about their care and these were responded to efficiently. Staff were knowledgeable about what support people required at the end of their life.

People’s relatives were confident in the management of the home and felt they achieved their aim of providing friendly and professional support. People were supported by a staff team who felt supported and invested in the home. People’s views regarding their satisfaction with their care and any areas for improvement were regularly sought and acted upon. Systems were in place to monitor the quality of the service provided at the home.

Accommodation for up to 40 people is provided in the home over two floors. The service is designed to meet the needs of older people living with dementia. There were 26 people using the service at the time of our inspection.

The registered manager was no longer working at the home. They had left the previous week and a representative of the registered provider was working as the acting manager. They were available during the inspection. 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.

Staff did not always safely manage identified risks to people and safe infection control practices were not always followed. However, people felt safe in the home and staff knew how to identify potential signs of abuse. The premises were managed to keep people safe. Sufficient numbers of staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe medicines practices were followed.

People’s rights were not fully protected under the Mental Capacity Act 2005. Staff received appropriate induction and supervision but training levels required improvement. People received sufficient to eat and drink but one person did not receive food that met their cultural needs. External professionals were involved in people’s care as appropriate.

Staff were kind and compassionate and knew people well. There was some evidence to show that people and their relatives had been involved in the care planning process. Advocacy information was made available to people. People’s independence was promoted and visitors could visit without unnecessary restriction. Staff treated people with respect and protected their dignity and privacy.

People received personalised care that was responsive to their needs. People were supported to take part in activities. Care records contained sufficient information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service.

Staff told us they would be confident raising any concerns with management and that they would take action. However, some staff felt that they did not receive feedback in a constructive and supportive way.