St. Cecilia's Nursing Home

St. Cecilia’s Nursing Home is a care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 44 people.

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

Due to a misunderstanding on the part of the provider, people living in the service were put at risk because in June 2021 the provider made a decision to move the previously approved Care Quality Commission (CQC) designated setting for COVID-19 positive people into a smaller setting. This smaller setting had previously been inspected by CQC in October 2020 and although it was approved as part of a larger setting, it was not intended to be used as a separate smaller setting. This five bedded setting did not meet the criteria for approval as it did not have sufficient infection prevention and control facilities. We have written to the provider separately about this matter. The five bedded setting is no longer to be used as a designated setting for people who have COVID-19.

Apart from our concerns about the five bedded setting, staff followed government guidance on the use of personal protective equipment (PPE). Equipment and the environment looked clean and hygienic and there had not been an outbreak of COVID-19.

Care plans and risk assessments were in place for people's support needs. These were reviewed regularly and covered people's health conditions.

The registered manager carried out regular checks and analysis of falls and incidents to ensure learning from events was undertaken. This meant risks to people's health and safety from repeated incidents were reduced.

People received their medicines on time and when they needed them. Staff had positive links with healthcare professionals which promoted people’s wellbeing.

Staffing levels were consistent, and staff were confident they could meet people’s needs. We observed staff being patient, kind and respectful towards people. Care was person-centred and staff had time to chat with people during the day.

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 was a registered manager in post: people and staff spoke highly of them.

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

Rating at last inspection

The last rating for this service was good (published 24 October 2018).

Why we inspected

We received concerns in relation to infection prevention and control (IPC)and the designated setting. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 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 remained good. 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. Cecilia's Nursing Home on our website at www.cqc.org.uk.

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.

St. Cecilia’s Nursing Home is a care home providing nursing and personal care for up to 44 people in one adapted building. We inspected the designated care unit on the second floor. This unit has 14 single bedrooms intended for people discharged from hospital who have tested positive for Covid-19.

The design of the proposed designated care unit was suitable to become a designated setting. We were assured that this service met good infection prevention and control guidelines as a designated care setting.

We found the following examples of good practice

¿ The systems in place allowed people to be admitted to the home safely. Each unit was separated to prevent cross infection.

¿ People isolating in the designated unit had their own dedicated staff who provided a support bubble to support all their needs, including their meals and social support.

¿ People had their own single rooms and access to toilets and bathing facilities.

¿ There was clear signage on the correct use of PPE and handwashing techniques and staff had received appropriate infection control and prevention training.

¿ A detailed risk assessment was in place for ensuring safe visits, this included a booking system, to allow for social distancing, visitor agreement form, health screening and use of PPE. Local restrictions on visiting were in place at the time of the inspection and alternative measures such as video calls were being used.

¿ The environment was very clean. Additional cleaning was taking place including of frequently touched surfaces.

¿ There were detailed risk assessments to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

¿ Staff had been consulted with about their specific risks or concerns. Each staff member had had a detailed risk assessment and health risk assessment.

Further information is in the detailed findings below.

St. Cecilia’s Nursing Home is a care home providing nursing and personal care for up to 44 people in one adapted building. We inspected the designated care unit on the second floor. This unit has five single bedrooms intended for people discharged from hospital who have tested positive for Covid-19. There was one person living on the unit at the time of our inspection.

We were assured by the infection, prevention and control practises within the service.

The design of the proposed designated care unit was not currently suitable to become a designated setting.

We found the following examples of good practice

¿ The systems in place allowed people to be admitted to the home safely. Each unit was separated to prevent cross infection.

¿ People isolating in the designated unit had their own dedicated staff who provided a support bubble to support all their needs, including their meals and social support.

¿ There was clear signage on the correct use of PPE and handwashing techniques and staff had received appropriate infection control and prevention training.

¿ A detailed risk assessment was in place for ensuring safe visits, this included a booking system, to allow for social distancing, visitor agreement form, health screening and use of PPE. Local restrictions on visiting were in place at the time of the inspection and alternative measures such as video calls were being used.

¿ The environment was very clean. Additional cleaning was taking place including of frequently touched surfaces.

¿ There were detailed risk assessments to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

¿ Staff had been consulted with about their specific risks or concerns. Each staff member had had a detailed risk assessment and health risk assessment.

Further information is in the detailed findings below.

St Cecilia’s Nursing Home is a care home providing personal and nursing care up to 44 people, some of whom were living with dementia. When we visited 41 people were using the service.

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

Since the last inspection the provider and new registered manager had worked to implement new systems and recruit new staff. Improvements were seen at this inspection and a plan was in place to continuously improve the service. Part of those improvements was to ensure the provider had more formal oversight of quality and safety of the service for effective governance.

The staff team had been inducted, supported and trained which had brought stability to the service. Staff understood their roles clearly and knew what was expected of them. People were treated with respect and dignity, they were also supported to maintain their independence.

People’s needs and preferences were known by the staff and this had led to people receiving person centred, responsive care. Staff had worked to improve or maintain people’s quality of life. Feedback from people and their relatives was positive. Staff had developed positive relationships with people which led to people feeling safe and happy.

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 environment had been improved and people were happy with the changes. People enjoyed access to a garden and were supported to access the community to take part in local activities. People told us they were offered a wide variety of activities to take part in if they chose this.

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

At the last inspection we gave the service a rating of requires improvement (published 26 April 2018) and there were two breaches of regulations. Following the last inspection we asked the provider to complete an action plan 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 intelligence 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.

St. Cecilia’s Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 accommodates up to 44 people in one adapted building. The building has five floors with office space and ancillary facilities on the basement floor, communal spaces and four bedrooms on the ground floor and bedrooms on the first, second and third floors. At the time of our inspection there were 39 people who used the service.

The provider is required to have a registered manager at the service. The last registered manager left the service in December 2017 and the vacant position had been recruited to. 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 an acting manager in place who had been seconded from a sister service until the new manager was in post. We have referred to them as ‘the manager’ in this report.

This is the first inspection of the service since it registered with the Care Quality Commission (CQC) in January 2017. We found breaches of Regulation 17 (good governance) and Regulation 18 (Staffing) of the Health and Social care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Management systems were not always effective in identifying shortfalls in the quality of the service. Some records were not complete or well maintained. The completion of pressure relief charts was inconsistent and the risks to people around weight loss were not always fully identified and reviewed by the care staff.

Staff induction was not robust and agency staff induction was not taking place. Staff supervision had also not been carried out, which meant their work practice was not discussed with them in an effort to improve their performance.

Staff were recruited safely. Whilst there were enough staff on duty to care for people safely, the deployment of staff sometimes impacted people’s care. The quality of care provided was inconsistent due to staff struggling with the environment and the increased needs of people who used the service. This was identified as an area that needed to improve.

Medicine management practices were being reviewed by the manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

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.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the district nursing team and speech and language therapists (SALT).

People had access to community facilities and the range of activities provided in the service ensured people could engage in stimulating and interesting social activities.

People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with.

This is the first time the service has been rated as Requires Improvement.