Archived: St Mary's

People’s experience of using this service:

The provider had systems in place to safeguard people from abuse. Staff could recognise and report any safeguarding concerns if they suspected abuse. Relevant risk assessments had been completed. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to reduce the risk of future harm.

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

People were supported by appropriate numbers of consistent staff who knew them well. Staff recruitment was safe and staff had completed relevant training, received regular supervision and annual appraisals and people were confident in staff skills and knowledge to deliver care and support people in a person-centred way.

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. Relevant mental capacity assessments had been completed. Staff gained consent before delivering care tasks and ensured people could make their own decisions and choices.

A variety of meals were provided to ensure people’s dietary needs were met. Assessments were seen which demonstrated relevant health professionals were involved in the care provided to people.

Care provided to people respected their privacy, dignity and promoted their independence. Staff knew people's needs well. We observed staff interacting with people and found they were kind and caring. Staff knew people well and responded to their needs in an understanding way.

Care plans had been completed and were regularly reviewed. These contained relevant information about how to meet people's needs. The activities coordinator was employed to ensure the activities provided by the service met people's individual needs. Where appropriate, plans were in place to ensure people's end of life wishes were taken into account and respected.

People knew how to raise a complaint and were confident their concerns would be addressed. Complaints were addressed in line with the provider's policy and procedure. Where complaints had been received, information had been used to improve the quality of the service.

There was an open culture within the service, where people and staff could approach the manager, who acted on concerns to make improvements to people's care.

Rating at last inspection: At the last inspection the service was rated good (published 16 September 2016)

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 any concerning information is received we may inspect sooner

This inspection was undertaken on 10 August 2016, and was unannounced. This meant the registered provider and staff did not know we would be visiting. At the time of this inspection there were 29 people using the service (10 of those on a respite basis). The service was last inspected on 27 May 2014 and found to be compliant with all of the regulations that we assessed at that time.

There was a registered manager at the service at the time of 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 and their relatives we spoke with told us they felt safe in the service and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm. Safeguarding alerts were appropriately sent to the local authority safeguarding team and fully investigated.

Risk assessments were in place to reduce and mitigate the known risks to people who used the service and medicines were managed safely and administered by trained staff.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with people using the service.

Staff received supervision and support and had completed a range of training that enabled them to meet people’s needs effectively.

We found staff supported people to make their own decisions. When people lacked capacity for this, staff acted within the principles of the Mental Capacity Act 2005 and ensured important decisions were made within best interest meetings with relevant people present. The registered manager understood their responsibilities in relation to the Deprivation of Liberty Safeguards.

We found there was sufficient staff on duty to support people with their assessed needs and to sit and chat with them. The interactions between people and staff were cheerful and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. People had access to a wide range of activities provided at the service.

We saw that people were offered plenty to eat and drink which helped to ensure that their nutritional needs were met. We saw that individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. People who lived at the service received additional care and treatment from health professionals based in the community.

A complaints policy was in place, we saw when complaints were received they were responded to in line with this.

A quality assurance system was in place that consisted of audits, checks and feedback from people who used the service. When shortfalls were identified action was taken to improve the service as required. The registered manager was a constant presence within the service and understood the requirement to report notifiable incidents to the Care Quality Commission.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risk to people and helped the service to continually improve.

The home had policies and procedures in relation to Deprivation of Liberty Safeguards (DOLS) although no applications had needed to be submitted. The manager had a good understanding of when an application should be made and in how to submit one. This meant that people were safeguarded as required.

People told us 'We get our medicine on time and when we need it' and we found that appropriate arrangements were in place in relation to recording, handling and safely administering medicines to people who used the service.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with mental and physical impairments.

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living. The equipment used in the service was serviced and maintained and service certificates were available for inspection.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One relative told us that they visited the service daily and they were delighted with their parent's care. The relative said "My parent is really well looked after and I am always made welcome when I visit."

People who spoke with us said 'We are very satisfied with our care, the food is good and there are plenty of choices available' and 'We get help from the staff when we need it, you only have to ask and they cannot do enough for you.'

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service.

Is the service responsive?

People we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems.

Is the service well led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality of service at all times.

People we spoke with told us the food was good and there was plenty of it. One person said 'It's brilliant and there's lots of choice.' Relatives we spoke with were complementary about the food. One relative told us, 'My father likes spicy food and they make sure he has this, he is on a pureed diet and this is always presented nicely.'

Although there were systems in place, the service did not have a robust way of monitoring and supporting people who were identified as at risk of becoming malnourished. We found the choice of snacks and specialist diet provision was limited.

Generally we saw there were effective systems in place to reduce the risk and spread of infection.

People told us they were generally satisfied with the facilities. Comments included, 'I love my room, it's a good size and very light. The wallpaper is lovely and bright' and '90% of the time the home is good, sometimes the cleaning could be improved.' During the visit we found odorous carpets in some people's bedrooms and the communal areas. This could affect people's dignity and wellbeing.

People we spoke with were complimentary about the staff and said they were kind and caring. The majority of people considered there were enough staff on duty to look after them. One person said, 'They (staff) are pretty good when I ring for them. Sometimes I am waiting a bit, but not for long usually.'

We saw the complaints procedure was available to people who used and visited the service. People told us they had no complaints, but said they would feel comfortable taking any concerns to the manager.

During our visit we also spoke with visiting relatives who confirmed the home offered excellent care and support for their relative. A relative commented, "Staff are lovely and my mother is happy about her care and her room is tidied and cleaned every day" and "If my mother rings her bell staff attend to her quickly."

We spoke to a visiting health care professional and they told us the people who used the service were well cared for and staff always called immediately when a person needed a specialist nursing visit. The health care professional also commented, "The staff always keep the health professional involved and if I ask the staff to do anything they just do it."

We found that the staff had completed a range of training. These included safeguarding of vulnerable adults, fire safety, health & safety, moving & handling, diet & nutrition, dementia awareness, advanced medication and The Mental Capacity Act 2005.