St Christopher's Care Home

St Christophers Care Home is a residential care home providing personal and nursing care to up to 168 people. The service provides support to older people, some of whom are living with dementia, in 5 purpose-built buildings. At the time of our inspection there were 62 people using the service. Only 3 buildings were in use at the time of our inspection.

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

The service had monitoring processes to help drive improvement. Quality assurance systems identified areas that needed further development and remedial actions were implemented. However, while the team were making improvements, more time was needed to ensure this practice was consistent and embedded in all units and with all staff.

People felt they were safe and well supported by the service. Individual risks were assessed, and staff were aware of these. Reviews of events and accidents were carried out and actions needed were carried out. Medicines were managed well, there were some areas of recording to improve upon, and staff knew how to report any concerns about a person’s safety or welfare. People told us there was enough staff to meet their needs. Better deployment on 1 of the 3 units was needed and this was discussed with the management team who took action to address it. Staff communicated well to ensure needs were met in a timely way. Infection control was managed well.

Staff received appropriate training for their role and people felt they had good knowledge and skills. Staff felt supported by the provider and management team. People and most relatives told us staff assisted them with eating and drinking as needed and respected their preferences and choices.

People and relatives told us staff were kind and caring, they were happy living at St Christophers Care Home. Interactions observed were very positive, staff responded to people in a way that anticipated their needs and demonstrated they knew people well. All observations found staff to be attentive and caring about the people they supported.

Staff enjoyed working at the home and wanted to ensure people were happy and well cared for. Care plans included all information needed to support people safely and in accordance with their wishes and preferences. These were reviewed regularly. Some of these plans needed to be rewritten as were difficult to read. This was carried out following our visit.

People, some relatives and staff felt their views about the service were sought but some relatives felt this could be done more often. People and staff told us that the manager was often around the home checking on how they were and how staff were working, offering guidance and support.

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.

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 (published 25 August 2022).

Why we inspected

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.

The inspection was prompted in part due to concerns received about management of risks and governance, staff training and records. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Christophers Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Christophers Care Home accommodates 163 people across five separate bungalows, each of which has separate adapted facilities. Only three of the bungalows had people living there at the time of our inspection.

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

There were monitoring processes in place to help improve the standard of service and address the shortfalls. However, while we found that there had been some improvements in the home, this had not yet improved all areas and we identified some issues.

People’s dignity was not always promoted due to management of laundry and their belongings. The building had recently been refurbished and the décor was pleasant. However more consideration needed to ensure the environment was enriching the lives of people living with dementia.

People felt they were safe and most felt well supported by the service. Individual risks were assessed in most cases, and staff were aware of these. Reviews of events and accidents were carried out and any actions needed were carried out in most cases. However, at times these were always not fully completed or recorded.

People were supported with eating and drinking. There were mixed views about the food. The management team were aware of these.

Staff enjoyed working for the service and told us morale had improved and the culture was to ensure care was person centred. They stated they would be happy to have a relative of theirs living there. Care plans were in place, but some were difficult to read due to the handwriting, but most included the appropriate information. Care plans were reviewed regularly, however when using the resident of the day review process, this did not always reflect if people were involved in the process.

Most people were supported to do things they enjoyed. However, some people cared for in bed were receiving limited stimulation. The management team were aware of this and had just recruited more wellbeing staff. There were mixed views about the responsiveness to complaints. The provider had a system in place, but staff may not have shared all information with management as they received it.

People told us staff were kind but busy. Staff told us there were enough staff to support people well. Staff received appropriate training for their role and people felt they had good knowledge and skills. Staff felt supported by the provider and management team. They were positive about the new manager. People’s medicines were managed safely. Staff knew how to report any concerns about a person’s safety or welfare. There were appropriate infection prevention and control processes in place and guidance was followed.

People and relatives were asked for their views about the service and were aware there had been changes to the management team. Staff told us the management team checked they were working safely and felt they were approachable.

The manager was new in post and they were recruiting for a supporting management team, such as a deputy manager. The manager was planning to register with the service and was supported by an area director.

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.

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

The last rating for this service was requires improvement (published 2 March 2021) and there were breaches of regulation 12 and 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider had made improvements and was no longer in breach of regulations.

Why we inspected

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.

The inspection was prompted in part due to concerns received about the safety of people, standards of care and changes to the management in the home. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the effective, caring, responsive and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Christopher’s Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Christophers Care Home is a care home providing accommodation for up to 163 people older people, some of whom are living with dementia. At the time of the inspection there were 53 people living at the home.

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

There were systems in place to help manage the risks associated with Covid-19. Training relating to infection control and Covid-19 had been delivered. Policies had been produced by the provider. Staff knew how to reduce the risk of transmission of Covid-19; however, they did not always follow safe practice. This related to donning and doffing of Personal Protective Equipment (PPE), cleaning regimes and working practice. Recent changes to PPE requirements had not been shared within the staff team and therefore staff did not use all the required equipment.

Governance systems were used in the service. There was an action plan in place to drive improvement throughout the service. However there had been a failure to embed good infection control practice in relation to Covid-19. This placed people at risk. Feedback from people and their relatives about staff was positive.

People felt safe and told us the staff looked after them well. People’s safety and welfare was monitored. However, we found one person had not always received care in accordance with their assessed needs. There was an overview of accidents and events and these were reviewed to help ensure there was not a reoccurrence. Medicines were managed safely.

People and staff told us that staffing levels were not appropriate to meet people’s needs. They told us this meant a delay in care needs being met and staff felt care was task led and not person-centred. On the day of inspection, we saw people’s needs got met in a timely way. The registered manager told us staffing levels were set according to people’s dependency. This was an area that needed to be reviewed by the provider to ensure staffing levels remain appropriate to meet people’s needs.

People were given choices and staff knew people well. Care plans gave staff the information needed to meet people’s needs in most cases and we saw these were reviewed regularly. People were encouraged to eat and drink well to help promote their wellbeing.

Rating at last inspection

The last rating for this service was Requires Improvement (published 31 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the care people received. A decision was made for us to inspect and examine those risks.

As a result, we undertook a targeted 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.

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 coronavirus and other infection outbreaks effectively.

Please see the safe and well led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Christophers Care Home on our website at www.cqc.org.uk

We have identified breaches in relation to infection prevention and control and management oversight at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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.

We found the following examples of good practice.

¿ Staff supported people's social and emotional wellbeing. The service had different methods including information technology to help people keep in contact with loved ones.

¿ Regular meetings were held between the registered manager and relatives to communicate and share updates.

¿ Staff did not take breaks together. For people symptomatic or positive with COVID-19, separate areas had been used on each unit to minimise the risk of transmission across the home.

¿ When people tested positive for COVID-19 they had to isolate in their room.

¿ Enhanced cleaning of all areas and frequently touched surfaces was in place and being carried out. Additional deep cleaning was further carried out where required.

¿ Staff had received training on donning and doffing personal protective equipment (PPE), infection control and COVID-19. They had their competency assessed. Additional infection prevention and control [IPC] leads supported and monitored the delivery of safe care.

¿ All staff we spoke with were clear on what processes were in place and why they were needed. Staff were given bags to take their uniform home in so they could wash it safely and help prevent transmission.

¿ Staff told us the registered manager had been supportive and provided leadership during difficult times. Staff were encouraged to access bereavement counselling and support.

St Christopher’s Care Home provides accommodation, personal and nursing care to older people. The care home accommodates up to 168 people in five purpose-built buildings. At the time of the inspection 108 people were living there.

People’s experience of using this service

Since the last inspection systems had been implemented to help address the shortfalls, promote safety and improve the quality of care in the home. We found that some of these systems had been effective and some were still a work in progress. However, the atmosphere in the home had changed for the better and staff told us they felt things had improved.

There were mixed views about the management of the home from people and their relatives about the amount of engagement from the management team.

People told us that their care needs were met in most cases. We found that for people less able to request support for themselves, there may be times when care was delayed. Relatives and staff told us that there were not always enough staff. People who were able to request support told us that there were enough staff most of the time.

Care plans were detailed and included enough information for staff to be able to support people with their care needs in many cases. However, they did not all include all elements of people’s needs and some areas needed more information. Mental capacity assessments and best interest decisions needed to be completed for some people.

People gave mixed views about the activities available. People who were in their rooms were at risk of being isolated.

People told us that they received their medicines when needed. However, medicines were not always managed safely, and systems needed to be developed to manage this appropriately. People told us that they enjoyed the food. The dining experience had improved in some units but needed further development in other units.

There were systems in place to help ensure staff were trained and received regular supervision and staff felt supported by the management team.

The service met the characteristics for the rating of "Requires Improvement" in all key questions.

We have made recommendations in relation to sharing of examples of poor practice, medicines management, completion of capacity assessments and best interest decisions.

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

The last rating for this service was Inadequate (published 16 April 2019). At this inspection the rating had improved. However, enough improvement had not been made and the provider was still in breach of a regulation.

This service has been in Special Measures since 15 April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to governance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will ask the provider to send us an action plan stating how they will make the required improvements. We may meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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.

About the service: St Christopher's Care Home is a large nursing and residential care home that accommodates up to 163 older people, some of whom live with dementia, in five adapted buildings. There were 135 people using the service at the time of this inspection.

People’s experience of using this service:

• Since our last inspection the service has not made the required improvements.

• The provider had systems in place to keep people safe, provide good quality care and ensure staff were trained. These systems had identified concerns within the home. However, not all the shortfalls had been addressed at the time of inspection and there had been a failure to learn from lessons and drive improvement.

• The service met the characteristics for a rating of “Inadequate” in two key questions and the rating of "requires improvement" in three key questions. This gives the service an overall rating of “inadequate”.

• People gave mixed views about if their needs were met at the service but they liked the staff.

People told us that they liked the food. However, ways in which the staff could support people in a more timely way needed to be considered.

• People were given choices in some instances but this was not applied consistently across all elements of their care. For example, times to get up and the use of bedrails.

• People who spent their time in their rooms had limited interaction and social opportunities.

• People told us they needed more to do and more opportunities for activities.

• People were not always supported by enough staff.

• Staff did not always deliver care that was safe and met people’s needs.

• Risks were assessed in some cases but this was not consistent.

• The principles of the Mental Capacity Act 2005 were not always adhered to.

• More information about our inspection findings is in the full report.

Rating at last inspection: At the last inspection the rating for this inspection was requires improvement.

Why we inspected: This inspection was brought forward due to information of risk or concern and the previous rating was requires improvement.

Enforcement: Action we told provider to take can be seen at the end of the full report.

Follow up: We will continue to monitor the service and work with other agencies to ensure the provider is working towards meeting the standards and regulations. A further inspection is planned for the future.

St Christopher's is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation for up to 163 people for older people including people with dementia. At the time of our inspection there were 144 using the service.

St Christopher's care home accommodates 163 people across five separate units, each of which have separate adapted facilities. Two of the units specialises in providing care to people living with dementia. Three of the units provided nursing care.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Recruitment processes were not as robust as they could have been. Care plans in some areas needed better guidance and information for staff.

People felt safe living at St Christopher’s Nursing Home. Staff were knowledgeable about how to keep people safe and reported and documented any incidents. However not all incidents had been reviewed and investigated appropriately.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued.

The atmosphere at the home was calm and people’s needs were met in a timely manner by sufficient numbers of skilled and experienced staff.

People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff we spoke with demonstrated their knowledge about individuals’ care and support needs and preferences.

People told us they had been involved in the planning of their care where they were able.

People were confident to raise concerns with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had any concerns.

The provider regularly monitored health and safety and the quality of the care and support provided for people who used the service.