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St Christopher's Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 17 September 2019

During a routine inspection

About the service

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.

Inspection carried out on 5 March 2019

During a routine inspection

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.

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 regulati

Inspection carried out on 21 February 2018

During a routine inspection

The inspection took place on 21 February 2018 and was unannounced. This was the first inspection for St Christopher's care home under the new provider HC-One Oval Limited. The provider changed in December 2017. HC One limited, purchased some Bupa Limited Homes including St Christopher's care home.

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.