Archived: St Marthas Care Centre

People’s experience of using this service:

At our previous inspection we found a breach of regulation12,14, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to risks to people not being managed effectively, nutritional and hydration needs not been met and ineffective quality monitoring of the service. At this inspection we found that improvements had been made and most breaches had been met.

Further improvements were needed to ensure the quality systems in place were fully effective and imbedded into day to day practice.

Improvements had been made to how risks to people were assessed and managed. Although some further improvements were needed to ensure people received consistent care. People's care records were not always detailed and kept up to date and some documentation was incomplete. Work was underway to improve these, so they were person centred and guided staff on the way people preferred their care and support to be provided.

There had been management changes and a number of care and nursing staff changes. Staff were caring and kind however, a number of staff were still settling into their role and familiarizing themselves with people’s care needs and working through their training requirements.

Recruitment practice was not always robust the provider had not followed their own policy regarding requests for second references. Recruitment to vacant posts was taking place and the provider had brought in additional management and clinical support during this unsettled time to provide leadership and stability to the staff team.

People and their relatives were positive about the support they received.

People were supported to receive their medication as prescribed and staff demonstrated a good knowledge of types and signs of abuse and how to report concerns of abuse.

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.

Rating at last inspection: The last rating for this service was requires improvement (published July 2019).

Why we inspected: We carried out an unannounced comprehensive inspection of this service on 29 May 2019. Breaches of legal requirements were found. We undertook this focused inspection to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-Led.

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 remains as requires improvement.

Enforcement

We have identified a breach in relation to the quality monitoring systems.

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 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.

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

St Marthas Care centre is a residential care home providing personal care for up to 50 people. The home is split into two separate units called Beech which provides residential care and Ash provides nursing care. At the time of the inspection 48 people lived at the home.

People’s experience of using this service:

Since the last inspection in February 2016 there had been a change in the management team and a new manager had recently been appointment. We received some concerns before our inspection about the service and the provider told us that their own quality monitoring systems had identified concerns at the service. When we inspected the provider and newly appointed manager had started to make improvements. However, although we found improvements were taking place these had not always been timely or the providers own systems had not always been effective in identifying areas that required improvement. For example, we found improvements needed to be made in supporting people who were at risk at hydration, improving the meal time experience for people, the management of risk and providing a safe and secure environment.

People were supported to receive their medicines as required to support their wellbeing. People’s consent was sought before providing support. However, not all staff we spoke with were clear about their role and responsibilities with regards to DoLS and what this meant for individual people.

Staff had not received all the training they needed, or training had not always been effective.

Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing.

People, staff and relatives all told us that the current manager and staff team had made improvements at the service and they felt able to raise any concerns they had if needed.

Rating at last inspection: Rated Good (February 2016)

Why we inspected: This was a planned inspection

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

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

On our last inspection in April 2014, we found that the service was not meeting the requirements of the cleanliness and infection control regulation. However, a follow up inspection was conducted in June 2014 and found the provider to be compliant with these essential standards.

St Martha’s Care Centre provides accommodation, nursing and personal care for up to 70 older adults. At the time of our inspection there were 46 people living at the home.

There was a registered manager in post. 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 not always safe because their call alarm systems were not always available or positioned appropriately. This meant that people could not summon help and support when they required it.

People were at risk of falling because bedrooms were not always arranged appropriately to ensure that the floor was clear of trip hazards.

The provider ensured that there were adequate numbers of staff available to meet people’s needs.

People were protected from the risk of abuse because staff were aware of the processes they needed to follow.

People received their prescribed medicines as required.

The service was effective because people received care from staff who had received adequate training and had the knowledge and skills they required to do their job effectively.

People received care and support with their consent and people’s rights were protected because key processes had been fully followed to ensure people were not unlawfully restricted.

People’s nutritional needs were assessed and monitored to identify any risks associated with nutrition and hydration and had food they enjoyed.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

The service was caring because people were supported by staff that were kind and caring and who knew them well including their personal preferences and dislikes.

People were cared for by staff who protected their privacy and dignity and who respected their equality and diversity needs.

People were encouraged to be as independent as possible.

The service was responsive because people and their relatives felt involved in the planning and review of their care.

People had the opportunity to engage in group and individual social activities that they enjoyed.

People were supported to maintain relationships with their friends and relatives.

People were encouraged to offer feedback on the quality of the service and knew how to complain.

The service was well led because the provider had a wide-range of systems in place to assess and monitor the quality of the service.

Staff felt supported in their work and reported St Martha’s Care Centre to have an open and honest leadership culture.

Staff reported the registered manager to be approachable and responsive to their requests.

We looked at information to help us gather evidence about whether improvement had been made. On the day of our inspection, the registered manager told us that 44 people lived there.

We spoke with the registered manager and with some staff on duty. We also spoke with four people that lived there.

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

We looked to see if the service was safe, clean and hygienic. We saw that bedrooms and communal areas of the home were visibly clean and were free from any strong odours.

We found that decoration had taken place in one part of the home and we saw that further decorating work was taking place during our inspection. This meant that improvement had and was still being made.

One person told us, 'I like the lighter colour in the room now it's been painted. It is better.'

We saw that stocks of foods had appropriate storage and the risk of contamination was reduced. This meant that improvement had been made.

The service had a quality assurance system. We looked at infection control and kitchen audits. These showed that the registered manager identified areas that needed improvement and we saw that action was taken when needed.

We spoke with the registered manager, an area manager and a quality assurance manager. We also spoke with care staff on duty and other staff members such as the chef and maintenance staff members. We also spoke with 16 people that lived there and observed other people that lived there and later spoke with five relatives. Our conversations with people helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All of the people spoken with told us that they felt safe living at the home. One person told us, 'I feel safe here.' All of the relatives spoken with confirmed to us that they felt that their family member was safe there. One relative told us, 'My family member is safe there. The staff have encouraged them to join in and they are no longer withdrawn. It is a safe home.'

Safeguarding procedures were robust. All of the staff spoken with could identify to us types of abuse and what action they would take if they had a concern or a disclosure of abuse was made to them. All of the staff spoken with were also able to tell us that they knew how to whistle-blow to an external agency such as Social Services or the Care Quality Commission if needed. One staff member told us, 'I would report any concerns straight away to the manager and go higher if I needed to.' This meant that staff understood their role in protecting vulnerable adults from abuse.

There was a system in place to record accidents and incidents. Staff spoken with showed that they were aware of the reporting system. We saw that six accidents and incidents were recorded for February to March 2014. We saw that the provider had taken appropriate action such as using a pressure sensor mat next to a person's bed so that staff were alerted when they got out of bed.

There was a system in place to handle concerns and complaints. The registered manager told us that no complaints had been received by the provider from people that lived there or their relatives since our last inspection in April 2013.

The registered manager told us that two new nursing staff were due to commence employment at the home once pre-employment checks had been completed. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.

As part of our inspection we looked at how the home implemented the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DOLS). We looked at two records and found that the guidance given by the Mental Capacity Act was not always followed. For example, we saw multiple decisions were recorded on the provider's own assessment form. We found that these were not robust and the information recorded was confusing. We discussed this during our inspection and the registered manager confirmed to us that people's mental capacity assessments would be reviewed.

We looked to see if the service was safe, clean and hygienic. We saw that most areas were visibly clean and were free from any strong odours. However, we saw some areas that were not visibly clean such as an area of the dining room carpet. We saw food debris and stains on the carpet. We saw that some d'cor was in need of being refreshed. The registered manager and the area manager told us that refurbishment would be completed by the end of October 2014.

We also saw that some fresh vegetables and dry foods such as cereals were being stored in a stair-well in the home. We saw that the carpet area was visibly dirty and stained. This was not appropriate storage and there was a risk of contamination. We have set a compliance action.

Is the service effective?

We saw that the provider's information guide was displayed in the home and gave people information about the service.

People's care and support needs were assessed and their relatives were involved in their plan of care. One relative told us, 'Staff always keep me informed about my family member.' Another relative told us, 'The home has a Kindle Fire and the staff support my relative to keep in touch with us. It's fantastic.'

Health information was detailed so that staff had the information they needed to support people safely.

Is the service caring?

People we spoke with told us that they thought staff were kind and caring. One person told us, "The staff are good.' One relative told us, 'I am happy with my family member's care at the home and the activities that they provide there.'

People that lived there and their relatives were asked for feedback about the service. Resident and relative meetings took place so that feedback could be gathered. Newsletters were published and included details about activities that took place.

Is the service responsive?

Relatives spoken with told us they had no concerns or complaints.

Is the service well led?

We saw documented evidence that showed that the provider worked with other health care professionals and made referrals for advice and guidance when needed. The management structure in place enabled the service to be well-led.

People were involved in their care and were encouraged to do things for themselves as far as possible.

Care plans were personalised and risk assessments were in place so that staff had the information they needed to meet people's identified needs.

People's nutritional needs were met. One person told us, "The food is good".

Arrangements were in place to ensure that people were safeguarded against harm.

People were not protected against the risk of infection by appropriate infection prevention and control measures.

There was adequate staff that were supported, supervised and trained in their roles. One staff member told us, "I enjoy my job; it's like a big family to me".

We saw systems, including large print guides, in place so that people could raise a concern or make a complaint about the services that they received.

We saw some systems in place to audit and monitor the quality of the service being provided. However, we did not find these to be effective.

Some people were, wherever possible, involved in their care. Where people were unable to be involved in decisions about their care, we saw that relatives and healthcare professionals were involved. One relative told us, "I am happy with how things are".

We saw staff knocked on doors to respect people's privacy and examples of staff speaking to people in a polite way. However, we saw people's dignity and respect was not always respected, for example at mealtimes people were referred to by the type of diet they ate.

We saw people were given opportunities to take part in some activities, but two people told us they were "bored". This meant that not some people's needs were not being met.

We saw that the organisation had a safeguarding policy but this was not accessible to staff. This meant staff did not have all the information they needed if they had any concerns or there was an allegation of abuse.

We saw some systems of audit in place to measure the quality of the service, however these were not always analysed. This meant that there was no evidence to show continuous improvement of the service.