7 July 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
This inspection was completed by two inspectors, a specialist advisor on medicines and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
St Brelades is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Brelades is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with three people and 13 relatives about their experiences of the service. We spoke with nine staff including the registered manager, operations manager and three care staff. We reviewed a range of records. This included six people’s care records, multiple medication records and three staff files in relation to recruitment. A variety of records relating to the management of the service, including checks and audits were reviewed.
7 July 2022
About the service
St Brelades is a residential care home providing personal care to up to 37 people. The service provides support to people living with dementia. At the time of our inspection there were 33 people using the service. The service is a large, converted property and accommodation is arranged over two floors.
People’s experience of using this service and what we found
People told us they were happy living at St Brelades. Relatives told us they felt their loved ones were safe and well cared for. However, we found a lack of strong leadership had failed to develop a culture of good dementia care and people were not always treated equally and with respect. The provider and registered manager’s checks and audits were ineffective and had not identified a number of shortfalls at the service.
When people and relatives had shared their views, these had not been acted on to develop the service. Relatives told us their loved one continued to wear other people’s clothes despite feedback about this. Not all the staff had been asked for their views of the service. Staff who had been asked had told the management team they did not always feel appreciated, however this had not been addressed and continued.
The registered manager and provider had not told us about all significant events at the service so we could check action had been taken to prevent them occurring again. The provider’s rating was not displayed to inform people and visitors of the quality of the service.
Risks to people were not constantly managed to protect them from harm. Some risks had not been assessed and action had not been planned to mitigate other risks. People’s medicines were not well managed, and some people had missed doses of important medicines. Effective systems were not in place to record medicines stocks and identify errors. Lessons had not always been learnt when things went wrong and there was a risk incidents would occur again.
Staff had not been recruited safely and robust checks had not been completed on staff’s conduct in previous roles. There were enough staff to meet people’s needs however, staff had not been supported to develop the skills they needed to fulfil their roles. Most staff had not completed in-depth dementia care training.
The service was clean, and people were protected from the risk of the spread of infection. One relative commented, “They handled Covid restrictions really well and made sure everyone was provided with the proper PPE. The cleanliness of the home has always been very good. The cleaners do a good enough job.’’
The registered manager had applied for and obtained appropriate legal authorisations to deprive some people of their liberty.
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 good (31 January 2018).
Why we inspected
We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of 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 COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. 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 Brelades on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to risk management, medicines, recruitment, staff skills and competency, checks and audits and gathering and acting on people’s views at this inspection. We also found we had not been notified of all significant events that happened at the service and the rating had not been displayed.
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.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.