St Marys Nursing Home

St Mary's Nursing home is an adapted building which specialises in residential and nursing care. There are three floors named St Mary's, St Alexius and St Josephs.

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

St Mary's Nursing Home is operated by Qualia Care Limited. Qualia Care Limited has been placed into administration and the administrators have appointed a healthcare management company to operate the care home during the period of administration. The provider, Qualia Care Limited remains legally responsible for the delivery of the regulated activities at this location.

There had been improvements to health and safety of the home. Ongoing work was being undertaken to ensure the improvements both in the building and in the care provided were sustained and continually improved. Any risks to people were identified and mitigation guidance provided for staff to follow.

Care plans and risk assessments captured peoples’ care requirements and gave guidance for staff to support each individual safely. We made a recommendation for families to be involved in reviewing care records to ensure they were accurate. Complaints were acknowledged and responded to. Relatives felt confident to raise any concerns they had with the management team.

People felt safe living at the home. Relatives confirmed staff safely cared for their relation and staff were kind and caring. Staffing levels were sufficient to meet the needs of people currently living at the home. Staff were recruited safely and felt supported by the management team. Staff were confident in recognising and reporting any safeguarding concerns they may have. Medicines were safely managed.

People, relatives and staff felt the management team were approachable and responsive and had improved the home. The manager was working with other professionals to embed and sustain quality improvements. Staff were continually updated with any changes to people’s health and well-being and about the management of the home.

A manager was in post. The manager was working for healthcare management company and was in the process of applying for registration with the Care Quality Commission (CQC).

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 focused inspection of this service was rated good (published 18 April 2023).

Why we inspected

The inspection was prompted in part due to concerns received about the management of complaints, staffing levels and visiting arrangements. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, 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 Mary's Nursing 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 Marys Nursing Home is a care home providing accommodation, personal and nursing care and the treatment of disease, disorder and injury. The service can support up to 74 older and younger people, living with dementia, mental health, physical disability and sensory impairment. At the time of the inspection there were 44 people living at St Mary's.

The home is purpose built and provides care across three units, St Marys, St Alexius and St Josephs, in Moston in Greater Manchester.

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

Risks to people were managed by staff following suitable risk assessments. Referrals were made to other services and health professionals when necessary. Systems were in place to safeguard people from the risk of abuse. Medicines were managed safely, and competency assessments were carried out to monitor staff performances. An issue with a person’s out-of-stock thickener was addressed on the day of inspection. Staffing levels were sufficient to meet people’s needs and staff were recruited safely. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection.

At the time of this inspection the provider was in administration. Management and oversight of the service had been delegated by the administrators to Healthcare Management Solutions Limited (HCMS), a company with experience in the long-term management of care homes. The team at HCMS continued to engage with people and their relatives, the local authority, the Care Quality Commission and other external bodies to ensure continuity of care.

Governance systems were in place to ensure oversight and monitoring of the home. The manager recognised that some processes had to be improved further. There had been some issues with the continuity of contractors. The management company were able to evidence actions they had taken to ensure maintenance works, repairs and services to the building and equipment continued.

People, their relatives and staff spoke positively of the manager and the changes they had made in a short space of time. The manager was aware of their regulatory requirements of the role and was keen to continue to improve the home for the people who lived there. They had started the application process for registration with the Care Quality Commission at the time of this inspection.

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 good (published 25 March 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

This report only covers our findings in relation to the Key Questions Safe 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.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report. The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Marys Nursing Home on our website at www.cqc.org.uk.

St Marys Nursing Home is a care home providing accommodation, personal and nursing care and the treatment of disease, disorder and injury to 49 older and younger people, people living with dementia, mental health, physical disability and sensory impairment at the time of the inspection. The service can support up to 74 people.

The home is purpose built and provides care across three floors (named St Mary’s, St Alexius and St Joseph’s), in the suburb of Moston in Greater Manchester.

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

Improvements had been made to the management and oversight of infection control processes and the home was clean and staff were wearing the appropriate PPE to keep them and others safe. Risks to people had been assessed with mitigation in place to reduce risk occurring.

Staff were aware of the risks people presented. Recruitment processes were in place; however, we made a recommendation that the provider ensures references are sought from the new employees’ previous employment or education setting. Where references cannot be obtained, the provider should always keep an audit trial of where they have attempted to gain a reference from and ensure they check the authenticity of the referee.

The provider ensured the home met all health and safety requirements. People felt safe living at the home and there were safeguarding processes in place to follow when concerns were raised.

Improvements had been made to the décor of the home and the home was accessible for people with varying levels of mobility and needs. Assessments of people’s needs were completed before they moved into the home and staff were able to read these and understand how people preferred to be cared for. People had their health and social care needs met in a timely manner and people were supported to eat and drink a diet suitable to their requirements.

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. Staff received regular supervision and training.

The provider had implemented a number of audits to monitor and improve the home and the registered manager had delegated role and responsibilities to staff and staff knew what was expected of them. The head of care and nursing completed a monthly governance review to ensure audits were embedded and highlighted improvements. People, their relatives and staff spoke positively of the registered manager and the changes made at the home and felt it was a positive place to live and work.The registered manager was aware of their regulatory requirements of the role and was keen to continue to improve the home for the people who lived there.

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 15 December 2020).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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

Follow up

We will continue to monitor information we receive about the service until we 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 wore personal protective equipment (PPE) appropriately. Staff had completed training in infection control, plus COVID-19 and donning and doffing of PPE. The provider was supporting people who used the service and staff to access regular testing; this included lateral flow device (LFD) testing for staff prior to the start of each shift. All residents and staff were double vaccinated.

The home was closed to non-essential visitors because of a COVID-19 outbreak at the time of this inspection however, we saw essential care giver visits were still taking place. We spoke with two nominated essential care givers on site and a third over the telephone. The home had built a pod area inside the home so other people could visit and speak with loved ones.

Social distancing was observed as far as it was practicable to do so. Changes to communal areas had been made to better promote social distancing, for example rearranging of furniture and a maximum of two people round dining tables. There were separate staffroom facilities for each unit. The home was clean and well-ventilated. Staff had access to cleaning products and cleaning schedules included high touch areas such as door handles and handrails, which were cleaned regularly.

The care home can accommodate up to 74 people on three separate units, namely St Mary’s, St Alexius and St Joseph’s, each of which has separate adapted facilities and communal areas. Two of the units specialise in providing care to people living with dementia. There are additional kitchen and laundry facilities in the home, a small church and surrounding garden space outside.

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

At this inspection we found improvements were still required in areas such as infection prevention and control and with the home’s auditing and quality monitoring processes. The service did not have a manager registered with the Care Quality Commission (CQC) at the time of this inspection. A previous manager had left the service shortly before this inspection; they had not been registered with the CQC. Management and oversight was being provided by a clinical lead, supported by a member of senior management. We identified two regulatory breaches and have made a recommendation regarding the premises. We identified improvements had been made in the management of medicines.

People were not always protected against the risk of infection. Policies and procedures in place were not always adhered to by staff and housekeeping staff were not always effectively deployed.

People’s needs were met safely with appropriate staffing levels; previously furloughed staff had returned to work and the use of agency staff was minimal. People were supported by staff who understood how to identify and report potential abuse. Checks were carried out on new staff to ensure they were suitable to work in the home. Handovers ensured information was communicated to all staff to ensure people received safe support however, one person had some clinical information missing from the handover record. We made the nurse and manager aware of this.

The concerns we identified at the last inspection in relation to medicines had been addressed. The provider was investigating concerns raised about medicines at the time of this inspection and had taken appropriate action. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

There was evidence of monitoring and review of care. We identified some recording issues and brought these to the manager’s attention. There had been some improvements made to the building since our last inspection, however further work was needed.

Contact with health professionals had been maintained during the COVID-19 pandemic; some guidance and advice had been received over the telephone. People’s specific dietary needs were communicated to staff employed in the kitchen, who were aware of recommendations made by health professionals. The manager was aware of their responsibilities in respect of consent and involving people as much as possible in day-to-day decisions.

Systems and processes to monitor the quality of the service had been introduced recently by the manager but these were in their infancy. Support for the manager was available from nurses and unit leaders and the Deputy Lead of Nursing was based in the home during the week to offer help and guidance.

Relatives we spoke with told us communication during the pandemic had not been consistent. The manager outlined how the service planned to improve how it engaged with people, relatives and staff. Plans were in place to improve the meal time experience for people and a ‘resident of the day’ audit had been adopted to ensure regular reviews of people’s care and experiences.

The provider needs to build on the progress made, ensuring this is fully embedded into practice and also make the required improvements identified in this report.

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 8 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns and complaints in relation to the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

After the inspection our findings identified a specific incident. This incident is potentially subject to a criminal investigation. Our enquiries are on-going and therefore this inspection does not examine the circumstances of the incident.

We carried out an unannounced comprehensive inspection of this service on 26 and 27 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well led which contain those requirements.

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. We were not assured that the provider was effectively managing infection prevention and control and brought this to the manager’s attention. Following the inspection, the manager was able to demonstrate the actions taken to mitigate the risks.

Please see the safe sections of this full report.

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. 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 requires improvement. This is based on the findings at this inspection.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control and management of the service at this inspection.

St Mary’s Nursing Home is a purpose built nursing and residential home located in the Greater Manchester suburb of Moston. The home provides nursing care for people with physical disabilities, those living with dementia or related conditions, as well as palliative care, day care and respite care. The home is registered to accommodate a maximum of 74 people across three floors (named St Mary’s, St Alexius and St Joseph’s), however due to some bedrooms not currently being used, the maximum occupancy level was 69. At the time of inspection 66 people were living at the home.

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

We found improvements were still required in key areas including the safe management of medicines, management of modified diets, person centred care, record keeping, staff training completion and the home’s auditing and quality monitoring processes. We identified four regulatory breaches, including three continuing breaches, as sufficient improvements in these areas had not been made.

People told us they felt safe living at the home. Relatives we spoke with also raised no concerns about the safety of their loved ones. Staff were knowledgeable about how to identify and report any safeguarding concerns, which had been reported to the local authority as per the reporting procedure. Accidents, incidents and falls had been documented consistently, with lessons learned discussed as a staff team to help prevent a reoccurrence.

People had not always received their medicines safely. We identified issues with administration practices, documentation and record keeping. The home was responsive to feedback and took steps during the inspection to address these concerns.

People and relatives spoke positively about the care provided and the caring nature of the staff. Staff were described as kind, warm and friendly.

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.

People received personalised care which met their needs and wishes. However, we identified some practices which were not person-centred, such as people’s bedroom doors being propped open, without staff confirming this was the person’s preference.

People spoke positively about the food and drink provided, confirming they were offered choice and received enough. We identified some concerns with two people who required a modified diet, as they had been given foods contrary to professional guidance. This issue was addressed during the first day of inspection.

People reported staff were competent and knew how to do their jobs. Staff also told us they received sufficient training to carry out their roles. However, the training matrix evidenced staff had not been completing regular refresher training, to ensure skills and knowledge were up to date. This had already been identified by the current registered manager and a plan was in place to ensure completion.

People and relatives acknowledged there had been a number of personnel changes at the home over the last 12 months, but felt the home was a better place for it. The new management team were reported to be accessible, approachable and actively engaged in making improvements. A more robust auditing and quality monitoring process was being developed, however additional work was required to ensure this was identifying the types of issues we found during inspection. Greater oversight was also required to ensure daily documentation and the completion of supplementary charts was being done fully, accurately and consistently.

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) and there were multiple breaches of the regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of medicines and modified diets, staff training completion, person centred practice and governance systems and processes.

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.

St Mary’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. St Mary’s is registered to provide accommodation and care to up to 74 people across three floors. On the day of the inspection there were 59 people using the service.

There was a registered manager in place at the home. 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. The registered manager was supported in their role by an operations support manager and the operations manager.

We found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to safe care and treatment, need for consent, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection, we found the atmosphere at St Mary’s was calm. People were well presented, settled and looked happy to be living here. We saw that families and visitors could visit as they wished and, on the whole, they were satisfied with how their loved ones were cared for at the home. Staff including the registered manager knew people and understood their needs.

People, their relatives and visitors told us St Mary’s was a safe environment and that staff knew what to do to help ensure people living there were safe. There were clear processes in place to record and report incidents and the home was well maintained and visibly clean and free from malodours. However we found examples where people were not always kept safe. We found the home’s management of medicines needed to be strengthened and personal evacuation plans were not in place for everyone living at the service. These examples were evidence of a breach of the regulations relating to the safe care and treatment of people living at St Mary’s.

The service did not always follow the principles of Mental Capacity Act as required by law. We found not all care records contained the required documentation or signed consent forms. This was a breach of the regulation relating to need for consent and meant people were potentially receiving care or support where consent had not been obtained in the right way.

Recruitment processes were inconsistent and needed to be strengthened. We found not all pre-employment checks had been carried out such as gaps in employment history that had not been investigated at interview. This information helps to ensure staff employed are fit for the role. We made a recommendation that the provider ensure the current recruitment process consistently addressed all aspects of pre-employment checks and was fit for purpose.

Preadmission assessments were carried out prior to people coming to live at St Mary’s; this process helped to ensure the home was able to provide the care and support required. We found examples where care and support was not always responsive to the person’s individual needs. Some care records were incomplete or contained information that was not current. This meant staff did not always have appropriate information to guide them in providing support. This evidence was a breach of the regulation relating to person centred care.

There was a clear procedure in place for managing concerns and complaints, both written and verbal. We found not all verbal concerns raised were documented; this was not in line with the provider’s policy and meant the provider and registered manager did not have a thorough oversight of concerns and possible themes for improvement.

There was also a system of internal quality checks carried out by the registered manager and supported by visits and audits from the provider. We found governance processes needed to be more robust and quality monitored to help ensure people received safe and effective care and support. We found evidence in this regard to support a breach of the regulation related to good governance.

People and their relatives expressed no concerns regarding the number of staff on duty. We found staffing levels to be sufficient to attend to people’s needs in a safe and unrushed manner.

Newly recruited staff received an induction and mandatory training before working unsupervised. These were recorded within the service’s training matrix but we saw no record of staff induction in any of the staff files we looked at nor were there any training certificates to verify what training actually took place. Staff confirmed training on offer had improved and that they had received recent training in areas such as moving and handling. The registered manager told us they would request certificates from their previous training provider but to the time of writing this report we had not received further information.

Records we looked at and conversations we had with staff indicated they received regular supervisions and had annual appraisals. Staff told us they felt supported by management and their peers. These interventions helped to ensure staff had appropriate professional support to carry out their roles in an effective way.

Care records demonstrated that people living at St Mary’s had good access to medical attention and healthcare professionals such as GPs and district nurses when required. People and their relatives confirmed this was the case. This meant people’s healthcare needs were being met in line with their individual needs and in a proactive way.

There was a suitable choice of nutritious food and drink on offer at St Mary’s throughout the day. Meals for the most part took into consideration people’s preferences and were prepared according to their specific needs, for example, texture-modified and suitable for diabetics. This helped to maintain people’s good health and wellbeing.

People and relatives were very complimentary about staff’s attitude, their experience and skills. We observed that staff had good interactions with people and their families. Relatives told us staff were very good with and genuinely cared for their family members.

A range of activities were on offer with a weekly schedule displayed on the noticeboards within the home. People told us they had been asked what activities they most enjoyed and this information was used to develop the current schedule. This helped to ensure people were engaged in activities that were meaningful to them. Staff we spoke with told us how they encouraged people to participate in these but respected a person’s wishes if they chose not to do so.

People living at St Mary’s, their relatives and friends thought the registered manager was very approachable and visible within the home. Daily departmental meetings were held to ‘flag up’ concerns within and share information about each department. Each staff member got the opportunity to attend and there was a ‘question and answer’ session at the end to help staff to understand their role and the impact this had on people living at the home.

There were relevant policies and procedures in place and staff meetings, including daily ‘flash’ meetings, were held; these helped to ensure staff had appropriate guidance to carry out their roles.