St Mary's Nursing Home

St Mary’s Nursing Home is a care home providing personal care and nursing. It can accommodate up to 56 people. Some people using the service were living with dementia. There were 42 people using the service at the time of the inspection.

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

Risks to people were identified, however these were not always effectively managed to ensure people’s needs were met and safety maintained. For example, people’s nutrition needs were identified, but fortified snacks and fluids were not always recorded, and people were not always given their preferred choice of drink. Infection prevention and control (IPC) practices and policies were not always followed. We found many areas that were not clean and areas that were not well-maintained to be able to be effectively cleaned. We have made a recommendation about IPC to ensure the improvements made following our site visit are maintained and sustained.

People were not supported to have maximum choice and control of their lives. The policies and systems in the service did not support this practice. We found most people were cared for in bed, and this was not always the persons choice. Staff told us there was not always enough staff on duty to ensure people could get up safely because many people required two staff to move and handle them safely. The registered manager showed us a dependency tool, but it was not clear how the hours were calculated to ensure adequate staff were on duty to meet people’s needs. We observed call bells ringing for long periods of time and a lack of staff available in communal areas. People told us staff were caring and kind. However, we observed staff did not always support people appropriately; their approach was not always person-centred and at times was task orientated.

Staff told us they did not feel supported. Staff said there was lack of effective communication from management. Systems and processes used to ensure the service was running safely were not robust or effective. Parts of the premises were not being used for their intended purpose. Environmental alterations were taking place, there was no evidence received from the provider these alterations were compliant with fire safety or building control regulations. During our inspection we identified many shortfalls had not been identified as part of the providers quality monitoring. For example, IPC practices, person centred care, staff deployment and safe working practices.

Feedback from people varied, there were some very positive comments about staff along with some negative feedback. Some people said communication was poor. One person said, “I speak with [registered manager] who is very nice by the way, about it but I don’t think she listens.”

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 20 August 2020).

The service remains rated requires improvement. Although there were some improvements at the last inspection, the overall rating for this service has been requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

This was a planned focused inspection.

We undertook this focused inspection to check they had continued to maintain improvements. This report only covers our findings in relation to the key questions safe and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 the provider needs to make improvement. You can see what action we have asked the provider to take at the end 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.

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 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 safe care and treatment, staffing and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about infection prevention and control.

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

St Mary’s Nursing Home is a residential care home providing personal and nursing care for up to 56 people. At the time of our inspection there were 20 people residing at the service, some of whom were living with dementia.

People’s experience and what we found

Improvements had been made since our last inspection which took place in August 2019. We found the service had made positive changes in how the service was managed and effective systems had been developed and embedded to ensure people received safe person-centred care and support.

We looked at care plans and found these had improved since our last inspection and now reflected people’s needs and preferences.

People were safeguarded from the risks of abuse, staff received training in this area and knew how to recognise and report abuse. Staff were confident that appropriate action would be taken to keep people safe. Risks associated with people's care were identified and risk assessments were in place to minimise the risk. Staff were knowledgeable about risks associated with people's care.

Accidents and incidents were monitored, and trends and patterns identified. Lessons were learned when thinks went wrong.

People received their medicines as prescribed. Competency checks were carried out and staff were knowledgeable about medicine management. The provider had a robust recruitment procedure which ensured new starters were recruited safely.

We observed there were sufficient staff available to meet people's needs and to socially engage with them whilst adhering to the current restrictions due to the COVID-19 pandemic. Staff we spoke with felt there were enough staff available and were able to meet people's needs.

The home was clean and there were PPE stations situated at several points throughout the home. The provider had managed the current COVID-19 pandemic well and implemented effective procedures.

A range of audits took place to ensure the service was monitored and quality maintained.

Since our last inspection the provider had employed a clinical governance manager who had oversight of quality audits and actions required to resolve any issues and drive improvements.

The management team supported staff to deliver person centred care to people. The provider engaged people in the service and listened to their comments.

We spoke with people who used the service and their relatives, and they were complimentary about the care they or their relatives received. Many described the home as being, ‘friendly and caring.’ Relatives felt involved in the care of their loved ones and felt staff were adequately trained. People felt the home had a ‘happy atmosphere.’

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 10 October 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 14 August 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

We carried out an unannounced comprehensive inspection of this service on 14 August 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, person-centred care, good governance, safeguarding and staffing.

We undertook this focused inspection in line with our current methodology in the COVID-19 pandemic, 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 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 inadequate to 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.

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.

St Mary’s Nursing Home provides accommodation for up to 56 people. The home consists of two separate units, one providing accommodation and personal care and the other providing nursing care. Some people receiving support at the home were living with dementia. The home is in Doncaster near to the town centre. At the time of our inspection there were 44 people using the service.

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

Medication systems were in place however, these were not always followed. Risks associated with people’s care and support had been identified, however, from records and observations staff were not supporting people following the assessments. Therefore, risks were not managed safely. Staff understood safeguarding and whistleblowing procedures and would use them when required. However, we identified safeguarding concerns had not be reported appropriately. We completed a tour of the home with the registered manager and found many areas in need of a deep clean and the home was not always well maintained.

People’s needs were assessed, but care was not always delivered in line with their preferences and choices. Care records we looked at did not record all food and fluid intake. People who were losing weight or at risk of weight loss did not have snack, supper and some meals recorded. People had access to healthcare professionals. People who lacked capacity to make decisions were supported to make decisions in the persons best interest.

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.

When staff engaged with people they were mostly kind and caring. However, we observed some staff did not engage when providing support and were task focused. From care plans we looked at it was not possible to see if people were involved in their care planning. Staff we spoke with understood people’s needs however, did not always follow care plans to ensure they respected their choices. Care and support provided and observed was not person-centred.

Care plans were not person centred and lacked information about people’s preferences and choices. The care plans we saw did not contain advise from health care professionals to ensure people’s needs were met. On the day of our inspection we saw no activities taking place and staff told us the activity co-ordinator was very often needed to cover care shifts. People told us they were bored. End of life care plans were very sparse and did not contain people’s preferences. People had assisted technology that they couldn’t use due to poor internet connection.

Care was not always planned in a way that promoted people’s independence. People who used the service did not have much opportunity to express their views. The provider had a range of audits in place to monitor the service delivery however these were not effective.

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 26 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care, staffing, safeguarding and leadership and oversight at this inspection.

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.

Please see the action we have told the provider to take at the end of this report. 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. Since our inspection we have been provided with a detailed action plan form the provider who is addressing the issues we identified at inspection.

St Mary’s Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a 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 Nursing Home provides accommodation for up to 56 people. The home consists of two separate units, one providing accommodation and personal care and the other providing nursing care. Some people receiving support at the home were living with dementia. The home is located in Doncaster near to the town centre. At the time of our inspection there were 40 people using the service. This included people who were staying at the home for a short period of respite care.

At the time of our inspection the service had a registered manager. 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.

Systems and processes were in place to safeguard people from the risk of abuse. Staff confirmed they had received training in this subject and told us what action they would take if they suspected abuse.

Risks associated with people’s care had been identified and actions had been considered to minimise them.

We observed staff interacting with people who used the service and found that there were enough staff available to meet people’s needs. However, we spoke with people who used the service, their relatives and staff and were told that sometimes there were not enough staff available to meet people’s needs in a timely way.

People received their medicines as prescribed, although we raised some concerns regarding the temperatures of the medicine store rooms and the recording of stock.

We conducted a tour of the building with the registered manager and found some concerns regarding fire safety and infection control. We brought these concerns to the attention of the registered manager who began to take action to address them.

We spoke with staff who felt they had the skills and knowledge to carry out the duties and responsibilities which were expected from them.

People received a healthy, balanced diet which met their needs and preferences. We observed lunch being served on both units and found people were offered a range of choices.

People had access to healthcare professionals who were contacted when people required their support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was compliant with the Mental Capacity Act 2005.

We observed staff interacting with people who used the service and found they were kind and caring in their nature. Staff ensured that people’s privacy and dignity were maintained. However, information relating to people’s care was not always treated confidentially.

People received personal care which met their needs. Care plans were detailed in a way they guided staff in how people preferred to receive their care.

The registered provider employed an activity co-ordinator who organised and delivered social activities.

The registered provider had a complaints procedure and people we spoke with felt able to raise concerns if they needed to.

The registered provider had systems in place to monitor the quality of the service. However, some audits had not been effective. Residents and relative’s meetings took place and people felt they had a voice.

We identified two breaches of regulation as the provider did not always ensure medicines were managed in a safe way and audit systems were not always effective. You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.