St Cecilia

St Cecilia is a residential care home registered to provide care and support to up to 15 older people. They specialised in providing care and support for people living with dementia. There were 14 people living at St Cecilia at the time of inspection. The home provided accommodation in an adapted property with rooms over three floors with access via stairs and a stair lift.

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

People were safe living at St Cecilia. The home had implemented various improvements following our last inspection. This included changes to make the environment safer and ensuring people’s risks were properly assessed. Staff knew how to keep people safe, how to raise concerns and were confident it would be dealt with correctly and efficiently.

There was enough staff on duty, and they had the necessary skills and training to support people. People who lived at St Cecilia were living with dementia and had complex needs. Staff were present and engaging with people and there was a calm, relaxed atmosphere.

Medicines were managed safely, and the home worked well with healthcare professionals to implement changes when necessary. Infection prevention and control procedures were robust, and the latest government guidance was being followed in regard to COVID-19. People were supported to eat and drink and enjoyed their likes and preferences. Where needed specialist advice had been sought such as where there was a risk of choking.

St Cecilia was homely, and the décor reflected the age of the property. There was an ongoing programme of redecoration and updating that was monitored by the provider and the registered manager. People had personalised care plans and they were reviewed and updated regularly; everyone was involved in this process. Electronic care plans and records meant that updates were instant and people were receiving the most up to date care.

People knew how to make a complaint and the home had a procedure in place. Improvements had been made to the oversight of the service. A range of audits checked the systems within the home. During the inspection the registered manager made additional improvements to the process. People, their relatives and staff were complimentary about the registered manager and compliance officer. They told us that St Cecilia was well led. Health and social care professionals explained that many people living at St Cecilia had complex health needs which were managed well by the home.

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. Where necessary people had capacity assessments and documentation to show care was delivered in their best interest with all relevant people involved.

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 18 November 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.

Why we inspected

At our last inspection breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when to improve safe care and treatment, person centred care and good governance. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the caring key questions. We therefore did not inspect it. The rating from the previous comprehensive inspection for the caring key question 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 Cecilia 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 Cecilia is a residential care home providing care and support to 14 older people living with dementia. The service can support up to 15 people and provides accommodation in an adapted property with rooms over three floors.

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

Assessments of people’s care needs, and preferences had not consistently been carried out. This meant that care plans had not always been created placing people at risk of inconsistent or inappropriate care that was not person centred.

Risks to people associated with their care, infection prevention and the premises were not consistently identified, assessed, reviewed or actioned which meant people were are risk of avoidable harm.

Governance and auditing processes were not always effective. They had not identified the shortfalls found at this inspection, did not ensure the service was compliant with regulations or that risks were managed effectively. Peoples records of their care and treatment were not always complete. Legal requirements for submitting notifications had not always been met. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them.

People were cared for by staff who had undertaken safeguarding training and understand their role in identifying and reporting suspected abuse or poor practice. People were supported by enough staff who had been recruited safely, including criminal record checks to ensure they were suitable to work with older people. Medicines were administered safely by trained staff who had their competencies regularly checked.

Staff completed an induction and had ongoing training and support that enabled them to carry out their roles effectively. People had their eating and drinking needs met and had home cooked, well balanced meals that provided plenty of variety and choice. Positive working relationships with other health and social care professionals meant people had effective care that provided good outcomes for them. 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.

Families and visiting professionals spoke positively about the care people received, including end of life care, describing staff as kind, patient and attentive to people’s needs. Staff had a good knowledge of people and understood their communication needs. This meant that people were able to be involved in decisions about their day to day lives. People had their privacy, dignity and independence respected by the staff team.

A complaints process was in place, including an easy read version. No complaints had been received since our last inspection. Families told us they felt able to raise a complaint and that they would be listened to and any necessary actions taken. Staff felt communication systems kept them up to date with people’s changing needs.

The management of the home was visible and promoted an open, positive culture. Feedback from families and visiting professionals was positive about the management of the home which they described as welcoming and friendly. Families and staff felt involved and informed about the home describing communication as good.

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 good (published 2 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risks to people associated with their care, infection control and premises, planning of person-centred care and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.

St Cecilia is registered to provide accommodation and nursing or personal care for up to 15 people. There were 14 people living at the service at the time of inspection. The home is situated in Poole and offers accommodation split over three floors. There is a communal lounge and dining area on the ground floor. There is stair lift access to the first floor and some bedrooms have an ensuite. There is a garden to the rear of the service. Everyone living at the home at the time of inspection had dementia and people were not able to verbally tell us about the home. We spent time observing people and their interactions with staff and spoke with relatives to gather this information.

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.

The service was not consistently safe because recruitment processes for staff were not always robust and because there were areas of the home where maintenance was required to ensure that people had a safe environment to live in. The registered manager had a plan in place to manage the repairs required and was responsive in introducing a more robust system for continued maintenance issues.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

Staff were aware of the risks people faced and understood their role in reducing these. People had individual risk assessments which identified risks and actions required by staff to ensure that people were supported safely.

There were enough staff available and people did not have to wait for support. People had support and care from staff who were familiar to them and knew them well. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs.

People received their medicines on time. We saw that people were supported by staff who had received appropriate training to administer medicines and that they followed safe procedures when giving people their medicines.

People were supported by staff who had received appropriate training and had regular supervisions to discuss and develop their practice. Additional training was arranged which was relevant to the needs of the people living at the home. Where referrals to healthcare professionals were required, these were made promptly.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation.

People had sufficient to eat and drink. The chef told us that they would make alternative choices for people if they did not want the menu option available and we saw that staff were flexible to the needs of each resident and how they preferred to receive their meals. Where people required support to eat safely, this was provided.

Staff had a clear rapport and there was a relaxed atmosphere in the home. People often approached staff for reassurance, guidance or comfort and interactions were gentle and tactile.

Most people at the home were not able to verbally communicate their needs and wishes and we saw that staff were able to communicate with people in ways which were meaningful to them. People were supported in a respectful way and staff encouraged people to be as independent as possible.

People had individual care records which were person centred and gave details about people’s history, what was important to them and identified support they required from staff. Records were reviewed regularly and involved relatives and loved ones.

People enjoyed a range of activities and care plans included details of people’s preferences and interests. We observed that staff spent time individually with people as well as in group activities.

Relatives felt welcomed by the home and visited whenever they chose. They spoke warmly about the staff and how well their loved ones were supported. The home had not received any complaints but relatives said that they would be confident to complain if they needed to do so.

Relatives were kept updated by staff at the home and invited to feedback informally and through regular meetings. Feedback was also sought using an online resource.

The service was well led and we were told that the registered manager was approachable and available. Staff were encouraged to raise ideas and suggestions and communicated effectively using regular handovers and a communication book. Staff were clear and confident in their roles and were supported to learn and develop by the management at the home.

Quality assurance measures were regular and the compliance officer used the information to identify any gaps or trends and then plan actions to further develop high quality care.

We undertook a tour of the home with a member of staff. We looked at the communal areas, toilets, bedrooms and bathrooms. Furniture had been replaced and works undertaken to secure wardrobes and radiator covers. One person told us the new armchairs were comfy.

We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

During observations we saw that care workers knew individual's well and understood their needs. They knew what interested people and what kept them occupied.

We observed that staff were caring and provided care and support in a sensitive way. They gently and discreetly spoke with people when they needed any support or personal care.

People experienced care and support that met their needs and protected their rights.

There were suitable medication management systems in place and there were enough qualified, skilled and experienced staff to meet people's needs.

The provider had not taken sufficient steps to provide care in an environment that was adequately maintained.

There were systems in place to monitor and assess the quality and safety of the service.