St Clare's Care Home

We found the following examples of good practice.

• Staff were provided with the appropriate personal protective equipment [PPE]. Staff were knowledgeable on when to change PPE and there were a number of changing stations around the home.

• The registered manager had registered for 'whole home testing' for staff and residents.

• The provider was very supportive of the registered manager and the well-being of the staff team, ensuring they were supported throughout the pandemic.

• Cleaning schedules were in place and appropriate decontamination processes were also in place. This included deep cleans of bedrooms, communal areas and touch points such as light switches and hand rails.

• The provider undertook contingency planning in case there were further outbreaks of COVID-19.

• The registered manager had an admission process in place which minimised the risk of potential transmission of infection to people living at the home. For example, all people were isolated for 14 days following admission to the home or when discharged from hospital.

• The service had supported people to keep in contact with loved ones including video calls and window visits. The provider had also invested in screening equipment and identified an area for relatives to visit when safe to do so.

• The service had implemented zoning and designated staffing teams, this meant people who had tested positive were cared for in isolated areas in a safe manner by the same team of staff.

• The registered manager monitored all people daily for symptoms of COVID-19 this included daily temperature checks.

• The registered manager worked well with visiting healthcare professionals and requested all visitors wore PPE prior to entering the home.

• The provider had implemented new policies and processes to reflect the impact of COVID-19.

St Clare’s Care Home is a residential care home providing personal and nursing care to 39 people at the time of the inspection. The care home can accommodate 40 people in one adapted building.

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

People were not always supported by adequate numbers of staff to meet their needs. The risks to people’s safety were assessed and measures in place to mitigate them.

People’s medicines were managed safely and the environment they lived in was clean. The provider had measures in place to protect people from possible abuse and responded positively to safeguarding issues.

People’s care was assessed in a person-centred way and staff had the guidance to provide this. However, the inconsistent staffing levels had sometimes impacted on the delivery of personalised care.

The registered manager undertook a range of quality audits to monitor the care people received. Relatives told us they were involved in their family member’s care, and staff worked with health professionals to support the people in their care.

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 8 August 2019). The provider was in breach of two of the regulations. 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 been sustained, and the provider was no longer in breach of those regulations.

Why we inspected

We undertook this focused inspection to follow up on concerns we had received and to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings related to the key questions safe, responsive 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 remained Requires Improvement. This is based on the findings at this inspection.

Enforcement

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 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 Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Failure to provide sufficient numbers of staff to meet people’s needs.

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.

People’s experience of using this service: People were placed at risk of harm as risks associated with their care and support were not always managed safely. Some improvements were needed to ensure people received their medicines as required. Overall there were enough staff to ensure people’s safety, however there were times when staff were too busy to ensure people’s needs were met in a timely manner. Changes had been made after incidents to reduce the risk of the same thing happening again. People told us they felt safe and staff, and the manager, had a good understanding of safeguarding adults’ procedures. Most areas of the home were clean and hygienic. Safe recruitment practices were followed.

Further work was needed to ensure people were supported to have maximum choice and control of their lives. It was unclear if staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. Mealtimes were positive experiences; however, more work was needed to ensure risks were managed safely. Staff were skilled and competent and told us they felt supported in their roles. People had access to a range of health care professionals, but more information was needed in care plans to ensure staff were able to offer effective support in this area. The home was adapted to meet people’s needs.

People’s right to privacy and to be treated with dignity were not always upheld. People told us some staff were kind and caring, but this was variable. Care plans did not always contain information about what was import to people, this placed them at risk of inconsistent support. People were supported to be as independent as possible.

People did not always receive personalised care that met their needs. Further work was needed to ensure that people provided with appropriate opportunities for meaningful activity. People were supported to raise issues and concerns and there were systems in place to respond to complaints. People and their families were given an opportunity to discuss their wishes for the end of their lives.

Systems to ensure the safety and quality of the service were not fully effective. This failure to identify and address issues had a negative impact on the quality of the service provided. The management team were responsive to feedback and took action to address issues identified. Feedback from people, families and staff was used to drive improvement. The home worked in partnership with health professionals.

The service met the characteristics of Requires Improvement in all areas. 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 23 June 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected: This was a planned inspection, based upon date of registration.

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.