St Peter's Care and Nursing Home

St Peter’s Care and Nursing Home provides nursing and personal care for up to 57 older people who were living with a range of health care needs. This included people who live with a stroke, diabetes and Parkinson’s disease. Some people had memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care. St Peter’s Care and Nursing Home is part of a retirement village, with 34 sheltered housing flats and cottages. There were 44 people living at St Peter’s Care and Nursing Home.

People’s experience of using this service

The providers’ governance systems had improved and were being used consistently to improve the service. There had been improvements made, but there were still areas that needed to be further improved to ensure people's safety. For example, there was a lack of clear and accurate daily records regarding some people's hydration support. Fluid charts were inconsistently recorded which meant that staff may not be able to monitor their health and well-being effectively.

People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “It’s a nice and safe place to live.” Care plans and risk assessments meant peoples’ safety and well-being were protected. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was well-maintained and comfortable. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service.

Staff had all received essential training to meet peoples support and care needs. Service specific training was sourced and staff competencies undertaken. One staff member said, “Best place to work, we get so much support and training.” People's dietary needs were assessed, and people were provided with a choice of cooked meals each day. Feedback about the food was positive and people said they enjoyed the meals. People’s health needs were consistently met with involvement from a variety of health and social care professionals.

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 were caring in their approach to the people they supported and at this inspection we saw people were treated with respect and dignity. People and visitors to the service were consistent in their views that staff were kind, caring and supportive. One health professional said, “The home atmosphere is friendly and welcoming.” People were relaxed, comfortable and happy in the company of staff and engaged with in a positive way.

People confirmed they were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Complaints made by people were taken seriously and investigated. Resident and family meetings were now recommencing.

The registered manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “Really supportive team, and a really good place to work.”

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 (01 August 2019) and there were three 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 had met the three breaches of regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This enabled us to review the previous ratings. We also used this opportunity to look at the breaches of Regulation 12, 13 and 17. As a result, we undertook a comprehensive inspection to review all the key questions.

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 included checking the provider was meeting COVID-19 vaccination requirements.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We found the following examples of good practice.

The home was very clean and well maintained. There was regular cleaning throughout the day, and this included high-touch areas. The housekeeping staff were knowledgeable regarding current Covid-19 cleaning guidelines and robust cleaning schedules were in place.

The home was currently closed to all visitors apart from those whose loved ones were on a palliative care pathway and receiving end of life care. Visitors at this time were asked to wear personal protective equipment (PPE), have a lateral flow test on arrival and have their temperature taken. This included family visitors and health professionals. Staff also supported people to remain in contact with their families through phone and video calls during the lock down.

There was a visiting policy to support visitors once the home re-opens to visitors. There was also a visiting room with an outside entrance where families will be able to meet their loved ones' safely.

There were systems in place to ensure that people who had tested positive for Covid-19 and were self-isolating cared for in their bedrooms to minimise the risk of spreading the virus. Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.

Regular testing for people and staff was taking place. There had been changes to testing following their outbreak of Covid-19 as people and staff who tested positive are not tested for 90 days. All staff have a weekly polymerase chain reaction (PCR) and daily lateral flow test (LFT). In addition, they have their temperatures taken. People have a monthly PCR test with daily temperatures and oxygen level checks.

The home had opened for admissions. All new arrivals will only be accepted with a negative PCR test and then isolate for 14 days. There are plans to use the lower floor unit with three ensuite bedrooms as an admission unit for self-isolation before moving into a room of their choice on the upper floors.

At present most people chose to spend time in their rooms. Staff were supported people to remain engaged with one to one activities. People who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people. Staff had developed a ‘Covid’ board with guidance for staff about how to help each other during the pandemic and maintain their well -being both physically and mentally. It also had help line numbers for staff to access should they need it. It had proved very beneficial to all staff.

Peterhouse provides nursing and personal care for up to 39 older people who were living with a range of health care needs. This included people who live with a stroke, diabetes and Parkinson’s disease. Some people had memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care. Peterhouse is part of a retirement village, with 34 sheltered housing flats and cottages. There were 34 people living at Peterhouse.

People’s experience of using this service

The providers’ governance systems had not identified the shortfalls found at this inspection. There was a lack of clear and accurate records regarding some people's care and support. The provider had undertaken audits in March 2019, which had identified shortfalls within care delivery. However, these had not been addressed to improve care and treatment for people.

The provider did not have an overview of staff training. The training programme identified that staff had not received training in essential and service specific training, such as fire safety, catheter care and moving and handling. There was also no reflection of the training received from previous provider or staff competencies. Nurse competencies were not up to date according to the providers records. This meant the provider had not ensured that people were supported by trained and competent staff. Notifications had been not always been completed in a timely way to inform CQC and other outside organisations when events occurred.

Both during and following the inspection we have received robust action plans, root cause analysis of wounds and audits that told us of actions taken and to be taken to mitigate risk to peoples' health and wellbeing.

We have also received confirmation of safeguarding referrals made in respect of wounds. We have also received retrospective notifications of serious injuries following the inspection.

People’s health, safety and well-being was not always protected, because not all people who lived at Peterhouse had a care plan and risk assessment that reflected their identified needs, such as pressure sores, post stroke pathways and catheter care. Weight loss and weight gain had not always been highlighted and there was no evidence that stated further action had been taken to mitigate risk. Wound care was not always accurately documented and associated risk assessments had not prevented further skin breakdown. Whilst the provider had systems in place to facilitate the analysis of incidents and accidents, these were not fully established. This meant that lessons had not been learnt and preventative measures were not put into place to prevent a re-occurrence. The training records available did not evidence specific training undertaken by registered nurses and care staff to keep people safe and provide safe care and treatment. People were not always protected from the risks of abuse and harm, because systems and processes were not fully established and operated effectively to prevent potential abuse of people who lived in Peterhouse. The registered manager agreed improvements were required for the safe management of ‘as required’ medicines.

Whilst there were areas of care planning and assessing risk to people that needed to be improved, there were systems to monitor people's safety and promote their health and wellbeing, which included risk of falls and choking. People told us, “I do feel safe, I am looked after,” and “I don’t have any worries, I am looked after.” Visitors told us, “I was concerned about all the staff changes, but its settling down now, I think I can say it’s safe here.” 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 had a choice of meals provided and staff knew people’s likes and dislikes. Comments included, “Good food,” “I like the food” and “Not bad, large portions, plenty of food” Referrals were made appropriately to outside agencies when required which ensured effective care. For example, GPs, community nurses and speech and language therapists (SALT).

People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback. One person said, “The staff are very good, very polite,” and another said, “Lovely staff, lots of humour here, nice place to live.”

People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families. One person told us. “Staff help me to ring my family, so I can keep in touch with them." The care ensured people's independence was encouraged and maintained. Staff supported people with their mobility and encouraged them to remain active.

People and families were involved in their care planning as much as possible. End of life care was planned for and some staff confirmed they had received training. There was a satisfactory complaints policy. People also had access to the service users guide which detailed how they could make a complaint. Feedback was sought from people and staff at this time through regular meetings. People told us “I can speak my mind at these meetings and I feel they listen.”

The service met the characteristics for a rating of Requires Improvement. We found four breaches of Regulation of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 05/11/2016). 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

The inspection was prompted in part due to concerns received about staffing levels, lack of training, poor care delivery and not informing CQC of serious injuries. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.