St Mary's Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At the last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We found the provider was in breach of the legal regulation relating to good governance.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider and registered manager had developed a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. The registered manager would actively learn lessons when concerns were raised and ensure practices were changed. However, when changing the service to one specialising in supporting people with a learning disability or autism they failed to identify negative impact of their and staff’s lack of understanding on their ability to support this group of people. Also prior to our inspection there were not enough staff in place to meet people needs and the negative impact this was having on people’s quality of life.

Staff did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. The people we observed whose presenting need related to their learning disability or autism spent large parts of their time sat with others, watching programmes others had chosen and did not have staff assigned to support them in 1:1 activity. They were not supported to engage in everyday activity such as shopping or cooking unless this was in a group and the majority of external activities involved going out in large groups. This does not reflect a model of care, which enables people to lead ordinary lives. Some people told us prior to moving to the service they had 1:1 support everyday, but this had not been replicated. The registered manager said, “We don’t need to have 1:1 staff. When we are offered it, I explain to the professionals organising the admission we don’t need it, as we always provide person-centred care.” They had failed to recognise having 1:1 support would be essential for enabling people to lead ordinary lives. Following the inspection the provider told us, the decision around 1:1 support was taken in collaboration with external professionals.

People, relatives and visiting professionals were complimentary about how staff supported individuals to gradually move into the home. A visiting professional said, “My client moved in here and staff have been really good with them. They don’t like much involvement with people and prefer their own company. Staff have worked with them and they now spend most of their time out of the home and have travelled around the country. This has been very positive.”

Staff did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff had not recognised people vulnerabilities to sexual exploitation in the home and outside the home and had therefore not worked with individuals to minimise these risks until we raised it. Staff told us everyone got on well and there were never any incidents. However, people told us about disagreements and arguments they had with others in the home. There were no records to show how staff managed disputes within the home.

The registered manager ensured when safeguarding concerns were raised these triggered alerts and they followed guidance from the safeguarding team and clinicians about how to reduce reoccurrence of incidents. The management team ensured Deprivation of Liberty Safeguard (DoLS) authorisations were applied for when needed and any conditions were followed.

Staff did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments that were in place covered people’s physical health and not risk associated with their individual wellbeing, developing independent living skills or going out. No records had been in place to provide staff with guidance around positive risk-taking. When people were openly distressed staff respond in a kind and caring manner but did not understand how autistic people displayed distress such as by stimming so did not respond to this or consider why the person might be upset. Autistic people were not supported to experience safe, consistent and predictable atmosphere. A relative said, “‘No safety concerns – lots of secure doors. Residents don’t know numbers to doors.’ During the inspection the provider employed an external consultant to work with staff to improve risk assessment systems and records.

The provider did not detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. The service is a very large care home where most bedrooms have no ensuite facilities, people had to share access to the 6 bathrooms and the communal toilets. Spread across 2 floors were 4 lounges, and a very large lounge/diner and there were no quiet rooms. The environment did not meet the principles of right care, right support and right culture as it did not maximise people’s choice, control and independence. Prior to the start of the inspection the provider had not recognised the need to adapt the environment or consulted with people to ensure adaptations were made to meet individuals’ needs, and make it more appropriate for providing a specialist service. There had been no access to domestic style kitchens and laundries, or sensory equipment. During the inspection the provider installed a domestic kitchen and laundry and made 2 lounges more appropriate for supporting working age adults and made people’s bedrooms more comfortable. These changes improved the quality of life for most people but not those whose presenting needs related to a learning disability. The environment continued to be filled with competing noises, very busy and when people used communal areas they had to sit in large groups. A relative said, “Not ideal home for [person’s name]. it is not an environment that a someone in their 40s would normally want to be in but because he is safe, I am happy.”

The provider did not make sure there were enough qualified, skilled and experienced staff. When we started the inspection, we raised issues around staffing levels in general and staff skills and experience to provide support for people with a learning disability or autism. For 53 people there had been 6 staff on duty during the day and 4 staff at night, plus 4 activities staff who worked across the week. The provider acted on this and did improve the staffing levels and altered shift patterns. Despite this change if people whose needs related to their learning disability or autism and did not access day services were not always getting their needs met. For example, 1 person sat for hours at a dining room table, when staff were free they encouraged them to colour in books or make Lego.

Although the registered manager promoted a learning culture and supported staff to access mandatory and condition specific training, they had not ensured staff were equipped with the necessary skills to effectively work with the working age people who used the service. During the inspection the registered manager who made sure staff received additional training in various topics around supporting working age adults and working with people who have a learning disability or autism but this has yet to be embedded into their practices.

Staff assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff appropriately followed the required infection control guidelines.

Staff always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They were passionate about supporting people to engage with medicines reviews and always involved individuals in planning, including when changes happened. Everyone had an annual medicines review from a healthcare professional. Medicines were stored securely; appropriate monitoring was in place to ensure medicines were fit for use. People were supported to take their medicines in a way that was best for them, records including medicines administration records, care plans and protocols were person centred. Stock balances matched signatures.

Where people were prescribed many medicines or high doses of medicines the staff supported people and health care professionals to reduce people’s medicines to the lowest effective dose. We saw examples of how staff were supporting people to reduce pain medicines and another where a person who had been supported to reduce a mental health medicine and this was now at the lowest effective dose for the person. Where people visited other care settings staff worked closely with the setting and health care professionals to ensure that plans were in place to support people with their medicines. For example, one person prone to constipation had a detailed multi agency plan in place we saw how this was followed and communicated between the services. People with diabetes were supported by the diabetes team, GP services and the home to self-administer their insulin, detailed care plans were in place to support the care staff in assisting people with their diabetes management.

Where errors had occurred, these were raised as incidents, investigated and learning shared. Internal audit processes were in place, where shortfalls were identified actions were developed with timelines for completion. The home worked in collaboration with and encouraged external medicines audits as they felt this helped them to continually improve their service.