Archived: St Mark's Care Home

St Mark’s Care Home is a residential nursing home providing personal and nursing care to people living with a dementia, mental health conditions and physical disabilities. It can support up to 39 people in a single, purpose-built building. There were 14 people using the service when we inspected.

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

We received mixed feedback on people’s experience of the service. Comments ranged from, “It is most welcoming and friendly” to, “I don’t think they look at or use the care plan.”

Information on people was not always consistently recorded or updated. Medicine records were not always accurately completed. Issues identified at our last inspection had not always been addressed.

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 5 February 2020) and there was a breach of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service was subject to monitoring and support as part of a serious concerns protocol with Stockton-on-Tees local authority. As part of this process, the provider regularly shared an action plan and met with stakeholders (including the Care Quality Commission) to demonstrate the improvements they had been making.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 have identified a continuing breach of regulations in relation to the accuracy and completeness of care records. Please see the action we have told the provider to take at the end of this report.

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 Marks Care Home is a care home providing both nursing and personal care to people. The service accommodates up to 39 people with a range of needs including some living with a dementia. At the time of inspection 26 people were living at the service.

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

The service failed to maintain accurate and complete records in respect of people’s care and support. Individual risks associated with medical conditions were not identified. Some care plans contained inaccurate and missing information. Medicines were not managed safely.

The communication of important information about changes in people’s needs was not always effective. Governance systems were ineffective and failed to identify these shortfalls.

The provider had made some improvements since our last inspection. People had a safe environment. Health and safety checks were regularly conducted. Areas of the home had been repaired, resolving infection control issues. Safeguarding matters had been appropriately managed by the service.

People said they were happy with their choice of care home and they liked the homely feeling. People and relatives were complimentary about the care and support received. One relative told us, “My parent needs 24/7 365 days care because of their condition. I have no concerns whatsoever regarding their safety and can only praise everyone for the care.”

The provider had systems to learn from accidents and incidents, analysing the information for trends to enable them to reduce future incidents.

The service was open and transparent. An effective complaints process was in place and relatives and people we spoke with had no complaints.

The activity co-ordinator was enthusiastic about making people happy. Not everyone had the opportunity to access the community due to their care and support needs and there were limited activities available for people living with a dementia.

We recommended that the service research environments and suitable activities to support people living with a dementia.

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 were confident with staff members’ ability to support them safely. One person told us, “The staff seem to be trained to manage care safely and I feel confident when they are helping me.” The service supported staff with regular supervisions and appraisals.

The service had established partnerships with healthcare professionals to ensure people received joined up care. People, relatives and staff were regularly asked to provide feedback about the service.

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 inadequate (published 18 June 2019) and there were multiple breaches of regulation. This service has been in Special Measures since 18 June 2019. During this inspection the provider demonstrated some 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

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we found some improvements had been made but the provider had a continued breach of regulation 17.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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's risk assessments did not consistently cover all potential areas of risk, such as poor skin integrity and behaviours that may challenge and did not mitigate risks. Medicines management was not managed safely and in line with national guidance. The provider had appropriate systems in place to support staff to raise any safeguarding concerns. However, these were not always put into practice. The provider did not maintain the safety of the building and equipment. Premises needed work to become safe and many areas were in need of a deep clean. People felt safe in the care of staff members and were happy with staffing levels. However, staff were not utilised effectively.

People told us they received effective support. Systems were yet to be put in place to ensure that staff received appropriate supervision to support them in their roles and to ensure their training was up to date. The dining experience needed improvement and we could not evidence people were supported with their nutrition and hydration needs. Staff failed to follow moving and handling assessments placing people at risk of harm.

People told us care staff were caring and kind. People's privacy and dignity needs were not always maintained by staff members caring for them. We could not evidence people were receiving regular baths or showers. We witnessed an agency staff member roughly handle a person, we acted on this straight away, making staff aware of the incident and raised a safeguarding alert. However, this person was not removed from their duties until four hours after the incident.

Care plans lacked information and were confusing as some care plans used old formats from the previous providers. Documentation was not fully completed, contained inaccurate information and in some cases, was missing.

The providers records, systems and processes in place to monitor and audit the service required improvement. The registered manager did not have oversight of the service and was slow to react to concerns raised.

Activities were taking place and people went out on a regular basis. No complaints had been received since the provider was registered.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: This was the providers first rated inspection since becoming registered in February 2019.

Why we inspected: This was a responsive inspection based on concerns received.

Enforcement: We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 including safe care and treatment, safeguarding service users from abuse and improper treatment, nutrition and hydration, and good governance.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.