St Lukes Care Home

St Lukes Care Home provides accommodation and nursing/personal care to up to 56 older people across 4 units; some of whom were living with dementia. There were 42 people living in the home at the time of our inspection.

People's experience of using the service and what we found

Risks to people's health, safety and well-being had been assessed and staff mostly had access to relevant information and guidance to support people safely. However, some care plans lacked detailed and person-centred information about people's identified risks and needs. Some charts used to monitor people's identified risks and needs, such and food and drink and hygiene charts, had not been completed consistently and some lacked detailed information to evidence the support people received.

Whilst quality assurance systems were in place, they had not always been effective at identifying issues and driving improvements to the overall quality and safety of the service.

We received mixed feedback about the staffing levels within the home. People and family members told us staff were often rushed, and that at times there were not enough staff available to support with tasks such as meals in a timely manner. We have made a recommendation regarding staffing levels.

Medicines were managed safely. People told us staff gave them their medicines when needed and family members told us they were kept informed of any changes or updates to medicines. However, records relating to the administration of topical creams, fluid thickeners and medicines used to reduce anxiety had not always been completed accurately. We have made a recommendation regarding this.

Accident, incidents and safeguarding concerns were recorded and acted upon appropriately by staff. Records showed that where needed, appropriate referrals were completed to health and social care professionals. However, we identified a lack of managerial and provider oversight of accidents and incidents. This meant there could be missed opportunities to learn from incidents and prevent them occurring in the future.

People told us they felt safe living at St Lukes and all family members we spoke with told us they were confident their relatives were safe and well looked after. One family member said, "[Relative] is safe here. He was wandering day and night and now I can sleep peacefully. They [staff] work so hard. They are always kind and patient no matter how busy they are." Another told us, "It’s absolutely brilliant, couldn’t have been better. It’s the care, the staff never seem to get flustered about anything, they are always on it."

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.

The new manager demonstrated a thorough understanding of their role and responsibilities and provided evidence of changes they planned to make to improve the overall quality and safety of the service. Staff and family members spoke positively about the manager; they told us the manager was approachable, supportive and not afraid to challenge issues where needed. One staff member said, "[Manager] is better equipped and prepared to guide staff in the right direction."

The overall feedback about the service and staff was positive from all people and family members we spoke with. They told us; “The atmosphere is always pleasant and staff are always so welcoming. I would recommend this home to anyone, they [staff] love [relative] and he loves them," "It’s like a little family to my day in St Lukes. The staff have comforted me" and "The care workers are caring and know each person personally. They are aware of people’s needs.”

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 4 February 2022).

Why we inspected

This inspection was prompted in part due to concerns received about falls management, personal hygiene and the overall quality of care people received. In addition, we received notification of an incident following which a person sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks associated with falls. As a result we undertook a focused inspection to review the key questions of Safe and Well-led only.

The overall rating for the service has changed from good to requires improvement based on the findings from this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. However, we have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and recommendations

We have identified breaches in relation to records and quality assurance. 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The majority of relatives were very positive about the service and shared their praise and thanks to the staff for keeping their family members safe. There was a process to respond to complaints with detailed audits and oversight in place to review ongoing feedback with concerns raised.

We observed positive care practices between the staff and people at the service. Staff spoke quietly and respectfully and had positive effects on each person. People looked relaxed and were smiling in the company of staff supporting them.

People were supported to eat and drink where need. Staff had been trained, supervised and appraised in line with the policy of the organisation. Recent training had been developed and inclusive of all staff.

Support plans were person centred and reflected the needs of each person. Choices were discussed with relatives and they had been involved in completing plans. Relatives confirmed communication from staff was good, and staff supported people to make healthcare appointments where needed.

Records for the administration of medicines were person centred, up to date and safely managed.

There were detailed audits and quality checks in place covering all aspects of the service, complete with action plans when improvement was identified.

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

Additional cleaning procedures had been introduced and cleaning audits were in use to monitor standards. The service was working closely with local infection control leads to implement best practice. Vaccinations against COVID-19 had provided to all residents and staff.

We were assured that this service met good infection prevention and control guidelines

Some areas of the environment were more well maintained than other areas but kept clean, tidy and safe. Each unit was welcoming.

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

This service was registered with us on 18/11/2019. This is the first full inspection to be rated.

The last rating for the service under the previous provider was rated good, published on 3/11/2018.

Why we inspected

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 inspected the part of the service that had been identified by the Local Authority as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. This was one of the four units at St Lukes and consisted of 10 individual bedrooms for people, served by wide corridors with access to a communal lounge and dining room. At the time of our visit, there were no people or staff in this part of St Lukes.

We found the following examples of good practice.

• The provider had completed a ‘lesson learned’ exercise together with other professionals, such as a local GP, to learn from previous outbreaks and make improvements. This had led to changes, such as introducing separate changing and dining facilities to promote social distancing for staff.

• For the unit identified as a designated care setting, no visitors were allowed unless in exceptional, nationally agreed circumstances. For those needing to visit, lateral flow tests to check for COVID-19 infections were in use. Personal protective equipment (PPE) was available for visitors, who also had to complete a declaration and risk assessment, as well as a temperature check.

• The designated unit was spacious, had been deep cleaned, refurbished and repainted. Communal areas were set out so that those wishing to leave their bedroom could use the lounge or dining room while maintaining safe distance from each other and staff.

• Due to staff availability, the designated was planned to be covered almost entirely by external agency staff. To provide consistency the provider had agreed booking of the same agency staff with their employer for a period of several months. This was further supported by an agreement of staff only working on the designated unit and in no other care setting.

• The provider had sought assurances from the agency that all staff had received essential training, such as in infection control. This was further supported by the provider’s in-house training, overseen by a quality assurance officer. To support consistency of care and quality, two established nurses at St Lukes had been identified to lead the designated unit and its care for people.

• Future planning for people’s discharge from the designated unit was part of their admissions process. The provider explained that the first multi-disciplinary team meeting for each person would include defining a discharge plan, to consider whether this would be to the person’s own home in the community or a care home. The provider explained that often this planning would have taken place prior to the admission to the unit, adhering to the ‘home first’ approach, whereby going home wherever possible is the default pathway.

• Additional cleaning procedures had been introduced and cleaning audits were in use to monitor standards. The service was working closely with local infection control leads to implement best practice. Vaccinations against COVID-19 had been offered to all residents and staff, including agency staff.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.