Background to this inspection
Updated
15 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
One inspector and an Expert by Experience carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
St Cuthbert’s House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the provider 24 hours' notice of the inspection. This allowed the provider time to let people know we would be contacting them for feedback and provide us with records for review as part of the inspection.
What we did before the inspection
We reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. We reviewed information we had received about the service since the last inspection.
We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.
We used all of this information to plan our inspection.
During the inspection
We spoke with six people and one relative about their experience of the care provided.
We reviewed a range of records. This included three people's care records. We spoke with four members of staff, including the registered manager.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with seven staff over the telephone and emailed six external healthcare professionals for feedback. We reviewed training information, recruitment information, maintenance records and quality assurance records.
Updated
15 July 2021
About the service
St Cuthberts House is a residential care home providing personal care to up to 28 people with enduring mental health needs. There were 22 people living at the service at the time of the inspection.
People’s experience of using this service and what we found
Safeguarding policies and procedures were in place but were not confidently followed by staff or appropriately managed and investigated by the registered manager.
Risks to people were not always effectively assessed or monitored. Lessons were not learned after specific incidents to ensure ongoing risks could be reduced.
Information was not always shared appropriately by staff when people raised concerns. The registered manager did not always appropriately share information of a safeguarding nature when required. There was a lack of scrutiny, oversight and accountability regarding any concerns raised and how these could be investigated and learned from.
Staff did not speak positively about the leadership of the service. The registered manager and staff worked well with some clinicians but the registered manager had not developed strong or positive working relationships with external agencies.
The premises were in need of repair and refurbishment in a number of areas. This impacted on people’s ability to make basic day to day choices, such as showering. There was no plan in place to complete or prioritise any of this work. Effective infection prevention and control was not always possible due to the refurbishments required.
Person-centred care plans had not been audited or updated in a timely fashion. Staff demonstrated a good knowledge of people’s preferences, histories and changing needs, but this was not reflected in up to date care planning. People were not stimulated or engaged with the activities on offer.
Staff meetings and supervisions had not taken place recently. Quality assurance processes were not effective in monitoring or improving the service. Care staff training in core areas was up to date.
Staff were recruited following the provider’s policies. Medicines processes we reviewed were safe.
People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People were supported to access healthcare appointments and received regular visits from clinicians.
People gave broadly positive feedback about meals.
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 good (published 22 October 2020).
Why we inspected
The inspection was prompted in part due to concerns received that safeguarding concerns were not fully investigated. A decision was made for us to inspect and examine those risks.
We have found evidence the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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 in relation to improvements required in the Responsive section.
The overall rating for the service has changed from good to inadequate. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Cuthbert’s House on our website at www.cqc.org.uk.
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 discharge our regulatory enforcement functions required 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 safeguarding, risk management, leadership and governance.
Please see the action we have told the provider to take at the end of this report.
Special measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.