Archived: St Cuthberts House

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.

St Cuthberts House is a residential care home providing personal care to up to 24 people with enduring mental health needs at the time of the inspection. The service can accommodate 28 people in one adapted building.

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

People confirmed they felt safe and were well cared for. Likewise, staff also felt the service was safe. The provider had whistle blowing and safeguarding procedures for staff to follow should they have any concerns about the service. Staff were confident to raise concerns if needed. Staff had completed safeguarding training.

The director was overseeing the service whilst the registered manager was absent. The service had a stable staff team who had worked with people using the servce for a considerable time. Staff told us the director was present at the service each day and provided them with anything they needed.

There were enough staff to meet people’s needs. Staff were visible around the home and resonded quickly to people’s requests for assistance.

Incidents and accidents had been investigated and action taken to keep people safe.

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 13 June 2019).

Why we inspected

We undertook this targeted inspection because we were informed the registered manager was to be unexpectedly absent from the service for an uncertain period of time. We needed to seek reassurance about the interim managememt arrangements and to check people were safe.

The overall rating for the service has not changed following this targeted inspection and remains good.

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.

As part of CQC’s response to the coronavirus pandemic we are also conducting a thematic review of infection control and prevention measures in care homes. The Safe domain also therefore contains information around assurances we gained from the registered manager regarding infection control and prevention.

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. The provider agreed to send us regular updates on progress.

St Cuthberts House is a residential care home providing personal care to 24 people with enduring mental health needs at the time of the inspection. The service can accommodate 28 people in one adapted building.

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

At our last inspection we found the registered manager was not submitting the required statutory notifications regarding significant events at the home. Since the last inspection this had improved and was no longer the case.

The home was a safe place to live. People and staff confirmed this. Staff knew about the procedures for identifying and reporting concerns, such as safeguarding and whistle blowing. Safeguarding concerns were reported correctly and investigated.

There were enough staff to meet people’s needs; new staff were recruited safely. People received the medicines they needed. Risk assessments and health and safety checks were carried out to help maintain a safe environment. Incidents and accidents were monitored to check robust action had been taken.

Staff were well supported and received appropriate training. People had enough to eat and drink and had access to external health care services. 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 told us they received good care from a team of kind and caring staff. Care records included information about people's preferences.

People's needs had been fully assessed; this was used as the basis for developing personalised care plans. Care plans were reviewed each month to reflect people’s current needs. People were supported to participate in activities based around their interests. Complaints were fully investigated and resolved.

People and staff said the home was well managed. There was a structured approach to quality assurance; this had been effective in addressing issues. There were regular opportunities for people and staff to provide feedback about the home.

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 18 May 2018) and there was a breach of the registration regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected.

This was a planned inspection based on the previous rating.

St Cuthberts House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Cuthberts House provides care and support for up to 28 people who have enduring mental health issues. At the time of the inspection there were 26 people living there. It currently has an all-male client group.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We previously inspected St Cuthberts House in September 2015, at which time the service was meeting all regulatory standards and was rated ‘Good’.

At this inspection we found the service had deteriorated to Requires Improvement.

At this inspection we found that there was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This related to the Registered Manager failing to notify the Care Quality Commission of incidents regarding abuse and a receipt of a Deprivation of Liberty Safeguard authorisation.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the service. Staff had completed training in safeguarding people and the registered manager actively raised any safeguarding concerns with the local authority.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

People commented on an ongoing issue with communal toilets and them being left in an unclean manner. We have made a recommendation about the maintenance and cleanliness of communal toilets in the home.

There were enough staff to meet people’s needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

People continued to receive their medicines in a timely way and in line with prescribed instructions. Staff had their competencies checked regularly and medicines audits were completed by the registered manager.

Staff received up to date training, regular supervisions and an annual appraisal to support them in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to access a range of health professionals and information of healthcare intervention was included in care records.

People told us the service was caring. Staff treated people with dignity and respect when supporting them with daily tasks.

People had access to advocacy services if they wished to receive support. Some people had active local advocacy services or Independent Mental Capacity Advocates (IMCAs) involved in decision making relating to specific aspects of their care.

People’s physical, mental and social needs were assessed prior to them moving into the home. Care plans were personalised, reviewed regularly and included people’s personal preferences.

There was a range of activities available for people to enjoy in the home. People were also supported, where necessary, to access activities in the local community including going to a local club, library and shopping.

There were audit systems in place to monitor the quality and safety of the service. The views of people, relatives and staff were sought by the registered manager via annual questionnaires. There were no negative comments received during the last questionnaires received in 2017.

People told us they were well cared for and most said they were happy living in the home. We saw that people's needs had been properly assessed and that appropriate plans were in place to help them meet their needs. Visiting health and social care professionals told us they had no concerns about the quality of the care in the home.

People's medicines were safely stored and administered to them, and clear records were kept.

Improvements had been made to the arrangements for preventing cross-infection in the home.

Robust and effective recruitment and selection processes were in place for the employment of new staff.

Comments and complaints people made were responded to appropriately.