Archived: St Mary's Nursing Home

The service provides accommodation, nursing and personal care for up to 56 older people who may live with dementia. Fifty-one people were living at the home on the day of our inspection.

The registered manager had been in post for almost three years. 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.

At our previous inspection in November 2015, we found a breach of the regulations, related to the number of skilled and experienced staff in post, which had an impact on all of the five questions we ask about services. We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. At this inspection, we checked whether the actions they had taken were effective.

Since our previous inspection, the registered manager had recruited additional staff. There were enough skilled and experienced staff on duty to meet people’s care and support needs safely and effectively.

The registered manager checked staff’s suitability to deliver care and support during the recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

People were safe from the risks of harm, because staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence.

People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support. Staff understood people’s needs and abilities because they worked with experienced staff until they knew people well. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority to restrict people’s rights, choices or liberty in their best interests.

People were offered meals that were suitable for their individual dietary needs and met their preferences. They were supported to eat and drink according to their needs. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed and updated when people’s needs changed.

Staff were guided and supported in their practice by a management team that they liked and respected. Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice.

Some improvements had been made in record keeping since our previous inspection, but further improvements were needed. Individual records were not completed consistently or sufficiently detailed to evidence that staff took the necessary actions to minimise risks to people’s treatment and care. Audits of people’s care and treatment needed to be more robust.

St Mary’s Nursing Home is divided into two separate floors and provides personal and nursing care for up to 56 older people, including people living with dementia. There were 53 people living at St Mary’s Nursing Home when we inspected the service.

A requirement of the service’s registration is that they have a registered manager. 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection. We refer to the registered manager as the manager in the body of this report.

People were protected against the risk of abuse as the provider took steps to recruit staff of good character, and staff knew how to protect people from harm. The provider had appropriate policies and procedures so staff understood how to report allegations of abuse. However, there were not always enough staff to care for people effectively and safely, or to meet people's individual needs. People were not always engaged in activities and interests that met their individual needs.

A full record of each person's individual care and support needs was not maintained. People's care records did not reflect the care and support they received from staff on a daily basis. However, permanent staff knew people well and could describe the care people received.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home which helped them maintain personal relationships.

People received medicines to maintain their health and wellbeing and were supported to access healthcare from a range of professionals inside and outside the home. People were offered nutrition that assisted them to maintain their health. However, the monitoring of records to record the amount of fluid people received required improvement.

People knew how to make a complaint if they needed to. Complaints were fully investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views on how the service was run. Quality assurance procedures identified where the service needed to make improvements, and where issues had been identified the manager took action to continuously improve the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with five visitors who made positive comments about the care and support their relatives received. We were told, 'This is a lovely home, it's always clean and I am made to feel welcome' and "It's very good here. Staff are friendly and helpful.'

We looked at the care records for three people and found that their needs were assessed prior to admission so that plans of care and support reflected the way people liked and needed to be cared for. We found that care records were reviewed on a regular basis to make sure they accurately described the care people needed.

The members of care and nursing staff we spoke with told us that staff meetings and formal supervision sessions took place infrequently. We were informed however that information about people's needs was discussed at the daily handover at the start of each shift.

We observed that staff responded promptly to people when they asked for support and treated people with respect whilst providing care.

We looked at the way medicines were being managed to make sure people received their medication in a planned and safe way.

We found that there was a system of measuring the quality of the service provided to people so that improvements could be made, based on people's comments and suggestions.

We spoke with four people who lived on both floors of the home during our visit. We were told, "I can't complain about anything" and "I have everything I need and am treated very well." We spent time talking to five visitors, members of the management team and six nurses and care staff.

We observed care staff supporting people with their daily routines and saw that people were treated with dignity and respect. A visitor commented, "The staff make sure my relative's privacy is respected."

We looked at records which described how people liked and needed to be cared for. The care staff we spoke with demonstrated an understanding of people's needs and clearly knew them well. We looked at training records and talked to staff about the training they had received to enable them to meet people's needs. A member of the care staff team told us, "The dementia care training is very good. It has changed the way I work with people so that I understand their needs better."

We found the complaints procedure was made available to people and their relatives so that concerns or complaints could be addressed. We saw there was a written record of the provider's response to complaints which included the action taken to resolve matters.

We saw there were arrangements in place for the secure storage of records.