St Leonards Rest Home

St Leonard’s Rest Home is a residential care home providing accommodation and personal care to up to 15 older people. The service provides support to older people and people with dementia. At the time of our inspection there were 8 people using the service.

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

This was a targeted inspection that considered the day to day management oversight arrangements in place in relation to ensuring people’s welfare and governance. Based on our inspection of governance arrangements we were assured there were leadership arrangements in place to provide support in overseeing 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

The last rating for this service was requires improvement (published 9 February 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook this targeted inspection to check on a specific concern we had about the day-to-day management oversight in place in relation to ensuring people’s welfare and governance. We found no evidence during this inspection that people were at risk of harm from this concern.

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

We use targeted inspections to follow up on Warning Notices or to check 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Leonards on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Leonards Rest Home is a residential care home that provides accommodation for up to 15 older people who may require personal or nursing care. At the time of the inspection 12 people were being supported and some people were living with dementia or other cognitive impairments.

During our previous inspection in October 2019 we identified five breaches of regulations. We took enforcement action and issued two warning notices. This was to ensure effective systems were operated to ensure compliance with regulations and to monitor and improve the quality of the service provided. At this inspection we found enough improvements had been made; however, there was a need to sustain the improvements made and to make further improvements. The service has been rated as requires improvement as it met the characteristics for this rating in the two inspected key questions. More information is in the full report.

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

Overall enough improvements had been made to protect people from the risk associated with poor prevention and control of infection, in the providers understanding of safe operating procedures and in the monitoring and improving the quality and safety of the service.

Improvements were still needed to ensure the provider followed their infection control and prevention procedures. We have made recommendations about some waste disposal, storage areas and the garden areas of the service.

Since the previous inspection the provider had improved their quality assurance audits however improvements were still needed to ensure they were effective. We have made recommendations about reviewing their safeguarding and quality assurance systems in line with best practice.

People told us they felt safe. Medication administration records (MAR) confirmed people had received their medicines as prescribed. The emotional well-being of people during the COVID-19 pandemic had been prioritised by the provider.

Staffing levels were meeting the care needs of people living in the service. Recruitment records showed staff were recruited safely and in line with current legislation. Staff felt supported and were positive about the internal improvements that had been made to the service since the previous inspection.

The provider was engaging with external professionals to address fire safety concerns and to update their care planning documentation.

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 inadequate (published 09 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found enough improvements had been made and the provider was no longer in breach of the regulations in four of the five previous breaches.

This service has been in Special Measures since April 2020. During this inspection the provider demonstrated that enough 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

We carried out an unannounced comprehensive inspection of this service on 08 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Leonards Rest Home 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 monitor the service.

We have identified a breach in relation to the provider failing to comply with the requirement to display their rating appropriately at this inspection.

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 Leonards Rest Home is a residential care home that provides accommodation for up to 15 older people who may require personal or nursing care. At the time of the inspection, some people were living with dementia or other cognitive impairments.

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

People were at risk of harm because the provider did not have effective arrangements in place for making sure the premises was kept clean and hygienic. This meant people, staff and others were not protected from the risk of infections. Risk associated with people’s needs were not always effectively assessed using best practice guidance and plans developed to mitigate risks. Risks associated with the environment and equipment were not considered and addressed to ensure people’s safety. not been considered in relation to the environment. We could not be assured effective training was provided to staff based on the needs of people.

Effective systems and processes were not in place to assess, monitor and improve the quality and safety of the service. Risks to people and others were not continually monitored and appropriate action was not taken where a risk had been identified. The provider did not comply with the requirements to display their rating.

Medicines were administered safely and as prescribed. Staff were recruited safely and there were enough staff to meet people’s needs. 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 interest. People’s nutritional needs were met, and they were supported to access other health professionals. Staff knew people well and people felt staff were kind, caring and compassionate. They understood people’s histories, preferences and supported them to do activities of their choice.

The adaptation, design and decoration of the building was very poorly maintained and did not meet the needs of people. The needs of people living with dementia had and they were supported to access other health professionals. Staff knew people well and people felt staff were kind, caring and compassionate. They understood people’s histories, preferences and supported them to do activities of their choice.

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 requires improvement (published 4 October 2018).

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced comprehensive inspection of this service on 10 July 2018. A breach of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their procedures in relation to staff recruitment.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. Before the inspection we had received some information of concern relating to the care people received. We used this information to support our inspection planning.

Enforcement

We have identified breaches in relation to the assessment and management of risk, the environment, staffing, the display or rating and the assessement and monitoring of safety and quality.

Please see the action we have told the provider to take at the end of this report.

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.

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 Leonards Rest Home 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 was providing personal care and accommodation for up to 15 people. The service cared for older people, people living with dementia and people with mental health needs. Care and support took place in one adapted building over two floors. During the inspection there were 15 people living at the service.

There was a registered manager in post. 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 last inspection published on 12 January 2018 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because people were placed at risk when staff were using wheelchairs to assist them to move around the service as staff were not using them safely. This was a breach Regulation 12 Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities). We found a breach of Regulation 13 Safeguarding service users from abuse and improper treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were no records of best interest decisions being made where people did not have the mental capacity to make informed decisions about their care. We also found a breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was a lack of accurate records to monitor, assess and make improvements to the service provided.

We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when. The provider sent us an action plan stating that they had addressed the breaches by 28 November 2017, before the report was published.

We found during this inspection that these regulations had been met. However, we found that safe recruitment practices were not followed.

The registered provider was not following safe recruitment practices. Issues we found with the records had not been identified by the registered provider.

Accidents and incidents were investigated and followed up by the registered manager but oversight and analysis of trends in incidents were not documented. Care records were comprehensive and detailed but recruitment records needed improvement. We have made a recommendation about record keeping and governance of the service.

Medicines were appropriately acquired, stored, dispensed and disposed of.

Staff had received safeguarding training, were knowledgeable on recognising signs of potential abuse and knew how to raise concerns.

There were sufficient numbers of staff employed to support people.

Appropriate checks and documentation in relation to fire safety and health and safety was up to date. The environment was clean and tidy.

The service was working in accordance with the Mental Capacity Act 2005 (MCA).

Staff received regular training and were well supported. Newly employed staff members completed the Care Certificate. This is a set of nationally recognised standards of care which staff who are new to care are expected to adhere to in their daily working life to support them to deliver safe and effective care.

The registered provider and registered manager understood the importance of promoting best practice and were members of various organisations that shared information on improving practice.

People were treated in a kind and compassionate way.

People and relatives were consistently involved in planning and delivery of care.

Staff knew people very well and understood their needs. People were referred to healthcare professionals as appropriate.

People were able to participate in a range of activities.

People and relatives were informed of how to make a complaint and any received were responded to.

People were treated equally and their diverse needs respected.

There was an open culture among the staff team.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

St Leonards 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 Leonards accommodates 15 people in one adapted building. People may be living with dementia or a mental health issue. At the time of our inspection there were 12 people living at the home. People were accommodated in 11 single rooms and two double rooms, with two shared lounges, a dining room and an enclosed garden.

There was 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.’

Medicines were not always managed safely as accurate records were not always kept regarding administration.

Accidents and incidents were not monitored to ensure that appropriate action had taken place or analysed to monitor any patterns of behaviours.

Environmental risks were not always well managed. The use of equipment such as wheelchairs was not always safe.

Emergency systems had been put in place to keep people safe. These were to be upgraded.

Care records contained detailed information about how individuals wished to be supported. Generally, people's risks were managed, monitored and regularly reviewed to help keep people safe. However there was no guidance regarding the risks associated with some medicines.

There were no records of best interest decision making where people lacked the mental capacity to make informed decisions about their care.

Applications had been submitted to deprive people of their liberty, in their best interest.

People's individual communication methods and needs were taken into account and respected

People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home.

Staff had a good understanding of people's needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe.

Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

People were supported to maintain good health through regular access to health and social care professionals, such GPs and district nurses. People's dietary needs and any risks were understood and met by the staff team.

We found three breaches 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.

St Leonards provides support and accommodation for up to 15 older people who may be living with dementia or a mental health issue. At the time of our inspection there were 14 people living at the home. People were accommodated in 11 single rooms and two double rooms, with two shared lounges, a dining room and an enclosed garden.

There was 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.

People, their families and staff were complimentary about the atmosphere and culture in the home. People expressed affection for the home and its staff. Staff expressed pride in the service provided, and described it as homely and well run. We saw examples of care and support that were very good. The registered manager and staff were motivated to make sure people had a positive experience of care.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risk of avoidable harm and abuse. Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only staff who were suitable to work in a care setting were employed. Arrangements were in place to store and administer medicines safely.

Staff received suitable training and support. They sought people’s consent for their care and support and had established caring relationships with people. They respected people’s individuality and dignity and encouraged people to participate in decisions about their care and support.

Staff made efforts to make meal times an enjoyable experience and encouraged people to eat and drink enough. Records showed people had access to healthcare services when they needed them.

People’s care and support was based on assessments and plans which took into account their needs, preferences and wishes. The provider had processes in place to review people’s care and check they received care according to their plans. There was a varied programme of activities and leisure interests which took into account people’s individual interests and preferences. There was a complaints process and complaints were followed up and investigated.

There was an open, friendly and positive atmosphere in the home. The registered manager and provider encouraged team work and motivated their staff. Staff responded to their management style and felt empowered to make suggestions. Systems were in place to monitor, assess and improve the quality of the service.

One person told us "I try to do things for myself, what I cannot do, staff help me with. Staff are very helpful". They said that they could choose how they spent their day. This meant that staff respected people's decisions and choices. Another person told us how good the service was and that they were happy living there.

We sampled three care plans. We saw that care plans were individualised and detailed the support and care each person required. People had signed their care plans where applicable.

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised.

We spoke with four relatives that were visiting residents during our visit. One relative told us "the provider communicates everything to me, it's great that I can still be so involved in the care of my mum".

We spoke to three care staff and both the registered providers. Staff comments included "the home is very friendly", "the providers are very approachable" and "turnover of staff is very low which speaks volumes".

Care plans were in place for each individual. We looked at four care plans which had been regularly reviewed to ensure they were up to date. People told us that "staff are always willing to help".

People we spoke with said that they felt safe in the home and that they would speak to a member of staff if they had any worries. Family members that we spoke with told us that they did not have any concerns about the home.