Archived: St Clements Nursing Home

Updated 20 September 2019

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.

Inspection team

The inspection was carried out by one inspector, a specialist advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

St Clements Nursing Home 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.

The manager had joined the service in May 2019 and had submitted an application to register with the Care Quality Commission. Registered persons 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

This inspection was unannounced.

What we did before inspection

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. We also looked for any feedback available from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and nine relatives about their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with eight members of staff including care staff, a cook and a nurse. We also spoke with the new manager, regional manager, the nominated individual and a visiting healthcare professional. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included seven people’s care records and six people’s medication records. We looked at three staff files in relation to recruitment and a variety of records related to the quality and safety of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 20 September 2019

About the service

St Clements Nursing Home is a residential care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service can support up to 37 people.

St Clements Nursing Home accommodates 37 people in one adapted building with three floors however only two floors were in use at the time of the inspection.

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

Improvements had been made to the quality and safety of the service since the last inspection. We identified a continued breach in relation to governance because these improvements were not yet embedded and sustained. We identified some record keeping issues and systems to oversee the safety of the service were not all robust.

People told us, and we saw the home was clean. We saw some improvements were required to ensure consistently good infection control practice. People and relatives told us they felt the service, and the support people received, was safe. Staff had received safeguarding training and knew how to escalate suspicions of abuse. However, systems to safely monitor some people’s monies were not robust. Staff knew about people’s risks and how to help promote people’s safety and health.

We saw improvements to how people’s risks were managed including support with medicines, and how incidents were responded to. Further improvements were being embedded. We found the breach of regulation identified at our last inspection had been met.

We saw, and relatives told us people received support when they needed it, however people’s feedback suggested this was not consistent. Further improvements needed to the provider’s recruitment processes were underway.

We saw improved support from staff who knew how to meet most people’s needs well, however improvements were required to achieve consistently good support, for example for people’s needs associated with mental health and dementia. Staff described improved support and development opportunities and training updates were underway.

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; although the policies and systems in the service did not always support this practice.

People received good support with meals and drinks but gave mixed feedback about the quality of meals provided. People were supported to access healthcare support. Improvements had been made to the design and décor within the floor of the home that was in use at the time of the inspection.

We saw, and relatives told us people were involved in aspects of their care however people’s feedback suggested this was not consistent. Staff took opportunities to speak with people and had a caring, friendly approach. People told us they were treated with dignity and respect. We found the breach of regulation identified at our last inspection had been met.

People and relatives described support that met people’s needs and we saw staff followed people’s preferences. However, care planning processes did not ensure all people’s needs were known and met as far as possible, including access to activities. Records were regularly reviewed but not always sufficiently detailed. Further improvements were planned.

People, relatives and staff all described a positive and improved culture. Staff felt involved in improvements at the service and told us they felt supported by the new management. Audits had helped identify further areas of improvement required to the quality of the service and people’s experiences.

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 February 2019).

Enforcement (and update)

After our last inspection, we carried out enforcement action to impose conditions on the provider’s registration. The conditions required the provider to submit monthly reports to the Commission in relation to their quality assurance activities, and to seek approval from the Commission prior to any admissions to St Clements Nursing Home.

At this inspection we found improvements had been made and the provider had met all but one of the breaches identified at the last inspection. We found the provider was still in breach of one regulation related to governance because improvements to the quality and safety of the service need to be embedded and sustained. We therefore decided that the condition requiring the provider to submit monthly reports to the Commission in relation to their quality assurance activities, will remain imposed on the provider’s registration to support continued improvements.

This service has been in Special Measures since February 2019. During this inspection the provider demonstrated that 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

This was a planned inspection based on the previous rating and was to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to continue to make improvements. Please see the full report for more information.

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

At the last inspection we recognised the provider had failed to always notify the Commission as required. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme and through the remaining condition imposed on the provider’s registration. We will work alongside the provider and 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.