Archived: St Helena's

At the last comprehensive inspection 4, 5 and 12 May 2017 we found a breach regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider's quality assurance systems were not effective. We issued the provider with a warning notice requiring them to become compliant with this regulation by 18 September 2017.

We also identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not always managed safely and people's environment was not safely monitored. After the inspection, the registered provider wrote to us to inform us of the action they would take to meet legal requirements.

At this inspection found improvements had not been made and further concerns were identified. The CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

St Helena’s is registered to provide accommodation and personal care for up to 33 people who require support with their personal care. They specialise in supporting older people. At the time of our inspection there were 24 people living at the service who were living with a range of age related conditions including dementia.

There was no registered manager in place. The last registered manager left the service 12 May 2017. 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. The day to day management of the service was being overseen by a manager who had started working at the service 7 July 2017.

The provider had not addressed the shortfalls identified at the last inspection. They had no effective internal quality assurance systems in place to assess and monitor the service provided identify shortfalls and drive improvement. In addition action plans given to the provider to address shortfalls identified by external agencies in relation to the management and safe administration of medicines, fire safety, and care planning had not been fully completed. There was no clear plan in place for when, how and by whom actions would be addressed. Records were not properly maintained to make sure they were accurate and fully complete. Care plans did not always contain accurate information regarding people’s care needs and failed to record the guidance provided by health care professionals involved in their care.

Action had not been to ensure the management of medicines was safe. Staff did not have access to specific guidance for when PRN (as required) medication, including pain relieving medicines, could be administered to individuals or for how long before medical advice should be sought. Medicines were not always stored in line with good practice guidelines and medicine records and audits were not accurate.

People’s privacy was not always ensured or their dignity respected. Staff opened toilet doors when people were using the toilet, in view of others. People’s rights were not always upheld. People who had expressed the desire to vote had not been supported to register to do so.

Risks to people’s health and safety were not always safely managed. Staff were not always aware of and did not always use the equipment people had been assessed as needing, when supporting them to move or transfer. The provider had not ensured the risks of experiencing falls were kept under review when their needs changed and appropriate steps taken to mitigate the risk of them experiencing another fall.

The provider had not ensured that staff understood and always worked within the principles of the Mental Capacity Act to gain lawful consent for people’s care and treatment. Decision specific capacity assessments had not been completed and best interest decisions recorded as required. Despite this people were supported throughout our visits to make a number of choices regarding how they received their care and we observed staff seeking consent from people before initiating care interventions.

People and their relatives were not always listened to. Complaints were not recognised recorded or investigated appropriately.

Recruitment checks were not safe. Required identity and security checks had not always been completed before staff started work. There was no evidence that new staff and agency staff had completed an induction to the service before working unsupervised. Staff had not received the training and support they needed to meet people’s assessed needs effectively and keep up to date with current good practice. Staffing levels were not always sufficient to protect people from the risk of harm. People in communal areas of the service were left unsupervised for prolonged periods of time.

The CQC had not been notified about incidents of potential abuse and deaths as required.

People were not always provided with the opportunity to participate activities they found enjoyable and stimulating to help them maintain their physical and psychological health. People enjoyed the food on offer but were kept waiting for over half an hour for their food before being served.

People and their relatives were invited to attend meetings to offer their views and discuss any changes or improvements needed around the service. People and their relatives were complimentary about staff who they described as “Kind” and “Caring”. Family members described the service as “Clean”.

Health care professionals visited the service on a regular basis to review, monitor and treat people’s health needs.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider’s registration of the service, will be inspected again within six months.

The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

We previously inspected St Helena’s in October 2017 and the service was rated Inadequate overall. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 9, 10, 11, 12, 13, 16, 17, 18 and 19. This meant the registered provider had failed to ensure people were fully protected from the risk of unsafe care, poor recruitment procedures, staff did not have sufficient training, people’s care was not planned in a person-centred way, complaints were not managed appropriately, people’s rights were not maintained under the Mental Capacity Act and there was ineffective oversight of the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet its legal requirements in relation to these breaches.

At this inspection we identified repeated breaches of the regulations in relation to assessing and mitigating risks to people’s health and wellbeing, person-centred care, dignity and respect, good governance, the management of complaints and the Mental Capacity Act, .

We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve in the key questions we ask, is the service safe, effective, caring responsive and well-led to at least good. The provider provided regular updated actions plans since the previous inspection to demonstrate how they thought they were meeting the regulations.

St Helena’s is a ‘care home’. People in care homes receive accommodation and 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 care home accommodates up to 33 people in one building. At the time of this inspection 13 people were living at the service.

There was no 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. The service had appointed a new manager that was due to commence their employment at the end of April 2018.

People’s care records and other records relating to the on-going management of the service were not properly maintained or secure. Care plans did not always maintain accurate up-to-date information regarding people’s care needs.

Risks to people’s health and safety were not always considered and planned for. Staff were not always aware of what and when equipment was to be used to meet people’s individual needs.

The provider had not ensured that staff understood and always worked within the principles of the Mental Capacity Act to gain lawful consent for care and support.

Complaints made about the service were not always well managed or fully recorded.

Improvements were needed to ensure that staff were deployed effectively around the service. People in communal areas were left unsupervised for periods of time.

There was no effective management and oversight of the service. Monitoring systems in place had failed to identify improvements needed in relation to people health and safety and the general management of the service.

Recruitment checks were not safe. Appropriate references had not been sought for new applicants and application forms had not been fully completed.

Improvements had been made as to how the service reported safeguarding concerns. However, we have made a recommendation in this report as further improvements were required to ensure that all information related to unexplained injuries or potential safeguarding concerns were recorded and managed.

Improvements had been made to the availability of training for staff to participate in. We have made a recommendation that the provider further develops the training available to staff and a system is developed to measure the effectiveness of training delivered.

An activities co-ordinator had been employed to support people in carrying out daily activities.

Improvements had been made as to how people’s medicines were managed. We found that people received their medicines safely and when they needed them.

People told us that they enjoyed the foods that were available to them and that there was always plenty to eat and drink.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 Helena's is a large detached building set in its own grounds in Huyton-with-Roby, with a car park to the side of the building. The service is registered to provide accommodation and personal care for up to 33 people. The service does not provide nursing care. At the time of the inspection there were 25 people living at the service.

A registered manager had been employed at the service, however, they left their employment on the last day of this inspection. Interim management arrangements were in place whilst a new manager for the service was recruited. 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.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s medicines were not always managed safely. This was because out of date stock was still being stored, medicines no longer required had not been returned to the pharmacy and records were not legible. Failure to manage people’s medicines safely may result in individuals’ not receiving their medicines when they need them.

Auditing systems in place to monitor the service were not effective. The systems had failed to identify areas for improvement in relation to the availability of people’s care planning documents, record keeping, areas of improvement needed around the environment in relation to the safety of people, medicines management and responses to complaints made about the service. A lack of regular robust audits throughout the service failed to ensure that areas of improvement were addressed quickly to improve the service that people received.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have made a recommendation in this report that the registered provider reviews people’s mealtime experiences and choice of menu. Tables were not always set with the correct cutlery and condiments, and the menu for the day was not always readily available to people.

We have made a recommendation in this report that the registered provider reviews their current systems in place to promote people’s rights to register their vote.

A further recommendation has been made in this report that the registered provider reviews the current systems in place for the reviewing and updating of people’s care plans. This is to ensure that people receive the care and support they require at all times.

Procedures were in place to reduce and manage any spread of infection within the service, Staff had a good awareness of how to protect people from harm and were aware of who to report any concerns they had.

People’s needs were assessed prior to their admission. This helped ensure that the service had the facilities to meet people’s needs.

Emergency procedures were in place. Each person had personal emergency evacuation plan (PEEP) that detailed what support individuals required in the event of them having to be evacuated from the service in an emergency.

Staff recruitment procedures were in place. The process involved obtaining references and carrying out checks to help ensure that only staff suitable to work with vulnerable people were employed.

People told us that staff were kind and looked after them well. Sufficient numbers of staff were on duty to meet the needs of people using the service and people told us that staff respected their privacy.

Health care professionals visited the service on a regular basis to review, monitor and treat people’s health needs.

People had the opportunity to participate in activities to help them maintain their physical and psychological health.

People and their relatives were invited to attend regular meetings with the registered provider to offer their views and discuss any changes or improvements needed around the service.

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

St Helena's is a large detached building set in its own grounds in Huyton-with-Roby, with a car park to the side of the building. The service is registered to provide accommodation and personal care for up to 33 people. The service does not provide nursing care. Accommodation is provided over two floors and approximately half of the bedrooms are en-suite. The building is accessible for people who have difficulty with their mobility, with access to the upper floor via a passenger and stair lift. St Helena's is close to local shops, pubs, and other amenities and there are good transport links close by. At the time of our inspection 32 people were living at the service.

A registered manager was 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 in October 2014 we found a breach in regulations as improvements were needed in relation to how the service was monitored. In addition we made a recommendation that the provision of hot water was monitored on a regular basis. A further recommendation was made that staff undertook training in the Mental Capacity and the Deprivation of Liberty Safeguards (DoLS). During this inspection we found that improvements had been made to the monitoring of hot water available to people and that systems had been introduced to monitor the quality of the service delivered at St Helenas’.

During this inspection we found the improvements were needed to the quality and content of daily records maintained by the staff team. We recommend that records of all care and support offered and provided to people are maintained.

During this inspection we found that procedures were in place to protect people from abuse. Staff had received training in protecting vulnerable adults.

Systems were in place to help ensure that medicines were managed appropriately and that people received their medicines when they needed them.

Procedures were in place that would enable people to be evacuated safely in the event of an emergency.

Sufficient numbers of staff were on duty to meet the needs of people using the service. Effective recruitment procedures were in place that helped minimise the risk of people not suitable to work with vulnerable people being employed.

People’s needs were assessed prior to admission to ensure that the service had the facilities to meet their individual needs.

Health care professionals were available to support people with their specific health needs and to help ensure that people received the care and support they required.

Systems were in place for the implementation of the Mental Capacity Act 2005 and to ensure that people’s rights in respect of the Act were upheld. When required appropriate referrals were made to the local authority in relation to Deprivation of Liberty Safeguards.

People enjoyed the food available at the service and had a choice of what they wanted to eat.

People were supported by a staff team who received training to carry out their role.

Staff respected people dignity and maintained their privacy.

People had the opportunity to participate in activities at the service to help maintain their physical and psychological health.

A complaints procedure was in place and people were confident that any complaints they had would be listened to and acted upon.

Systems were in place to monitor the service that people received. The registered manager had identified areas of improvement they wished to implement over the next 12 months in the Provider Information Return to improve the service.

Although there had been two recent safeguarding issues, staff and management responded appropriately. As a result of staff being appropriately trained, they followed clear procedures to ensure satisfactory outcomes for people using services.

The provider ensured that there were sufficient staff with appropriate knowledge, experience and qualifications to adequately support people. Consequently, people`s health and welfare needs were being met by staff with the right skills.

All staff received a comprehensive induction and ongoing relevant training that took account of the needs of people using services. The provider ensured that staff were properly trained and supervised to ensure they provided quality care and treatment to people who used services.

'I'm very very happy'.

'It couldn't be cleaner, the place is spotless and my bedding's changed every day'.

'We're well looked after'.

'There's plenty to eat and the food is good'.

We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do. People were cared for in an environment that was safe and suitable for their needs.

The people who accessed the service provided at St Helena's were cared for by staff that were appropriated recruited, well trained and experienced at supporting them.