St Anthony's Residential Home Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection we found necessary safety checks of the services environment had not been completed and medicines were not stored or administered safely. This was a breach of the regulations. At this inspection we found, necessary safety checks on the service’s environment and equipment had been completed and medicines were now managed safely. However, additional breaches of the regulations were identified. Staff disciplinary processes were ineffective and had exposed people to risk of harm. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s capacity to make decisions had not been appropriately assessed and necessary applications for the authorisation of potentially restrictive care plans had not been made. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risk assessments did not provide staff with sufficient guidance on how to keep people safe. In addition, floor coverings were damaged in some areas, creating trip hazards. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff understood how to raise safety concerns and necessary safeguarding referrals had been made. The service was well staffed and medicines were managed safely.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt safe at St Anthony’s and their relatives spoke positively about the care provided. Comments received included, “You are cared for. I don’t feel abandoned”, “There is a nice atmosphere here” and “Everyone looks after me really well”.

The staff team and the deputy manager had a good understanding of local Safeguarding procedures. Appropriate safeguarding referrals had been made in response to incidents that had occurred. However, the staff team had only a limited understanding of the requirements of the Mental Capacity Act.

None of the service’s leadership team understood the requirements of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). One individual living with dementia asked to leave the service to go home during the inspection. Staff supported this person with compassion using appropriate distraction techniques. However, their care plan did not include details of recent mental capacity assessments or best interest decision making processes. In addition, no application had been submitted to the local authority for the authorisation of restrictions to this individual’s freedoms. The leadership team accepted there had been an occasion where the registered manager had restricted a small number of individuals to their own rooms for a short period. These restrictions had been introduced without appropriate authorisation.

The service did not have robust staff disciplinary processes and allegations of staff misconduct had not been effectively or appropriately investigated. The service’s leadership had failed to maintain records of investigations into staff performance and conduct issues. Where investigations into staff conduct had been discontinued no details had been retained of the investigations finding or associated decision making. The service did not have effective systems in place to ensure the people's freedoms were safeguarded.

People were confident their staff knew how to protect them from risk of harm. They told us, “The staff definitely know what they are doing”, “The care is good and if I needed medical help, they would organise it for me” and “They would pick up if I was unwell. The doctor visits regularly. They sort out hospital visits for me.”

Staff had a good understanding of current risks within the service as there were effective handover procedures between care shifts. These meetings ensured all staff were aware of any changes to people’s needs before they began providing support.

Staff responded positively to people’s requests for support and used appropriate techniques to meet people’s mobility needs. Lifting equipment was well maintained and had been regularly serviced.

Risk assessments within people’s care plans were not informative and did not provide staff with sufficient information to enable them to protect people from known risks. Risk scores were displayed as a number in people’s care plans without any background information to help staff identify what the risk was and how it should be mitigated. Falls risk assessments had not been consistently completed. This meant limited guidance was available for new staff on how specific risks should be managed.

The premises were shabby and communal areas were in need of redecoration . Carpets and floor coverings on the ground floor were damaged, worn and in need of replacement. In some areas damaged carpets were beginning to lift, creating an unnecessary trip hazard to people using the service. Window restrictors had been installed on the majority of windows. The provider was introducing a specific risk assessments where individuals with capacity had refused to have restrictors fitted to high level windows in their rooms. The service was clean, and equipment had been appropriately maintained. Comments from people and their relatives included, “The home is OK, it’s clean enough”, “Everything is cleaned every day, even the towels are changed daily even if you haven’t used them” and “They have done the best they can with the place. My [relative’s] room is always clean.”

There were no processes in place to formally audit and monitor the quality of the environment. Instead, any maintenance defects were reported to the providers director who undertook small scale repairs. The director and the registered manager both recognised floor coverings on the ground required replacement. However, no plans had been developed detailing when these works would be completed. Issues in relation to the service’s fire safety arrangements had recently been identified. Some of the necessary works had been completed but plans to address the more challenging issues had not yet been developed. Since our previous inspection the provider had introduced systems to ensure necessary safety checks by external contractors were completed. These records showed all necessary checks of the services utilities and lifting equipment had been completed.

People and their relatives were complimentary of the staff team and the quality of care they provided. Comments received included, “Staff are available if you want someone”, “Everyone looks after me really well. There are no problems at all” and “There are enough staff, I’ve noticed that there are more staff than residents”.

Staff and managers recognised the service was well staffed. Staff comments included, “The service is well staffed”, “We have enough staff” and “We always seem to cover all the shifts”. While managers said, “We have used agency a couple of times to cover nights”.

The service was well staffed during both on site assessment visits and people’s requests for support were promptly addressed. It was notable that at one point during the first visit, that there were more staff working in the building that people using the service.

Rotas confirmed planned staffing levels were routinely achieved and sufficient to ensure people’s safety. Support from staffing agencies was infrequently required as the staff team worked together to cover periods of leave or unexpected staff absence. Recruitment practices were safe. All necessary pre-employment checks, including DBS checks, had been completed to ensure staff were suitable for employment in the care sector.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were confident staff knew how to support them with medicines and we observed staff supporting people to take their medicines safely. People’s comments included, “My pills are on time, they watch me take them” and “I don’t know what I am taking but it’s always on time and they stand and watch me take them”.

Staff were confident supporting people with their medicines and records showed medicines were not regularly given covertly. One staff member told us, “I do the medicines, they are all alright. You can talk through the medicines with people and explain what they are for, and they will normally take them”.

The service is now managing medicines effectively. Medicines administration records (MAR) charts had been accurately completed and demonstrated people had received their medicines as prescribed. Some medicine audits had been completed and, where issues in relation to staff performance had been identified, they had been reported to the registered manager and provider’s director. There were no medicines that required stricter controls in the service at the time of the onsite visit. We noted current arrangements for the storage of these medicines were unsuitable and provided guidance on changes necessary for the secure storage these medicines.