St Christopher's Home

St Christopher’s Home is a residential care home providing personal care to 40 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

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

Systems and process in place to review and monitor the quality, effectiveness of the service required improvement.

Risks to people had not consistently been mitigated. Staff had not always followed the strategies in place and we found gaps in records for pressure care and food and fluids.

Records of injuries to people had not always been appropriately recorded.

Not everyone we spoke to felt there was enough staff on duty and staff did not always respond to people in a timely manner. Call bells were found to be unanswered for periods of time over 10 minutes on three separate occasions.

Medicine administration required improvements. We found gaps in the recording and best practice was not consistently followed.

Infection control measures were in place, however we found gaps in the cleaning records. The home appeared clean

People were supported by staff who had been recruited safely and who knew them well.

People were supported to stay in contact with their family during the pandemic via phone calls, video chats and outdoor visiting.

The registered manager and staff were open and transparent throughout the inspection and put actions into place after feedback.

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 Good (published 26 April 2018).

Why we inspected

We received concerns in relation to staffing levels and pressure sores. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Christopher’s 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 breaches in relation to risk management, medicine management and oversight at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

St Christopher’s Care 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.

St Christopher's Care Home accommodates up to 52 people in one adapted building. At the time of our inspection, the service was providing support to 39 people .

At the last inspection in February 2016, the service was rated Good. At this inspection on 21 March 2018 we found the service remained Good overall, however improvements were required under the ‘well led’ domain.

The provider had systems in place to monitor the quality of the service. We found that whilst all areas of the service were monitored, actions were not always taken and improvements were not always made.

The service did not always notify the Care Quality Commission of certain events and incidents in a timely way.

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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place. Staffing support matched the level of assessed needs within the service during our inspection.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the registered manager and senior team, and had regular one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place, and were happy with the support they received.

People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

There was a registered manager in post at the time of our inspection. 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.

Systems were in place to ensure people were protected from abuse; staff had received training and were aware of their responsibilities in raising any concerns about people’s welfare. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The provider had robust recruitment systems in place; which included appropriate checks on the suitability of new staff to work in the home. Staff received a thorough induction training to ensure they had the skills to fulfil their roles and responsibilities. There were enough suitably skilled staff available to meet people’s needs.

People’s care was planned to ensure they received the individual support that they required to maintain their health, safety, independence, mobility and nutrition. People received support that maintained their privacy and dignity and systems were in place to ensure people received their medicines as and when they required them. People had opportunities to participate in the organised activities that were taking place in the home and were able to be involved in making decisions about their care.

There was a stable management team and effective systems in place to assess the quality of service provided.

We spoke with five people living at the home and two of their relatives. We also spoke with a regular visitor to the home and five members of staff. We reviewed three people's care records.

The people and relatives of people living at the home told us that the care at St Christopher's Home was of a good standard. Three people also told us that when they needed assistance from the staff they could use their call bell and the staff responded to their needs quickly. A regular visitor to the home told us that the home had a 'happy atmosphere' and that there were lots of daily activities taking place such as yoga and tai chi. Most people told us that they enjoyed the range of activities that took place at the home and that they were encouraged to socialise with one another.

We found that the registered manager had made improvements to the way the home managed people's medicines and to reviewing the performance of staff working at the home. We also found that there were procedures in place to safeguard people from the risk of abuse and that people were looked after in line with their care needs. We found that there were systems in place to make sure that people received a good quality service.

We spoke with three staff members who worked at the service. They all told us that they felt well supported in their roles. When we asked them about the standard of care that people who used the service received, one staff member told us "It's excellent". Another staff member told us "It's really good care and all of the staff are very caring".

We observed staff treating people who used the service with respect and providing them with choices of meals. We found that people's needs were assessed and care plans were put in place to ensure that their needs were met. We observed that medication was given to people appropriately but we had concerns over the records of stock medication that were kept.

We found that staff were provided with regular training but we were concerned that they did not receive annual appraisals.