Archived: St Mark's Care Centre

Updated 22 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over two days on 16 and 17 April 2018. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.

A planned inspection of St Mark’s Care Centre was brought forward in response to information of concern received by the Care Quality Commission (CQC). These concerns were of a safeguarding nature.

In advance of our inspection we contacted external stakeholders including Trafford local authority, Trafford safeguarding team and Trafford care commissioning group (CCG). Stakeholders expressed continued concerns regarding St Mark's Care Centre and the engagement of the provider and their management team with statutory bodies. We used this information to inform our inspection planning.

On 16 April 2018, the inspection team consisted of three adult social care inspectors, a pharmacist inspector and a medicines team support officer from the Care Quality Commission (CQC). On 17 April 2018, three adult social care inspectors completed the inspection.

Due to the timeframe in which this inspection was completed, a Provider Information Return (PIR) was not requested to support us with our inspection planning. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. However, we reviewed information we already held in the form of statutory notifications received from the service, including safeguarding incidents, deaths and serious injuries.

Due to the nature of the service, a large number of people living at St Mark’s Care Centre were unable to communicate their experience of the care provided so we observed the care and interactions in the communal areas which included lounges and dining rooms.

During our inspection we spoke with the nominated individual, the registered manager, and 11 staff including nurses, care staff and maintenance. We also spoke with six relatives to ascertain their views regarding the care provided at St Mark's Care Centre.

We looked at various documentation including 13 care records for people receiving support and 12 medicine administration records (MAR). We also looked at staff recruitment information, supervision notes, training, induction process, staff rotas and policies and procedures.

Updated 22 June 2018

This inspection took place over two days on 16 and 17 April 2018. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.

St Mark's Care Centre is a care home which was purpose built and registered with CQC in July 2015. It is located near the centre of Sale in Trafford, South Manchester. The home is registered with CQC to provide nursing care for 62 people living with dementia, acquired brain injury or enduring mental health needs. The home has five units which are called Walton, Walkden, Woodhey's, Worthington and Ashton.

Due to enforcement action taken following our October 2017, the provider has not been able to admit any new service users to St Mark’s Care Centre. This meant at the time of this inspection, there were 31 people living at the home and there were three units in operation; Walton, Walkden and Worthington.

St Mark’s Care Centre 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.

At our last inspection in October 2017, the home was rated as ‘Inadequate’ overall and in the key questions, safe, effective, responsive and well-led. Caring was rated as ‘Requires improvement’. We identified the provider was in breach of the following regulations; Regulation 9, person-centred care; Regulation 12, safe care and treatment; Regulation 13, safeguarding service users from abuse and improper treatment; Regulation 14, meeting nutrition and hydration needs; Regulation 16, receiving and acting on complaints; Regulation 17, good governance and Regulation 18, staffing. As a result of our findings, St Mark’s Care Centre remained in special measures.

Other enforcement action is on-going and the outcome of this will be added to the report after any representations and appeals have been concluded.

At this inspection, we identified continued breaches of the regulations and the overall rating for St Mark’s Care Centre is inadequate. Special measures remains in place and we will continue to monitor the service closely and will expect to see continuing and sustained improvement.

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, it 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.

At the time of our inspection, there was a registered manager in post who had started at St Mark’s Care Centre in December 2017 and commenced the process of registering with CQC. Their registration was completed 13 April 2018. A registered manager is a person who has registered with CQC 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 this inspection, we identified failures in respect of the delivery of safe care and treatment and how risks to people who used the service were identified and mitigated. In particular, risks associated with the management of people’s dietary needs and pressure areas.

We found the provider and management team could demonstrate greater transparency in the reporting of events and incidents. However, we identified inconsistencies across the three units in regards to the recognition of safeguarding matters and identified a number of safeguarding referrals on Walton unit that should have been made to the local authority.

We found there was ambiguity regarding people’s care records and identified concerns regarding risk management. We found the most current risk assessments and up to date care plans were not in people’s care files but stored electronically and all the care staff did not have access to this information. This meant care staff did not have access to the identified risk in order to mitigate the risks and provide safe care.

We expressed concerns with the current quality and safety of the electronic method of care planning. At the time of the inspection, all the care plans, risks assessments and other service user documentation were written into word and excel files and stored on the local network drive. Concerns with this method include overwriting errors, duplications of files, and the lack of security in relation to care plan reviews, as anyone could write that a named nurse had reviewed a care plan with no electronic signature or secure method to determine this.

Appropriate recruitment checks were undertaken prior to staff commencing in post. We saw the use of agency staff had significantly reduced since our last inspection and recruitment was on-going to address the homes agency use.

Medicines were not always managed safely. Issues were identified regarding documentation and the consultation of a pharmacist when covert medicines were being given.

We found the provider was not always working within the principles of the Mental Capacity Act (2005). This was because best interest decisions were not evident for the use of restrictive practices such as lap belts and bed rails. Although we acknowledge these had been implemented to mitigate risks, we found best interest meetings had not been convened to determine that the use of these measures were in people’s best interest in accordance with the Mental Capacity Act 2005.

Since our last inspection, we saw that all the locks had been removed from communal doors and there was an emphasis in care plans regarding supportive measures to meet people’s needs. We saw this had translated to practice since implementation as there had been no recorded use of restraint on the accident and incident forms since these changes had been made.

We saw daily meetings had been introduced to support communication and management oversight of occurrences and support required within the home.

The induction had vastly improved. Staff received an induction to the service that was aligned with the care certificate and undertook shadow shifts with an experienced member of the staff team. The staff member continued to mentor them through the induction to support them within the role. Training had significantly improved. This included, staff competency assessments and there was an on-going rolling programme of on the spot training and supervision to address any shortfalls in practice.

The meal time experience had improved but we observed insufficient time was maintained between meals which we raised with the provider on the day of our inspection.

Relatives were extremely positive about the care provided and felt consulted about the care their family member required. We observed positive interactions between staff and people throughout the inspection visits across all the units. We did inform the registered manager of one instance observed of staff not maintaining a person’s dignity. This was because staff had transferred a person in a wheelchair without footplates which resulted in their feet being dragged across the floor in an unsafe and undignified manner. The registered manager gave assurance this would be addressed straight away and all wheelchairs without footplates would be removed from use.

We observed staff providing people with choices during the inspection and promoting people’s independence where able. People were engaged in daily activities and there was a singer that performed at the home on the second day of our inspection that was observably enjoyed by all those that attended.

The complaints process had significantly improved as there was now a process in place that logged complaints and a clear audit trail could be seen of actions taken. Relatives spoken with confirmed they were aware of the complaints process and that any complaints they had made had been resolved to their satisfaction.

The registered manager and care consultancy firm were not always coordinated in their approach to determine that there was a cohesive approach to achieving regulatory compliance. There were two action plans in progress at the time of the inspection and the registered manager did not have access to documents requested to determine progress against one of the action plans to demonstrate they had oversight.