Archived: St Mary's

Updated 25 January 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 was 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.

We undertook an unannounced inspection of this service on 27 July 2017 and visited the provider on 1 August 2017 and 9 August 2017. The inspection was carried out by three inspectors..

We spent some time talking with people in the service and staff; we looked at records as well as operational processes. 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.

Before the inspection we reviewed the information we held about the service. We considered information which had been shared with us by whistle blowers, relatives, visiting professionals and a member of the public. On this occasion the provider had not received a Provider Information Return (PIR) to complete. This 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. We gathered and reviewed information about the service before the inspection, including previous inspection reports and notifications. A notification is information about important events, which the provider is required to tell us about by law.

We reviewed a range of records. This included eight care plans and associated risk assessments and environmental risk information. We looked at four staff files, their recruitment, and training and supervision records, in addition to the training records for the whole staff team. We viewed records of accidents/incidents, complaints information and records relating to some equipment, servicing information and maintenance records.

We viewed policies and procedures, medicine records and quality monitoring audits. We spoke with 10 people, 3 relatives, 5 five staff, and the two deputy managers. We spoke with the nominated individual, a director of the provider’s company and the registered manager from the provider’s other service.

At the previous inspection of this service in January 2017, there were continued breaches of regulations and CQC took enforcement action. At the time of this inspection there were 5 continued breaches and a further 5 breaches were identified.

Updated 25 January 2018

We undertook an unannounced inspection of this service on 27 July and 2 and 9 August 2017.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a garden to the rear of the property. At the time of inspection there were 21 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. At the previous inspection the provider told us that they were in the process of appointing a new manager but this had not been done. A registered manager from the provider’s other location was supporting the service two days a week and there were two deputy managers in day to day charge of the service. The two deputy managers supported three inspectors during the first day of the inspection. A registered manager is a person who is 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.

We last inspected this service in January 2017. We found significant shortfalls and the service had an overall rating of requires improvement with an inadequate rating in the well led domain. The service had been rated ‘inadequate’ overall at our inspection in August 2016 and been placed in special measures. As the provider remained in breach of the regulations and there was a lack of leadership the service remained in special measures which required the provider to make improvements. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information and records about actions taken to make improvements following our previous inspection.

At this inspection improvements had not been made and the provider had not complied with all of the requirement notices issued at the previous inspection in January 2017 and further breaches of the regulations were found at this inspection.

The provider had failed to comply with a condition we had applied to their registration requiring them to appoint a registered manager. Although some efforts had been made to register a manager and an application had been sent to CQC this was subsequently withdrawn.

The systems in place to audit the quality of the service were not effective. The provider had not ensured that the requirement notices issued at the previous inspection were complied with. There remained continuous breaches of 5 regulations and 6 further breaches of regulations were identified at this inspection.

Whistle blowers had contacted the Care Quality Commission to inform us that staff were getting people up in the dementia unit from 5 am onwards. We arrived at 7 am; four people were up in the dementia unit and two people were up in the residential unit. Action had not been taken to address this concern and to make sure people had the choice of when they wanted to get up.

People were not protected from harm as the provider had failed to take action to ensure people were safe and report safeguarding issues to the local authority.

Risks to people’s health when they fell were not being mitigated and there continued to be a lack of risk assessments to guide staff how to support people safely. People were at risk of choking however, detailed risk assessments were not in place to ensure that staff had information to support people with their meals and drinks.

People sometimes displayed behaviour that challenged and were at risk of harming themselves or others. The deputy manager had implemented behavioural risk assessments to give staff guidance on how to positively support people with their behaviour. However, the assessments lacked information on what may trigger the behaviours and how to reduce the risk of them happening again.

The premises were not being routinely maintained to provide a safe and comfortable environment. The provider had not acted in a timely manner to ensure the repairs and maintenance were carried out to ensure the environment was safe. The garden had not been maintained.

Equipment to support people with their mobility had been serviced to ensure that it was safe; however staff told us one there were issues with a battery on one hoist which was not charging properly. The deputy managers were aware of this but no action had been taken to resolve this issue.

Pressure relieving equipment had not been checked to confirm it was set to the individual setting for each person to reduce the risk of pressure sores.

Concerns were raised with regard to the telephone system not working as this was having an impact of how staff were managing the service. There was limited access to the internet to send and receive emails and the printer was not working.

Accidents and incidents were recorded; but further action had not been taken to ensure the service learnt lessons for the continuous improvement of the service. There was a summary of events but no further analysis had been carried out to identify any patterns or trends, to prevent further occurrences.

Staffing levels were not always sufficient to ensure people received the care they needed. The deployment of staff needed to be reviewed so that sufficient staff were on duty at all times. Staff had not been recruited safely to ensure they were suitable to work at the service.

Medication was not being safely managed or stored securely. Referrals to health care professionals had been made but not followed up to ensure that people were getting the professional guidance and support they needed.

Applications to apply for authorisations to deprive people of their liberty in line with the Mental Capacity Act had been applied for, but in one instance staff had not recognised that a person’s liberty was being restricted.

People told us the food was good and they had enough to eat and drink. The four weekly menus needed to be reviewed as at times the meals were repetitive, such as for four days in a row the main meal was beef and mince. The provider had not ensured that people and staff had the necessary supplies of food and gloves to ensure people received safe and effective care. On occasions the shopping had arrived late and the service had run out of milk and bread. At the time of the inspection they also run out of tea bags and the deputy manager gave a member of staff some of their own money to go to the local shop to purchase a supply.

The provider had not ensured that bed linen and some towels were fit for purpose or suitable for people to use.

Staff interaction was kind and caring but there was a lack of contact from staff when people remained in their rooms. People’s privacy and dignity was not always maintained when incidents occurred in people’s bedrooms.

Care plans were not person centred or detailed enough to ensure consistent care was being provided. When reviews had taken place, in some cases, staff had recorded incidents that had occurred but no action had been recorded. The care plans and risk assessments had not always been updated to reflect people’s current needs.

People were not being supported to follow their interests and take part in social activities of their choice. There were no dedicated activities co-ordinator and activities were limited.

The system to monitor complaints was not effective as complaints had not been recorded. There were no records to show that complaints had been investigated and satisfactorily resolved.

Staff and relatives told us that they thought the care being provided was good but the service was not well led as the provider lacked leadership skills.

The service was not being supported by the provider to ensure that people were receiving safe and effective care. There was a lack of leadership and oversight of the service. The deputy managers in day to day control of the service lacked autonomy, support and skill to be able to manage and provide the service.

The audits carried out by the deputy managers were not effective as they did not identify the concerns raised at this inspection. The provider had visited the service twice in the last six weeks and no formal checks had been made on the quality of care being provided.

Checks on the fire system had been made on a regular basis and fire drills had been completed. There was a personal evacuation plan for each person and an emergency procedure in place. Not all staff had received the fire training they needed to safely evacuate people from the premises.

Since the previous inspection only staff had received a quality assurance survey which was in the process of being collated. The results of the survey last year had not been acted on or summarised or shared with people.

A whistle blower told CQC that there were continuing issues with their wages and mistakes were still being made. They had raised these concerns with the provider who assured them this would not happen again but errors were still occurring.

Although some improvement to records had been made, there remained areas where records were inconsistent and not accurately completed or secure, such as care plans, night checks and accident forms.

Staff told us they were loyal to the people who lived at the service as many people had lived there for several years. They said that improvements to the service were slow but new staff had been recruited which had helped improve their morale. There were concerns about keeping their jobs, the lack of gloves and having to purchase items like food, for the service.

There was an ongoing