St Martins Care Home Ltd

St Martins Care Home is a residential care home providing personal care for up to 15 people aged 65 and over, at the time of the inspection 11 people were living there. Some people living at St Martin’s Care Home were living with dementia and others had high dependency needs due to reduced mobility.

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

Improvements had been made since the last inspection to improve some of the safety of the home environment. However further improvements were still needed, furniture that posed a risk of falling onto people had not been secured and had not been identified as a safety issue until the inspection.

People received their medicines in line with their prescribed needs. However, where medicine patches were used the recording of where the patches were sited was unclear, leading to an increased risk of people receiving too much medication.

People's care and support was person-centred and reflected people's preferences. Staff provided care that was respectful of people's dignity, privacy and human rights.

People's care plans were personalised and reflected people's own individualities and interests as well as their specific health needs.

People were protected from the risks of COVID-19 by effective infection control procedures. Staff had training in relation to COVID-19 and had access to sufficient supplies of personal protective equipment (PPE). The registered manager and provider ensured that infection control procedures reflected current government guidance.

Staff had the training, skills and knowledge to meet people's needs and preferences. Staff told us that they felt supported in their roles and where additional training or support was identified as being needed this was provided.

People were referred to health professionals when needed. Health professionals were positive about the support from the management and staff in achieving positive outcomes for the people in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was increased governance and oversight of risks and of people’s care and support. People and staff were positive about the management of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 22 December 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Martins Care Home is a residential care home providing personal care for up to 15 people aged 65 and over, at the time of the inspection 10 people were living there. Some people living at St Martin’s Care Home were living with dementia and others had high dependency needs due to reduced mobility.

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

This was a focussed inspection that considered Safe and Well Led.

People were not always protected from the risks of infection. The home environment did not always provide people with a well maintained, clean and secure place to live in. People were exposed to environmental risks, COSHH chemicals were not safely stored and personal care products were stored in an outside building that was damp and unclean.

Medicines were well managed. We found a system that ensured medicines were stored appropriately and administered in line with people’s prescribed needs.

People received support when needed and there were enough staff to make sure people’s needs were met in a timely way.

The provider’s governance systems were not effective. There was a lack of provider and registered manager oversight in the maintenance and safety of the home environment. The provider's systems failed to identify that care and treatment was not always provided in a safe way. Steps had not been taken by the provider or registered manager to ensure that guidance to keep people safe from COVID-19 was followed effectively by staff.

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 March 2020) where there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 January 2020. Breaches of legal requirements were found. The provider completed an action plan to show what they would do, and by when, to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements.

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 COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained at requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins Care 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to premises and equipment and good governance 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 Martin’s Care Home is a residential care home providing personal care and accommodation to 15 people aged 65 and over at the time of the inspection. The service can support up to 15 people in one house and is situated in a residential area. Some people living at St Martin’s Care Home were living with dementia and others had high dependency needs due to reduced mobility.

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

People did not always feel there were enough staff working at St Martins Care Home Ltd. Staffing levels in the evening meant people were left unsupervised or supervised by visitors to the home whilst staff attended to other people’s needs. Daily checks of the premises and oversight of the building’s maintenance to ensure its safety were not routinely carried out, which exposed people to unnecessary risk. There were missed opportunities to interact and staffing levels meant care workers did not always have time to spend with people engaged in meaningful activity or conversation. Although staff could tell us how to respect people’s dignity and privacy, care practices did not always support this.

Referrals to healthcare agencies to improve people’s outcomes was inconsistent. People were referred to some health professionals including district nurses, their G.P, and speech and language therapists. However, the provider had not always referred people for assessments following declines in their mobility which meant them needing to be cared for in bed. There were not enough activities for people to help stimulate, engage and minimise isolation. Activities were not planned in partnership with people to make them responsive to people’s enjoyment.

Systems to monitor and improve the safety and quality of the service were not effective. Tools were used to calculate staffing numbers, but lack of oversight meant staffing levels did not always safely meet the needs of people. Maintenance of the building and its safety was not monitored effectively which meant people were exposed to unnecessary risks. There was no system to safely store people’s confidential information. Audits were carried out but not always recorded and failed to identify the issues discovered during the inspection.

People felt safe living at St Martins Care Home Ltd, and risks to people’s health were assessed with risk management plans for staff to follow. Accidents and incidents were recorded and monitored by management to learn from them. Staff were confident reporting safeguarding concerns and contact information for reporting concerns was located on people’s bedroom doors. Medicines were administered and stored safely.

Staff had access to online training relevant to their roles and some had completed vocational qualifications in health and social care. People were supported by regular care workers who knew them, because staff had worked at St Martins Care Home Ltd for a long time. People enjoyed the food and were given options and choices. Staff understood people’s needs relating to their eating and drinking and provided appropriate support and encouragement for those who needed it. Overall, people were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, staff did not always respond to the needs of one person living with dementia in a positive way. This person liked to explore their environment but was sometimes told to sit down rather than being encouraged to interact or engage. However, people said staff were kind and caring and the atmosphere at St Martins Care Home Ltd was homely and friendly. There were friendly and warm interactions between staff and people.

Staff were fully engaged in a game of ‘bingo’ and supported people to take part. Internet access was installed throughout the home so people could maintain contact with others through social media or video calls. The internal decoration had been improved in response to feedback, but further improvement was needed to address the quality and maintenance of people’s environment and make it more conducive to the needs of people living with dementia. Care plans were personalised and included guidance for staff to support people who experienced distress. Complaints were responded to promptly and in writing.

Staff described the registered manager as approachable and supportive and were confident sharing their concerns if they needed to. Meetings for people who used the service and annual questionnaires were used to encourage views and opinions. However, improvements were needed to promote and value people’s engagement in these. The provider had plans to improve the garden and internal decoration.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 17 January 2019) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of Regulation 12. However, enough improvement had not been made in relation to Regulation 17 and the provider remained in breach of this regulation.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken some immediate action to mitigate the risks relating to staffing and introduced daily checks of the premises to ensure its safety. Gas and electrical inspections were also completed immediately following our inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins Care Home Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe staffing levels and their knowledge of fire safety and evacuation, and management systems which oversee the quality and safety of the service at this inspection.

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

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

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 Martins provides accommodation with personal care and support for up to 15 older people who may needs due to physical disabilities. Some people were living with dementia and other associated illnesses.

A requirement of the services’ registration with us is that they have a registered manager. 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. There was a registered manager in place.

This was the first inspection under a new provider of the service. It was previously registered with us under a different provider and was registered as St Martins Care Home for the Elderly.

At this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service requires improvement in safe, effective, caring, responsive and well led. The overall rating for the service is Requires Improvement.

The provider had systems in place to monitor the quality and safety of the service people received, but these were not always effective. Actions to mitigate risks to people had not always been taken by the provider. There were areas of the home that posed potential risks to people's safety and welfare. There were insufficient numbers of staff to ensure that people were given the appropriate support to keep safe. Medicines were not always administered in line with the person's prescriptions. Some medicine recording errors had occurred and it was not clear when rescue medicines had been given.

Some people felt that staff understood and responded to their health needs. Some aspects of diabetes care were not monitored appropriately and information for health professionals was not always accurate.

Staff felt supported by the manager and received training in their roles. Staff on shift met some people’s individual needs. People could take part in some activities, however some people were at risk of becoming isolated.

People told us they felt safe with staff. Staff understood their responsibilities in keeping people safe from abuse. There were systems and processes in place to support this. People felt staff were kind and caring and enjoyed the food that they were offered.

Further information is in the detailed findings below.