Archived: Saint Mary's Nursing Home

There were 28 people living in the service when we inspected on 14 August 2017. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 28 September 2015, we found breaches of regulation that affected the well-being of people using the service, this included safety, staffing and how the provider monitored the service that people received. The overall rating for the service was ‘Inadequate’. At a further comprehensive inspection of 27 June 2016 we found that there had been improvements made and the service was rated ‘Requires improvement’ overall. These improvements needed to be embedded in practice and sustained. The registered manager sent us reports on a monthly basis which kept us informed of the improvements they were making.

You can read the report from our last inspection, by selecting the 'all reports' link for Saint Mary’s Nursing Home on our website at www.cqc.org.uk.

At this comprehensive inspection of 14 August 2017 we found that the improvements previously made had been sustained and further improvements had been implemented.

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.

There were robust systems in place which supported the registered manager to monitor and assess the service provided to people. These systems allowed the provider and registered manager to effectively address shortfalls, take action to address them and put measures in place to minimise the risks of similar issues arising in the future.

Staff were provided with the training and support that they needed to meet people’s needs. There was a training plan in place to ensure that the staff’s knowledge was kept up to date. People had good relationships with the people using the service. People were treated with care and their independence, privacy and dignity was promoted and respected.

Systems were in place to minimise the risks to people and to keep them safe. This included risk assessments to identify how assessed risks were minimised and processes designed to keep people safe from abuse.

There was a system in place to assess how many staff were needed to meet people’s assessed and changing needs. This was kept under review to ensure that staffing numbers were increased if people required more care and support or if more people used the service. There were safe staff recruitment processes in place.

People’s care records had been reviewed and updated, they were more person centred and included the input from people and their representatives. Improvements had been made in the social activities provided for people to participate in to reduce the risks of isolation. There were plans in place to develop these further.

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.

Improvements had been made in the infection control and environment. Systems were in place to monitor the cleanliness of the service. There was an ongoing refurbishment plan in place.

People were provided with their prescribed medicines safely and when they needed them.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration. People were supported to see, when needed, health and social care professionals.

There was a complaints procedure in place and systems to respond and address to people’s comments, concerns and complaints.

There were 22 people living in the service when we inspected on 27 June 2016. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 19 January 2015. The service was rated inadequate. Breaches of legal requirements were found. These related to infection control, staffing levels, staff training and support, how people’s consent was obtained, how the service met the care and welfare needs of people and governance. We undertook a focused inspection on 27 April 2015 to check that they had followed their improvement plan and to confirm that they now met legal requirements. We found that the provider had made improvements which were ongoing and needed to be sustained and embedded into practice to provide people with good quality care. Another comprehensive inspection was carried out on 28 September 2015, although some improvements had been made we found breaches of regulation that affected the well-being of people using the service, this included safety, staffing and how the provider monitored the service that people received. The overall rating for the service was ‘Inadequate’. This means that it was placed into ‘Special measures’ by CQC. The provider had sent us reports on a monthly basis which kept us informed of the improvements they were making. This inspection of 27 June 2016 was to check that improvements had been made to provide a safe good quality service for the people living there. We found that there had been improvements made in the governance systems in place for monitoring that people receive a good quality service. However, these were not yet embedded into practice.

There was not 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. There was an acting manager in post who had started working in the service following our last inspection, they had made a registered manager application with CQC.

We found that there had been improvements made in the governance systems in place for monitoring that people receive a good quality service. However, these were not yet embedded into practice. Once embedded, these new systems would allow the provider to effectively address the identified shortfalls to prevent issues reoccurring. Feedback received regarding the new manager was positive. The manager had recognised the areas that still needed improvements, this told us that the service had independently identified shortfalls and were in the process of addressing them. The provider had employed an external consultant who was working with the manager to make the necessary improvements.

There had been some improvement made in staff training. However, further improvements were needed. This was acknowledged by the manager who was in the process of negotiating a new training provider to ensure that all staff received up to date training. Improvements had been made in how staff were supported.

Systems were in place to ensure the safety of people who used the service, however, bed rails assessments were not completed appropriately. Following our inspection the manager told us that these had been put into place.

Improvements had been made in how the staffing numbers were calculated to meet people’s needs. These would be revisited when plans to accommodate more people in the service, from one of the other provider’s locations. This would also include increased staffing. We will continue to monitor how this is managed when the provider is aware of the numbers of people moving in.

People’s care records were being reviewed and updated, they were more person centred and included the input from people and their representatives. This was ongoing and the manager and staff were working on ensuring all care plans were up to date, included appropriate terminology and reflected people’s needs and preferences. The manager acknowledged that improvements made regarding social activities for people were ongoing and they were not yet where they wanted to be.

Improvements had been made in the infection control and environment. New systems were in place to monitor the cleanliness of the service. There was an ongoing refurbishment plan in place.

Improvements had been made in the safe management of medicines. People were provided with their prescribed medicines safely and when they needed them.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration. People were supported to see, when needed, health and social care professionals.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. There were systems in place to obtain and act in accordance with people’s consent to respect people’s rights and choices.

We spoke with nine of the 32 people who used the service and one person's relative. We also spoke with five staff members and the registered manager from another of the provider's services. We observed the care and support provided to people to check that staff interactions were effective and caring. We looked at three people's care records. Other records viewed included staff training and supervision records, staff recruitment records, the staff rota, meeting minutes and records associated with the quality assurance in the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We looked at the training records of eight staff members and found that only one of these held information to show that they had been provided with training in DoLS and Mental Capacity Act (MCA) 2005. The registered manager from another of the provider's service told us that they were aware of the changes relating to DoLS following a supreme court judgement in March 2014. However, we were not able to check the understanding with the current management of the service as they were on leave during our inspection.

Staff records showed that the staff, particularly the newer staff, had not been provided with the training and support that they needed to meet people's needs in a safe and effective manner. This included five of the staff member's that we tracked had not been provided with training in safeguarding vulnerable adults from abuse. A compliance action has been set and the provider must tell us how they plan to improve.

Staff recruitment records showed that the provider's recruitment procedures and processes were not robust enough. Robust checks had not been undertaken to ensure that people were supported by staff who were of good character and able to work with vulnerable people. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We had not planned to inspect the infection control in the service during this inspection. However, we noted that the service was not clean and hygienic; therefore we included this in our inspection. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy living in the service and that the ways that the staff supported them were effective. One person said, "We are very happy." Another person said, "I am quite comfortable and the staff help me when I need anything."

Discussions with staff, our observations and the staff rota showed that there were sufficient staff members to meet people's needs. People told us that they felt that the staff were available when they needed assistance.

Is the service caring?

People told us that the staff treated them with respect. One person said, "They (staff) are good, some better than others, but no one is unkind." Another person said, "The staff are very kind."

We saw that staff interacted with people in a caring, respectful and professional manner.

Is the service responsive?

We were concerned that the ways that people's care records were maintained did not reflect people's needs accurately, how these needs were met and any changes in people's needs and preferences. Therefore we could not be assured that staff were provided with the information to meet people's needs and that people were provided with the care and support that they required. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw that the staff responded to people's requests for assistance, including call bells, in a timely manner.

Is the service well-led?

The shortfalls which we identified in the care provided to people, infection control, staff training and the recruitment of staff identified concerns about how the service was led to ensure that people were provided with safe and effective care.

There was no evidence in the service to show that the provider had effective quality assurance systems in place to ensure that they continued to identify shortfalls, addressed them and continued to improve.

The registered manager of the service had recently left and their application to cancel their registration was being processed by CQC. When this is complete the registered manager will be removed from our records relating to this service. The registered manager from another of the provider's services and a staff member told us that there was a new manager working in the service. However, they were on leave at the time of our inspection.

During our inspection we spoke with five people who used the service. They were complimentary about the approach of the staff. They told us that they were happy living in the service and staff treated them well. One person said, 'I am happy here. It is not home but I feel safe and secure and they (staff) are kind to me and help me to manage. I couldn't do that on my own anymore.'

We saw that staffing levels were sufficient to meet people's care needs and staff interacted with people in a caring, respectful and professional manner.

People told us that the staff treated them with respect and kindness. One person said, 'They (staff) are very good. I know their name and they know me.' Another person said, 'The staff are smashing.' Another person said, "They (staff) are all wonderful." This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We also spoke with three people's visitors who told us that they were happy with the service provided. One visitor said, "It never smells, it is cleaner than clean. My (relative) is always clean, I am very impressed." Another said, "The staff are all so kind, they are all smiling."

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

We found that the service was clean throughout and equipment was fit for purpose and safe for use.