St Catherine's Care Centre Limited

People’s experience of using this service:

There were not always enough staff available to meet people’s needs. Some people told us they often had to wait for care when they needed it, and several relatives said staffing levels were not sufficient to ensure their family members received support in a timely way.

Staff told us they found it difficult to respond to people promptly when they needed care. Three of the 7 relatives who returned satisfaction surveys in 2023 said the home was not well-staffed. Call bell records showed people sometimes had to wait a significant period of time for staff when they needed them.

Risks to people were assessed but not always managed effectively. We found no action had been taken when weight charts demonstrated a person had lost a significant amount of weight. Some people’s care plans stated they needed to be repositioned regularly as they were at risk of pressure damage. However, care records did not demonstrate that repositioning was being carried out as often as it should be.

Medicines were not always managed safely. Guidance regarding the administration of ‘as required’ and variable dose medicines lacked sufficient information to support staff when administering these medicines. There was no guidance for staff about how often emollients should be applied and body maps were not in place to show where barrier creams should be applied.

Professionals had raised concerns about standards of hygiene in the home in October 2023. We found some improvements had been made in relation to this, however concerns around cleanliness remained. Some communal toilets and the sluice rooms were not adequately clean, and some people’s bedrooms smelled of urine.

Quality assurance systems had not been effective in identifying shortfalls. The management team had not always worked effectively with other professionals to ensure people received safe, high-quality care. Some relatives and staff told us their views and suggestions were not listened to or acted upon, including if they raised concerns.

Some risks were managed effectively, including where people had been identified as at risk of aspiration and people with diabetes. Staff used nationally-recognised tools to identify if a person’s health was deteriorating and made referrals to healthcare professionals when necessary.

Staff were recruited safely and understood their role in safeguarding people from abuse. People told us the staff who supported them were kind and caring. Relatives said staff understood their family members’ needs and demonstrated a caring approach in their work.

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.

The provider had developed a service improvement plan (SIP) in response to concerns raised by professionals in October 2023. This detailed the actions the provider planned to take to address the concerns, and timescales within which improvements would be achieved. In addition to responding to the concerns raised, the SIP outlined plans to improve communication amongst managers and staff, review and update people’s care plans, and to develop risk management plans where necessary.

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 29 March 2022).

Why we inspected

Professionals had raised concerns in October 2023 regarding staffing levels, moving and handling practice, cleanliness, medicines management, and a lack of responsiveness from the management team.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St Catherine’s Care Centre is a residential care home providing personal and nursing care to up to 34 people. The service provides support to adults requiring care and support due to their physical health and those living with dementia. At the time of our inspection there were 30 people using the service.

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

People felt safe living at St Catherine’s Care Centre. Risks to people’s safety and well-being were assessed and action taken to minimise these risks. Staff had received training in safeguarding people from potential abuse and were aware of reporting procedures should they identify concerns. Safe medicines practices were followed and staff competencies in this area were assessed. Staffing levels were regularly reviewed and action taken should concerns arise. Robust recruitment processes were in place to ensure staff were suitable for their roles.

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. People and their loved ones were involved in the assessment and care planning process and their preferences were known to staff. People had access to healthcare professionals in line with their needs. The registered manager and clinical lead worked closely as a team to ensure people’s clinical needs were regularly reviewed and monitored.

Staff treated people with kindness and spent time socially with them. People were supported to maintain contact with those who were important to them and were able to receive visitors. People told us they had enough to do and enjoyed a variety of activities. The registered manager and well-being co-ordinator were looking to extend links within the local community.

People and their relatives felt they were able to raise concerns and would receive a response. The provider and registered manager had implemented a range of quality assurance processes to monitor the service people received. There was a positive culture within the service and people, relatives and staff were highly complementary regarding the improvements and on-going support the registered manager provided.

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 20 November 2019) 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.

At our last inspection we recommended processes in relation to the Mental Capacity Act 2005 were reviewed and monitored to ensure detailed records were maintained. At this inspection we found improvements had been made and records were personalised and comprehensive.

Why we inspected

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

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.

Follow up

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

St Catherine's Care Centre Limited is a care home with nursing and accommodates up to 34 people in an adapted building. The service supports adults requiring care and support due to their physical health and those living with dementia. At the time of our inspection there were 22 people living at the service.

There was a lack of management oversight of the service. There had been a number of changes to the management team which had resulted in staff not receiving the guidance and oversight they required. Audits and review processes were not consistently effective in ensuring improvements. Records relating to people’s care were not person centred and lacked detail. The provider had implemented a detailed action plan and appointed a new manager to the service in order to move the service forward and improve people’s care.

Risk to people safety and well-being were not always monitored effectively. Guidance was not available to support people with their anxiety and behaviours and staff required support to develop skills in this area. The support people received was often task focussed and activities did not always reflect people’s hobbies and interests. Individual caring interactions with people were seen. However, we found on some occasions people’s dignity was not respected.

People were not supported to have maximum choice and control of their lives and staff supported did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we have made a recommendation regarding how records are maintained in relation to people’s capacity and decisions made in their best interests.

There were sufficient staff deployed to meet people’s needs and staff understood their responsibility in protecting people from potential abuse. People received their medicines safely and had access to healthcare professionals when required. A choice of foods were available and people told us they enjoyed their meals.

Staff respected people’s privacy when supporting them with personal care. We observed instances of staff taking time to support people to make decisions and choices regarding how they wished to spend their day. Areas of the service had been refurbished and people had access to a pleasant outside patio area.

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 30 October 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the care people received at night. The provider had reassured us these concerns had been addressed. A decision was made for us to inspect and examine if people were receiving safe care. We arrived for our inspection at 0630 and found that people had received the support they required during the night.

Enforcement

We have identified breaches in relation to the management of risks to people’s safety, staff skills, person-centred care, the activities provided and the management oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.