St Anthony's - Care Home with Nursing Physical Disabilities

St Anthony’s – Care Home with Nursing Physical Disabilities is a nursing home providing personal and nursing care to up to 34 people. At the time of the inspection, there were 26 people using the service. The service provides support to people with neurological and mental health conditions and people living with physical and learning disabilities in a purpose-built building.

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

Right Support: People told us they felt safe when having their care needs met by experienced staff but did not always feel safe when supported by newly recruited staff who they did not consider to be competent. For example, despite staff having completed moving and handling training, people told us new staff were not always competent in supporting them with hoisting. People’s medicines were not always stored and administered safely. We found examples of missed medicines and recording errors which meant people’s medicines were not always being administered as prescribed. Risks were not always managed safely. For example, staff told us they had undertaken a clinical task without training as they did not have time to wait for a nurse. Accidents and incidents were recorded but the provider could not be assured that action was always taken as forms weren’t always completed in full. Staff underwent stringent recruitment checks prior to employment but this did not always ensure they had adequate skills and competence to meet people’s needs safely. Staff understood how to report abuse and safeguarding referrals were made when required. The home was clean, and staff had been trained in Infection Prevention and Control (IPC). However, the provider could not be assured staff always understood the training as staff told us of instances where the IPC policy had not been complied with.

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.

Right Care: Care was not always person centred. People told us they did not always feel safe when their care was provided by newly recruited staff who were not sufficiently competent in the English language to understand and meet their needs. People told us experienced staff at the home made them feel safe and were able to meet their needs in a way they preferred.

Right Culture: The registered manager did not promote a person-centred culture throughout the home. Staff morale was low, and staff did not feel supported by the registered manager. People and relatives were aware of the low staff morale which did not support people to be empowered. People were not always asked for feedback regarding the care received and staff felt they weren’t involved or asked for feedback regarding the home. Systems in place to check the quality of care provided at the home were ineffective and failed to ensure concerns were identified and addressed. The provider had taken action following the inspection to address some of the concerns raised and improve the culture at the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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 28 July 2021).

Why we inspected

We received concerns in relation to medicines administration, the management of risk and governance. 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.

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

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Anthony’s - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and the governance 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Anthony's - Care Home with Nursing Physical Disabilities is a nursing home providing personal care to 20 people at the time of the inspection. The service can support up to 34 people in a purpose-built building.

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

People were cared for by staff in a way that kept them safe and protected them from avoidable harm. Enough staff were available to respond to people’s needs in a timely manner. People received their medicines when they needed them, and systems were in place to ensure that medicines were stored and administered safely and that adequate supplies were available. Accidents and Incidents were investigated, and measures were taken to prevent re-occurrences. The premises were clean, and staff knew and followed infection control principles.

The service was effective. Peoples needs were assessed and planned and delivered in accordance with legislation and best practise. Staff were well trained and knowledgeable about the needs of the people they supported. Balanced and nutritious meals were served, and people were complimentary about the quality of the food. People were supported to have 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 practise.

People were cared for by staff who were kind and caring, the atmosphere in the home was friendly and relaxed. People were involved in making decisions about their care and were supported to maintain their independence.

There were systems to ensure care was responsive. People received care in accordance with their needs and preferences. People were supported to maintain contact with their friends and families. There were opportunities for social stimulation. People felt their concerns and complaints would be listened to and responded to. People had plans relating to end of life care decisions where required.

People gave us positive feedback about the quality of care they received. The feedback on the leadership of the service and the registered manager from people and staff was positive. There were effective governance systems in place to monitor the quality of service and the health, safety of welfare of people.

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 the service under the previous provider was requires improvement, published on 15 May 2019.

Why We Inspected

This was a planned inspection based on the previous rating.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.