St Anthony's - Care Home with Nursing Physical Disabilities

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they were safe and relatives thought they were safe. A safeguarding policy was in place and safeguarding referrals were made when needed. Staff recorded accidents and incidents and patterns and trends were analysed to reduce the risk of reoccurrence. The home was clean. Risks were assessed and clear guidance was in place for staff to mitigate risk to people. Some risk assessments for clinical risks such as diabetes did not always guide staff what symptoms to look for but these were immediately reviewed and amended in order to maintain people’s safety. Some windows were not secured with tamperproof restrictors as required by current guidance which may have placed people at risk but this was immediately addressed during the course of the assessment. People were supported with positive risk taking. People were supported by staff who were kind and caring and knew how to meet their needs safely. Staff were well trained and underwent competency checks to ensure they maintained the skills to meet people’s needs safely. Medicines were stored and administered safely. Where things went wrong, the provider was proactive in identifying the cause and putting measures in place to reduce the risk of reoccurrence.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives gave positive feedback regarding improvements made at the home since the last site visit. People told us they received support following accidents. One person told us how staff supported them safely and increased their confidence following a fall. People told us they could raise concerns and complaints openly. One person said, “We have a residents meeting where we raise concerns. Things are done about what we say.” People were fully involved in their care which meant they were able to get information and advice regarding their health and how best to meet their needs.

Staff told us there had been significant improvement at the home since the last inspection and learning had been taken on board to improve care provided to people. Staff told us they were encouraged to raise concerns and were not blamed when things went wrong. One staff member told us, “They don't blame us if something goes wrong and they tell us when we are doing well, they appreciate us for doing what we do.” The regional manager was aware of the duty of candour and was open and honest with people and relatives when things went wrong.

Lessons were learnt when things went wrong. An accidents and incidents policy was in place that was followed. When accidents and incidents occurred, patterns were identified and trends analysed in order to mitigate further risk to people. Risk assessments were reviewed with the person, relatives (where appropriate) and professionals aiming to reduce the chance of recurrence.

People told us they received appropriate support from staff and health professionals to manage their health conditions safely. One person said, “The nurses help me to manage my diabetes.” Where people were moving from and to the home, they were supported by staff with the transition. People told us the provider involved social workers and other professionals where needed to support with planning their transitions.

We observed staff speaking to visiting health professionals about risks to people. Staff told us how helpful these visits were when managing risks to people. The regional manager told us how they had involved social workers and other health professionals where people had expressed a wish to move from the home in order to support them with safe transitions.

Visiting professionals told us the provider discussed risks to people effectively and openly. Professionals told us that referrals to them were appropriate and made in a timely manner to ensure people received the care they needed.

Initial assessments, care plans and risk assessments were in place to keep people safe and these were regularly reviewed. The provider made referrals to health professionals when required. However, some diabetes risk assessments did not clearly document the actions for staff to take following concerns over people’s blood sugar readings. This had not resulted in harm to people and the provider immediately reviewed these at the time of the site visit in order to maintain people’s safety.

People told us they felt safe with the staff who supported them. One person said, “The staff help me to feel safe.” Relatives told us people were safe at the home. One relative told us, “My relative is absolutely safe there.” People and relatives told us there had been an improvement in their involvement in decision making at the home. One relative told us, “Staff always involve us with decision making regarding [person’s name]. Care plans are being updated more regularly and we are always involved, this is much better.”

Staff told us they had completed safeguarding training and they understood how to raise any safeguarding concerns. The regional manager told us staff completed accident and incident forms which were then reviewed by senior managers and if a safeguarding referral was required, this was referred to the local authority. The regional manager told us they looked at trends around safeguarding concerns and ensured they learnt from any errors. The regional manager told us they had worked closely with social workers to ensure they took learning from incidents that had occurred and improved their communication with relatives.

We observed staff supporting people to stand and mobilise safely. People were supported to eat slowly and with dignity. People’s meal consistency was appropriately altered to meet their swallowing needs.

The provider submitted safeguarding referrals in accordance with their regulatory responsibility. A safeguarding policy was in place that made reference to relevant legislation and provided clear guidance and contact numbers for staff to raise safeguarding concerns if needed. Quality checks in place ensured safeguarding referrals had been made when needed.

People were supported to take positive risks. Two people chose not to follow health professional guidance regarding meal choice. These choices were respected by the provider and risk assessed according to their decisions. People were supported safely to manage risks to themselves. One person told us, “Staff know what they’re doing when they're helping me in my wheelchair”. One relative told us, “The staff are really careful with [person’s name] positioning. They also check on them regularly in the night”. People told us their relatives were supported with PEG feeds safely. One relative told us, “Only the nurses are allowed to help with the PEG”.

Staff told us how they respected people’s rights to take risks and make their own decisions. The regional manager told us they involved people in decision making around risks ensuring they considered each individual's communication needs. The regional manager told us where people had capacity, they supported them with positive risk taking and gave examples where people had made informed decisions not to take their medicines or eat at risk with the support of the provider. The regional manager confirmed they also engaged with professionals to speak with people regarding positive risk taking where needed to ensure they were fully informed of the risks.

We observed staff encouraging people to make safe choices and decisions, however where people chose not to follow their advice, we observed staff respect their decisions. We observed staff reminding people about risks to them where appropriate and supporting them in a way that helped to mitigate risk. For example, encouraging people to sit in chairs that met their needs or eat in a way that maintained their safety.

Risk assessments clearly documented risks to people and people’s choices. Mental capacity assessments confirmed where people lacked capacity to make their own decisions. Deprivation of Liberty Safeguards (DoLS) had been applied for when needed to ensure restrictions on people were lawful. Where we identified some gaps in clinical risk assessments, the provider immediately reviewed and addressed these. For example, some diabetic risk assessments did not contain sufficient information for staff regarding the symptoms of diabetes to look for. We found one risk assessment had not been updated to contain the most recent guidance given from health professionals regarding the amount of medication required if there were concerns around a person’s specific health need. This did not impact on the person and was immediately reviewed and updated by the provider.

People told us they lived in a safe environment and staff used equipment competently. One person said “Staff use the hoist well; I feel safe when they use the hoist. The hoists are regularly maintained.” However, although window restrictors were in place at the home, some window restrictors were not compliant with current guidance as they were not robustly secured with tamper proof fittings where needed to maintain people's safety which placed people at risk of harm. The provider actioned this immediately once raised by the inspector and tamper proof window restrictors were immediately installed in line with guidelines.

Staff told us people were supported in a safe environment. One staff member told us, “Some people may require more frequent safety checks than others, the doors are all secured. All of their mobility equipment and electric wheelchairs have safety straps and belts.” The regional manager told us they had taken action to update some of the flooring in the home to improve the home environment.

We observed staff moving furniture and items out of the way to reduce the risk of trips and falls. We observed staff ensuring they put equipment away and stored it safely when it was not being used. The home was free of obstruction and enabled people to mobilise freely through the home safely.

Health and safety checks were carried out regularly by the provider and visiting professionals. However, systems failed to identify where tamperproof window restrictors were not always in place where needed which placed people at increased risk in the event of a fall. This was addressed by the second day of the site visit.

People told us there were enough staff on duty to support them safely. One person said, “When I ring that buzzer the staff come straight away, they never moan. The staff are always happy to help me.” Another person told us, “If I want something, staff come straight away. I have a call bell in my bedroom and they come if I use that.” People were supported by staff who were knowledgeable and knew how to meet their needs. One person told us, “I like living here because they look after me. The staff are really good. They know me well and know what support I need”. One relative told us, “The carers are real carers. They really do care.” Relatives told us there had been an improvement in the competence of staff since the last inspection. One relative told us, “Staffing is much better now. We had a big influx of staff all at once with mixed abilities. All the staff now here know my relative really well and they have been trained well by the other staff. The new influx of staff are much better trained to begin with, I feel so much more confident with them.” Relatives told us there were now more permanent staff which had improved care provided to people. One relative told us, “There are a lot more staff nurses now and this has made it much better.”

Staff told us there were a sufficient number of staff to meet people’s needs safely. Staff told us they had noticed an improvement in the level of training and competence expected before new staff started to support people. Staff told us the quality of care had improved since they had a settled permanent nursing team as there were less staff changes. The regional manager was confident there were enough competent staff to meet people’s needs. They told us the home was currently overstaffed according to the dependency tool that was used.

We observed staff responding to people when needed. People did not need to wait long to be supported. We observed staff sitting and talking to people and staff did not appear rushed.

Staff were recruited safely. However, where overseas staff were sponsored to work in the home, we raised concerns that records of employment interviews were very similar for multiple staff. The provider confirmed these interviews had been carried out by an external agency but all of these staff had undergone competency checks prior to supporting people at the home. The provider confirmed they no longer used the external agency for recruitment but immediately re-interviewed all staff this affected to assure themselves regarding their competence and suitability for the role. This did not affect the standard of care people received. A supervision tracker was in place which showed 94% compliance over the last 2 months. The training matrix showed a high level of completion of mandatory training.

People told us they lived in a clean home. One person said, “The staff clean my bedroom for me.” Another person said, “I would say this place is clean and tidy.” People were supported by staff who wore Personal Protective Equipment (PPE) in line with guidance.

The regional manager told us there was an Infection Prevention and Control (IPC) policy in place that was followed and staff had cleaning schedules in place that were complied with. The regional manager confirmed they had completed an annual IPC statement required by the provider and they had not had any infection outbreaks in 2023. The regional manager also told us they had IPC checks from the local authority and all actions set had been completed and signed off. The regional manager told us that where people had specific clinical needs, risk assessments were in place to ensure the risk of infection was mitigated. Staff were aware of how to reduce the risk of infection and wore PPE in line with current guidance.

We observed domestic staff cleaning areas of the home and touch points. The home smelt clean and fresh. We observed staff wearing PPE in line with current guidance.

An IPC policy was in place and an IPC lead had been appointed. Cleaning schedules were in place which were complied with and staff compliance with IPC training was 100%. Induction records confirmed staff reviewed the importance of following infection prevention control practices and understood the risks from infection. The home was required to complete an IPC annual statement each year which provided a summary of any IPC concerns within the previous 12 months and enabled them to action any concerns if needed.

People and relatives told us they received their medicines safely. One person said, “We sign a form to say that the nurse can give us our medicines. The nurses can't change anything without the doctors say so. The nurses give out the medicines at the right time.” One relative told us, “My relative has a list of medications, they are on many things. Their medication is always administered on time”. People’s medicines were stored safely. Fridge and room temperature checks were undertaken to ensure medicines were stored at a temperature that did not affect their efficacy.

The regional manager told us all staff completed medication awareness training and nursing staff complete pharmacy training. The regional manager told us competency assessments were completed with staff annually which included observing 3 supervised medication rounds. Staff told us they underwent medicines competency checks regularly but only nurses who had completed their training administered medicines. The regional manager told us they had found there were less medicines administration errors since they had recruited more permanently employed nursing staff.

A medicines policy was in place and available to staff. Medicine administration records showed people received their medicines when required. Where people chose not to take their medicines, this was recorded and reported appropriately. Where people received their medicines through skin patches, this was managed and recorded safely. People had protocols in place to guide staff when to administer ‘when required’ medicines. A pharmacy advice visit had recently been undertaken to review medicine storage and administration which resulted in positive feedback and no advice given. Medicines were stored safely and staff completed fridge/room temperature records.