Archived: St.Theresa's Nursing Home

Updated 29 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 1 November 2016. The inspection team consisted of three inspectors and a specialist advisor. The specialist advisor was a person with professional experience of this type of service.

Before the inspection we reviewed information held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with the provider, Moreligh’s operation manager, the manager at St Theresa’s and the duty nurse. Seven care staff, the cook and one member of the domestic staff team. We also spoke with a visiting professional.

Not everyone who was living at St Theresa’s was able to tell us their views about the care and support they received due to their health needs. We spoke with five relatives and four people using the service. We also observed staff interactions with people.

We looked at care documentation for five people, medicines records, staff files, training records, maintenance records and other records relating to the management of the service.

Updated 29 November 2016

We carried out this unannounced comprehensive inspection of St Theresa’s nursing home on 1November 2016. We undertook this visit as we had received concerns in respect of the care and welfare of people using the service. We looked at the concerns raised, plus we checked what action the provider had taken in relation to concerns brought to the commission’s attention during our last inspection in January 2106. At that time we found a breach of legal requirements, in that new staff were starting work at the service without a satisfactory Disclosure and Barring Service (DBS)check in place. We received information of concern prior to this inspection that a person had been allowed to work alone with vulnerable people before required checks had been completed. We discussed this with the manager who confirmed this to have occurred. A record showed a DBS check for a staff member appointed in August 2015 had not been requested until June 2016. The failure to complete necessary checks before allowing staff to provide care exposed people to unnecessary risk. This was a repeated breach of regulation requiring action to be taken from the comprehensive inspection in January 2016.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Theresa’s Nursing Home on our website at www.cqc.org.uk The provider for this location is registered under the legal entity of Morleigh Limited which is part of a group of nursing and residential care homes.

St Theresa’s is a care home which provides accommodation for up to 45 people who require nursing care. At the time of the inspection 22 people were living at the service. Most people who lived at St Theresa’s required general nursing care due to illness. Some people were living with dementia. St Theresa’s is a purpose built single storey building with a range of aids and adaptation in place.

The service is required to 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. St Theresa’s has been without a registered manager since March 2014. Since that time five managers have been appointed. Two of those managers left after a short employment period at St Theresa’s. One was moved to manage another service in the group and then left. One was moved from another service in the group to manage St Theresa’s on a part time basis and the current manager commenced in October 2016.This has meant there has been no management stability at the service. The current manager told us they had submitted an application to the commission for registration. However, this could not be verified at the time of the inspection visit and was not found to be the case following the inspection.

Medicines were not being managed safely. Handwritten entries were not always double signed. There were gaps in records of when creams had been applied and not consistently signed as given. There were inaccurate records of the amounts of medicines being stored. Medicines were not being returned to the pharmacist as required. Medicines requiring cold storage were being stored at above the recommended temperature range. This had been identified by the manager but not acted upon.

The premises and equipment were not being maintained in a safe and secure way. The collection of soiled laundry from bedrooms and cleaning procedures did not ensure suitable standards of cleanliness. There was no designated facility to wash commode bowls effectively. A broken shower door was propped against a wall in the bathroom. Water temperatures were inconsistent with one hot bath tap supplying water at a temperature above the safe range. A door to a store room which contained cleaning products was left open and accessible.

Systems and processes to ensure good governance were not being effectively operated. Records relating to managing the health and care needs for people were not always being updated or completed by staff. People’s fluid intake was not being recorded as instructed in the care plan. There were gaps in records where people needed to have their position changed regularly to prevent pressure sores. Wound care records were not accurate according to the care required in the care plans. Care records did not always contain records of external healthcare professional visits.

We identified a person had needed support with pressure relief and regular turns in bed due to risk of pressure damage to their skin. However, there had been a delay of five days in seeking appropriate specialist advice which meant the risk of suffering further skin damage was increased.

At the last inspection we found that the manager had not informed the CQC that a Deprivation of Liberty Safeguard (DoLS) authorisation had been granted, as they were required to do by law. This notification had still not been submitted to CQC at the time of the inspection.

Staff told us they felt supported by the manager. However, the records relating to staff supervision and appraisal were incomplete and did not demonstrate that staff were being supported.

The staff had daily handover meetings to discuss the day’s events. These meetings discussed people’s care and information was shared with staff coming on duty. However, the records were not always accurate. The information was not always visible because of the way the record had been copied.

Prior to this inspection we received information of concern regarding a poor culture at the service. We were told people’s choices in relation to their care needs were not always respected. During the day of our inspection visit most staff were observed to be supporting people sensitively. However, we did observe a senior staff member speaking in an overbearing and harsh tone to a person requesting support. The person was made to wait for a period of time before their request was met.

We had received concerns equipment was not suitable and some was faulty. Hoists and equipment had recently been serviced and were in working order, although staff told us an additional hoist and stand aid would help them to support people without having to move equipment around the service.

We had received concerns about the quality of food. People had mixed views about this. Some people told us they liked the food and others said it could be improved. In general we found that the quality of food was adequate though not of a high quality.

Care plans contained risk assessments for a range of circumstances including moving and handling, nutritional needs and fall. Where a risk had been clearly identified there was guidance for staff on how to support people appropriately in order to minimise risk and keep people safe whilst maintaining as much independence as possible. Some people required slings to support them when using hoists. There was evidence slings were being inappropriately shared.

Some people required aids to support continence. People were prescribed continence aids which met their individual needs. However, we found packs of pads throughout the service which were not named for the individual and were being shared communally. Net pants used to secure continence pads were also shared communally.

The service had a system to report any maintenance issues. A weekly maintenance report was submitted to head office by the manager and some repairs carried out. Faults and defects were not dealt with in a timely manner. For example a toilet seat in need of replacement had been on the maintenance report for three weeks without being addressed. There were areas of the building which were in need of decoration due to previous water damage and this work had been outstanding since out last inspection in January 2016.

Staff had access to training in order for them to develop their skills. The registered provider told us many staff carried out e-learning training, a computer based way of learning. This type of training is remote and there was no evidence to identify how much staff had understood the training. There had been some spot checks to look at staff practice but these observations by senior staff were taking place infrequently..

The service had a system of induction but it was not in line with current best practice. This is completion of a nationally recognised induction training programme. We discussed this with the manager who told us staff were being enrolled onto a diploma level programme and an assessor visited on the day of our inspection. There were systems in place to support staff through meetings and daily handovers.

There was no evidence people’s views had been sought but the provider told us a survey had been sent recently to people and the families of people using the service. There was no information available to view this survey at the time of the inspection.

There were examples where the registered manager and nursing staff had responded to changes in people’s needs. For example, when a person’s health had suddenly deteriorated, staff responded by seeking urgent medical advice and support. This resulted in the person receiving emergency treatment followed by a hospital admission.

The service calculated staffing levels using their own assessment tool and we saw these numbers of staff were usually working at the home. People told us they thought there were generally enough staff to support them.

The provider has overall responsibility for the quality of management in the service and the delivery of care to people using the service. The provider has repeatedly not achieved this at St Theresa’s Nursing Home and the service has been rated as either Inadequate or Requires Improvement since the first rated inspection carried out in February 2015. The service has also not met th