St Mary's

St Mary's is a residential care home providing personal and nursing care for up to 47 people. The service provides support to people with dementia, mental health, older people and younger adults. At the time of our inspection there were 41 people using the service in one adapted building.

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

The provider had not ensured all staff were suitably trained or supported to perform their roles. Some staff required refresher training to ensure they had the knowledge and skills to safely meet people’s needs. Staff did not receive regular supervision however; staff felt the registered manager was supportive and approachable.

Medicines were managed safely however, guidance for staff relating to medicines which were prescribed on an ‘as and when required basis’ (PRN) were not in place. We have made a recommendation about this.

Records relating to people’s fluid intake were not regularly reviewed to ensure people had enough to drink. We have made a recommendation about this.

Care plans and risk assessments were person centred and reflective of people's current needs.

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.

There were enough staff. Staff were recruited safely and received an induction to ensure they had the skills and knowledge to undertake their role.

Regular activities were carried out to promote social inclusion.

Systems were in place to protect people from abuse. Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made. Relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

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 July 2022) and there were multiple 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 that the provider made improvements in relation to safeguarding, staffing levels and staff support and supervision. At this inspection we found the provider had made improvements on staffing levels and safeguarding but had not made improvements in relation to staff supervision.

Why we inspected

We carried out an unannounced inspection in May 2022 and found improvements were needed. We undertook this focused inspection to check the service had followed their action plan and to confirm improvements were made. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well-led which contain those improvements.

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.

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 requires improvement to good. This is based on the findings at this inspection.

Follow up

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

St Mary’s is a residential care home providing personal and nursing care for up to 47 people. The service provides support to people with dementia, mental health, older people and younger adults. At the time of our inspection there were 40 people using the service in one adapted building.

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

People did not have their risks managed effectively. Care plans and risk assessments were not always up to date and reflective of people’s current needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Consent to care and treatment and best interest decisions did not always follow the principles of the Mental Capacity Act 2005. Staff were unclear of their responsibilities under MCA. Relatives were not always involved in best interest decisions.

Governance systems were not reliable or effective. Systems were not regularly reviewed, and risks were not always identified and managed. Investigations were not always completed and there was little evidence of learning from accidents and incidents.

Staff did not always listen to people or act on their concerns about safety. Staff lacked some knowledge and understanding on how to respond and report a safeguarding incident. We have made a recommendation about safeguarding.

Staff did not always have time or availability to offer any meaningful engagement. We have made a recommendation about staffing levels.

Staff supervision and appraisals were not consistent and did not support staff to maintain their knowledge of best practice. We have made a recommendation about supervisions and appraisals to support staff development.

People were not always involved in decisions about their care. People’s care needs were not regularly reviewed. Care plans were out of date and did not give enough guidance to staff on their current care, treatment and support needs. People were not supported to engage in person centred activities to help them maintain hobbies and interests.

People felt supported and told us staff cared about them. People were treated with dignity, respect and kindness. Relatives told us they were not always involved in decisions about people’s care.

Medicines were managed consistently and safely and people who administered medications were appropriately trained. Appropriate recruitment checks were carried out as standard practice.

People had choice and access to enough food and drink throughout the day. Mealtimes were not rushed, and people were supported with their meals where required.

Complaints were investigated and recommendations were followed in an action plan. People's end of life wishes were not always recorded.

Staff have access to and followed clear policies and procedures on infection control that meet current and relevant national guidance.

For more details, please see the full report which is on the Care Quality Commission website at http://www.cqc.org.uk

Rating at last inspection

This service was registered with us on 06 April 2021 and this is the first inspection.

The last rating for the service under the previous provider was good (published on 21 March 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the principles of the Mental Capacity Act 2005, safety and quality of the service and the overall leadership and management of the service.

You can see what action we have asked the provider to take at the end of this full 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.