St Judes Nursing Home

St Judes is a residential care home providing personal and nursing care to up to 39 people. The service provides support to adults living with dementia. At the time of our inspection there were 39 people using the service.

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

People were kept safe. Staff knew how to raise safeguarding concerns and were aware of the processes to follow in order to keep people safe. People told us they felt safe. In the comments we received, relatives agreed with this.

Care and support plans were person centred and developed to ensure people’s needs were met appropriately.

Risk management strategies were in place to assist staff to help people to manage these risks safely and to maximise their potential in terms of their quality of life.

Staffing levels were good and appropriate to ensure people's needs were met in a safe, timely and consistent way.

The service was following safe infection prevention and control procedures to keep people safe.

The administration of medicines was managed in a safe way and people received their medicines safely.

The service was flexible and adapted to people's changing needs and wishes and promoted their independence.

The provider created a cohesive team culture where staff were able to develop and improve their practice. They were provided with the right training and support to make sure they could fulfil their roles appropriately.

People and their families described care as being kind and compassionate. They said they were treated with dignity and respect. We received consistently positive feedback about the caring nature of staff and their empathetic approach. People, their relatives and staff referred to the trust, kindness, understanding and sensitivity to their individual needs as reasons why they felt the service was good.

People were encouraged and supported to lead as fulfilled a life as possible. They were supported to follow their hopes and aspirations. The activities programme developed together with those people [who were able to engage with this programme] contributed greatly to this.

People's individuality was respected. People were involved in making decisions about their day to day lives and staff respected people's choices. People were supported to maintain their independence with creativity and enthusiasm.

People's diversity and their unique individual needs were well respected by staff. The staff team knew people well and were able to provide appropriate support discreetly and with compassion.

People's privacy was respected, and people were supported to maintain contact with relatives and friends.

There was clear evidence of collaborative working and good communication with other professionals in health and social care sector. People's health care needs were being met and they had access to healthcare services where needed.

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.

Robust processes were in place to manage and respond to complaints and concerns.

St Judes was well led. The provider's ethos and values put people at the heart of the service. This vision was driven by the leadership of the registered manager and the senior management team. The staff team were empowered and engaged in providing an effective, person-centred model of care. This helped people using the service, with complex needs, to achieve their maximum potential and quality of life.

There was a wide ranging and effective governance system in place.

People, relatives and staff were confident about approaching the registered manager if they needed to. They recognised that their views and feedback were valued and respected and consistently used to support quality service development. A wide range of comprehensive audits took place to ensure the quality of the service was maintained.

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 10 October 2017).

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.

Follow up

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

We found the following examples of good practice:

The provider had developed new ways of recording observations about people's health which were shared with healthcare professionals in advance of appointments. This had reduced the need for external visitors to the home and had facilitated good virtual consultations with healthcare professionals.

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. The provider kept in touch with family members and people's friends through emails and video conferencing. The provider had a detailed visitor protocol which was sent to visitors by email after booking for a visit.

The provider had arrangements for visitors to meet with people virtually through video conferencing and physically in a visiting pod (designated area for visits) with a transparent screen separating the room and an intercom for people to speak with their family. The provider informed us they discussed visiting arrangements with families of people and one designated visitor from each family was allowed inside the home to meet the resident and other family members were allowed to the visiting pod which had a separate entrance and they could see through the transparent screen and speak via the intercom. All visitors were asked to complete a COVID-19 screening form on arrival, and had their temperature checked. A COVID-19 lateral flow test was carried out on all visitors and visiting professionals who were not on the national testing programme. All visiting professionals on the national testing programme were asked to show proof of their recent COVID-19 negative test. On entry all staff and visitors were asked to change their footwear or wear a shoe overall and escorted to a hand hygiene station near the entrance for handwashing. This was to ensure the safety of staff and people. People were supported to see their family in the garden during summer.

The provider had appointed a visiting supervisor who performed visitor screening on arrival and escorted visitors to a testing pod set up in their garden for COVID-19 lateral flow testing. Only visitors and visiting professionals who test negative for COVID-19 were allowed inside the service.

The provider had appointed antigen testing supervisors to oversee the completion of antigen testing processes.

The provider had dedicated entrances for staff for each social bubble to ensure there was no mixing of staff. The provider informed us they had increased the number of staff since the pandemic to ensure they have enough staff to cover the social bubbles without being mixed. They also had staff facilities for resting. The provider informed they owned the house next to their service and offered staff free accommodation and meals during lockdown; they also had a driver and a car to pick up staff from their home. The provider informed us they also collected staff feedback and concerns through a questionnaire and had a counsellor available for staff to speak.

The provider had two activity co-ordinators who did individual and group activities. All activities were performed within their two social bubbles. The provider also had a hairdresser who visited them twice a week and informed they were part of COVID-19 weekly testing programme for staff.

The provider had an admissions process in place. People had a COVID-19 test within 24 to 48 hours prior to being admitted into the service and were isolated for 14 days following admission to reduce the risk of transmission of COVID-19. The provider informed they arranged meetings with family members before admitting a person to their home.

The home had four clean areas for staff to don and doff (put on and take off) Personal Protective Equipment (PPE).

Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.

The provider had access to a vaccine hesitancy pack which they were planning to use from next week with staff who had refused to take the COVID-19 vaccine. This pack would help ascertain staff concerns about the vaccine and to educate them about the importance of taking the vaccine.

Further information is in the detailed findings below.

We carried out this inspection on 10 October 2017. At our last inspection in May 2015 the service was rated as 'Good’. At this inspection we found the service remained Good.

The service had a registered manager in post at the time of the inspection. 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.

People living in St Jude’s Nursing Home were safe because staff assessed and took action to reduce their risks of avoidable harm and abuse. The provider undertook thorough checks of staff during the recruitment process to ensure they were safe and suitable to provide care and support. Medicines were stored safely and administered in line with the prescribers’ instructions. Staff followed appropriate hygiene practices to reduce people’s risks of infection.

Staff were trained to deliver care to people effectively and were supervised when doing so. People gave their consent to the care and support they received in line with the Mental Capacity Act 2005. People received the support they required to choose and eat nutritious meals throughout the day. Healthcare professionals attended the service regularly ensure people’s health needs were met in a timely manner.

Staff were kind and caring towards people and treated them with respect. People’s privacy and dignity were promoted and staff shared positive relationships with people. People received compassionate care and support to manage their pain as they approached end of life.

People’s needs were assessed and care plans guided staff towards meeting them as people preferred. People were supported to engage in a variety of activities and measures were in place to prevent social isolation. The provider gathered and acted upon feedback from people and their relatives and complaints were dealt with appropriately.

The registered manager developed an inclusive culture within the service. Staff felt supported and able to share their views about improving the service. The quality of care people received was the subject of audits and the service worked closely with other organisations to promote best outcomes for people.

We considered our inspection findings to answer questions we always ask. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection and information from records. These included policies and procedures, minutes of meetings, care records, staff files and records relating to quality monitoring and quality assurance systems. At the time of our visit 39 people used the service and one person was in hospital. We spoke with five people, six visitors and eleven staff including the home manager and a company director representing the provider.

Is the service safe?

People who used the service told us they felt safe and secure. Their comments included, 'I like the staff, they are kind and gentle', also 'They (staff) look after me well'.

Records showed people experienced safe and appropriate care. A range of risk assessments had been undertaken, for example, in relation to people's mobility and nutritional needs, for pressure sore prevention and behaviour management. Risk management plans had been produced and staff followed them. Care plans and risk assessments had been reviewed monthly and updated, as necessary. This meant changes in needs had been identified and responded to, ensuring people were not exposed to unnecessary risk.

Suitable arrangements were in place for obtaining and acting in accordance with people's consent in relation to their care and treatment. Where people did not have capacity to consent the provider had acted in accordance with legal requirements.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and DoLS. Records showed mental capacity assessments had been carried out for some people. These had been specific to decisions made in their best interest and DoLS authorisations. There was an on-going programme of staff training ensuring staffs' understanding of their responsibilities under the Mental Capacity Act (2005) and DoLS. The home manager was clear in what circumstances a DoLS application should be made.

Incidents and accidents had been recorded and monitored by staff. This meant the home manager could identify trends regarding such events and implement prevention measures, minimising risks to people.

Records showed environmental risk assessments and audits had taken place for the protection of people who used, visited or worked at the service

Procedures were in place to protect people from abuse. Staff had received safeguarding vulnerable adults training and knew how to respond to allegations or suspicions of abuse.

Procedures for dealing with emergencies were in place and staff trained to competently implement them.

Is the service effective?

People experienced effective, safe and appropriate care and treatment that met their needs and respected their rights. Comprehensive needs assessments had taken place and individualised care plans produced. These took account of peoples' diversity, rights and preferences. Records showed people and/or others acting on the behalf had been involved in this process. Care plans had been reviewed monthly and updated as necessary. This meant changes in peoples' needs had been identified and responded to. We saw people had access to health and specialist services. They had the equipment they needed to meet their needs.

Contact with relatives established they considered the service effective in the way people's needs were met. People told us staff respected their privacy and dignity and our observations of staff working practices verified this feedback. Staff respected people's choices, for example, where they spent their time and with whom and what they did with their time. People had a choice of meals and opportunity to engage in a diverse range of suitable social activities. Entertainment was provided and social events organised to which their families and friends had been invited. People had also enjoyed various outings throughout the year. A person living at the home said, 'We went out for a meal recently to a restaurant in Richmond Park. It was very nice and I had a lovely time'.

Visitors confirmed they were welcome to visit at any time and could see people in private if they wished.

Is the service caring?

A person using the service told us, "Staff are kind". People were dressed in clean clothing and good attention had been given to their personal appearance and hygiene. Staff were knowledgeable about people's preferences and needs. They were attentive to people with high levels of engagement. We saw staffs' interactions with people and their approach was friendly, cheerful, caring and respectful.

Is the service responsive?

People and those acting on their behalf had been informed of the procedure for making a complaint or expressing a concern. Comments from relatives included, 'I am very happy with the home, the quality of care is usually good. The manager is accessible and encourages feedback. The manager took immediate action on the few occasions I have had a concerns'. Another relative stated, 'I have attended meetings to review the care needs of my relative. I was able to openly express my views about the service and the standard of care and my feedback was listened to and taken seriously'. These systems enabled issues and concerns to be discussed and acted upon.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Systems were in place for analysing incidents, complaints and safeguarding alerts. Learning from these events had been constructively used, promoting continuous service improvement and developments.

Is the service well-led?

The environment was clean, hygienic and well- maintained. A range of audits had taken place to ensure people benefited from quality care and appropriate management of risks, ensuring their health, welfare and safety.

Systems enabled staff to learn from events such as accidents, incidents, practice shortfalls, complaints and concerns. This minimised risks to people and promoted continuous service improvements.

The home manager named in the report is no longer in post. A new manager took up post in March this year and was going through the registration process at the time of the visit. The provider's representative visits the home most days. The home manager and the staff team was supported by the provider's operations director who regularly visited the home, monitoring quality and compliance.

People told us that they were free to spend their days as they wanted to, joining in with activities or occupying themselves. There were activities arranged for those who wished to participate. Those people who were mobile were free to walk around the home as they wished and out into the garden.

We saw that care was planned and delivered in line with people's individual care needs. Families were involved in discussions about how people liked to be supported. Regular reviews made sure any changes were identified and addressed.

A training programme was in place for staff to help them meet the needs of the people that they were supporting.