Bluebells Care Home

St Martins is ‘care home’ a providing personal care to up to 30 older people who may be living with dementia, in one large, adapted building. At the time of our inspection there were 25 people using the service.

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

Relatives told us they felt their loved ones were safe living at the service, however, the quality of the service had deteriorated since our last inspection.

People had not been protected from abuse and discrimination. The registered manager had not reported incidents to the local safeguarding authority for investigation. There was a closed culture within the service, the registered manager and senior staff within the service were related. Staff told us they did not feel confident to raise concerns with the registered manager. The provider had not developed a strategy to manage the conflict of interest.

The culture within the service was not open and transparent, relatives told us they had not been informed when incidents involving their loved ones had happened. Staff told us, there was a toxic unprofessional culture and they had been reprimanded by management for acting to keep people safe.

Potential risks to people’s health and welfare had been assessed but there was not always guidance in place to keep them safe, some guidance had placed people at risk. Fire risks had not always been assessed, fire drills had not been completed and people’s evacuation plans were not up to date. Medicines were not always managed safely.

Staff had not been recruited safely, people had been placed at risk, by staff not having all the required checks before they started work. There was not always enough staff to meet people’s needs, there had been a high turnover of permanent staff and agency staff were used to cover any gaps. Staff had not received inductions when they started at the service and their competency to undertake basic tasks had not been assessed.

People were not supported to have maximum choice and control of their lives and staff did not always 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. People were not supported to make day to day decisions, the registered manager had placed restrictions on aspects of people’s daily lives such as where they could eat their meals.

Records were not always accurate or did not exist, there were no records of pre-admission assessments being completed or referrals to health professionals made when people’s needs changed. The service did not always follow government guidance, though visitors were welcomed into the service, they had not been able to visit people in communal areas until 3 weeks before the inspection.

People were supported to eat and drink enough, but they were not offered a choice of meal at lunch time, there was limited choice of jacket potato or salad if they did not want the main meal. People were not always supported to eat their meal when it was served.

People, staff, and relatives had not been asked their opinion on the quality of the service or encouraged to make suggestions to improve the service. Checks and audits completed by the registered manager had not identified the shortfalls found at this inspection.

The providers oversight of the service had been poor until recently when the provider changed their representative to oversee the service. They had identified the majority of the shortfalls found at this inspection and had started to develop an action plan to improve the service.

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 21 November 2019).

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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 Martins on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, recruitment, training, safeguarding people and governance at this inspection.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Martins is a residential care home providing personal care and support to up to 30 people in one large extended detached building. At the time of the inspection, there were 24 older people living at St Martins, some of whom were living with dementia.

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

People told us, and our observations confirmed, that they felt happy and safe living at the service. Potential risks to people’s health, safety and welfare had been assessed and there was guidance in place to mitigate risks.

Accidents and incidents had been recorded, analysed and action taken to reduce the risk of them happening again. When incidents had happened, the provider had been open and transparent, they had worked with external agencies to reduce the risk of them happening again.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received training, supervision and appraisal to develop their skills and meet people’s needs. Staff monitored people’s health and referred them to healthcare professionals when required. Staff followed the guidance given to keep people as healthy as possible. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to eat a balanced diet. People had access to activities they enjoyed and kept them as active as possible.

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.

Each person had a care plan that contained details of their choices and preferences. People had been involved as much as possible in developing the plan.

People met with staff before moving into the service to check staff would be able to meet their needs. People were treated with dignity and respect. People were supported to express their opinion on the service. People’s end of life wishes were recorded. Staff worked with GP’s and district nurses to support people at the end of their lives.

Complaints had been recorded and investigated following the provider’s policy. The environment had been developed to support people living with dementia following good practice guidance. People were given information in a way they can understand.

Checks and audits had been completed on the quality of the service and action had been taken when shortfalls were found. The registered manager attended local forums to keep up to date with developments in adult social care to continuously improve the service.

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 15 November 2018) and there were four 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 regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Martins is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and care provided, and both were looked at during the inspection. St Martins accommodates up to 30 people in one adapted building. The building is an older building providing large communal areas. At this inspection, 23 people were living at the service. People who used the service were older people with a range of care needs including diabetes, dementia and reduced mobility.

The registered manager worked at the service each day and was supported by a deputy manager. A registered manager is a person who has registered with CQC 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.

We last inspected St Martins in March 2017. This was a focussed inspection, looking only at the key area of ‘Effective’, which was rated as ‘Requires Improvement’. This was because the registered manager and staff had limited knowledge of their responsibilities about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). At that inspection, the required improvement was made and the service received a rating of ‘Good’. The last comprehensive inspection was completed in October 2016. At that inspection, except for ‘Effective’, the service received a rating of ‘Good’ for each key area as well as an overall rating of ‘Good’.

People and their visitors told us were happy with the care and quality of service provided. However, at this inspection there were three breaches of regulation and two other areas identified that required improvement. This is the first time the service has been rated Requires Improvement.

Medicines were not always managed safely, PRN protocols for medicines to be taken as and when needed required updating, there was no guidance to distinguish medicines that needed to be taken at times outside of the usual medication rounds, medicines to be returned to the pharmacy were not handled in line with the service’s policy and skin creams were kept insecurely in people’s bedrooms. Storage of creams in people’s rooms had not been risk assessed and the temperature at which the creams were kept was not monitored as required.

The building was adapted to meet people’s needs. Staff completed checks on the environment and equipment, these helped to ensure people were safe. However, the safety certificate for the fixed electrical wiring at the service had expired and there was no record whether electrical work noted as requiring urgent remedial attention had been addressed.

A complaints procedure was in place and was under review to include pictorial prompts to make it easier for some people to use. However, we found a complaint received had not been recorded in line with the service’s policy.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This is so we can check that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner, however, they had not always done so.

Staff were recruited safely, however, some decisions about the employment of staff, although considered, were not always recorded. This is an area identified for improvement.

Pre-assessments for people moving to the service were comprehensive. Potential risks to people’s health and welfare were identified, however although staff were knowledgeable about people’s conditions, there was not always guidance for them to refer to. This is an area identified for improvement.

Staff knew how to recognise the signs of abuse and knew how to report any concerns they may have. They were confident the manager would deal with the concerns appropriately. The manager had reported concerns to the local safeguarding authority and worked with them to resolve these concerns.

Accidents and incidents were analysed and measures were in place to reduce the occurrence of repeated incidents. Referrals were made to specialist services and medical professionals when needed.

People were supported to have maximum choice and control of their lives and in the least restrictive way possible. Policies and systems in the service supported this practice.

People told us that staff were kind and encouraged them to be as involved as possible in their care and, where people wanted to, they took part in a wide range of activities.

People were supported to express their end of life wishes. Staff were aware of people’s religious beliefs and received training to support people at the end of their life and keep them comfortable.

The culture within the service was open and transparent. Staff meetings enabled discussion of care practice and how staff could work towards improvement. Staff felt supported by the registered manager and service provider and received regular training and supervision.

People told us their rooms were clean and tidy. Communal areas were clean and odour free, staff used personal protective equipment when required to protect people from infection.

The registered manager attended training and local forums and worked with the local commissioning group and safeguarding authority to ensure people received joined up care.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the services can be informed of our judgements. The provider had conspicuously displayed the rating in the reception area of the service and on their website.

At this inspection three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

St Martins is a residential service which provides care to older people, most of whom were living with dementia. St Martins is registered to provide care for up to 30 people. At the time of our inspection there were 29 people living there.

This service was last inspected on 18 October 2016, one regulation was not met and improvement was required.

The home 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager.

People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Mental capacity assessments were completed and correct procedures were followed under Deprivation of Liberty Safeguards.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve the best outcomes for people. The care and support needs of each person were different, and each person’s care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff to support people in an individual way.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. Staff continued to receive training, competence checks and support to meet the needs of people. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs very well. Feedback we received from people and their relatives was positive. We were told about high standards of care; which improved the quality of people’s lives and gave their families peace of mind. We observed warm, caring attitudes from staff and commitment to provide the best service for people.

People were complimentary about the food and were offered choices around their meals and hydration needs. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy and nutritious diet.

St Martins is a residential home which provides care to older people including some people who are living with dementia. St Martins is registered to provide care for up to 30 people. At the time of our inspection there were 27 people living at the home.

This service was last inspected on 12 October 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The home 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager.

People enjoyed living at St Martins and they considered it their home. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were supported to make their own decisions and care was given in line with their expressed wishes.

Care plans contained accurate and relevant information for staff to help them provide the individual care people needed. People’s care and support was provided by a consistent staff team who were knowledgeable, trained and knew people well.

People were encouraged and supported by a caring staff team. People told us they felt safe living at St Martins and staff knew how to keep people safe from the risk of abuse. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. The registered manager knew what action to take if concerns regarding people’s safety were brought to their attention. Potential risks were considered positively so that people did things they enjoyed. People were encouraged to maintain relationships and kept in touch with those people who were important to them.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

The registered manager and staff had limited knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records did not always ensure people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided personal care and supported people to retain as much independence as possible.

People were supported to pursue various hobbies and leisure activities.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided.

People told us they could raise concerns or complaints if they needed to because the provider, registered manager and staff were available and approachable.

The registered manager had quality monitoring processes which included audits and checks on medicines management, care records and accidents and incidents. Following their appointment, the registered manager was improving the system of audits and checks to make sure people received a quality service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at paperwork and found that people had the right support to give consent. People had a full assessment and a care plan, which were reviewed regularly. We saw that the service responded quickly when people's needs changed.

Medicines were managed in a safe way, and the environment was safe, helping people to retain as much independence as possible.

People have fresh, home cooked food. We found meals to be well thought out and people's preferences and allergies were known by the cook. People got ready for lunch at their own pace, with staff encouraging people to lay the table if they could. Visitors were coming and going. The house was busy; there was a happy but calm atmosphere.

A staff member introduced us to eight people, two of whom we spoke to in detail. One person told us that 'It's a big something to get used to, but its good here'. Another said 'We don't argue, we get on very well, and dinner is good'. We observed and saw staff were skilled in the way they responded to people. They spoke gently to people and interpreted what support was needed. We saw that staff were busy, but they didn't rush. They responded in a paced way that seemed to help people remain calm and confident.

We spoke to two relatives. They told us that their relative was happy, and looked well since moving to the home. Another said they felt relieved that their relative was in safe hands.

Not all the people at St. Martins were able to talk to us directly to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Other people were able to talk with us and tell about their experiences at the home.

The three people we spoke with gave us positive feedback about the service.

They told us, "I get everything I need here, I have no complaints. I couldn't ask for more. The food is excellent and varied' and 'You are speaking to a contented person, it's like home here. The food is just like I would cook at home', "They let me do as much as possible for myself and then step in when I need help. The staff are very patient'.

People told us that they were treated with respect by the staff that supported them and that their privacy was maintained. They felt listened to and supported to make decisions about their care. They said that they received the health and personal care they needed and that they were comfortable. They said that their likes and dislikes were taken into consideration.

People said that they felt safe at the home and any concerns they had would be listened to and acted on.