Archived: St Marys Care Centre

St Marys Care Centre is a residential care home providing personal and nursing care up to 60 people. The service providers support to older people, some of whom may be living with dementia or a physical disability. The premises are on one ground floor level split into two areas; residential and nursing. At the time of the inspection, there were 47 people using the service.

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

The service had recently had a change in management, including a new manager and clinical lead. The manager had started to make changes to the service, but these were not yet embedded.

There was a lack of consistency in how well the service was managed and led. Systems in place were ineffective at identifying risk. The provider had failed to ensure effective infection and prevention control measures were in place.

We received mixed feedback about the quality and quantity of food provided. We fed back people’s experiences regarding the quality and quantity of food to the provider. They told us they were confident people’s dietary needs were being met. We have made a recommendation about this.

People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We have made a recommendation about this.

Staff training, appraisals and supervision had not been kept updated. The service continually reviewed their staffing levels and had recently increased these. However, people told us that they felt the service was short staffed. People felt rushed and did not feel their care was person centred.

Complaints had not always been dealt with in line with the provider’s policy. Relatives found raising concerns difficult. We made a recommendation for the provider in relation to complaints.

Medicines were managed safely.

Staff were kind and caring but did not always promote people's dignity and privacy.

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 13 February 2021).

At our last inspection we recommended that the provider sought advice and reviewed their practice in relation to IPC practice. We made a second recommendation in relation to governance and oversight of the service.

At this inspection we found that these recommendations had not been actioned sufficiently.

Why we inspected

The inspection was prompted in part due to concerns received about medicines management. A decision was made for us to inspect and examine those risks.

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.

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 management of risk, person centred care, governance and oversight at this inspection. Please see the action we have told the provider to take at the end of this 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.

St Marys Care Centre is a care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 60 older people, some of whom may be living with dementia or a physical disability. The premises are on one ground floor level and split into two areas; residential and nursing.

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

Audits were in place to maintain people’s health and safety. We identified some areas that required further oversight such as; Infection Prevention and Control (IPC) practices and medicines administration records. These were discussed during the inspection and measures were taken by the provider to immediately address these.

There was a manager who had recently come into post. They were highly regarded by staff and relatives who made comments about how helpful and approachable they were. There was evidence of some good leadership, oversight and management within the service. However, this had been inconsistent at times and in some areas required further improvement.

We made a recommendation about IPC practices, governance and oversight.

People felt safe and told us staff were caring towards them. The service was clean and tidy. Relatives said they were confident that staff had worked hard to keep their relatives safe during the pandemic. Staff worked alongside health and social care professionals to support people’s health and well-being.

Care plans and risk assessments were in place to support people’s needs. The majority of families felt they were able to contribute to their relative’s care and support plans during reviews.

The provider had care plans and risk assessments in place which guided staff to manage risks. These were continually assessed and monitored to identify any themes so improvements could be made.

Staffing levels were managed well during the pandemic. Staff absences were covered by using the provider’s contingency plans. Staff commented on how they had worked together as a team to make sure people’s needs were met.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 January 2018).

Why we inspected

We undertook this Infection Prevention and Control Inspection to follow up on information received from the Local Authority in relation to a coronavirus outbreak. A decision was made for us to inspect and examine potential risks.

We inspected and found there were some concerns with IPC practices and the overall management, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Marys Care Centre on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St. Marys Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

St Marys Care Centre provides accommodation, nursing or personal care for a maximum of 60 people. The service provides support for older people and people who may have a physical disability. At the time of our inspection there were 59 people using the service.

We last carried out a comprehensive inspection of this service on 10 and 11 September 2015. The service was rated Good overall. At that inspection we identified a breach of regulation. We carried out a focused inspection on 20 January 2017 and found that the registered provider had achieved compliance with the breach we had identified.

At this inspection we found the service remained ‘Good’ overall with the responsive domain improving to ‘Outstanding.’

There was a registered manager employed by the service. 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.

The registered manager and staff team demonstrated commitment to providing the best possible responsive care and opportunities for people. Staff had an excellent understanding of how to ensure people’s preferences were met. People participated in a range of creative projects and activities that provided new experiences and the opportunity to develop new skills. Activities within the service were designed to promote stimulation, mobility and dexterity and to promote fundraising for the service for the benefit of all. The service fully understood and promoted the diversity of the people living at the service and as such was able to proactively support their needs.

People were at the heart of the service, which was organised to suit their individual needs. We saw examples of caring interactions between people and staff. One person said, " Yes, (staff are caring), extremely so.”

We received feedback via a letter from the relative of a person who had received care at the service, they told us, ‘I must stress that if it hadn’t been for the staff [Name] wouldn’t be with us today. The tender loving care [Name] received was absolutely marvellous.”

The mealtime we observed was relaxed and organised. People were supported to eat in a supportive and calm setting that provided opportunity to socialise as well as eat. The staff were attentive and provided the support people needed to be able to enjoy a meal. Food and the dining spaces were attractively presented and people were able to choose what they wanted to eat. Special dietary requirements were understood and provided for.

Staff had a good understanding of safeguarding and knew what steps to take if they believed someone was at risk of abuse or harm. Risks to people had been identified and were managed safely. Guidance was provided for staff about keeping people safe.

We found there were enough care staff, nurses and ancillary staff on each shift to safely meet people's needs. Recruitment systems were established and only suitable staff were employed to work at the service.

There were systems in place to ensure people’s medicines were safely managed. We found people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s plans of care were organised and had identified the care and support people required. We saw people who lived at the service had access to healthcare professionals and their healthcare needs had been met.

Complaints were investigated and responded to and people knew who to speak with if they had any concerns.

Staff worked well together and felt supported by the management team. The provider's quality monitoring process looked at systems throughout the service, identified issues and appropriate action was taken to resolve these.

Further information is in the detailed findings below

We carried out a focused inspection on 20 January 2017 to check whether the registered provider had achieved compliance with the breach we identified. This report covers our findings in relation to the requirement for medicine management. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Marys Care Centre on our website at www.cqc.org.uk.

St Marys Care Centre is a purpose-built care home situated in a residential area in Anlaby. The service supports people with long-term nursing care needs and can accommodate a maximum of 60 people. Accommodation is provided in spacious, en-suite rooms with four different room designs. People using the service are provided with a wide variety of communal spaces including lounges, a cinema room, a hairdressing salon, a physiotherapy room, a library and music room.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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.

During this focused inspection we found the staff had completed medicine management training in the last year. This ensured they had the skills and knowledge to safely manage and administer medicines to people using the service. Improvements were seen to the recording of medicines on the medication administration sheets.

The service used a risk based approach to people self-administering their medicines. Those people who had capacity and were able to do this safely were supported by the staff to achieve this goal. The risk assessments gave staff clear and precise information on how to reduce the risk of harm to people and there were detailed care plans for medicine management that reflected and recorded each person’s ability and support needs.

We saw these changes resulted in the registered provider meeting the breach of Regulation12 in respect of medicine management.

People were supported through a care planning process to have their needs met; they told us they felt their needs were met in the home and that staff 'Do their best.'

We observed that people received appropriate support with their nutritional needs and that staff support was polite and respectful

Staffing levels remained consistent throughout the week in order to meet people's needs.

Quality assurance systems were in place which included seeking the views of people who lived in the home. Maintenance work and risk assessment were undertaken to help ensure peoples safety.

As part of our inspection we spoke with four people who used the service and looked at care records and associated documents. We also observed staff practice and saw that staff understood and respected people's rights and capacity to consent to care. People said 'The care we receive is very good. We can talk to the staff about our care and treatment and they listen to our opinions and respect our wishes.'

Infection control systems within the service were looked at. These were monitored regularly by the manager. The clinical and communal areas were clean, tidy and there were systems in place to lower the risk of spread of infection. People told us 'The home is immaculate, our bedrooms are cleaned daily and the staff keep everything spotless.'

People who used the service were all very happy with their care. They told us that they were given support when needed, but were also given the chance to be as independent as possible. We saw the service had an effective recruitment policy and procedure, which ensured staff working in the home had the right skills and qualifications to meet people's needs.

We saw there was a complaints system in place, with information and complaints forms readily available to people who used the service. People told us they saw the provider and manager most days to talk to and they were confident of using the complaints system if they needed to.