Archived: St Lukes Care Home

Updated 27 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 inspection took place on 24 and 29 January 2018 and was unannounced.

The service was inspected by one adult social care inspector on both days with the assistance of a medicines special advisor and an expert by experience on the first day. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert had experience in caring for older adults.

The provider had completed a Provider Information Return (PIR). We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

When planning our inspection, we looked at the information we already held about the provider. This included any notifications they had sent us. These contain details of events and incidents the provider is required to notify us about by law, including unexpected deaths and injuries occurring to people receiving care. We reviewed information about the care home from the local authority who commission services. We reviewed information the provider had sent us about how they were going to address our concerns from the last inspection. We used this information to plan what areas we were going to focus on during our inspection visit.

During our inspection visit we spoke with seven people who used the service and three people's relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with the home manager, the regional manager for the service and six members of care staff. We spoke with a GP whose practice provided services to almost all of the people using the service. We sampled three people's care plans and medicine records of five people. We reviewed other records used by the provider to manage the service such as staff files, audits, communication records and incident records.

We also reviewed additional information the provider sent us after our inspection visit.

Updated 27 April 2018

The inspection took place on 24 and 29 January 2018 and was unannounced. At our last inspection of the service on 25 October 2016 we found the service to be in breach of three regulations. These were:

Regulation 9 Person centred care as we found people's preferences were not achieved and their needs were not been met. Care plans were not person-centred and did not accurately identify people's care needs.

Regulation 12 Safe care and treatment as we found PRN protocols were not in place and staff medication competency had not been assessed. Pain assessments had not been completed.

Regulation 18 Staffing as we found there were insufficient numbers of suitably qualified, competent, skilled and experienced staff deployed in the service.

Following our October 2016 inspection, the registered provider sent us an action plan detailing the changes and improvements they intended to make in respect of each of these breaches of regulation. We took this into account when planning this inspection to make sure we checked these actions had been completed. At this inspection, we found the provider had made all the required improvements and addressed all the concerns that had been highlighted last time we visited the service. The management team were also responsive to concerns we raised during our inspection.

St Lukes Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 40 people in one adapted building. At the time of this inspection there were 20 people using the service.

The service did not 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.

In September 2017, the registered provider went into administration. The administrators had employed a care company to run the home while a buyer was sought and had oversight of their management. The home manager remained in post and a regional manager for the care company employed by the administrators visited weekly. There had therefore been some changes at the home in the months preceding this inspection. Due to various factors, a number of staff had left the service since the last inspection. Recruitment for a number of posts continued, although this had been challenging due to the registered provider's administration status.

Concerns we identified about the administration of medicines at the home were responded to promptly by the management team. This was because care staff had not completed the appropriate training with regards to supporting nursing staff with the administration of controlled drugs. However, this was arranged whilst we were onsite.

The provider did not have a policy in place regarding the Accessible Information Standard. We have made a recommendation about this.

Risks to people were assessed and recorded, and staff acted to manage identified risks safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take if they had any concerns. There were systems in place to ensure people were protected from the risk of infection. The environment was tired in places and required updating. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place.

Although appropriate numbers of staff were observed to be on duty throughout the home to meet people's needs, they had not been deployed effectively. We have made a recommendation about the deployment of staff.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. The manager ensured staff received the training and supervision they needed to provide effective care. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005. Staff were also aware of the conditions under which a person may be deprived or their liberty, and acted in accordance with the Deprivation of Liberty Safeguards, to ensure people were only lawfully deprived when this was in their best interests.

People's nutritional needs and preferences were met and people had access to health and social care professionals when required.

People told us staff treated them with kindness and their privacy and dignity was respected. People were involved in day to day decisions about their care and had care plans in place which reflected their individual needs and preferences. People were supported to maintain relationships with relatives and friends. Activities were available to meet people's interests and to promote stimulation. However, feedback from people using the service suggested activities did not always meet their needs.

The service provided appropriate care and support to people at the end of their lives. People's needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people's needs were met.

There were systems and processes in place to monitor and evaluate the service provided. People's views about the service were sought and considered through residents meetings and satisfaction surveys.