Archived: St Martin's Residential and Nursing Home

St Martin’s is situated in the town of Camborne. It is a purpose built one storey building with a range of aids and adaptations in place to meet the needs of people living there. There were people living at the service who were living with dementia and were independently mobile. There was pictorial signage at the service to support some people, who may require additional support with recognising their surroundings. There is a central hub of lounge and dining spaces, as well as three separate lounges. People’s bedrooms were personalised and were for single occupancy. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a courtyard which people could use.

This unannounced comprehensive inspection took place on 5 November 2018. At the last inspection, in May 2016 the service was rated Good. At this inspection we found the service remained Good.

The registered manager commenced at St Martins in April 2018. People and relatives were positive about recent management changes and said management were approachable, would listen to suggestions and felt supported. Staff told us with the change of manager and changes at senior management level there had been a number of positive improvements to the service.

The registered provider had improved quality assurance and governance arrangements. The management team were keen to implement changes that would improve the quality of people’s care and assist staff. For example, they had reviewed the deployment of staff to ensure that people’s needs were better met. One impact fof this was the number of incidents at the service had reduced significantly.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and understood their needs and preferences. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they needed and wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to themselves and other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.

Staff held a daily handover where information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.

There were systems in place for the management and administration of medicines. People had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effective in identifying errors occurred such as not dating creams on opening.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly.

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

The registered manager had implemented a nutrition project and invited people and relatives to contribute to this. This meant people preferences were being considered and were offered a choice in line with their dietary requirements.

People had access to activities both within the service and outside. Activities co-ordinators organised a planned programme of events. Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and could visit at any time.

Staff were supported by a system of induction training, supervision and appraisals. Staff said they felt supported by the manager and could approach them with any queries. Staff meetings were held regularly.

Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

People were asked for their views on the service regularly. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The staff team were motivated and happy working at the service. The staff felt valued and morale was good.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the manager and members of the senior management team.

St Martins provides nursing care and support to predominately older people who have a diagnosis of dementia. The service can accommodate up to a maximum of 40 people. There were 36 people living at St Martins when we inspected the service.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. 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 atmosphere at the service was welcoming, calm and friendly. The service had a central hub of lounge and dining space, as well as three separate lounges. People were able to spend their time in various areas of the service as they chose. There were a range of mobility aids and equipment to support people. People’s bedrooms were personalised as were the furnishings in lounge areas. There was an ongoing maintenance programme taking place with two rooms being decorated at the time of the inspection visit.

Most people had complex needs and were not able to tell us about their experiences. However, comments from relatives and friends visiting told us they felt people were safe because there were sufficient staff on duty to meet their needs. Comments included, “The home is very good and I wouldn’t want (relative) in another home. I am in the home most days for about 3 hours and I’ve never seen or heard any abuse to the residents” and “I am totally confident in the staff. Yes I believe residents are very safe here.”

People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure people’s safety. Care records included details of people’s choices, personal preferences and dislikes.

The service had reviewed the way it was staffed and had made changes to increase staffing levels at the busiest times of the day. This ensured there were enough staff on duty to respond to people’s needs.

Staff had been suitably trained to recognise potential signs of abuse and to take action should they be concerned about a person’s welfare.

Staff managed medicines competently. They were given as prescribed and stored and disposed of correctly. Additional training had been delivered to senior care staff to support nurses when administering medicines. A nurse told us, “It’s been really helpful to have care staff trained to HCA 3 level because it gives us (nurses) more time to deal with nursing tasks.”

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. A member of staff told us, "The training has been good, really helpful." Staff received other suitable training to carry out their roles.

Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

People were offered a choice of healthy and nutritious meals. Staff made sure people's dietary and fluid intake was sufficient for good nutrition. People had a choice of meals and relatives said they often saw snacks and drinks outside of meal times. The cook had information about people’s dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Families told us staff were caring and helpful. They said their relative’s health needs were met and they were always told of any changes which had occurred. A relative said, “There have been a few changes in (relatives name) and they (staff) always let me know when I come in to visit, or if more urgent by phone."

Activities were designed to meet the needs of people living with dementia. There was a designated staff member who had completed training in activities which were meaningful, varied and were delivered in groups or on a one to one basis.

People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Families and staff felt they could raise any concerns or issues they may have with the manager, who they said was approachable. People told us they felt their views and experiences were listened to.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits and meetings with all stakeholders of the service. Response from this monitoring showed that there was overall satisfaction with the service.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of St Martins we saw evidence to support a judgement that this service was not always safe.

People were treated with dignity and respect by the staff. During our inspection we did not speak with people living in the home because the vast majority had a communication deficit caused by a dementia-type illness or a mental illness. We did speak with one visiting relative who told us they were 'confident their relative was safe'.

Care plans were not personalised to the individual, and gave inconsistently clear guidance for staff to follow to meet people's needs. This included how staff should provide care to people who had complex needs and were not always orientated to their surroundings.

Staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm.

The management of medicines at St Martins did not protect people from potential risk.

We saw St Martins understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people's needs.

Is the service effective?

During our inspection of St Martins we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of St Martins we saw evidence to support a judgement that this service was caring.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people's wishes.

Staff were seen to be caring and attentive to people's needs. A visitor to the home told us 'they [staff] are very good' and 'staff look after X very well'. We observed staff responded to people in a kind and sensitive manner.

Is the service responsive?

During our inspection of St Martins we saw evidence to support a judgement that this service was responsive.

People were able to take part in a range of group and individual activities such as card games, listening to music, outings in the local community and craft work, although the activities were not always well recorded.

St Martins gave clear information to people about how to complain. We saw the home responded appropriately when complaints were made and took prompt action to resolve the concerns raised.

Is the service well-led?

During our inspection of St Martins we saw evidence to support a judgement that this service was not well-led.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

Best interest meetings had been held to ensure the care and support provided was still meeting the needs of the person.

People who used the service and their representatives were not asked for their views about their care and treatment. Care plans did not show people's involvement in their care.

Quality assurance tools were used, but when issues were identified action or a change in practice was not evident.

As part of our inspection we spoke with the deputy manager and the nurse on duty. We did not speak with people who lived at St. Martins House due to their health needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

At this inspection we saw care plans were in place to direct staff as to the care and support people needed. The care plans had been reviewed since the last inspection and people's records were personalised and provided clear information about the person's wishes and abilities.

Information about people's lifestyle in the daily records was consistent. It was now clear how information was collected. Food and drink charts, were consistently monitored, interpreted and communicated so that appropriate action could be taken where necessary.

At this inspection we saw care plans were in place to direct staff as to the care and support people needed. Some of the care plans had been reviewed since the last inspection and people's records were personalised and provided reasonably clear information about the person's wishes and abilities.

Information about people's lifestyle in the daily records was inconsistent. It was unclear how information collected, such as by food and drink charts, was consistently monitored, interpreted and communicated so that appropriate action could be taken where necessary.

During our inspection, we found people's privacy; dignity and independence were respected. We saw people were spoken with in an adult, attentive, respectful, and caring way. We saw people assisted by staff and equipment being used properly, for example, staff took the time to put on protective equipment such as aprons and gloves.

We saw care plans were in place to direct staff as to the care and support people needed. People's records were personalised and provided reasonably clear information about the person's wishes and abilities, although this was inconsistent.

It was unclear how information collected, such as by food and drink charts, was consistently monitored, interpreted and communicated so that appropriate action could be taken where necessary.

During our inspection, we found people's privacy; dignity and independence were respected. We saw people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw people assisted by staff and equipment being used properly, for example, wheelchairs with footrests in place.

We saw care plans were in place to direct staff as to the care and support people needed. People's records were personalised and provided clear information about the person's wishes and abilities.

St Martins adhered to robust and safe medicine practices in order to protect people.

Two visitors were complimentary about the environment their relatives lived in and they thought the home was clean and tidy.

There were enough staff on duty to provide care that met people's care needs.