This unannounced comprehensive inspection took place on 24 and 29 January 2018. The last comprehensive inspection took place on 24 November 2015. The service was meeting the requirements of the regulations at that time.St Teresa's - Care Home with Nursing Physical Disabilities 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.
St Teresa's - Care Home with Nursing Physical Disabilities provides single room accommodation for up to 27 people with nursing physical disabilities. At the time of the inspection there were 26 people using the service including two people who were staying at St Teresa’s on periods of respite. The service is based in a purpose built single storey detached property which was suitably adapted for the purpose of providing nursing care and support to people. St Teresa’s is close to the local amenities in Marazion and Penzance.
There was a registered manager 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.
Some people who lived at St Teresa’s had limited communication skills meaning we were unable to gain some people’s verbal views on the service. We observed staff interactions and spoke with seven people who lived there. We observed that people were relaxed, engaged in their own choice of activities and appeared to be happy and well supported by the service. We also spoke with people’s relatives and staff to understand their experiences.
The atmosphere at the service was welcoming, calm and friendly. The service was divided into three units but people moved freely between each one. Each unit area provided large lounges and dining areas suitable for people to use with mobility aids. 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.
Some people had complex needs and were not able to tell us about their experiences. Comments from those people we spoke with about the quality of their care and support were positive. People told us, “They [the staff] have given me a life back, I can do things I thought I would never do” and “This is our home, not just a care home.”.
We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect. People told us, “Staff are lovely, they will do anything for you.”. Staff demonstrated a good depth of knowledge about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals.
St Teresa’s used a staffing assessment tool to work out the required numbers required to staff the service. Staffing levels were perceived to be low by both service users and staff. People commented, “They could do with more staff. I know other people need help too but sometimes I have to wait for a really long time before it’s my turn to get up” and “It’s an excellent place, they do an excellent job but the staff are really stretched.” Staff commented, “Our units are pretty well staffed. Recently we have had a large amount of sickness which is unusual. It is rare for us to have agency but we have had to use agency recently”. We spoke with the registered manager about this and were shown the staffing assessment that demonstrated that the core staffing hours was currently being met. The registered manager said she was aware that due to recent staff illness and increasing complexity of people’s care needs there had been additional pressure on staff. The registered manager was in the process of undertaking a new assessment for people whose needs were increasing to ensure there were adequate funds in place to increase staff numbers when required.
One nurse was available to provide nursing support to people. Staff told us this put pressure on the nurse on duty due to the complexity of people’s needs. A relative of a person who lived at St Teresa’s shared their concerns about staffing levels generally and in particular about the availability of appropriately trained staff to support their relative with their feeding regime. The deputy manager told us specialist training to support individual feeding regimes had been provided to staff on one of the three units but had not yet been provided to staff on other units.
We have made a recommendation about staffing levels in the Safe domain of this report.
People's care and support needs had been assessed before they moved into the service. This included risk assessments to ensure peoples safety. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence. For example, we saw risk assessments regarding appropriately supporting people to access their local community as well as keeping safe in their home environment. People told us, “I feel safe, I don’t have to worry about what will happen to me all the time, knowing someone is always around, it’s a good feeling.”
People had a care plan that provided staff with direction and guidance about how to meet people’s individual needs and wishes. Care records included details of people's choices, personal preferences and dislikes. These were regularly reviewed and any changes in people’s needs were communicated to staff.
Staff had been recruited safely and received training relevant to their role. Staff said they were supported by the registered manager. They had the skills, knowledge and experience required to support people in their care.
Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.
The manager used effective systems to record and report on, accidents and incidents and take action when required.
The service was suitably maintained. It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.
Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedure in place to manage infection control risks.
Medicines management systems were robust. Staff were confident about the action to take if they had any safeguarding concerns and were confident the registered manager would follow up any worries they might have.
The service worked successfully with healthcare services to ensure people's health care needs were met. People were supported to access services from a variety of healthcare professionals including GPs, dentists, psychological services, occupational therapists as well as other specialist medical services to provide additional support when required. Health and social care professionals were positive about the service, comments included, “I feel that St Theresa’s Nursing Home is generally a well run home with caring staff who are always are happy and willing to accommodate any visits from [multi-professionals].”
People's nutrition and hydration needs were being met. 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.
Staff were positive about their work and confirmed they were supported by the management team. Staff received regular training to make sure they had the skills and knowledge to meet people's needs. The service had signed up and achieved the Gold Standard Framework. This aimed to provide optimal care for people approaching the end of life.
We found the building generally met the needs of people who lived there. For example, corridors were wide and spacious for people who used a wheelchair. There was overhead tracking available in two of the wings of the building which accommodated 18 people and had en-suite facilities to their bedrooms which meant people's movement was less restrictive. There was insufficient signage available to help people orientate around the service. For example, each unit had a small naming plate at the entrance but this was difficult to read. There was a lack of signage for communal toilets. This would negatively impact users with visual or learning impairments. We brought this to the attention of the registered manager who told us she would ensure clearer signage was made available to help orientate people around the service.
There was a complaints procedure which was made available to people on their admission to the home and their relatives. People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Complaints received were investigated and issues raised were dealt with in a timely way with the complainant being informed of the outcome.
There were regular feedback opportunities for people to give their thoughts on how the service was working. This included a compliments, complaints and suggestions book on main reception for people to leave their comments. The organisation also employed a regional customer support advisor. They visited the service and spent time with people regularly to gather people’s views. There was also an annual ‘Have Your Say’ survey. This was provided to all people who used the survey. The last results of the survey in 2017 demonstrated people were happy with the care and sup